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Gayete-Lafuente S, Vilà Famada A, Albayrak N, Espinós Gómez JJ, Checa Vizcaíno MÁ, Moreno-Sepulveda J. Indirect markers of oocyte quality in patients with ovarian endometriosis undergoing IVF/ICSI: a systematic review and meta-analysis. Reprod Biomed Online 2024; 49:104075. [PMID: 38943812 DOI: 10.1016/j.rbmo.2024.104075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 07/01/2024]
Abstract
This systematic review and meta-analysis aimed to evaluate the impact of ovarian endometriomas (OMA) on indirect markers of oocyte quality in patients undergoing IVF, compared with women without anatomical or functional ovarian abnormalities. The search spanned original randomized controlled trials, case-control studies and cohort studies published in MEDLINE, the Cochrane Controlled Trials Register and the ClinicalTrials.gov database up to October 2023. Thirty-one studies were included in the meta-analysis, showing no significant differences in fertilization (OR 1.10, 95% CI 0.94-1.30), blastulation (OR 0.86, 95% CI 0.64-1.14) and cancellation (OR 1.06, 95% CI 0.78-1.44) rates. However, patients with OMA exhibited significantly lower numbers of total and mature (metaphase II) oocytes retrieved (mean difference -1.59, 95% CI -2.25 to -0.94; mean difference -1.86, 95% CI -2.46 to -1.26, respectively), and lower numbers of top-quality embryos (mean difference -0.49, 95% CI -0.92 to -0.06). The Ovarian Sensitivity Index was similar between the groups (mean difference -1.55, 95% CI -3.27 to 0.18). The lack of data published to date prevented meta-analysis on euploidy rate. In conclusion, although the presence of OMA could decrease the oocyte yield in patients undergoing IVF/intracytoplasmic sperm injection, it does not appear to have an adverse impact on oocyte quality.
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Affiliation(s)
- Sonia Gayete-Lafuente
- Obstetrics and Gynaecology Department, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Department of Gynecology, Obstetrics and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
| | - Anna Vilà Famada
- Department of Obstetrics and Gynaecology, Catalan Health Institute, Barcelona, Spain
| | - Nazli Albayrak
- Department of Obstetrics and Gynaecology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Juan José Espinós Gómez
- Obstetrics and Gynaecology Department, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fertty Clinic, Barcelona, Spain
| | - Miguel Ángel Checa Vizcaíno
- Fertty Clinic, Barcelona, Spain; Faculty of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
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Perrone U, Ferrero S, Gazzo I, Izzotti A, Leone Roberti Maggiore U, Gustavino C, Ceccaroni M, Bogliolo S, Barra F. Endometrioma surgery: Hit with your best shot (But know when to stop). Best Pract Res Clin Obstet Gynaecol 2024:102528. [PMID: 38977389 DOI: 10.1016/j.bpobgyn.2024.102528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/08/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
Ovarian endometriomas (OEs) are commonly detected by ultrasound in individuals affected by endometriosis. Although surgery was widely regarded in the past as the gold standard for treating OEs, especially in the case of large cysts, the surgical management of OEs remains debated. Firstly, OEs often represent the "tip of the iceberg" of underlying deep endometriosis, and this should be considered when treating OEs to ameliorate patients' pain for focusing on the surgical objectives and providing better patient counseling. In the context of fertility care, OEs may have a detrimental effect on ovarian reserve through structural alterations, inflammatory responses, and oocyte reserve depletion. Conversely, the surgical approach may exacerbate the decline within the same ovarian reserve. While evidence suggests no improvement in in-vitro fertilization (IVF) outcomes following OE surgery, further studies are needed to understand the impact of OE surgery on spontaneous fertility. Therefore, optimal management of OEs is based on individual patient and fertility characteristics such as the woman's age, length of infertility, results of ovarian reserve tests, and surgical background. Among the available surgical approaches, cystectomy appears advantageous in terms of reduced recurrence rates, and traditionally, bipolar coagulation has been used to achieve hemostasis following this approach. Driven by concerns about the negative impact on ovarian reserve, alternative methods to obtain hemostasis include suturing the cyst bed, and novel methodologies such as CO2 laser and plasma energy have emerged as viable surgical options for OEs. In instances where sonographic OE features are non-reassuring, surgery should be contemplated to obtain tissue for histological diagnosis and rule out eventual ovarian malignancy.
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Affiliation(s)
- Umberto Perrone
- Unit of Obstetrics and Gynecology, P.O. "Ospedale del Tigullio"-ASL4, Via Gio Batta Ghio 9, 16043, Chiavari, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.
