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Paik H, Jee BC. Impact of Ablation Versus Cystectomy for Endometrioma on Ovarian Reserve, Recurrence, and Pregnancy: An Updated Meta-Analysis. Reprod Sci 2024; 31:1924-1935. [PMID: 38509401 DOI: 10.1007/s43032-024-01512-z] [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: 06/12/2023] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
This study aimed to compare the impact of ablation and cystectomy for ovarian endometrioma on ovarian reserve, recurrence rates, and pregnancy rates. Databases were searched for studies reporting ovarian reserve (measurement of anti-müllerian hormone [AMH] only), recurrence rates, and/or pregnancy rates after cystectomy and ablation for ovarian endometrioma. Six randomized clinical trials and five prospective cohort studies were included in this meta-analysis. All included studies had a low risk of bias. After ablation, weighted mean difference (WMD) between post- and pre-operative AMH values was - 0.40 (95% confidence interval [CI]: -0.61 to -0.19, p = 0.0002, I2 = 0%). After cystectomy, the WMD of AMH was - 1.08 (95% CI: -1.34 to -0.82, p < 0.00001, I2 = 48%). The intergroup comparison revealed that pre-operative AMH values were similar between the two groups, but post-operative AMH was significantly higher in the ablation group (WMD: 0.38, 95% CI: 0.13 to 0.63, p = 0.003, I2 = 3%). Subgroup analysis showed that the favorable effects of ablation compared to cystectomy are evident after three months of operation, in a bilateral setting, or with the laser ablation method. Overall recurrence rate (risk ratio [RR]: 1.51, 95% CI: 1.08 to 2.12, p = 0.02, I2 = 0%) and one-year recurrence rate (RR: 2.36, 95% CI: 1.30 to 4.31, p = 0.005, I2 = 0%) were significantly higher in the ablation group than in the cystectomy group. Pregnancy rates were similar between the two groups (odds ratio: 1.18, 95% CI: 0.92 to 1.52, p = 0.20, I2 = 72%). These results demonstrate that ablation could result in a smaller serum AMH decrement than cystectomy, but the recurrence rate could be higher after ablation.
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Affiliation(s)
- Haerin Paik
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi- ro 173beon-gil, Bundang-gu, 13620, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi- ro 173beon-gil, Bundang-gu, 13620, Seongnam, Republic of Korea.
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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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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Somigliana E, Piani LL, Paffoni A, Salmeri N, Orsi M, Benaglia L, Vercellini P, Vigano' P. Endometriosis and IVF treatment outcomes: unpacking the process. Reprod Biol Endocrinol 2023; 21:107. [PMID: 37936154 PMCID: PMC10629090 DOI: 10.1186/s12958-023-01157-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
Advanced endometriosis is associated with a reduction of IVF success. Surgical damage to the ovarian reserve following the excision of endometriomas has been claimed as a critical factor in the explanation of this detrimental effect. However, it is generally inferred that other mechanisms might also hamper IVF success in affected women. They include diminished responsiveness to ovarian stimulation, altered steroidogenesis, a decline in oocyte quality, reduced fertilization and embryo development, and impaired implantation. To navigate these limitations, we scrutinized available literature for studies specifically designed to address distinct phases of the IVF process. Utmost consideration was given to intra-patient ovarian response comparisons in women with unilateral endometriomas and to studies applying a meticulous matching to control confounders. The following observations have been drawn: 1) endometriosis has a negligible impact on ovarian response. A slight reduction in stimulation response can only be observed for endometriomas larger than 4 cm. Follicular steroidogenesis is unaffected; 2) oocyte quality is not hampered. Fertilization rates are similar, and intracytoplasmic sperm injection (ICSI) is not justified. Embryonic development is uncompromised, with no increase in aneuploidy rate; 3) endometrial receptivity is either unaffected or only slightly impacted. In conclusion, our study suggests that, aside from the well-known negative effect on ovarian reserve from excisional endometrioma surgeries, endometriosis does not significantly affect IVF outcomes.
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Affiliation(s)
- Edgardo Somigliana
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Letizia Li Piani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Noemi Salmeri
- Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Orsi
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Benaglia
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Vigano'
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Paik H, Jeong HG, Jee BC. Cumulative pregnancy rate via multiple fresh or frozen embryo transfers in women with current, resected, or recurred endometrioma. Taiwan J Obstet Gynecol 2023; 62:677-681. [PMID: 37678994 DOI: 10.1016/j.tjog.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE This study aimed to retrospectively analyze the cumulative pregnancy rate (PR) via multiple fresh or frozen embryo transfers (ET) in women with current, resected, or recurred endometrioma. MATERIALS AND METHODS The IVF data including oocyte pick-up (OPU) and fresh or frozen ET in women with current (37 women; 56 OPU, 18 fresh and 14 frozen ET), resected (24 women; 50 OPU, 17 fresh and 42 frozen ET), or recurred endometrioma (28 women; 49 OPU, 22 fresh and 24 frozen ET) were obtained. All cycles were performed from 2015 to 2022 in a single university hospital. RESULTS The median serum AMH level (ng/mL) was 1.44, 1.47, and 0.98, respectively. The number of total or mature oocytes, fertilized oocytes, cleavage embryos at day-3, and top-quality embryos at day-3 were all similar in the three groups. Cycles with no oocyte occurred in 2 (3.6%), 1 (2%), and 3 cycles (6.1%), respectively. Freeze-all was performed in 46.3%, 59.2%, and 47.8% of the cycles, respectively (p > 0.05). The cumulative clinical PR per total ET (43.8%, 25.4%, and 21.7%), per OPU (25%, 30%, and 20.4%), and per woman (37.8%, 62.5%, and 35.7%) were all similar in the three groups. The cumulative ongoing pregnancy and live birth rate per total ET, per OPU, and per woman were also similar in the three groups. CONCLUSION Similarity in ovarian reserve, number of oocytes, number of embryos, cumulative clinical PR, and live birth in the three endometriosis groups indicates that the IVF outcomes in the 'recurrent endometrioma' group are not inferior to 'current' or 'resected' group.
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Affiliation(s)
- Haerin Paik
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Gyeong Jeong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Honde C, Agostini A, Pivano A, Piechon L, Courbiere B, Netter A. [Management of endometriomas in France: A survey of practices]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:408-414. [PMID: 37353080 DOI: 10.1016/j.gofs.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/02/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES To present an overview of French practices for the management of endometriomas. METHODS We carried out a nationwide survey of practices concerning the management of endometriomas between October 2021 and January 2022. This study was carried out by means of two questionnaires sent to surgical centers used to treat endometriosis (n=62) and to Assisted Reproductive Technology (ART) centers (n=102). RESULTS At the end of the survey, 39/62 (62.9%) surgical teams from the centers contacted had given a response and 51/102 (50.0%) from ART centers. Laparoscopic cystectomy was the technique most frequently used by almost two thirds of the surgical teams (61%) when there was no known infertility, whereas it was the most common technique for only 14% of the ART teams. On the contrary, ultrasound-guided sclerotherapy was the most frequent technique for more than half of the ART teams (56%) and for only 8% of the surgical teams. In case of recurrence, 49% of surgical teams would choose ultrasound-guided sclerotherapy. Prior to IVF, 73% of ARP teams stated that they 'rarely' treated endometriomas. CONCLUSION The results of our study show a certain variability in practices between different centers and depending on the presence or absence of infertility for the management of endometriomas in France.
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Affiliation(s)
- C Honde
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - A Agostini
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - A Pivano
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - L Piechon
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - B Courbiere
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France; Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France
| | - A Netter
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France; Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France.
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Daniilidis A, Grigoriadis G, Kalaitzopoulos DR, Angioni S, Kalkan Ü, Crestani A, Merlot B, Roman H. Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes. J Clin Med 2023; 12:5324. [PMID: 37629367 PMCID: PMC10455819 DOI: 10.3390/jcm12165324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Ovarian endometriomas have a negative impact on a patient's reproductive potential and are likely to cause a reduction in ovarian reserve. The most commonly employed ovarian reserve parameters are anti-Müllerian hormone (AMH) and antral follicular count (AFC). Surgical management options of endometrioma include cystectomy, ablative methods, ethanol sclerotherapy and combined techniques. The optimal surgical approach remains a matter of debate. Our review aimed to summarize the literature on the impact of surgical management of endometrioma on AMH, AFC and fertility outcomes. Cystectomy may reduce recurrence rates and increase chances of spontaneous conception. However, a postoperative reduction in AMH is to be anticipated, despite there being evidence of recovery during follow-up. The reduction in ovarian reserve is likely multi-factorial. Cystectomy does not appear to significantly reduce, and may even increase, AFC. Ablative methods achieve an ovarian-tissue-sparing effect, and improved ovarian reserve, compared to cystectomy, has been demonstrated. A single study reported on AMH and AFC post sclerotherapy, and both were significantly reduced. AMH levels may be useful in predicting the chances of conception postoperatively. None of the aforementioned approaches has a clearly demonstrated superiority in terms of overall chances of conception. Surgical management of endometrioma may, overall, improve the probability of pregnancy. Evidence on its value before medically assisted reproduction (MAR) is conflicting; however, a combination of surgery followed by MAR may achieve the optimal fertility outcome. In view of the complexity of available evidence, individualization of care, combined with optimal surgical technique, is highly recommended.
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Affiliation(s)
- Angelos Daniilidis
- 1st Department in Obstetrics and Gynaecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece;
| | - Georgios Grigoriadis
- 2nd Department in Obstetrics and Gynecology, Hippokratio General Hospital, School of Medicine, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | | | - Stefano Angioni
- Department of Obstetrics and Gynecology, University of Cagliari, Monserrato, 09042 Cagliari, Italy;
| | - Üzeyir Kalkan
- Department of Obstetrics and Gynecology, Koç University, 34010 Istanbul, Turkey;
| | - Adrien Crestani
- Institut Franco-Europeen Multidisciplinaire d’Endometriose (IFEMEndo), Endometriosis Centre, Clinique Tivoli-Ducos, 33000 Bordeaux, France; (A.C.); (B.M.)
| | - Benjamin Merlot
- Institut Franco-Europeen Multidisciplinaire d’Endometriose (IFEMEndo), Endometriosis Centre, Clinique Tivoli-Ducos, 33000 Bordeaux, France; (A.C.); (B.M.)
