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Kheil MH, Sharara FI, Ayoubi JM, Rahman S, Moawad G. Endometrioma and assisted reproductive technology: a review. J Assist Reprod Genet 2022; 39:283-290. [PMID: 35072837 PMCID: PMC8956763 DOI: 10.1007/s10815-022-02403-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/13/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Endometriomas are a common cause of infertility necessitating assisted reproductive technology (ART). It had been previously thought that surgical removal of the endometriomas prior to ART would improve reproductive outcomes, but recent data suggests that surgical cystectomy might affect the ovarian reserve, decreasing the chances of ART success. The aim of this article is to review the literature on the effects of endometrioma surgery on ART outcomes providing an overview of the current evidence and assessing the need for further studies. METHODS A literature search was performed using PubMed and MEDLINE databases to identify studies that discuss endometriomas and assisted reproductive technology before versus after surgery. RESULTS In women with an endometrioma requiring ART, growing evidence suggests that surgery might result in damage to the ovarian reserve and further decrease chances of fertility. However, pregnancy rates, implantation rates, fertilization rates, and live birth rates seemed to be consistently similar across both groups. CONCLUSION The current evidence is inconclusive on whether endometriomas should be surgically removed prior to ART. Further large randomized controlled trials are needed for a definite answer, and until then, management should be individualized.
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Affiliation(s)
- Mira H. Kheil
- grid.254444.70000 0001 1456 7807Department of Pathology, Wayne State University, Detroit, MI USA
| | - Fady I. Sharara
- grid.490589.90000 0004 0466 0970Virginia Center for Reproductive Medicine, Reston, VA USA ,grid.411841.90000 0004 0614 171XDepartment of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC USA
| | - Jean Marc Ayoubi
- grid.414106.60000 0000 8642 9959Department of Obstetrics and Gynecology, Foch Hospital, Suresnes, Faculty of Medicine, Paris Quest (UVSQ), Suresnes, France
| | - Sara Rahman
- grid.411841.90000 0004 0614 171XDepartment of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC USA
| | - Gaby Moawad
- grid.411841.90000 0004 0614 171XDepartment of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC USA
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Younis JS, Nelson SM. What is the recommended management of a young woman with an intact endometrioma desiring future fertility? Front Endocrinol (Lausanne) 2022; 13:1005597. [PMID: 36440194 PMCID: PMC9685664 DOI: 10.3389/fendo.2022.1005597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Johnny S. Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine, Bar-Ilan University, Safed, Israel
- *Correspondence: Johnny S. Younis,
| | - Scott M. Nelson
- School of Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
- National Institute of Health Research (NIHR) Bristol Biomedical Research Centre, Bristol, United Kingdom
- The Fertility Partnership, Oxford, United Kingdom
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Understanding pre-operative staging and surgical practice in advanced endometriosis: A survey of Canadian gynaecologists. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520924500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Study objective: To determine the pre-operative evaluation, surgical management and referral practices in patients with advanced stage endometriosis by Canadian gynaecologists. Design: A survey of obstetricians and gynaecologists. Setting: The survey was initiated and piloted at an academic centre by general gynaecologists and endometriosis specialists. Intervention: Electronically distributed to 733 individuals by the Society of Obstetricians and Gynaecologists of Canada. This included all members, irrespective of subspecialty and practice patterns. Measurement: Responses were collected using a web-based survey tool and analysed using Excel. Results: The response rate was 15.7% (115 respondents). Pre-operatively, 62.2% of respondents perform a transvaginal ultrasound on all of their patients, while magnetic resonance imaging is reserved for patients with physical exam findings suspicious for advanced endometriosis (26.7%) or in whom the surgeons suspect deep infiltrating endometriosis, bowel, bladder or uterosacral disease (54.4%). Most surgeons (81.4%) report encountering advanced disease that they did not suspect pre-operatively <10% of the time. Although 40% of respondents would refer their patients in whom they suspected deep infiltrating endometriosis, endometriomas, bowel, bladder or uterosacral ligament involvement to an endometriosis specialist prior to any attempted surgery, 54.4% would never refer without previously confirming the diagnosis at laparoscopy. In contrast, only 15% felt comfortable treating advanced endometriosis completely at time of laparoscopy (including deep infiltrating endometriosis, bladder and bowel disease). Post-operatively, 67.8% of respondents refer patients to an endometriosis specialist only if their disease was not appropriately treated surgically, while 23.3% do not refer any of their patients. Conclusion: Our study identified significant variability in the management of advanced endometriosis in Canada. Understanding these patterns will help us formulate a more universal investigation and management plan, which may improve the identification of patients pre-operatively with advanced stage endometriosis that could benefit from treatment by an endometriosis specialist.