| | - Irene Gazzo
- Department of Reproductive Medicine, Ospedale Evangelico Internazionale, Genoa, Italy
| | - Alberto Izzotti
- Unit of Mutagenesis and Cancer Prevention, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | | | - Claudio Gustavino
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Stefano Bogliolo
- Unit of Obstetrics and Gynecology, P.O. "Ospedale del Tigullio"-ASL4, Via Gio Batta Ghio 9, 16043, Chiavari, Genoa, Italy
| | - Fabio Barra
- Unit of Obstetrics and Gynecology, P.O. "Ospedale del Tigullio"-ASL4, Via Gio Batta Ghio 9, 16043, Chiavari, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
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Naem A, Krentel H, Moawad G, Naem J, Venezia R, Etrusco A, Terzic S, Laganà AS. Hormonal Therapies before in vitro fertilization in women with endometriosis: The Minotaur's Labyrinth and the Ariadne's Thread. Best Pract Res Clin Obstet Gynaecol 2024; 95:102500. [PMID: 38772765 DOI: 10.1016/j.bpobgyn.2024.102500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/02/2024] [Indexed: 05/23/2024]
Abstract
Endometriosis-related infertility is one of the most debated topics in reproductive medicine. In recent years, prolonged pre-cycle hormonal regimens gained attention as a mean of improving the assisted reproduction technologies (ART) success rates in endometriosis patients. GnRH agonists, dienogest, medroxyprogesterone acetate, and aromatase inhibitors are the most studied medications. Conflicting results and a high risk of bias exist in almost all of the conducted studies in the field. However, current evidence suggests that pre-cycle treatment with GnRH agonists may be beneficial for patients with stage III/IV endometriosis. Dienogest and medroxyprogesterone acetate-based progestin-primed ovarian stimulation protocol was shown to be comparable to the prolonged GnRH agonists protocol. Finally, aromatase inhibitors seem to be of limited benefit to the assisted reproductive outcomes of endometriosis patients. Although it is challenging to draw any clinical conclusions, pre-cycle hormonal treatments seem to be best indicated in endometriosis patients who had previously failed ART treatment.
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Affiliation(s)
- Antoine Naem
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany; Faculty of Mathematics and Computer Science, University of Bremen, 28359 Bremen, Germany.
| | - Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA
| | - Joelle Naem
- Faculty of Medicine of Damascus University, Damascus, Syria
| | - Renato Venezia
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
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Impact of endometriosis on embryo quality and endometrial receptivity in women undergoing assisted reproductive technology. Reprod Biol 2023; 23:100733. [PMID: 36821944 DOI: 10.1016/j.repbio.2023.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 02/24/2023]
Abstract
ART is an important treatment method for infertile patients with endometriosis. However, the effects of endometriosis on embryo quality and endometrial receptivity remain unclear. Thus, we aimed to simultaneously investigate the impact of endometriosis and its stage on embryo quality and endometrial receptivity in women undergoing ART. We retrospectively analyzed the data from patients with and without endometriosis who underwent oocyte retrieval and/or high-quality embryos transfer between July 2015 and December 2020, including 1312 IVF cycles and 608 IVF or frozen-thawed embryo transfer (FET) cycles, respectively. The endometriosis group had a lower percentage of good cleavage-stage embryos and fertilization rates than those in the control group (p = 0.038 and 0.008, respectively). The number of retrieved oocytes, MII oocytes, cleavage, blastocysts, and blastulation rates was comparable between two groups. We found no significant difference in clinical pregnancy, implantation, live birth, miscarriage, or multiple pregnancy rates between the two groups among patients who transferred high-quality embryos. Stratification analysis showed that patients with stage III-IV endometriosis had fewer retrieved oocytes than those with stage I-II endometriosis (p = 0.012) and marginally fewer retrieved oocytes than the control group (p = 0.051). The stage I-II group had the lowest percentage of good cleavage-stage embryos, which was significantly lower than that of the control group (p = 0.043). In FET cycles, patients with stage III-IV endometriosis had a higher miscarriage rate than those in the control group (p = 0.023). Our results suggest that endometriosis does not alter endometrial receptivity but affects embryo quality, oocyte fertilization ability, and ovarian response.
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Deng Y, Ou Z, Yin M, Chen Z, Chen S, Sun L. Does current ovarian endometrioma increase the time for DOR patients to reach live birth in IVF? BMC Pregnancy Childbirth 2022; 22:324. [PMID: 35428243 PMCID: PMC9011965 DOI: 10.1186/s12884-022-04670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The contents of ovarian endometrioma (OMA) such as inflammatory mediators, reactive oxygen species, and iron may disrupt normal folliculogenesis and result in subsequent oocyte apoptosis. Therefore, women with OMA have a potential risk of diminished ovarian reserve (DOR). The purpose of this study is to compare the in vitro fertilization (IVF) outcomes and efficiency between DOR patients with and without current OMA. METHODS This retrospective case-control study included a total of 493 women with DOR (serum anti-Müllerian hormone level < 1.1 ng/mL). Ninety patients with OMA (Group A) underwent 191 IVF cycles and 403 patients without ovarian OMA (Group B) underwent 888 IVF cycles in our center between January 2014 and December 2018. Basal characteristics and IVF outcomes were compared between Group A and Group B. Time to achieve live birth were compared between patients with live birth in two groups (Group A1, 31 patients; Group B1, 132 patients). RESULTS Clinical and demographic characteristics of patients were similar respectively between groups (A vs. B, A1 vs. B1). There were no statistically significant differences in implantation rate, live birth rate per OPU and per ET cycle and the cumulative live birth rate per patient and per patient with good-quality embryos between Group A and Group B (P > 0.05). Total time to achieve live birth has no statistically significant difference between Group A1 and Group B1 (P > 0.05). CONCLUSION For DOR women, presence of endometrioma did not affect the IVF outcomes. Even the time to get live birth was not prolonged by current OMA.