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi 7400, United Arab Emirates
| | - Horace Roman
- Institut Franco-Europeen Multidisciplinaire d’Endometriose (IFEMEndo), Endometriosis Centre, Clinique Tivoli-Ducos, 33000 Bordeaux, France; (A.C.); (B.M.)
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi 7400, United Arab Emirates
- Aarhus University, 8000 Aarhus, Denmark
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Candiani M, Ottolina J, Salmeri N, D’Alessandro S, Tandoi I, Bartiromo L, Schimberni M, Ferrari S, Villanacci R. Minimally invasive surgery for ovarian endometriosis as a mean of improving fertility: Cystectomy vs. CO2 fiber laser ablation what do we know so far? Front Surg 2023; 10:1147877. [PMID: 37051570 PMCID: PMC10083313 DOI: 10.3389/fsurg.2023.1147877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
Minimally invasive surgery emerged in the 1980s as a safe and effective technique which requires smaller incisions and, usually, a shorter hospital stay compared to traditional surgery. Since then, minimally invasive surgery has expanded in many surgical specialties. One of its newest application in gynecology stands in the infertility management of young women with unexplained infertility or suspected endometriosis. In these cases, laparoscopy allows to diagnose and treat the disease aiming to increase at best the chances of spontaneous pregnancy or trough assisted reproductive technology. Nowadays, minimally invasive surgical approach of ovarian endometriosis consists of either laparoscopic cystectomy or ablative techniques such as laparoscopic CO2 fiber laser vaporization. Although cystectomy represents the gold standard according to the latest Cochrane review, some endometriosis experts are worried about its detrimental effect on healthy ovarian parenchyma and suggest preferring a less aggressive approach such as CO2 fiber laser vaporization. The aim of this review is to give an overview of the available evidences about the impact of the two surgical procedures on ovarian reserve markers and pregnancy outcome.
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Giannini A, Tebache L, Noti G, Cosimi G, Nisolle M, Simoncini T. Impact on ovarian reserve and fertility using carbon dioxide laser for endometriosis treatment: a systematic review. Gynecol Endocrinol 2022; 38:617-622. [PMID: 35822466 DOI: 10.1080/09513590.2022.2087218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BackgroundThe application of carbon dioxide (CO2) laser for laparoscopic gynecologic surgery was introduced in 1979 and spread after improving instrumentation, due to the versatility of the CO2 laser technology and the parallel increase of laparoscopic use. In a gynecologic setting, laser laparoscopy has been demonstrated to be effective in treating infertility and pain associated with mild to severe endometriosis.Aim and methods: This document aims at conducting a systematic review to provide a comprehensive literature overview regarding the rationale, indications, safety, and efficacy of CO2 laser treatment of endometriosis and related outcomes on ovarian reserve and fertility.ResultsCO2 laser seems to lead to lower heat damage in the ovarian tissue than bipolar energy during endometriomas treatment. Moreover, several reports have pointed out that laser vaporization allows to selectively destroy the endometrioma wall's internal surface, preserving the pericystic fibrotic capsule or the adjacent healthy ovarian cortex. Despite this, robust data we have so far indicates that the most effective laparoscopic approach for managing endometriomas is the traditional excisional technique providing better postoperative outcomes than drainage and electrocoagulation, and laser treatment. Data about fertility after treatment of deep infiltrating endometriosis (DIE) using dioxide laser are emerging but very poor.ConclusionsCurrent scientific evidence in this field is inconclusive, and the debate about the safety and efficacy of the CO2 laser on fertility outcomes is still ongoing. Further randomized case-control studies are mandatory to attain more consistent evidence.
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Affiliation(s)
- Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Linda Tebache
- Department of Obstetrics and Gynecology, Hospital CHR Liège, University of Liège, Liège, Belgium
| | - Giacomo Noti
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Giulia Cosimi
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Michelle Nisolle
- Department of Obstetrics and Gynecology, Hospital CHR Liège, University of Liège, Liège, Belgium
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
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Endometriosis and Infertility: A Long-Life Approach to Preserve Reproductive Integrity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106162. [PMID: 35627698 PMCID: PMC9141878 DOI: 10.3390/ijerph19106162] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
Laparoscopic surgery was originally considered the gold standard in the treatment of endometriosis-related infertility. Assisted reproductive technology (ART) was indicated as second-line treatment or in the case of male factor. The combined approach of surgery followed by ART proved to offer higher chances of pregnancy in infertile women with endometriosis. However, it was highlighted how pelvic surgery for endometriosis, especially in cases of ovarian endometriomas, could cause iatrogenic damage due to ovarian reserve loss, adhesion formation (scarring), and ischemic damage. Furthermore, in the last few years, the trend to delay the first childbirth, recent technological advances in ultrasound diagnosis, and technological progress in clinical and laboratory aspects of ART have certainly influenced the approach to infertility and endometriosis with, ART assuming a more relevant role. Management of endometriosis should take into account that the disease is chronic and involves the reproductive system. Consequently, treatment and counselling should aim to preserve the chances of pregnancy for the patient, even if it is not associated with infertility. This review will analyse the evolution of the management of infertility associated with endometriosis and propose an algorithm for treatment decision-making based on the most recent acquisitions.
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Benaglia L, Mensi L, DI Gesaro L, Somigliana E. Safety of in-vitro fertilization in women with endometriosis. Minerva Obstet Gynecol 2021; 73:333-340. [PMID: 34008387 DOI: 10.23736/s2724-606x.21.04711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Management of women with endometriosis in general is complex. It requires a multidisciplinary and tailored approach. The time of in-vitro fertilization (IVF) may be particularly complicated because women with the disease face peculiar additional risks. In particular, oocytes retrieval may be more difficult and women with endometriomas are exposed to a low but consistent risk of infection and ovarian abscess development. There are also concerns regarding progression of deep invasive peritoneal lesions and misdiagnosis of an occult early ovarian cancer. However, evidence on these latter points is more controversial. Taken together, this body evidence is generally reassuring and does not justify prophylactic surgery prior to IVF to shrink these risks. However, given the uncertainties, women with endometriosis must be informed in depth of these peculiar additional risks.
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Affiliation(s)
- Laura Benaglia
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Laura Mensi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,University of Milan, Milan, Italy
| | - Luca DI Gesaro
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,University of Milan, Milan, Italy
| | - Edgardo Somigliana
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,University of Milan, Milan, Italy
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Aflatoonian A, Tabibnejad N. Aspiration versus retention ultrasound-guided ethanol sclerotherapy for treating endometrioma: A retrospective cross-sectional study. Int J Reprod Biomed 2020; 18:935-942. [PMID: 33349801 PMCID: PMC7749973 DOI: 10.18502/ijrm.v13i11.7960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/02/2020] [Accepted: 04/11/2020] [Indexed: 11/24/2022] Open
Abstract
Background Endometrioma is a common high-recurrence gynecological disease that affects infertility. Surgical resection using laparotomy or laparoscopy is applied as a standard treatment. Moreover, sclerotherapy is reported to be effective as a non-invasive method for treating endometrioma. Objective To evaluate whether the ethanol retention or aspiration after sclerotherapy improve pregnancy outcome in infertile women with endometrioma. Materials and Methods In a retrospective study, hospital records of 43 women with recurrent or bilateral endometrioma who had been undergone transvaginal ultrasound sclerotherapy were reviewed. They were selected to receive either ethanol for 10 min, ethanol injection, irrigation, and then aspiration or total retention without aspiration based on the surgeon's decision. The participants were followed-up for 3, 6 and 12 months for natural or artificial conception as well as for cyst recurrence. Results Chemical pregnancy was positive in 52% of the women in the aspiration group and 53.8% in the retention group. Ongoing pregnancy (44% vs 46.2%, p = 0.584) and live birth (40% vs 46.2%, p = 0.490) were reported marginally higher in the retention group compared with the aspiration group, and the differences were not statistically significant. Moreover, the recurrence rate were found to be 48.1% and 37.5% in the aspiration and retention groups, respectively (p = 0.542). The cysts size in the retention group was significantly correlated to the recurrence rate. Conclusion Both the aspiration and left in situ of ethanol 95% sclerotherapy have the similar impact on the treatment of ovarian endometrioma regarding pregnancy and recurrence rate. However, larger randomized studies with strict inclusion criteria are needed.
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Affiliation(s)
- Abbas Aflatoonian
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Tabibnejad
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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12
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Vignali M, Solima E, Barbera V, Becherini C, Belloni GM. Approaching ovarian endometrioma with medical therapy. Minerva Obstet Gynecol 2020; 73:215-225. [PMID: 33314904 DOI: 10.23736/s2724-606x.20.04751-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endometriosis is a chronic inflammatory gynecological disorder associated with pelvic pain symptoms and infertility. Ovarian cysts (endometriomas) are the most common localization of endometriosis in the pelvis. Considering non-invasive methods, transvaginal ultrasound has high sensitivity and specificity for endometrioma diagnosis. Laparoscopic removal of endometrioma is related to a damage to the ovarian reserve and should be limited to patients with suspicious cysts or unresponsive to medical treatment. The main goal of medical therapy of symptomatic endometrioma is the control of pain symptoms, while no benefits have been demonstrated in terms of improving fertility rates of women seeking pregnancy. The aim of medical treatment is the inhibition of ovulation, stop of menstruation and achievement of a stable hypo-hormonal milieu. Estroprogestins and progestins are indicated by guidelines as first line medications for symptomatic patients. Several hormonal treatments have been proposed for the treatment of symptomatic endometriomas. In particular, dienogest, a relatively new progestin, has shown promising results. Medical treatment should be conceived as a long-term treatment. Safety, tolerability, a low percentage of side effects and an easy route of administration are essential for patient acceptance and adherence to therapy.