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Maheshwari A, Healey J, Bhattacharya S, Cooper K, Saraswat L, Horne AW, Daniels J, Breeman S, Brian K, Burns G, Hudson J, Gillies K. Surgery for women with endometrioma prior to in vitro fertilisation: proposal for a feasible multicentre randomised clinical trial in the UK. Hum Reprod Open 2020; 2020:hoaa012. [PMID: 32529045 PMCID: PMC7275637 DOI: 10.1093/hropen/hoaa012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/15/2020] [Accepted: 02/10/2020] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Is it feasible to undertake a randomised controlled trial to establish whether surgical removal of endometrioma or not, improves live birth rates from IVF? SUMMARY ANSWER A randomised controlled trial (RCT) comparing surgery versus no surgery to endometrioma prior to IVF is only feasible in UK if an adaptive rather than traditional study design is used; this would minimise resource wastage and complete the trial in an acceptable time frame. WHAT IS KNOWN ALREADY There is wide variation in the management of endometriomas prior to IVF, with decisions about treatment being influenced by personal preferences. STUDY DESIGN, SIZE, AND DURATION This was a mixed-methods study consisting of an online survey of clinicians, a focus group and individual interviews with potential trial participants. PARTICIPANTS/MATERIALS, SETTING, METHODS Endometriosis and fertility experts across the UK were invited to participate in an online anonymised questionnaire. Potential future trial participants were recruited from a tertiary care fertility centre and invited to participate in either individual interviews or focus groups. MAIN RESULTS AND THE ROLE OF CHANCE Clinicians and potential trial participants confirmed the need for an RCT to inform the management of an endometrioma prior to IVF. There were 126 clinicians who completed the survey, and the majority (70%) were willing to recruit to a trial. Half of those who responded indicated that they see at least 10 eligible women each year. The main barriers to recruitment were waiting lists for surgery and access to public funding for IVF. One focus group (n = 7) and five interviews were conducted with potential trial participants (n = 3) and their partners (n = 2). The findings from these discussions highlighted that recruitment and retention in a potential RCT could be improved by coordination between IVF and surgical services such that an operation does not delay IVF or affect access to public funding. Live birth was considered the most important outcome with an improvement of at least 10% considered the minimum acceptable by both patients and clinicians. LIMITATIONS, REASONS FOR CAUTION This feasibility study captured views of clinicians across the UK, but as patients were from a single Scottish centre, their views may not be representative of other areas with limited public funding for IVF. WIDER IMPLICATIONS OF THE FINDINGS There is a need for an appropriately powered RCT to establish whether or not surgical treatment of endometrioma prior to IVF improves live birth rates. There are logistical issues to be considered due to limited number of participants, funding of IVF and waiting times. These could be overcome in a RCT by using an adaptive design which would include a prospectively planned opportunity for modification of specified aspects of the study design based on interim analysis of the data, coordination of IVF treatments and endometriosis surgeries and international collaboration. Similar principles could be used for other questions in fertility where a traditional approach for randomised trials is not feasible. STUDY FUNDING/COMPETING INTEREST(S) Funding was received from the NHS Grampian R&D pump priming fund (RG14437-12). S.B. is Editor-in-Chief of HROPEN, and A.W.H. is Deputy Editor of HROPEN. Neither was involved in the review of this manuscript. L.S. reports grants from CSO and NIHR to do endometriosis research, outside the submitted work. K.C. reports grants from NIHR/HTA and CSO during the conduct of the study. J.H.e., A.W.H., J.D., S.B.r., K.B., G.B., J.H.u. and K.G. report no conflict of interest.