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Affiliation(s)
- Yu Deng
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, Guangdong, PR China
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, Guangdong, PR China
| | - Zhanhui Ou
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, Guangdong, PR China
| | - Minna Yin
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, Guangdong, PR China
| | - Zhiheng Chen
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, Guangdong, PR China
| | - Shiling Chen
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, Guangdong, PR China.
| | - Ling Sun
- Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510623, Guangzhou, Guangdong, PR China.
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Ren Z, Huang J, Zhou C, Jia L, Li M, Liang X, Zeng H. Transferrin and antioxidants partly prevented mouse oocyte oxidative damage induced by exposure of cumulus-oocyte complexes to endometrioma fluid. J Ovarian Res 2020; 13:139. [PMID: 33243289 PMCID: PMC7690000 DOI: 10.1186/s13048-020-00738-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background Exposure of oocytes to the endometrioma fluid has an adverse effect on embryonic quality. To determine whether adding transferrin and antioxidants to culture medium could counteract detrimental effects on mouse cumulus-oocyte complexes (COCs) induced by exposure to endometrioma fluid or not, we conducted an in vitro cross-sectional study using human and mouse COCs. Methods Eighteen women who had their oocytes exposed to endometrioma fluid during oocyte retrieval were enrolled. COCs from superovulated ICR female mice were collected. They were first exposed to human endometrioma fluid and then treated by transferrin and/or antioxidants (cysteamine + cystine). Subsequently, COCs function was assessed by molecular methods. Results This study observed that human COCs inadvertently exposed to endometrioma fluid in the in vitro fertilization (IVF) group led to a lower good quality embryo rate compared to intracytoplasmic sperm injection (ICSI) group. Exposure of mouse COCs to endometrioma fluid accelerated oocyte oxidative damage, evidenced by significantly reduced CCs viability, defective mitochondrial function, decreased GSH content and increased ROS level, associated with the significantly higher pro-portion of abnormal spindles and lower blastocyst formation (p < 0.05, respectively). This damage could be recovered partly by treating COCs with transferrin and antioxidants (cysteamine + cystine). Conclusions Transferrin and antioxidants could reduce the oxidative damage caused by COCs exposure to endometrioma fluid. This finding provides a promising new possibility for intervention in the human oocyte oxidative damage process induced by endometrioma fluid during oocyte pick-up. Supplementary Information The online version contains supplementary material available at 10.1186/s13048-020-00738-0.
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Affiliation(s)
- Zi Ren
- Center for Reproductive Medicine, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jiana Huang
- Center for Reproductive Medicine, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Chuanchuan Zhou
- Center for Reproductive Medicine, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lei Jia
- Center for Reproductive Medicine, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Manchao Li
- Center for Reproductive Medicine, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoyan Liang
- Center for Reproductive Medicine, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Haitao Zeng
- Center for Reproductive Medicine, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
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7
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Benaglia L, Busnelli A, Biancardi R, Vegetti W, Reschini M, Vercellini P, Somigliana E. Oocyte retrieval difficulties in women with ovarian endometriomas. Reprod Biomed Online 2018; 37:77-84. [DOI: 10.1016/j.rbmo.2018.03.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 03/18/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
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Paffoni A, Bolis V, Ferrari S, Benaglia L, Vercellini P, Somigliana E. The Gametotoxic Effects of the Endometrioma Content: Insights From a Parthenogenetic Human Model. Reprod Sci 2018; 26:573-579. [DOI: 10.1177/1933719118777637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alessio Paffoni
- Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Bolis
- Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Ferrari
- Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Benaglia
- Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Edgardo Somigliana
- Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Nickkho-Amiry M, Savant R, Majumder K, Edi-O'sagie E, Akhtar M. The effect of surgical management of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and meta-analysis. Arch Gynecol Obstet 2018; 297:1043-1057. [PMID: 29344847 PMCID: PMC5849664 DOI: 10.1007/s00404-017-4640-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/22/2017] [Indexed: 01/13/2023]
Abstract
Objective To assess the impact of surgical management of endometrioma on the outcome of assisted reproduction treatment (ART). Design A systematic review and meta-analysis. Setting Department of reproductive medicine at teaching university hospital, UK. Patients Subfertile women with endometrioma undergoing ART. Interventions Surgical removal of endometrioma or expectant management. Main outcome measures Clinical pregnancy rate, pregnancy rate, live birth rate, number of oocytes retrieved and number of embryos available and ovarian response to gonadotrophins. Results An extensive search of electronic databases for articles published from inception to September 2016 yielded 11 eligible studies for meta-analysis. Meta-analysis was conducted comparing surgery versus no treatment of endometrioma. There were no significant differences in pregnancy rate per cycle, clinical pregnancy rate and live birth rate between women who underwent surgery for endometrioma and those who did not. Conclusion Current evidence suggests that women with endometriosis-related infertility have similar cycle outcomes to other patients going through ART. It is pertinent for clinicians to assess the risks of surgical intervention on ovarian reserve prior to initiating therapy.
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Affiliation(s)
- M Nickkho-Amiry
- University Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK.
| | - R Savant
- Central Manchester Foundation Trust, Manchester, UK
| | - K Majumder
- Central Manchester Foundation Trust, Manchester, UK
| | | | - M Akhtar
- Central Manchester Foundation Trust, Manchester, UK
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Strategies to Preserve and Optimize Fertility for Patients with Endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endometriosis is commonly associated with dysmenorrhea, chronic pelvic pain, and infertility. When medical therapy fails, surgery is often recommended; unfortunately, endometriosis surgery can adversely impact fertility and ovarian reserve in women desiring future childbearing. This review will focus on mechanisms of infertility in endometriosis patients as well as strategies for optimizing fertility in endometriosis patients when surgery is indicated. In addition, fertility preserving techniques such as oocyte and ovarian tissue cryopreservation as well as issues relevant to in vitro fertilization for patients with endometriosis are discussed.