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Affiliation(s)
- Michele Vignali
- Department of Biomedical Sciences for Health, M. Melloni Hospital, University of Milan, Milan, Italy -
| | - Eugenio Solima
- Department of Biomedical Sciences for Health, M. Melloni Hospital, University of Milan, Milan, Italy
| | - Valeria Barbera
- Department of Biomedical Sciences for Health, M. Melloni Hospital, University of Milan, Milan, Italy
| | - Chiara Becherini
- Department of Biomedical Sciences for Health, M. Melloni Hospital, University of Milan, Milan, Italy
| | - Gaia M Belloni
- Department of Biomedical Sciences for Health, M. Melloni Hospital, University of Milan, Milan, Italy
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13
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Cecchino GN, Cozzolino M, Roque M, García-Velasco JA. Endometrioma and reproductive issues: a well-informed patient may be the driver for change. ACTA ACUST UNITED AC 2020; 72:149-156. [PMID: 33000615 DOI: 10.23736/s0026-4784.20.04595-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Endometriosis affects a great proportion of women during their reproductive years and may impair female fertility in several ways. Ovarian endometrioma (OE) is the most frequent phenotype and growing evidence suggest an endometrioma-mediated damage to the ovary, ovarian reserve and oocyte quality. Traditionally, surgery has been the first-line treatment in cases of OE. Great advances in assisted reproduction and fertility preservation techniques opened new possibilities towards a more conservative approach. Herein we discuss multiple mechanisms responsible for the deterioration of the reproductive capacity in cases of OE as well as the pros and cons of different treatment options. The management of endometrioma-related subfertility remains controversial and it will depend on patient's intentions and priorities. In the "internet era" patients tend to be hyper-informed and more participative, but they are often misguided and misinformed. Thus, doctors should be able to convert these individuals into well-informed patients in order to facilitate the process of shared decision making, which is extremely relevant in the context of OEs.
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Affiliation(s)
- Gustavo N Cecchino
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil - .,Department of Gynecology and Obstetrics, Rey Juan Carlos University, Madrid, Spain - .,Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil -
| | - Mauro Cozzolino
- Department of Gynecology and Obstetrics, Rey Juan Carlos University, Madrid, Spain.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.,IVIRMA, IVI Foundation, Health Research Institute La Fe, Valencia, Spain
| | - Matheus Roque
- Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil
| | - Juan A García-Velasco
- Department of Gynecology and Obstetrics, Rey Juan Carlos University, Madrid, Spain.,Department of Reproductive Medicine and Infertility, IVIRMA Madrid, Madrid, Spain
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14
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Vignali M, Belloni GM, Pietropaolo G, Barbasetti Di Prun A, Barbera V, Angioni S, Pino I. Effect of Dienogest therapy on the size of the endometrioma. Gynecol Endocrinol 2020; 36:723-727. [PMID: 32065005 DOI: 10.1080/09513590.2020.1725965] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Studies have been published on the efficacy of Dienogest in the management of pain symptoms in endometriosis. Nonetheless, few data are available on the reducing effect on endometrioma's size. The aim of the study was to evaluate if Dienogest could determine significant changes in size, as well as in symptoms. In this prospective observational study, patients were enrolled with pain symptoms and at least one endometrioma diagnosed via TV-US. The volume of the endometrioma and pain symptoms was measured according to the LxDxWx0.5233 formula and VAS, respectively. Dienogest 2 mg was administered daily. Follow-up visits were scheduled after 6 and 12 months of treatment to assess changes in patients' symptoms and endometrioma's volume. Seventy patients were enrolled, 63 patients completed a 6-month treatment. The reduction of the mean volume after 6 months was 66.71%. Fifty-eight patients completed the 12 month-treatment. The reduction of the mean volume after 12 months was 76.19%. Dysmenorrhea showed a 74.05% reduction after 6 months and a 96.55% reduction after 12 months. Patients reported a reduction in dyspareunia and chronic pelvic pain of 42.71% and 48.91% after 6 months and 51.93% and 59.96% after 12 months, respectively. Dienogest leads to a statistically significant reduction of endometrioma's volume and pain symptoms.
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Affiliation(s)
- Michele Vignali
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Gaia Maria Belloni
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Giuliana Pietropaolo
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Allegra Barbasetti Di Prun
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Valeria Barbera
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Stefano Angioni
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Ida Pino
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
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15
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Fertility Outcome after CO 2 Laser Vaporization versus Cystectomy in Women with Ovarian Endometrioma: A Comparative Study. J Minim Invasive Gynecol 2020; 28:34-41. [PMID: 32712323 DOI: 10.1016/j.jmig.2020.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVE To assess the postoperative likelihood of conception in patients with endometriomas managed by either CO2 laser vaporization or cystectomy. DESIGN A retrospective study with prospective recording of data. SETTING University hospital. PATIENTS One hundred and forty-two patients with symptomatic endometriomas. INTERVENTIONS Patients underwent a standardized laparoscopic stripping technique (Group 1) or cyst vaporization with CO2 fiber laser (Group 2). Patients wishing to become pregnant were allowed to attempt a spontaneous conception after surgery. If spontaneous conception failed, patients were referred for in vitro fertilization (IVF). MEASUREMENTS AND MAIN RESULTS The primary objective was to compare pregnancy rates between the 2 groups. The secondary objective was the identification of independent predictors of pregnancy. Thirty-nine women in Group 1 (53.4%) and 39 women in Group 2 (56.5%) desired to conceive after surgery. Three patients (7.7%) in Group 1 became pregnant following donor-IVF and were excluded. Pregnancies were recorded in 72.2% of patients treated with cystectomy and in 74.3% of those managed with CO2 fiber laser (p = .83). Twenty patients (55.6%) in Group 1 and 14 patients (35.9%) in Group 2 conceived spontaneously (p = .08). Among patients who failed spontaneous conception, 21 patients (28%) achieved pregnancy through IVF (Group 1: n = 6, 16.7%; Group 2: n = 15, 38.5%; p = .08). Twenty patients (26.7%) never became pregnant. Age at the time of surgery (odds ratio (OR) = 0.86; 95% Confidence intervals (CI): 0.78-0.96, p = .002) and duration of infertility (OR=0.80; 95% CI: 0.69-0.92, p = .006) were identified as independent indicators for pregnancy. CONCLUSION CO2 laser-treated endometrioma is associated with pregnancy rates equal to those observed after cystectomy and favorable IVF outcomes. The one step CO2 fiber laser technique may represent a viable alternative to cystectomy.
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Ottolina J, Ferrari S, Bartiromo L, Bonavina G, Salmeri N, Schimberni M, Makieva S, Tandoi I, Papaleo E, ViganÒ P, Candiani M. Ovarian responsiveness in assisted reproductive technology after CO2 fiber laser vaporization for endometrioma treatment: preliminary data. MINERVA ENDOCRINOL 2020; 45:288-294. [PMID: 32638581 DOI: 10.23736/s0391-1977.20.03256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data about endometrioma ablation using energies with little thermal spread reported good results in terms of ovarian reserve and postoperative pregnancy rates. The aim of the present study was to assess the impact of one step CO<inf>2</inf> fiber laser vaporization for endometrioma on subsequent controlled ovarian stimulation. METHODS This prospective observational cohort study included a consecutive series of infertile patients who have undergone CO<inf>2</inf> fibre laser vaporization for endometrioma treatment. The primary endpoint was to assess the number of follicles per ovary growing during controlled ovarian stimulation. The secondary endpoints included the number of oocytes retrieved, the total number of embryos obtained and the cumulative clinical pregnancy rate per patient treated. RESULTS Twenty-six patients underwent assisted reproductive technology after surgery for endometriosis-related infertility. In unilateral operated ovaries at the end of controlled ovarian stimulation no significant differences emerged from comparison of total recruited follicles in the operated ovary and in the contralateral ovary (P=0.55). If considering only bilateral endometriomas, the number of recruited follicles at the end of controlled ovarian stimulation was similar in both operated ovaries (P=0.79). The number of cumulative clinical pregnancies was 15 (57.7%; 95% CI: 38.5-76.9%). When comparing women aged ≤35 years to those aged >35 years, controlled ovarian stimulation outcomes were significantly higher in the younger patients. Age at the time of assisted reproductive technology was the only independent predictor for follicular growth during ovarian hyperstimulation (95% CI: -1.27 to -0.116, P=0.027). CONCLUSIONS CO2 laser-treated endometrioma is associated with favorable reproductive assisted reproductive technology outcomes.
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Affiliation(s)
- Jessica Ottolina
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Stefano Ferrari
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ludovica Bartiromo
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Bonavina
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Noemi Salmeri
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Schimberni
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sofia Makieva
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Iacopo Tandoi
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Papaleo
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola ViganÒ
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Li X, Zhang W, Chao X, Dai Y, Shi J, Jia S, Chen S, Wu Y, Gu Z, Leng J. Clinical characteristics difference between early and late recurrence of ovarian endometriosis after laparoscopic cystectomy. Arch Gynecol Obstet 2020; 302:905-913. [PMID: 32583208 DOI: 10.1007/s00404-020-05657-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ovarian endometriosis is the most frequent type of endometriosis. Despite the use of surgery and medication, many patients suffer from recurrence within near future. Currently, there are no effective clinical characteristics available to predict the time to recurrence in ovarian endometriosis patients. PURPOSE To identify the effective clinical indicators for early and late endometrioma recurrence, we compared the clinical characteristics of early and late recurrence after treatment. METHODS We collected 358 patients with ovarian endometriosis who had a minimum of 5 years of postoperative follow-up after undergoing a laparoscopic excision of ovarian endometrioma performed at Peking Union Medical College Hospital from January 2009 to April 2013. RESULTS A total of 358 patients were recruited in the validation set, with a median follow-up time of 83 months (60-120 months). Till the last follow-up, 68 patients exhibited recurrence. Three-year and 5-year recurrence rates were 9.2% and 15.4%, respectively. Univariate analysis in our study showed that patient with endometrioma surgery history had higher incidence of recurrence in 3 years after re-surgery (OR: 5.594, P = 0.029). Univariate and multivariate analyses using the logistic regression showed that the presence of tenesmus before surgery affected the incidence of early recurrence with a ratio of 57.9% (11/19) and 89.5% (17/19) in 3 years and 5 years after surgery, respectively. CONCLUSIONS Presence of tenesmus before surgery may be linked to the early recurrence of endometrioma.