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11
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Santulli P, Somigliana E, Bourdon M, Maignien C, Marcellin L, Gayet V, Chapron C. [Conservative management of endometrioma in women undergoing in vitro fertilization]. J Gynecol Obstet Hum Reprod 2017; 46:203-209. [PMID: 28403916 DOI: 10.1016/j.jogoh.2016.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/10/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
Endometriosis is a chronic disease. The pathogenesis is actually still unclear. Endometriosis is responsible for infertility and/or pelvic pain. One of the most important features of the disease is the heterogeneity (clinical and anatomical). Among the different phenotypes of endometriosis, the ovarian endometrioma seems to most important lesion in the management of endometriosis-related infertility. Surgical treatment is associated to a decrease of the ovarian reserve and a potential detrimental effect on in vitro fecondation (IVF) outcomes. Thus, the choice between conservative or surgical management of endometrioma before IVF is actually debated. The advantages and drawback of surgical and conservative management should be discussed before to plan the treatment. In the present review, we aimed at assessing the risks of a conservative management of endometrioma as compared to surgery before IVF.
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Affiliation(s)
- P Santulli
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Inserm U1016, laboratoire d'immunologie, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France; Inserm U1016, département de génétique, développement et cancer, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France.
| | - E Somigliana
- Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italie
| | - M Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Inserm U1016, laboratoire d'immunologie, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France
| | - C Maignien
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France
| | - L Marcellin
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Inserm U1016, laboratoire d'immunologie, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France; Inserm U1016, département de génétique, développement et cancer, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France
| | - V Gayet
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France
| | - C Chapron
- Service de gynécologie-obstétrique II et médecine de la reproduction, hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, bâtiment Port Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Inserm U1016, département de génétique, développement et cancer, institut Cochin, université Paris Descartes, Sorbonne Paris Cité, Paris 14, France
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12
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Embryonic development after exposure of mouse oocyte to various amount of ovarian endometriotic fluid. Obstet Gynecol Sci 2016; 59:307-10. [PMID: 27462598 PMCID: PMC4958677 DOI: 10.5468/ogs.2016.59.4.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/08/2022] Open
Abstract
This study assesses the fertilization and blastocyst-forming rate in mice cumulus-oocyte complexes (COCs) after the exposure of human ovarian endometriotic fluid. Endometriotic fluid was obtained from a single patient by aspiration at the time of a laparoscopic cystectomy and serially diluted. COCs were obtained from 46-week-old female BDF1 mice. After exposure to ovarian endometriotic fluid for five minutes, the COCs were washed three times and the oocytes were then fertilized by mice sperm. The fertilization and blastocyst formation rate and the proportion of hatching/hatched blastocyst in the four treatment groups were not inferior to those in non-exposure group.
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Endometriosis-Related Infertility: The Role of the Assisted Reproductive Technologies. BIOMED RESEARCH INTERNATIONAL 2015; 2015:482959. [PMID: 26240824 PMCID: PMC4512514 DOI: 10.1155/2015/482959] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/10/2014] [Indexed: 12/15/2022]
Abstract
The assisted reproductive technologies, particularly in vitro fertilization (IVF), represent the most efficient and successful means of overcoming infertility associated with endometriosis. Although older studies suggest that IVF outcomes are compromised in endometriosis patients, more contemporary reports show no differences compared to controls. The exception may be evidence of poorer outcomes and diminished ovarian response in women with advanced disease, particularly those with significant ovarian involvement or prior ovarian surgery. Prolonged pre-IVF cycle suppressive medical therapy, particularly gonadotropin releasing hormone agonists, appears to improve success rates in a subset of endometriosis patients. However, as of yet, there is no diagnostic marker to specifically identify those who would most benefit from this approach. Pre-IVF cycle surgical resection of nonovarian disease has not been consistently shown to improve outcomes with the possible exception of resection of deeply invasive disease, although the data is limited. Precycle resection of ovarian endometriomas does not have benefit and should only be performed for gynecologic indications. Indeed, there is a large body of evidence to suggest that this procedure may have a deleterious impact on ovarian reserve and response. A dearth of appropriately designed trials makes development of definitive treatment paradigms challenging.
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Somigliana E, Benaglia L, Paffoni A, Busnelli A, Vigano P, Vercellini P. Risks of conservative management in women with ovarian endometriomas undergoing IVF. Hum Reprod Update 2015; 21:486-99. [DOI: 10.1093/humupd/dmv012] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/16/2015] [Indexed: 12/14/2022] Open
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IVF outcome in women with accidental contamination of follicular fluid with endometrioma content. Eur J Obstet Gynecol Reprod Biol 2014; 181:130-4. [DOI: 10.1016/j.ejogrb.2014.07.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 11/22/2022]
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Filippi F, Benaglia L, Paffoni A, Restelli L, Vercellini P, Somigliana E, Fedele L. Ovarian endometriomas and oocyte quality: insights from in vitro fertilization cycles. Fertil Steril 2014; 101:988-93.e1. [DOI: 10.1016/j.fertnstert.2014.01.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/07/2014] [Accepted: 01/07/2014] [Indexed: 11/28/2022]
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Shu J, Xing L, Ding G, Luo Q, Liu X, Yan Q, Sheng J, Huang H. The effect of peritoneal fluid from patients with endometriosis on mitochondrial function and development of early mouse embryos. PLoS One 2013; 8:e82334. [PMID: 24386092 PMCID: PMC3873265 DOI: 10.1371/journal.pone.0082334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/01/2013] [Indexed: 01/08/2023] Open
Abstract
Background Peritoneal fluid (PF) from patients with endometriosis can inhibit early embryo development via probable functional changes of embryo mitochondria in the early stage of embryo development. The purpose of this study was to determine the effect of PF from patients with endometriosis on mitochondrial function and development of early mouse embryos. Methodology/Principal Findings PF was collected from patients with infertility and endometriosis, infertility due to tubal factors, and normal control subjects, and the level of NO was measured. Early murine embryos were then cultured with PF from normal control subjects, those with endometriosis, and with human tubal fluid (HTF), respectively. Cleavage and blastulation rates, mitochondrial DNA (mtDNA) copy numbers, adenosine triphosphate (ATP) level, and mitochondrial membrane potential (ΔΨm) of the different groups were compared. The NO level in the PF of patients with endometriosis was significantly greater than in those without endometriosis and control patients. The embryos cultures with PF from patients with endometriosis had a lower cleavage rate and blastulation rate, and higher ATP and ΔΨm level at the 2- and 4-cell stages. No significant difference was found in mtDNA copies among the 3 groups. Conclusions/Significance PF from patients with endometriosis can inhibit early embryo development via probable functional changes of embryo mitochondria in the early stage of embryo development. Understanding the effects of PF on embryo development may assist in developing new methods of treatment for infertility.
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Affiliation(s)
- Jing Shu
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou, PR China
| | - Lili Xing
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou, PR China
| | - Guolian Ding
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Qiong Luo
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Xinmei Liu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Qingfeng Yan
- Institute of Genetics, College of Life Science, Zhejiang University, Hangzhou, PR China
| | | | - Hefeng Huang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
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Harb HM, Gallos ID, Chu J, Harb M, Coomarasamy A. The effect of endometriosis on in vitro fertilisation outcome: a systematic review and meta-analysis. BJOG 2013; 120:1308-20. [PMID: 23834505 DOI: 10.1111/1471-0528.12366] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endometriosis is found in 0.5-5% of fertile women and 25-40% of infertile women. It is known that endometriosis is associated with infertility, but there is uncertainty whether women with endometriosis have adverse pregnancy outcomes in in vitro fertilisation (IVF) treatment. OBJECTIVES To explore the association between endometriosis and IVF outcome. SEARCH STRATEGY Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science (inception, December 2012) in all languages, together with reference lists of retrieved papers. SELECTION CRITERIA Studies comparing IVF outcome in women with endometriosis with women without endometriosis. Patients were classified by stage of endometriosis. The outcomes were fertilisation, implantation, clinical pregnancy and live birth rates. Study selection was conducted independently by two reviewers. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. DATA COLLECTION AND ANALYSIS Data extraction was conducted independently by two reviewers. Relative risks from individual studies were meta-analysed. MAIN RESULTS Twenty-seven observational studies were included, comprising 8984 women. Meta-analysis of these studies showed that fertilisation rates were reduced in stage I/II of endometriosis (relative risk [RR] = 0.93, 95% confidence interval [95% CI] 0.87-0.99, P = 0.03). There was a decrease in the implantation rate (RR = 0.79, 95% CI 0.67-0.93, P = 0.006) and clinical pregnancy rate (RR = 0.79, 95% CI 0.69-0.91, P = 0.0008) in women with stage III/IV endometriosis undergoing IVF treatment. CONCLUSION The presence of severe endometriosis (stage III/IV) is associated with poor implantation and clinical pregnancy rates in women undergoing IVF treatment.
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Affiliation(s)
- H M Harb
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham Women's Hospital Foundation Trust, Birmingham, UK
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Piromlertamorn W, Saeng-anan U, Vutyavanich T. Effects of ovarian endometriotic fluid exposure on fertilization rate of mouse oocytes and subsequent embryo development. Reprod Biol Endocrinol 2013; 11:4. [PMID: 23332096 PMCID: PMC3551806 DOI: 10.1186/1477-7827-11-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 01/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accidental exposure of oocyte/cumulus complex to endometriotic fluid is not uncommon during oocyte retrieval. Only two studies were available on this subject and they gave conflicting results. In this study, we used a mouse model to evaluate the effect of controlled exposure of oocytes to ovarian endometriotic fluid. METHODS Mouse oocytes/cumulus complexes (n = 862) were divided into 4 groups, and were exposed to endometriotic fluid (group 1), pooled sera from subjects without endometrioma (group 2), phosphate-buffered saline (group 3), and fertilization medium (controls). After five minutes, oocytes were washed and inseminated. Embryo development was observed daily. The quality of hatching blastocysts was assessed by counting the number of inner cell mass (ICM) and trophectoderm (TE) cells. RESULTS The fertilization, cleavage and blastocyst formation rates in the four groups were not statistically different. The proportions of hatching/hatched blastocysts from fertilized oocytes in groups 1 and 2 were significantly lower than those in group 3 and controls (P = 0.015). Hatching blastocysts from all groups showed no significant difference in the number of ICM and TE cells. CONCLUSIONS Exposure of mouse oocytes/cumulus complexes to endometriotic fluid had subtle detrimental effects on subsequent blastocyst development. However, one should be cautious in projecting the results of this study to contaminated human oocytes in a clinical setting.