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Affiliation(s)
- Xiaoyan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Wen Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiaopei Chao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Jinghua Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Shuangzheng Jia
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Sikai Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Yushi Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Zhiyue Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Jinhua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
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18
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Cobo A, Giles J, Paolelli S, Pellicer A, Remohí J, García-Velasco JA. Oocyte vitrification for fertility preservation in women with endometriosis: an observational study. Fertil Steril 2020; 113:836-844. [PMID: 32145929 DOI: 10.1016/j.fertnstert.2019.11.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe the outcome of fertility preservation (FP) using vitrified oocytes in patients with endometriosis and to determine the impact of ovarian surgery. DESIGN Retrospective observational study. SETTING University-affiliated private in vitro fertilization (IVF) center. PATIENT(S) Four hundred and eighty-five women with endometriosis who underwent FP from January 2007 to July 2018. INTERVENTION(S) Vitrification of metaphase II (MII) oocytes for future use. MAIN OUTCOME MEASURE(S) Oocyte survival rate and cumulative live-birth rate (CLBR). RESULT(S) Mean age at vitrification was 35.7 ± 3.7 years. The women undergoing operations were younger than the nonsurgical patients (33.4 ± 3.6 years vs. 36.7 ± 3.7 years). The survival rate and CLBR were 83.2% and 46.4%, respectively. The number of vitrified oocytes per cycle (6.2 ± 5.8) was higher for the nonsurgical patients compared with the unilateral (5.0 ± 4.5) or bilateral (4.5 ± 4.4) surgery groups, but was comparable among the surgical patients. The effect of age (adjusted odds ratio [OR] 0.904; 95% CI, 0.858-0.952), number of oocytes (adjusted OR 1.050; 95% CI, 1.025-1.091), and survival (adjusted OR 1.011; 95% CI, 1.001-1.020) on the CLBR was confirmed. However, the effect of surgery was not observed (adjusted OR 1.142; 95% CI, 0.778-1.677). Nonetheless, the ovarian response (vitrified oocytes = 8.6 ± 6.9 vs. 5.1 ± 4.8) and CLBR (72.5% vs. 52.8%) were higher in young (≤35 years) nonsurgical patient versus the surgical patients; older women showed similar outcomes. CONCLUSION(S) Fertility preservation gives patients with endometriosis a valid treatment option to help them increase their reproductive chances. We suggest performing surgery after ovarian stimulation for FP in young women. In older women, an individualized treatment should be considered.
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Affiliation(s)
- Ana Cobo
- IVIRMA Valencia, Valencia, Spain.
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19
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Kim SJ, Kim SK, Lee JR, Suh CS, Kim SH. Oocyte cryopreservation for fertility preservation in women with ovarian endometriosis. Reprod Biomed Online 2020; 40:827-834. [PMID: 32295746 DOI: 10.1016/j.rbmo.2020.01.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 01/25/2023]
Abstract
RESEARCH-QUESTION What is the clinical usefulness of oocyte cryopreservation for fertility preservation in women with ovarian endometriosis? DESIGN Clinical characteristics were retrospectively analysed in 34 women with endometrioma before a planned ovarian cystectomy. Ovarian stimulation outcomes were compared according to laterality. A one-to-one propensity score-matched analysis was conducted to compare ovarian stimulation outcomes of the first cycle in patients with endometrioma undergoing fertility preservation with those in infertile patients without endometrioma who underwent IVF treatment. The number of oocytes cryopreserved in repeated ovarian stimulation cycles was analysed. RESULTS The mean endometrioma size at diagnosis was 6.0 ± 2.5 cm. The mean age, serum anti-Mullerian hormone levels and number of oocytes cryopreserved were 30.7 ± 5.9 years, 1.85 ± 1.14 ng/ml, and 4.8 ± 3.2, respectively. The number of oocytes cryopreserved in bilateral endometrioma compared with unilateral endometrioma patients was 4.1 ± 2.9 versus 5.7 ± 3.4 (P = 0.600). In the propensity score-matched cohort (n = 22 per group), the number of oocytes retrieved was significantly lower in the patients with endometrioma undergoing fertility preservation compared with that in infertile patients without endometrioma (5.4 ± 3.8 versus 8.1 ± 4.8; P = 0.045). A total of 13 (38.2%) patients with endometrioma underwent repeated stimulation. The median (interquartile range) number of cryopreserved oocytes at the first and the second cycle were 3.0 (2.5-6.0) and 5.0 (2.5-7.5), respectively. CONCLUSIONS Women with endometrioma should be counselled about oocyte cryopreservation for fertility preservation before surgery. The number of cryopreserved oocytes can be increased by repeated oocyte retrieval.
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Affiliation(s)
- Se Jeong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Korea 13620; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080; Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul Korea 06125
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Korea 13620; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Korea 13620; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080
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20
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Lantsberg D, Fernando S, Cohen Y, Rombauts L. The Role of Fertility Preservation in Women with Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2019; 27:362-372. [PMID: 31546067 DOI: 10.1016/j.jmig.2019.09.780] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/01/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To summarize the available evidence concerning fertility preservation techniques in the context of women with endometriosis. DATA SOURCES We searched for studies published between 1984 and 2019 on endometriosis and Assisted Reproductive Technology outcomes. We searched MEDLINE and PubMed and performed a manual search of reference lists within identified studies. METHODS OF STUDY SELECTION A total of 426 articles were identified, and 7 studies were eligible to be included for the systematic review. We included all published studies, excluding reviews, case reports, and animal studies. TABULATION, INTEGRATION, AND RESULTS Despite a significant increase in the number of studies addressing fertility preservation over the study period, we found a relative lack of evidence addressing the use of fertility preservation techniques in women with endometriosis. The studies identified included 2 case reports, 1 histological science study, and 4 retrospective cohort studies. CONCLUSION Women with endometriosis may benefit from fertility preservation techniques. However, there currently is a paucity of data in this population, especially when compared with other indications for fertility preservation. Although much knowledge can be translated from the oncofertility discipline, we have identified and discussed endometriosis-related changes to ovarian reserve and oocyte health that justify further well-designed research to confirm that fertility preservation outcomes are similar for women with endometriosis.
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Affiliation(s)
- Daniel Lantsberg
- Department of Obstetrics, Gynecology and Fertility, Lis Maternity Hospital (Drs. Lantsberg and Cohen); Sourasky Tel-Aviv Medical Center (Drs. Lantsberg and Cohen), and Sackler Faculty of Medicine (Drs. Lantsberg and Cohen), Tel-Aviv University, Israel.
| | - Shavi Fernando
- Department of Obstetrics and Gynecology, Monash University, Clayton (Prof. Rombauts and Dr. Fernando), Australia; Women's Health, Monash Health, Clayton (Prof. Rombauts and Dr. Fernando), Australia
| | - Yoni Cohen
- Sourasky Tel-Aviv Medical Center (Drs. Lantsberg and Cohen), and Sackler Faculty of Medicine (Drs. Lantsberg and Cohen), Tel-Aviv University, Israel
| | - Luk Rombauts
- Department of Obstetrics and Gynecology, Monash University, Clayton (Prof. Rombauts and Dr. Fernando), Australia; Women's Health, Monash Health, Clayton (Prof. Rombauts and Dr. Fernando), Australia; Monash IVF Group, Richmond (Prof Rombauts), Australia
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21
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Di Nisio V, Rossi G, Di Luigi G, Palumbo P, D'Alfonso A, Iorio R, Cecconi S. Increased levels of proapoptotic markers in normal ovarian cortex surrounding small endometriotic cysts. Reprod Biol 2019; 19:225-229. [PMID: 31416694 DOI: 10.1016/j.repbio.2019.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 02/07/2023]
Abstract
Endometriosis can impair fertility by reducing ovarian reserve and the production of good-quality oocytes. The surgical removal of endometriotic lesions is generally recommended for women who wish to conceive. In this paper we studied whether ovarian cortex adjacent to excised small (diameter ≤ 4 cm) endometriotic cyst (here referred as Cortex Surrounding Endometriotic Cyst, CSEC) showed signs of tissue damages by evaluating the expression of proteins involved in DNA repair and apoptosis. To this end, phosphorylated H2A.X, Chk1 and 2, ATM and ATR, Bcl-2, Bid, phosphorylated and total p53, caspases (9, 8 and 3), XIAP, phosphorylated and total NFκB were analyzed by western blot. Results showed that caspase 8, XIAP, p53/p-p53 and NFκB were more abundantly expressed in all samples of CSEC group in comparison with ovarian cortex of controls. Conversely, the levels of the other proteins were comparable between the two groups. In conclusion, these results suggest that NFκB, caspase 8 and p53/p-p53 elevated expressions in samples of CSEC can be considered as an early sign of tissue injury, indicating that ovarian cortex is already sensitized to apoptosis and inflammation. Therefore, excision of EC should occur very early, to avoid further ovarian damages.