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Affiliation(s)
- Waraporn Piromlertamorn
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Ubol Saeng-anan
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Teraporn Vutyavanich
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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Luo Q, Chen XJ, Ding GL, Dong MY, Huang HF. Downregulative effects of nitric oxide on oocyte fertilization and embryo development: possible roles of nitric oxide in the pathogenesis of endometriosis-associated infertility. Cell Physiol Biochem 2011; 26:1023-8. [PMID: 21220933 DOI: 10.1159/000323977] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2010] [Indexed: 11/19/2022] Open
Abstract
AIMS To investigate the effects of elevated nitric oxide (NO) levels in peritoneal fluids (PF) on oocyte fertilization and pre-implantation embryo development, and the relation of those effects to endometriosis-associated infertility. METHODS PF from women undergoing laparoscopy for infertility of minor endometriosis, tubal blockage and operation for tubal ligation was aspired at the pouch of the cul-de-sac during surgery. Oocytes and embryos of adult ICR mice were cultured in vitro with or without endometriotic PF. The fertilization rate of oocyte and the cleavage rate of 2-cell embryos were examined. Also, the clinical indexes of IVF-ET of women with minor endometriosis and tubal infertility were analyzed. RESULTS Oocyte fertilization rate of endometriotic women with IVF-ET treatment was significantly lower than that of tubal block women. The dose-related adverse effects of endometriotic PF and SNP (NO donor) in culture medium on oocyte fertilization and embryos development were confirmed. CONCLUSION Increased NO levels in PF play an important role in mediating the effects of endometriotic PF on oocyte fertilization and embryo development. IVF might serve as an alternative treatment for endometriosis-associated infertility.
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Affiliation(s)
- Qiong Luo
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
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Ding GL, Chen XJ, Luo Q, Dong MY, Wang N, Huang HF. Attenuated oocyte fertilization and embryo development associated with altered growth factor/signal transduction induced by endometriotic peritoneal fluid. Fertil Steril 2010; 93:2538-44. [DOI: 10.1016/j.fertnstert.2009.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 11/02/2009] [Accepted: 11/04/2009] [Indexed: 11/29/2022]
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Merviel P, Cabry R, Boulard V, Lourdel E, Oliéric MF, Claeys C, Demailly P, Devaux A, Copin H. Risques de la stimulation ovarienne et du prélèvement ovocytaire. ACTA ACUST UNITED AC 2009; 37:926-33. [DOI: 10.1016/j.gyobfe.2009.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 06/10/2009] [Indexed: 10/20/2022]
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Busacca M, Vignali M. Endometrioma Excision and Ovarian Reserve: A Dangerous Relation. J Minim Invasive Gynecol 2009; 16:142-8. [DOI: 10.1016/j.jmig.2008.12.013] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 12/15/2008] [Accepted: 12/18/2008] [Indexed: 11/30/2022]
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Garcia-Velasco JA, Somigliana E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 2008; 24:496-501. [DOI: 10.1093/humrep/den398] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pouly JL, Canis M, Velemir L, Brugnon F, Rabischong B, Botchorichvili R, Jardon K, Peikrishvili R, Mage G, Janny L. La stérilité par endométriose. ACTA ACUST UNITED AC 2007; 36:151-61. [PMID: 17267133 DOI: 10.1016/j.jgyn.2006.12.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
From the literature, the crucial knowledge were drawn among endometriosis related infertility. Endometriosis is an important factor of infertility in minimal or light stages and a major one in mild or moderate stages. Thus, a laparoscopy must be performed to confirm endometriosis when suggestive clinical or biological signs exist. In absence of them, laparoscopy can be delayed after intra-uterine inseminations (IUI). The first line treatment is laparoscopic surgery. Its efficacy is proven. It is useless to prescribe a post-operative medical treatment (GnRH analogues). Surgery leads to 25 to 40% of deliveries. It is dependant on age, infertility duration, tubo-ovarian adhesion and tubes involvement. But, surgery can be avoided and the patient is directly referred to In Vitro Fertilization (IVF) when the lesions extension is so important that surgery exposes to complications or when there is a permanent other indication for IVF (severe male infertility). When infertility persists 6 to 12 months after surgery and without patent recurrence, ovulation stimulations and IUI are performed as the second line treatment. After IUI failure, or in case of recurrence, IVF must be applied. A second surgery is not recommended. The IVF results are not impaired by the presence of endometriosis and even of endometriomas. Thus, it is useless to operate again endometriosis before IVF. In opposition, in severe stages or in cases of recurrence, a pre-IVF medical treatment (GnRH analogues) improves the results. IVF do not increased the risk of endometriosis acute growth. In case of infertility and pain, infertility is considered as the first target. But medical treatment can be prescribed between the IVF attempts.
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Affiliation(s)
- J-L Pouly
- Département de Gynécologie - Obstétrique et de Reproduction Humaine, Polyclinique Hôtel-Dieu, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand, France.
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Chavez-Badiola A, Drakeley A. Optimising in vitro fertilisation (IVF) outcome in women with endometriosis. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.rigapp.2006.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Somigliana E, Infantino M, Benedetti F, Arnoldi M, Calanna G, Ragni G. The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins. Fertil Steril 2006; 86:192-6. [PMID: 16716316 DOI: 10.1016/j.fertnstert.2005.12.034] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 12/11/2005] [Accepted: 12/11/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To clarify whether the presence of ovarian endometriomas is associated with a reduced responsiveness to ovarian hyperstimulation. DESIGN Observational study. SETTING University teaching hospital. PATIENT(S) Women selected for in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) cycles who were found to have unilateral ovarian endometriomas and who did not undergo previous ovarian surgery. INTERVENTION(S) Ovarian hyperstimulation using gonadotropins. MAIN OUTCOME MEASURE(S) Number of codominant follicles (mean diameter >15 mm) in the affected and in the contralateral intact gonads. RESULT(S) Thirty-six patients were enrolled. They underwent 56 IVF-ICSI cycles. The number of codominant follicles in the intact and affected ovaries were 4.0 +/- 2.2 and 3.0 +/- 1.7, respectively (P=.01). This difference corresponded to a mean reduction (95% confidence interval [CI]) of 25% (6%-44%). This deleterious effect was more evident in women with larger cysts, in those with more than one cyst, and in those who were more responsive to ovarian hyperstimulation. CONCLUSION(S) The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins.
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Affiliation(s)
- Edgardo Somigliana
- Infertility Unit, Department of Obstetrics, Gynecology and Neonatology, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy.
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Somigliana E, Vercellini P, Viganó P, Ragni G, Crosignani PG. Should endometriomas be treated before IVF–ICSI cycles? Hum Reprod Update 2005; 12:57-64. [PMID: 16155094 DOI: 10.1093/humupd/dmi035] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The laparoscopic excision of ovarian endometriomas appears to increase the chances of spontaneous conception, but the value of this treatment in women selected for IVF-ICSI cycles is debated. Studies recruiting women with unilateral disease and comparing ovarian responsiveness in the affected and contralateral intact gonads indicate that excision of endometriomas is associated with a quantitative damage to ovarian reserve. There are no randomized trials comparing laparoscopic excision to expectant management before IVF-ICSI cycles. The idea that surgery increases IVF pregnancy rates is not supported by the available evidence. However, the chance of conception is not the only issue that has to be considered. Some potential drawbacks are associated with both therapeutical strategies. Specifically, costs and hazard of surgical complications support expectant management whereas oocyte retrieval risks, the possibility of missing occult malignancy and endometriosis progression due to ovarian stimulation would favour surgical treatment. Alternative therapeutical options include medical treatment and ultrasound-guided aspiration. Whereas prolonged GnRH agonist down-regulation may be beneficial, data on ultrasound aspiration are more controversial.
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Affiliation(s)
- Edgardo Somigliana
- Department of Obstetrics, Gynecology and Neonatology, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy.
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Audebert A. Endométriome ovarien associé à une infertilité : quelle est la place de l'abstention thérapeutique? ACTA ACUST UNITED AC 2005; 33:416-22. [PMID: 15927511 DOI: 10.1016/j.gyobfe.2005.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 04/15/2005] [Indexed: 11/30/2022]
Abstract
Ovarian endometrioma is not infrequently encountered in infertile patients. Its etiopathogeny, its relations with attributed symptoms and the recommanded treatment to apply, are still debated. Various therapeutic tools are available, such as abstention, ultrasonographically guided aspiration and drainage, and surgery. Each option carries specific advantages and disadvantages. Ultrasonographically guided aspiration bears infectious risks. Among various proposed surgical procedures, cystectomy appears to offer the best performances. Results of IVF are slightly or not altered, neither by an ovarian endometrioma, nor by previous surgery, except in case of iterative surgery or if operated lesions were very severe. Laparoscopic surgery is still the first line treatment in many cases. Abstention can be applied in particular circumstances. Ultrasonographically guided aspiration needs to be further evaluated.
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Nadir Ciray H, Bener F, Karagenç L, Ulug U, Bahçeci M. Impact of assisted hatching on ART outcome in women with endometriosis. Hum Reprod 2005; 20:2546-9. [PMID: 15905297 DOI: 10.1093/humrep/dei064] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Assisted hatching can improve the implantation rate in cycles with poor outcome. The impact of assisted hatching in embryos from women with endometriosis is not known. Therefore, the hypothesis that the implantation potential of embryos obtained from women with endometriosis can be improved with assisted hatching was tested. METHODS In a prospective randomized study, transfer embryos obtained from 60 women with endometriosis were hatched using a laser system and compared to embryos obtained from patients with the same diagnosis which were left intact (n = 30). RESULTS The characteristics of cycles were similar between groups. The pregnancy (40% zona intact, 28.3% assisted hatching), and implantation rates (19.4% zona intact, 17.8% assisted hatching) did not differ in endometriosis cycles regardless of assisted hatching. CONCLUSION Assisted hatching does not improve outcome in women with endometriosis undergoing assisted reproduction.