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Affiliation(s)
- Valentina Di Nisio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianna Rossi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Paola Palumbo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Angela D'Alfonso
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberto Iorio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sandra Cecconi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
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22
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Candiani M, Ottolina J, Schimberni M, Tandoi I, Bartiromo L, Ferrari S. Recurrence Rate after "One-Step" CO 2 Fiber Laser Vaporization versus Cystectomy for Ovarian Endometrioma: A 3-Year Follow-up Study. J Minim Invasive Gynecol 2019; 27:901-908. [PMID: 31377455 DOI: 10.1016/j.jmig.2019.07.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To assess postoperative recurrence rates in patients with endometriomas managed by either "one-step" CO2 fiber laser vaporization or cystectomy. DESIGN Retrospective study with prospective recording of data. SETTING University hospital. PATIENTS One hundred twenty-five patients with symptomatic endometriomas. INTERVENTIONS Patients underwent a standardized laparoscopic stripping technique (group 1) or cyst vaporization with CO2 fiber laser (group 2). After surgery, patients were incorporated in a prolonged surveillance program with periodic clinical follow-up to check for recurrence of the cyst and/or recurrence of symptoms. Endometrioma recurrence was defined as an ovarian cyst (>10 mm) with a typical aspect arising on the operated ovary identified by transvaginal ultrasound. MEASUREMENTS AND MAIN RESULTS The primary endpoint was the comparison of recurrence rates between the 2 groups. The secondary endpoint was the evaluation of endometriosis-related pain recurrence in the 2 groups. Other endpoints selected for analysis included the identification of risk factors for the recurrence of endometrioma and of endometriosis-related symptoms. The mean follow-up was 29 ± 13 months (range, 13-49). Recurrence of ovarian endometriosis was recorded in 6.3% of patients (n = 4) treated with cystectomy and in 4.9% of patients (n = 3) managed with CO2 fiber laser (p = .74). Recurrence of endometriosis-related pain was observed in 5 patients (7.8%) in group 1 and in 6 patients (9.8%) in group 2 (p = .67). Mean endometrioma diameter > 5 cm at the time of surgery was identified as the only independent poor prognostic indicator for cyst recurrence (p = .008; odds ratio [OR], 2.21; 95% confidence interval [CI], 1.19-3.32). Moreover, the presence of deep endometriosis at surgery (p = .032; OR, 4.60; 95% CI, 1.14-18.57) and discontinuation of hormonal treatment (p = .015; OR, 3.18; 95% CI, 1.25-8.06) were independent poor prognostic indicators for pain recurrence. CONCLUSION This study suggests that one-step CO2 fiber laser vaporization may be effective for endometrioma treatment because it is associated with recurrence rates comparable with those occurring after cystectomy, with the advantage of being an ovarian tissue-sparing technique.
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Affiliation(s)
- Massimo Candiani
- Gynecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (all authors)
| | - Jessica Ottolina
- Gynecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (all authors)..
| | - Matteo Schimberni
- Gynecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (all authors)
| | - Iacopo Tandoi
- Gynecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (all authors)
| | - Ludovica Bartiromo
- Gynecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (all authors)
| | - Stefano Ferrari
- Gynecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (all authors)
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Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, Kohlmeier A, Yin P, Milad M, Wei J. Endometriosis. Endocr Rev 2019; 40:1048-1079. [PMID: 30994890 PMCID: PMC6693056 DOI: 10.1210/er.2018-00242] [Citation(s) in RCA: 371] [Impact Index Per Article: 74.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/08/2019] [Indexed: 02/08/2023]
Abstract
Pelvic endometriosis is a complex syndrome characterized by an estrogen-dependent chronic inflammatory process that affects primarily pelvic tissues, including the ovaries. It is caused when shed endometrial tissue travels retrograde into the lower abdominal cavity. Endometriosis is the most common cause of chronic pelvic pain in women and is associated with infertility. The underlying pathologic mechanisms in the intracavitary endometrium and extrauterine endometriotic tissue involve defectively programmed endometrial mesenchymal progenitor/stem cells. Although endometriotic stromal cells, which compose the bulk of endometriotic lesions, do not carry somatic mutations, they demonstrate specific epigenetic abnormalities that alter expression of key transcription factors. For example, GATA-binding factor-6 overexpression transforms an endometrial stromal cell to an endometriotic phenotype, and steroidogenic factor-1 overexpression causes excessive production of estrogen, which drives inflammation via pathologically high levels of estrogen receptor-β. Progesterone receptor deficiency causes progesterone resistance. Populations of endometrial and endometriotic epithelial cells also harbor multiple cancer driver mutations, such as KRAS, which may be associated with the establishment of pelvic endometriosis or ovarian cancer. It is not known how interactions between epigenomically defective stromal cells and the mutated genes in epithelial cells contribute to the pathogenesis of endometriosis. Endometriosis-associated pelvic pain is managed by suppression of ovulatory menses and estrogen production, cyclooxygenase inhibitors, and surgical removal of pelvic lesions, and in vitro fertilization is frequently used to overcome infertility. Although novel targeted treatments are becoming available, as endometriosis pathophysiology is better understood, preventive approaches such as long-term ovulation suppression may play a critical role in the future.
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Affiliation(s)
- Serdar E Bulun
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bahar D Yilmaz
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christia Sison
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kaoru Miyazaki
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lia Bernardi
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Shimeng Liu
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amanda Kohlmeier
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ping Yin
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Magdy Milad
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - JianJun Wei
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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24
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Dong S, Zhang J, Zhai F, Zhao X, Qin X. Comparative efficacy and safety of traditional Chinese patent medicine for endometriosis: A Bayesian network meta-analysis protocol. Medicine (Baltimore) 2019; 98:e16473. [PMID: 31335707 PMCID: PMC6709182 DOI: 10.1097/md.0000000000016473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Endometriosis is a common disease of women of childbearing age. In recent years, the incidence of endometriosis has been on the rise. The main clinical manifestations are pelvic pain and infertility. In recent years, traditional Chinese patent medicine (TCMP) has played an important role in the treatment of endometriosis. So far, there is a lack of comparison among all the current common TCPMs for endometriosis. Consequently, it is indispensable to propose a network meta-analysis (NMA) protocol to discuss the strengths and weaknesses of different TCMPs. METHODS We will comprehensively and systematically retrieve the relevant Chinese and English databases from their inceptions to the May 2019. All randomized controlled trials (RCTs) of TCMPs for Endometriosis will be included. Two researchers will independently screen literature, extract data and assess the risk of bias of included studies. We will conduct pairwise meta-analyses and Bayesian network meta-analyses to assess all the available evidence. Data will be analyzed using STATA and WinBUGS software. RESULTS This work will compare and rank the relative efficacy of different TCPMs in the treatment of endometriosis in detail. CONCLUSION The results of this study will provide reliable evidence for the selection of clinical treatment program and guideline development. PROSPERO REGISTRATION NUMBER CRD42019127781.
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Affiliation(s)
| | - Jianwei Zhang
- Hospital Affiliated to Shandong University of Traditional Chinese Medicine, Jinan
| | | | - Xinglong Zhao
- Traditional Chinese Medical Hospital of Tai’an, Tai’an
| | - Xiuyun Qin
- Rizhao Maternal and Child Health Care Hospital, Rizhao, Shandong Province, China
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25
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Candiani M, Ottolina J, Posadzka E, Ferrari S, Castellano LM, Tandoi I, Pagliardini L, Nocun A, Jach R. Assessment of ovarian reserve after cystectomy versus 'one-step' laser vaporization in the treatment of ovarian endometrioma: a small randomized clinical trial. Hum Reprod 2019; 33:2205-2211. [PMID: 30299482 PMCID: PMC6238368 DOI: 10.1093/humrep/dey305] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/19/2018] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does CO2 laser vaporization offer better results in treating endometrioma in terms of ovarian reserve preservation compared to traditional cystectomy? SUMMARY ANSWER Assessing both antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) levels as measures of ovarian reserve, the results suggest that CO2 technology may be an alternative treatment for endometrioma, causing minimal damage to adjacent healthy ovarian tissue. WHAT IS KNOWN ALREADY Excisional surgery has been questioned as an ideal surgical approach for endometriomas because it is associated with potential reduction of ovarian reserve. Recently, vaporization with CO2 laser in-line-of-sight, according to the 'three-step procedure', has been proposed as the best method to preserve ovarian function. However, no randomized controlled trials have been conducted to compare cystectomy and 'one-step' CO2 fiber laser vaporization (without GnRH agonist therapy) with respect to the ovarian reserve. STUDY DESIGN, SIZE, DURATION A multicentre randomized clinical trial including 60 patients was performed between July 2017 and February 2018. Computerized randomization was conducted to allocate them in a proportion of 1:1 either to Group 1 (laparoscopic stripping: cystectomy) or Group 2 (CO2 laser vaporization). Patients in Group 1 underwent a standardized laparoscopic stripping technique; patients in Group 2 underwent drainage of the cyst content, biopsy and vaporization of the internal wall with a CO2 fiber laser. Patients underwent pelvic ultrasound examination to determine the AFC and blood sampling to determine AMH levels before surgery and at 1- and 3-month follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients undergoing surgery for symptomatic endometriomas (infertility and/or pelvic pain) larger than 3 cm were randomized in two groups according to the surgical technique. Patients aged ≥40 years, or with deep infiltrating endometriosis/adenomyosis, or previously submitted to surgical procedures on the ovaries or to hysterectomy were excluded from the study. The primary endpoint was the comparison of intra-group AFC changes before and after surgery (ΔAFC) between the two groups (ΔAFC Group 1 versus ΔAFC Group 2). The secondary endpoint was the modification of serum AMH before and after surgery (ΔAMH) between the two groups (ΔAMH Group 1 versus ΔAMH Group 2). MAIN RESULTS AND THE ROLE OF CHANCE The AFC of the operated ovary was significantly increased in Group 2 (laser vaporization) compared with Group 1 (cystectomy) after surgery (Group 1: from 4.1 ± 2.2 [mean ± SD] at baseline to 6.3 ± 3.5 at 3-month follow-up; 95% CI: 0.9-4; Group 2: from 3.6 ± 1.9 at baseline to 8.6 ± 4.2 at 3-month follow-up; 95% CI: 2.8-7.1; P = 0.016); serum AMH levels were significantly reduced at 3 months in Group 1 (from 2.6 ± 1.4 ng/mL at baseline to 1.8 ± 0.8 ng/mL at 3-month follow-up; 95% CI: -1.3 to -0.2; P = 0.012) compared with no reduction in Group 2 (from 2.3 ± 1.1 ng/mL at baseline to 1.9 ± 0.9 ng/mL at 3-month follow-up; 95% CI: -1 to -0.2; P = 0.09). LIMITATIONS, REASON FOR CAUTION The key limitations of the trial were the low accuracy of AFC in estimating the ovarian reserve in ovaries with endometriomas, the limited study size and the relatively short follow-up, which do not allow us to draw definitive conclusions. WIDER IMPLICATIONS OF THE FINDINGS The present study suggests that CO2 technology may treat endometrioma with minimal damage to the adjacent healthy ovarian tissue; however, this study should be considered as a preliminary clinical trial, intended to stimulate future larger trials to address this clinically relevant issue. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03227640. TRIAL REGISTRATION DATE 9 July 2017. DATE OF FIRST PATIENT’S ENROLLMENT 24 July 2017.
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Affiliation(s)
- M Candiani
- Gynaecological Surgery and Endometriosis Departmental Unit, San Raffaele Scientific Institute, Milan, Italy
| | - J Ottolina
- Gynaecological Surgery and Endometriosis Departmental Unit, San Raffaele Scientific Institute, Milan, Italy
| | - E Posadzka
- Endocrinological Gynecology Department, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - S Ferrari
- Gynaecological Surgery and Endometriosis Departmental Unit, San Raffaele Scientific Institute, Milan, Italy
| | - L M Castellano
- Gynaecological Surgery and Endometriosis Departmental Unit, San Raffaele Scientific Institute, Milan, Italy
| | - I Tandoi
- Gynaecological Surgery and Endometriosis Departmental Unit, San Raffaele Scientific Institute, Milan, Italy
| | - L Pagliardini
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Nocun
- Centre of Ultrasound Diagnostic MWU DobreUSG, Cracow, Poland
| | - R Jach
- Endocrinological Gynecology Department, Jagiellonian University, Collegium Medicum, Cracow, Poland
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26
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Inal ZO, Engin Ustun Y, Yilmaz N, Aktulay A, Bardakci Y, Gulerman C. Does the anti-Müllerian hormone truly reflect ovarian response in women with endometrioma? J OBSTET GYNAECOL 2019; 39:516-521. [PMID: 30744464 DOI: 10.1080/01443615.2018.1533542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this study, our aim was to determine which factor is more correlated with the number of oocytes retrieved in patients with endometrioma compared with controls undergoing in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles: antral follicle count (AFC) or anti-Müllerian hormone (AMH). A total of 60 women with endometrioma and a control population of 60 women without endometrioma in the same period were randomly selected underwent the injection IVF-ICSI treatment. No significant differences were found between the groups in terms of age (28.78 ± 3.49 vs. 29.52 ± 2.47, p = .187), body mass index (23.62 ± 2.05 vs. 23.91 ± 2.11, p = .449), duration of infertility [(3 (2-4) vs. 3 (2-3), p = .139)], AMH level (1.52 ± 0.51 vs. 1.32 ± 0.92, p = .133), duration of stimulation [(9 (9-10) vs. 10 (9-10), p = .135)], total gonadotropin dose [(2750 (2262.5-3337.5) vs. 2770 (2680-3562.5), p = .125)], endometrial thickness [(10 (10-11) vs. 10 (9-11), p = .463)], fertilisation rates (67.20 ± 18.04 vs. 62.28 ± 17.13, p = .123), grade I embryo (43.3% vs. 30%, p = .185), clinical pregnancy rates (40% vs. 26.7%, p = .123), and the perinatal outcomes between the groups. The AFC was higher in the controls than in those with endometrioma (9.20 ± 1.80 vs. 6.32 ± 2.04, p < .001). The number of oocytes retrieved was also higher in the controls than in those with endometrioma [(7 (6-8) vs. 4 (4-5.75), p < .001)]. We found that women with endometrioma had a significantly lower number of oocytes retrieved than the controls despite the same AMH levels in both groups. AFC is a better marker of ovarian response than AMH in women with endometrioma undergoing IVF-ICSI. Impact statement What is already known on this subject? Utilising the ovarian reserve is important in the success of ovarian stimulation and in evaluating the success of assisted reproductive technologies. The anti-Müllerian hormone (AMH) level and the antral follicle count (AFC) are widely used in the prediction of ovarian functional reserve and response. However, no perfect marker exists in the evaluation of ovarian reserve and ovarian response. What do the results of this study add? Our study demonstrated that women with endometrioma have a significantly lower number of oocytes retrieved than the controls, despite the same AMH levels in both groups; which strongly suggests that AFC is a better reflection of ovarian response than AMH in women with endometrioma undergoing an in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI). What are the implications of these findings for clinical practice and/or further research? This important issue has been reviewed and discussed for years, however, the conclusions are still controversial. Additional research is needed to understand which ovarian reserve test could better predict ovarian response outcome?
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Affiliation(s)
- Zeynep Ozturk Inal
- a Department of Reproductive Endocrinology , Konya Education and Research Hospital , Konya , Turkey
| | - Yaprak Engin Ustun
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Nafiye Yilmaz
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Ayla Aktulay
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Yesim Bardakci
- c Department of Embryology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Cavidan Gulerman
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
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Endometrioma, fertility, and assisted reproductive treatments: connecting the dots. Curr Opin Obstet Gynecol 2019; 30:223-228. [PMID: 29847457 DOI: 10.1097/gco.0000000000000464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Surgery has traditionally been the primary treatment option for endometriosis-related infertility of any phenotype. However, advances and refinements of assisted reproductive technologies (ART) permit a more conservative approach in many scenarios. This review summarizes the latest findings in the field of reproductive medicine, which have supported a paradigm shift towards more conservative management of ovarian endometrioma. RECENT FINDINGS The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy. Conventional laparoscopic surgery is associated with significant risk of additional damage, and less invasive treatment approaches require further evaluation. With regard to infertile women with ovarian endometrioma who are scheduled for ART treatment, current data indicate that prior surgical intervention does not improve ART outcomes, and that controlled ovarian hyperstimulation (COH) does not affect quality of life or pain symptoms. SUMMARY Reproductive medicine physicians frequently encounter patients with ovarian endometrioma. The current evidence does not support the postponement of infertility treatment in favour of surgery, except in cases with severe symptoms or to improve follicle accessibility. Although these patients may exhibit diminished ovarian response to COH, their endometrial receptivity, aneuploidy rates, and fertility outcomes are similar to healthy controls. Surgery for ovarian endometrioma provides no benefits in ART treatments.
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Younis JS, Shapso N, Fleming R, Ben-Shlomo I, Izhaki I. Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: a systematic review and meta-analysis. Hum Reprod Update 2019; 25:375-391. [DOI: 10.1093/humupd/dmy049] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/14/2018] [Accepted: 01/11/2019] [Indexed: 01/03/2023] Open
Affiliation(s)
- Johnny S Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine, Galilee, Bar-Ilan University, Israel
| | - Nora Shapso
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
| | | | - Izhar Ben-Shlomo
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine, Galilee, Bar-Ilan University, Israel
| | - Ido Izhaki
- Department of Evolutionary and Environmental Biology, University of Haifa, Haifa, Israel
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Abstract
Endometriosis is a common inflammatory disease characterized by the presence of tissue outside the uterus that resembles endometrium, mainly on pelvic organs and tissues. It affects ~5-10% of women in their reproductive years - translating to 176 million women worldwide - and is associated with pelvic pain and infertility. Diagnosis is reliably established only through surgical visualization with histological verification, although ovarian endometrioma and deep nodular forms of disease can be detected through ultrasonography and MRI. Retrograde menstruation is regarded as an important origin of the endometrial deposits, but other factors are involved, including a favourable endocrine and metabolic environment, epithelial-mesenchymal transition and altered immunity and inflammatory responses in genetically susceptible women. Current treatments are dictated by the primary indication (infertility or pelvic pain) and are limited to surgery and hormonal treatments and analgesics with many adverse effects that rarely provide long-term relief. Endometriosis substantially affects the quality of life of women and their families and imposes costs on society similar to those of other chronic conditions such as type 2 diabetes mellitus, Crohn's disease and rheumatoid arthritis. Future research must focus on understanding the pathogenesis, identifying disease subtypes, developing non-invasive diagnostic methods and targeting non-hormonal treatments that are acceptable to women who wish to conceive.
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30
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[Management by assisted reproductive technology in women with endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29523480 DOI: 10.1016/j.gofs.2018.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Should the presence of endometriosis change the management of assisted reproductive technology? There is no difference in pregnancy rate after IVF between an agonist or antagonist protocol in patients with endometriosis, so the choice between one or the other of these protocols is free. But the review of the literature has shown an improvement in the chances of pregnancy in case of prolonged ovulation suppression before stimulation for IVF with a GnRH agonist analogue or with oral contraception, especially in cases of severe endometriosis. Endometriosis, regardless of the stage and type of lesions, would have no effect on the IVF results in terms of pregnancy rate and live birth rate, but with a lower number of oocytes collected, especially in cases of severe endometriosis. In a context of superficial endometriosis without pain and of infertility, surgical treatment of superficial endometriosis is not recommended just to increase the chances of pregnancy in IVF. Surgery may have a place in case of failure of IVF to improve the results of the ART. In case of recurrence of endometriosis, surgery is not better than IVF, a medico-surgical concertation is recommended. In addition, studies on ovulation stimulation for IVF do not show any aggravation of the symptoms associated with endometriosis lesions, or an acceleration of its progression, or an increase in the rate of recurrence of the disease.
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Decanter C, d'Argent EM, Boujenah J, Poncelet C, Chauffour C, Collinet P, Santulli P. [Endometriosis and fertility preservation: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530556 DOI: 10.1016/j.gofs.2018.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Fertility preservation (FP) techniques are progressing rapidly these past few years thanks to the oocyte vitrification. Indication of FP techniques is now extended to non-oncological situation that may induce risk of premature ovarian failure. Ovarian endometriosis can lead to premature ovarian failure and further infertility due to the high risk of ovarian cysts recurrence and surgery. To date, there is no cohort study regarding FP and endometriosis as well as no recommendation. Our purpose is to review the arguments in favor of FP in this specific area and to elaborate strategies according to each clinical form.