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Affiliation(s)
- H Nadir Ciray
- Bahceci Women Health Care Centre and German Hospital at Istanbul, Istanbul, Turkey
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dos Reis RM, Corrêa ILA, Gonçalves De Angelo A, Manetta LA, de Moura MD, Ferriani RA. In vitro fertilization in patients with ovarian endometrioma. J Assist Reprod Genet 2004; 21:311-4. [PMID: 15568333 PMCID: PMC3455436 DOI: 10.1023/b:jarg.0000043706.57616.74] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the influence of ovarian endometrioma during IVF. METHODS Patients were submitted to cystectomy by the laparoscopic route for exeresis of ovarian endometrioma. Group I (n = 28) consisted of patients without ovarian endometrioma and group II (n = 14) consisted of patients with recurrence of ovarian endometrioma during IVF. RESULTS Fertilization and cleavage rates were higher in group I and the pregnancy rate per transfer was similar in the two groups. CONCLUSIONS The presence of endometrioma during IVF causes a worsening of oocyte fertilization and embryo cleavage but does not affect the pregnancy rate per transfer.
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Affiliation(s)
- Rosana Maria dos Reis
- Department of Gynecology and Obsterics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
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Pritts EA, Taylor RN. An evidence-based evaluation of endometriosis-associated infertility. Endocrinol Metab Clin North Am 2003; 32:653-67. [PMID: 14560892 DOI: 10.1016/s0889-8529(03)00045-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although endometriosis is associated with infertility, a clear causal relationship has yet to be established, unless adhesive disease is found. Despite this indirect association, multiple theories have been promulgated and studies are currently underway to investigate theoretic pathogenetic mechanisms. The data regarding the treatment of endometriosis-associated infertility are limited and conflicting; however, some general preliminary conclusions can be drawn. It seems that, with early-stage disease, surgical treatment increases pregnancy rates. Using the US Preventive Services Task Force classification scheme, the evidence in support of this finding is of the highest quality, or level I. Surgical treatment for moderate and severe disease also confers benefit, although the evidence in support of this treatment is of lesser quality, level II-3 by the scheme. Medical treatment, particularly if it induces an anovulatory state, has no benefit and may delay fertility. This evidence is again of the highest quality, with a classification of level I. Although assisted reproductive technologies are of benefit regarding fertility for women with endometriosis, the IVF evidence is inconclusive, with both treatments being evaluated by at least one randomized, controlled trial conferring a level I classification to the evidence. It is unclear at this time whether endometriomas have an impact on IVF outcome. The evidence consists of only a few lower-quality studies, with a classification level of II-2. Despite the haziness of current insight into the treatment of endometriosis-associated infertility, well-designed clinical trials and basic mechanistic investigations are underway in many reproductive medicine centers. As the data from these scientific inquiries emerge, clinicians will have a clearer view of effective treatment regimens for endometriosis.
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Affiliation(s)
- Elizabeth A Pritts
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin, H4/630 CSC, 600 Highland Avenue, Madison, WI 53792-6188, USA.
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Abstract
Management of infertility associated with endometriosis remains challenging. The clinician must rule out all other causes of infertility before creating a treatment plan. It is important to remember that women with infertility and endometriosis with tubal patency can conceive spontaneously, albeit at lower rates than in the fertile population. Surgical ablation or resection seems to provide benefit even in the absence of correctable anatomic defects. One should note, however, that the goal of surgery is not only to eliminate disease effectively but also to restore pelvic anatomy to normal. After reconstruction or in patients with less extensive disease, controlled ovarian hyperstimulation techniques potentially in conjunction with intrauterine inseminations can be effective. It is important to monitor patients carefully given the risk of high order multiple gestation reported with these techniques. IVF represents an effective means of bypassing the hostile peritoneal environment and anatomic distortion associated with this disease state. Although medical suppression of endometriosis alone has virtually no benefit in the asymptomatic patient, there seems to be significant benefit of pretreatment with GnRH agonists immediately before IVF cycle initiation. Whether only a specific subset or all patients with endometriosis would benefit from this approach has not yet been determined. The use of endometrial implantation markers may be helpful in this regard. The selection of the most effective approach to overcome infertility must be individualized and based on extent of disease, additional infertility factors, patient comfort, and a frank discussion of success rates and risks with patients.
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Affiliation(s)
- Eric S Surrey
- Colorado Center for Reproductive Medicine, 799 East Hampden Avenue, #300, Englewood, CO 80110, USA.
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Nisolle M. Ovarian endometriosis and peritoneal endometriosis: are they different entities from a fertility perspective? Curr Opin Obstet Gynecol 2002; 14:283-8. [PMID: 12032383 DOI: 10.1097/00001703-200206000-00006] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review summarizes the recent literature concerning new data on the pathogenesis of peritoneal endometriosis and its natural evolution. Indeed, the main concern in endometriosis is the choice of treatment in cases of infertility problems: medical or surgical. This concern could hypothetically be avoided if endometriosis were considered as a spontaneously regressive phenomenon. The present paper also discusses the risk of recurrence and the results of in-vitro fertilization and embryo transfer in cases of ovarian endometriosis. Whatever type of surgery is performed, the results of in-vitro fertilization and embryo transfer are not impaired, especially if damage to the ovarian cortex is avoided. Further studies are required to determine if oocytes from endometriosis patients are altered and could be responsible for the development of lower quality embryos.
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