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Affiliation(s)
- C Decanter
- Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène Avinée, 59037 Lille cedex, France; EA 4308 gamétogenèse et qualité du gamète, CHRU de Lille, 59037 Lille cedex, France.
| | - E M d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 75005 Paris 6, France; Hôpital Tenon, GRC6-UPMC: centre expert en endométriose (C3E), 75020 Paris, France
| | - J Boujenah
- Service de gynécologie-obstétrique, CHU Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - C Poncelet
- Service de gynécologie-obstétrique, CH Renée-Dubos, 6, avenue de l'Ile-de-France, 95300 Pontoise, France; Université Paris-13, Sorbonne-Paris-Cité, UFR-SMBH, 93022 Bobigny, France
| | - C Chauffour
- Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - P Santulli
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétiques et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris-Descartes, Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
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Saito N, Yamashita Y, Okuda K, Kokunai K, Terai Y, Ohmichi M. Comparison of the impact of laparoscopic endometriotic cystectomy and vaporization on postoperative serum anti-Mullerian hormone levels. Asian J Endosc Surg 2018; 11:23-29. [PMID: 28786171 DOI: 10.1111/ases.12412] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/13/2017] [Accepted: 06/05/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the effect of laparoscopic endometriotic cystectomy and vaporization on ovarian reserve. METHODS We prospectively analyzed the serum level of anti-Mullerian hormone (AMH) in 62 patients at four different time points- preoperatively and at 1 month, 6 months, and 1 year postoperatively. Among the 62 cases, a bilateral cystectomy was performed in 10, bilateral vaporization in 16, a unilateral cystectomy in 24, and unilateral vaporization in 12. RESULTS The rate of AMH decline after unilateral cystectomy or bilateral cystectomy was higher than that after unilateral vaporization or bilateral vaporization. Age and bilaterality were associated with an AMH decline at 1 month, and age alone was associated with an AMH decline at 1 year. Moreover, being older than 38 years of age and having a revised American Society for Reproductive Medicine score >80 were independent risk factors for the non-recovery of AMH. CONCLUSION The rate of AMH decline after laparoscopic endometriotic vaporization is significantly lower than that after cystectomy. Both methods, however, have the potential to lower ovarian reserve, especially in cases of severe endometriosis or in patients older than 38 years of age.
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Affiliation(s)
- Natsuho Saito
- Department of Obstetrics and Gynecology, Hokusetsu General Hospital, Takatsuki, Osaka, Japan
| | - Yoshiki Yamashita
- Department of Obstetrics and Gynecology, Hokusetsu General Hospital, Takatsuki, Osaka, Japan.,Umeda Fertility Clinic, Osaka, Japan
| | - Kiyoji Okuda
- Department of Obstetrics and Gynecology, Hokusetsu General Hospital, Takatsuki, Osaka, Japan
| | | | - Yoshito Terai
- Department of Obstetrics and Gynecology, Hokusetsu General Hospital, Takatsuki, Osaka, Japan.,Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan
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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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Alborzi S, Hosseini-Nohadani A, Poordast T, Shomali Z. Surgical outcomes of laparoscopic endometriosis surgery: a 6 year experience. Curr Med Res Opin 2017; 33:2229-2234. [PMID: 28760003 DOI: 10.1080/03007995.2017.1362377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of the present study was to review 6 year experience on the surgical outcomes of laparoscopic endometriosis surgery. METHODS A cohort study was performed in Shiraz University of Medical Sciences using data from medical records of 1315 cases of patients with endometriosis undergoing laparoscopic surgery with follow-up of 6 to 72 months. RESULTS This study concerned a cohort of 1315 patients diagnosed with endometriosis operated between April 2010 and April 2016, 1086 (82.5%) of whom were in stage III and IV; 968 (73.61%) had endometrioma (regardless of having deep infiltrative endometriosis [DIE] or peritoneal involvement) and 347 (26.39%) of patients had either DIE or peritoneal involvement without endometrioma. Regarding the patients, unilateral endometrioma was statistically significant in the left ovary (p = .002). One hundred and thirty-three (10.7%) rectal wall, 7 (0.32%) sigmoid colon, 4 (0.18%) vagina, 125 (5.6%) ureter and 33 (1.52) bladder involvements were detected. Prior to operation, the pain VAS score was 8.23 ± 2.03, which decreased to 4.46 ± 2.47 in 93.07% of patients. Fifty-three patients (6.56%) needed reoperation. Sixty-six (33.1%) infertile women had spontaneous pregnancy and 15 (25%) became pregnant using intrauterine insemination (IUI) or assisted reproductive technique (ART) post-operatively. CONCLUSION Surgical treatment of endometriosis seems to be an effective treatment. DIE can be present in the absence of endometrioma. The rate of left endometrioma is higher due to the pressure effect of the sigmoid colon. Nonetheless, if an expert surgeon performs this procedure, not only the rate of post-operative complications, but also the possibility of recurrence would decrease.
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Affiliation(s)
- S Alborzi
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - A Hosseini-Nohadani
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - T Poordast
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Z Shomali
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
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Bilaterality of ovarian endometriomas does not affect the outcome of in vitro fertilization/intracytoplasmic sperm injection in infertile women after laparoscopic cystectomy. Biomed J 2017; 40:295-299. [PMID: 29179885 PMCID: PMC6138598 DOI: 10.1016/j.bj.2017.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
Background To assess whether the unilateral or bilateral lesions can affect ovarian reserve and pregnancy outcome in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in infertility patients underwent laparoscopic cystectomy. Methods A total of 148 IVF/ICSI cycle in patients who had undergone laparoscopic cystectomy for unilateral or bilateral endometriomas were reviewed retrospectively. There were 103 cycles where laparoscopic cystectomy had been carried out for unilateral endometriomas and 45 cycles after bilateral-side surgery. Primary outcome measures were ovarian reserve and ovarian response. Secondary outcome measures were the implantation rate, clinical pregnancy rate, and live birth rate. Results The number of dominant follicle on the day of human chorionic gonadotropin (hCG) administration (5.2 ± 3.1 vs. 4.2 ± 2.7; p = 0.048), and oocytes retrieved (10.0 ± 6.9 vs. 7.6 ± 6.6; p = 0.047) were significantly lower in the bilateral-side group compare with the unilateral-side group. However, the mean number of antral follicle count, metaphase II oocytes, the doses of gonadotropin used, fertilization rate, the rate of good quality embryos transferred, implantation rate and clinical pregnancy, live-birth rate and miscarriage rate were similar between the two groups. Conclusion There were no associations among the bilaterality of ovarian endometriomas, ovarian reserve and pregnancy outcomes in IVF/ICSI cycles. However, bilateral ovarian endometriomas after laparoscopic cystectomy may impair ovarian response as compared to unilateral ovarian endometrioma.
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The Impact on Ovarian Reserve of CO2 Laser Fiber Vaporization in the Treatment of Ovarian Endometrioma: A Prospective Clinical Trial. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background In recent years, excisional surgery has been questioned as an ideal surgical approach for endometriomas because it is associated with potential removal of healthy ovarian tissue and loss of ovarian follicles with subsequent reduction of ovarian reserve. The aim of our study was to evaluate the benefits of CO2 laser vaporization through a clinical trial assessing the postoperative changes in ovarian reserve as indicated by antral follicle count (AFC) and anti-Müllerian hormone (AMH). Materials and Methods Fifteen patients undergoing surgery for primary unilateral or bilateral symptomatic endometriomas were enrolled in the study. During surgery, the cystic lining was completely vaporized with CO2 laser fiber (AcuPulse Duo system, Lumenis); before surgery and at 1 and 3 months after surgery, ovarian reserve was evaluated by pelvic ultrasound to determine the AFC, and blood sample to determine AMH levels. Results The AFC of the operated ovary was significantly increased after treatment at 1 and 3 months' follow-up (p = 0.0021; p = 0.005, respectively); the increase is particularly significant in women younger than 35 years (p = 0.012). No statistically significant changes were reported in serum AMH concentrations at 1 or 3 months' follow-up. No recurrences of symptoms and no recurrences of endometrioma were reported. Conclusions These data support the hypothesis that endometrioma vaporization with CO2 laser fiber may be a valid method to preserve ovarian function; however, further studies are required before advocating the routine use of CO2 laser vaporization for the management of ovarian endometriosis.
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Salihoğlu KN, Dilbaz B, Cırık DA, Ozelci R, Ozkaya E, Mollamahmutoğlu L. Short-Term Impact of Laparoscopic Cystectomy on Ovarian Reserve Tests in Bilateral and Unilateral Endometriotic and Nonendometriotic Cysts. J Minim Invasive Gynecol 2016; 23:719-25. [DOI: 10.1016/j.jmig.2016.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 01/07/2023]
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Song T, Kim MK, Kim ML, Jung YW, Yun BS, Seong SJ, Kwon SH. Impact of opportunistic salpingectomy on anti-Müllerian hormone in patients undergoing laparoscopic hysterectomy: a multicentre randomised controlled trial. BJOG 2016; 124:314-320. [DOI: 10.1111/1471-0528.14182] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 01/24/2023]
Affiliation(s)
- T Song
- Department of Obstetrics & Gynaecology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - MK Kim
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - M-L Kim
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - YW Jung
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - BS Yun
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - SJ Seong
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - S-H Kwon
- Department of Obstetrics & Gynaecology; Dongsan Hospital; Keimyung University School of Medicine; Daegu Korea
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Santulli P, Lamau M, Marcellin L, Gayet V, Marzouk P, Borghese B, Lafay Pillet MC, Chapron C. Endometriosis-related infertility: ovarian endometriomaper seis not associated with presentation for infertility. Hum Reprod 2016; 31:1765-75. [DOI: 10.1093/humrep/dew093] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/23/2016] [Indexed: 11/14/2022] Open
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Serdyńska-Szuster M, Jędrzejczak P, Ożegowska KE, Hołysz H, Pawelczyk L, Jagodziński PP. Effect of growth differentiation factor‑9 C447T and G546A polymorphisms on the outcomes of in vitro fertilization. Mol Med Rep 2016; 13:4437-42. [PMID: 27035733 DOI: 10.3892/mmr.2016.5060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/02/2016] [Indexed: 11/06/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) in the growth differentiation factor (GDF)‑9 gene are associated with premature ovarian failure, insufficient ovarian stimulation and a poor in vitro fertilization (IVF) score in women with diminished ovarian reserve. The aim of the present study was to assess the effect of C447T (rs254286) and G546A (rs10491279) SNPs on ovary stimulation response, oocyte quality, fertilization rate and outcome of clinical pregnancy in an infertile population of Polish females (n=86) treated with IVF. The present study also included a group of fertile women (n=202). The P‑trend value, calculated for the GDF‑9 C447T transition in infertile women, was statistically significant and were equal to 0.0195. A significant association of the GDF‑9 C447T SNP was observed with infertility for the C/C vs. T/T + C/T model (OR= 2.140; 95% CI=1.043‑4.393; P=0.0349). The GDF‑9 G546A SNP was significantly associated with the G/A vs. G/G model with poor ovarian stimulation (OR=9.303; 95% CI=2.568‑33.745; P=0.0008) and poor fertilization rate (OR=2.981; 95% CI=1.033‑8.607; P=0.0385). For the GDF‑9 C447T SNP, a significant association was observed between the C/C + C/T vs. T/T model and a poor ovarian stimulation response (OR=15.309; 95% CI=0.875‑267.83; P=0.0078), and a poor fertilization rate (OR=4.842; 95% CI=1.310‑17.901; P=0.0121). The present genetic evaluation revealed associations between IVF outcomes and the GDF‑9 A546G and C447T SNPs. Additionally, these results indicated that the GDF‑9 C447T SNP is a possible candidate genetic risk factor for female infertility in the Polish population.
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Affiliation(s)
- Monika Serdyńska-Szuster
- Division of Infertility and Reproductive Endocrinology, Department of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Sciences, 60‑781 Poznań, Poland
| | - Piotr Jędrzejczak
- Division of Infertility and Reproductive Endocrinology, Department of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Sciences, 60‑781 Poznań, Poland
| | - Katarzyna Ewa Ożegowska
- Division of Infertility and Reproductive Endocrinology, Department of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Sciences, 60‑781 Poznań, Poland
| | - Hanna Hołysz
- Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, 60‑781 Poznań, Poland
| | - Leszek Pawelczyk
- Division of Infertility and Reproductive Endocrinology, Department of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Sciences, 60‑781 Poznań, Poland
| | - Paweł Piotr Jagodziński
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 60‑781 Poznań, Poland
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Clinical management of endometriosis-associated infertility. Reprod Med Biol 2016; 15:217-225. [PMID: 29259439 DOI: 10.1007/s12522-016-0237-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/01/2016] [Indexed: 12/19/2022] Open
Abstract
Endometriosis is a common chronic benign disease that affects reproductive age women and causes chronic pelvic pain and infertility. Despite its prevalence, the exact mechanisms of the pathogenesis of endometriosis-associated infertility are unknown, and precise standards of management have not yet been established. Medical and surgical treatments for endometriosis have different effects on the chance of conception, either spontaneously or via assisted reproductive technologies (ART). In this manuscript, we review the literature from years 1979 to 2015 to report on the proposed mechanism of endometriosis-associated infertility, the staging system of endometriosis for pregnancy outcomes and the current management of patients with endometriosis-associated infertility.
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Demirel C, Bastu E, Aydogdu S, Donmez E, Benli H, Tuysuz G, Keskin G, Buyru F. The Presence of Endometrioma Does Not Impair Time-Lapse Morphokinetic Parameters and Quality of Embryos: A Study On Sibling Oocytes. Reprod Sci 2016; 23:1053-7. [PMID: 26865544 DOI: 10.1177/1933719116630426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To see whether the oocytes retrieved from an ovary with an endometrioma would develop into embryos with aberrant timings of cleavage as assessed using time-lapse monitoring (TLM) and poorer morphologic quality compared with sibling oocytes from the contralateral ovary with no endometrioma in the same patient after intracytoplasmic sperm injection. METHODS This was an observational prospective study at an in vitro fertilization (IVF) center of a private hospital. It included analysis and comparison of 128 embryos (69 embryos developed from the ovary with endometrioma and 59 embryos from the contralateral ovary without endometrioma serving as controls from a total of 20 women with infertility). Morphology of the embryo was assessed twice (days 3 and 5), again by capturing images with the TLM system. Morphokinetic parameters of embryos and clinical pregnancy rates were recorded separately from ovaries with and without endometrioma and were the primary outcomes of the study. Secondary outcomes included number of retrieved oocytes, number of metaphase II (MII) oocytes, fertilization rates, and conventional morphological classification of embryos. RESULTS There were no differences in terms of the following time-lapse morphokinetic parameters of embryos. The mean numbers of oocytes and MII oocytes collected from the ovary with the endometrioma were similar to those collected from the contralateral ovary without endometrioma. Fertilization rates and the percentage of embryos with top morphologic quality were also similar. CONCLUSIONS According to the morphokinetic parameters, this study further strengthens the notion that removal of endometriomas before IVF is not a necessity in terms of better oocyte quality and development.
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Affiliation(s)
- Cem Demirel
- IVF Center, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Ercan Bastu
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
| | - Serkan Aydogdu
- IVF Center, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Ersan Donmez
- IVF Center, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Hasan Benli
- IVF Center, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Gulsum Tuysuz
- IVF Center, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Gulsah Keskin
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
| | - Faruk Buyru
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
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Effect of second-line surgery on in vitro fertilization outcome in infertile women with ovarian endometrioma recurrence after primary conservative surgery for moderate to severe endometriosis. Obstet Gynecol Sci 2015; 58:481-6. [PMID: 26623412 PMCID: PMC4663226 DOI: 10.5468/ogs.2015.58.6.481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 11/09/2022] Open
Abstract
Objective To evaluate the effect of second-line conservative surgery on in vitro fertilization (IVF) outcome in comparison with IVF without second-line surgery in infertile women with ovarian endometrioma recurrence after primary conservative surgery. Methods In this retrospective cohort study, 121 consecutive IVF/intracytoplasmic sperm injection cycles that were performed after second-line surgery (n=53) or without second-line surgery (control group, n=68) between January 2006 and December 2011 in 121 infertile women with ovarian endometrioma(s) recurrence after primary conservative surgery for moderate to severe endometriosis were included. The two groups were compared in terms of controlled ovarian stimulation and IVF outcomes. Results There were no differences in patients' characteristics between the two groups. Total dose and days of gonadotropins administered were significantly higher in the second-line surgery group than in the control group (P<0.001, P=0.008). The numbers of oocytes retrieved, mature oocytes and grade 1 or 2 embryos were significantly lower in the second-line surgery group (P=0.007, P=0.001, P<0.001, respectively). Clinical pregnancy rate per cycle and embryo implantation rate were also significantly lower in the second-line surgery group of 24.5% and 11.8% compared with 48.5% and 25.3% in the control group (P=0.008, P=0.005, respectively). Conclusion Ovarian response to controlled ovarian stimulation and IVF outcome after second-line surgery is worse than those
in IVF cycles without second-line surgery in infertile women with ovarian endometrioma recurrence after primary
surgery for moderate or severe endometriosis.
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Kang JH, Kim YS, Lee SH, Kim WY. Comparison of hemostatic sealants on ovarian reserve during laparoscopic ovarian cystectomy. Eur J Obstet Gynecol Reprod Biol 2015; 194:64-7. [DOI: 10.1016/j.ejogrb.2015.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/13/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
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Asgari Z, Rouholamin S, Hosseini R, Sepidarkish M, Hafizi L, Javaheri A. Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial. Arch Gynecol Obstet 2015; 293:1015-22. [DOI: 10.1007/s00404-015-3918-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
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Vignali M, Mabrouk M, Ciocca E, Alabiso G, Barbasetti di Prun A, Gentilini D, Busacca M. Surgical excision of ovarian endometriomas: Does it truly impair ovarian reserve? Long term anti-Müllerian hormone (AMH) changes after surgery. J Obstet Gynaecol Res 2015; 41:1773-8. [DOI: 10.1111/jog.12830] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/09/2015] [Accepted: 07/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Michele Vignali
- Department of Biomedical Science for the Health; University of Milan; Italy
| | - Mohamed Mabrouk
- Gynecologic Oncology and Minimally Invasive Pelvic Surgery Unit; Sacred Heart Hospital; Verona Italy
| | - Erika Ciocca
- Department of Biomedical Science for the Health; University of Milan; Italy
| | - Giulia Alabiso
- Department of Biomedical Science for the Health; University of Milan; Italy
| | | | - Davide Gentilini
- Molecular Biology Laboratory; Istituto Auxologico Italiano; Milan Italy
| | - Mauro Busacca
- Department of Biomedical Science for the Health; University of Milan; Italy
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Karaman Y, Uslu H. Complications and their management in endometriosis surgery. ACTA ACUST UNITED AC 2015; 11:685-92. [PMID: 26315050 DOI: 10.2217/whe.15.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endometriosis is a common chronic disease mostly seen in young women. Endometriosis surgery may be considered as rather challenging in gynecology. In this article, we tried to emphasize on basic concepts of endometriosis surgery, the best surgical method that should be applied and the complications and the management of the complications.
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Affiliation(s)
- Yucel Karaman
- Department of Obstetrics & Gynecology, Bruksel IVF & Endoscopic Laser Surgery Center, Istanbul, Turkey
| | - Husamettin Uslu
- Department of Obstetrics & Gynecology, Bruksel IVF & Endoscopic Laser Surgery Center, Istanbul, Turkey
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Abstract
Endometrioma surgery should be planned and executed very carefully as it is associated with risks that may hamper future reproductive potential. Symptoms, age, risk of malignancy, bilaterality, ovarian reserve, and desire to have children should all be taken into account prior to surgical intervention. Cyclic and noncyclic severe pain may be an indicator or deep infiltrating diseases. Laparoscopic surgery is the gold standard, however, the issue of resection versus ablation should be further studied.
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Affiliation(s)
- Bulent Urman
- Obstetrics & Gynecology & Assisted Reproduction Unit, American Hospital, Istanbul, Department of Obstetrics & Gynecology, Koc University, Faculty of Medicine, Guzelbahce sokak No:20, Nisantasi, Istanbul, Turkey
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Taniguchi F, Enatsu A, Ota I, Toda T, Arata K, Harada T. Effects of low dose oral contraceptive pill containing drospirenone/ethinylestradiol in patients with endometrioma. Eur J Obstet Gynecol Reprod Biol 2015; 191:116-20. [DOI: 10.1016/j.ejogrb.2015.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/27/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
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