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Affiliation(s)
- Abha Maheshwari
- Aberdeen Fertility Centre, NHS Grampian, Aberdeen AB25 2ZL, UK
| | - Jemma Healey
- Health Service Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Siladitya Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | | | - Andrew W Horne
- The Queen's Medical Research InstituteEdinburgh, EH16 4TJ, UK
| | - Jane Daniels
- Faculty of Medical & Health Sciences, Nottingham, NG7 2UH, UK
| | - Suzanne Breeman
- Clinical Trials Unit, Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Kate Brian
- Women's Voices, Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
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Sweed MS, Makled AK, El-Sayed MA, Shawky ME, Abd-Elhady HA, Mansour AM, Mohamed RM, Hemeda H, Nasr-Eldin EA, Attia NS, Eltaieb E, Allam H, Hussein A. Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas. J Minim Invasive Gynecol 2018; 26:877-882. [PMID: 30193971 DOI: 10.1016/j.jmig.2018.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/19/2018] [Accepted: 06/07/2018] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE Because laparoscopic ovarian cystectomy of endometriomas is known to adversely impact patient ovarian reserve, the search for other techniques of surgical management is ongoing. The present study was undertaken to evaluate laparoscopic cyst deroofing as a feasible alternative. STUDY DESIGN Prospective, randomized clinical trial (Canadian Task Force classification I). SETTING University maternity hospital. PATIENTS Women diagnosed with unilateral or bilateral ovarian endometriomas. INTERVENTIONS Patients were managed with either laparoscopic ovarian cystectomy or cyst deroofing. MEASUREMENTS AND MAIN RESULTS A total of 122 women with endometriomas were randomized to either laparoscopic cystectomy (group 1) or laparoscopic cyst deroofing (group 2). The primary endpoint was the effect on ovarian reserve based on changes in anti-Müllerian hormone (AMH) values. At 1 month postsurgery, anti-Müllerian hormone values were significantly decreased (p < .001) from preoperative values, from 4.25 ± 0.87 ng/mL to 1.66 ± 1.02 ng/mL in group 1 and from 4.2 ± 1.69 ng/mL to 2.15 ± 1.48 ng/mL in group 2. In addition, antral follicle count and ovarian volume decreased significantly (p < .001) in both groups by 1 month postsurgery. The decreases in these 3 parameters were more significant (p < .001) in group 1 than in group 2. CONCLUSION Laparoscopic cyst deroofing of endometriomas appears to be a promising alternative to laparoscopic cystectomy, with less postoperative decrease in ovarian reserve; however, the higher rate of endometrioma recurrence warrants future clinical research to determine the optimal surgical management of endometriomas.
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Affiliation(s)
- Mohamed S Sweed
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein).
| | - Ahmed K Makled
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Medhat A El-Sayed
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Mohamed E Shawky
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Hamdy A Abd-Elhady
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Ahmed M Mansour
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Radwa M Mohamed
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Hossam Hemeda
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Eman A Nasr-Eldin
- Department of Radiodiagnosis, Helwan University,Cairo, Egypt (Dr Nasr-Eldin)
| | - Neveen S Attia
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Ebtihal Eltaieb
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Heba Allam
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
| | - Ahmed Hussein
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt (Drs. Sweed, Makled, El-Sayed, Shawky, Abd-Elhady, Mansour, Mohamed, Hemeda, Attia, Eltaieb, Allam, and Husseein)
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Chauffour C, Pouly JL, Gremeau AS. Endométriome et prise en charge en FIV, RPC Endométriose CNGOF-HAS. ACTA ACUST UNITED AC 2018; 46:349-356. [DOI: 10.1016/j.gofs.2018.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 12/26/2022]
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Miron-Shatz T, Rapaport SR, Srebnik N, Hanoch Y, Rabinowitz J, Doniger GM, Levi L, Rolison JJ, Tsafrir A. Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability. J Genet Couns 2017; 27:59-68. [DOI: 10.1007/s10897-017-0120-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
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Nicholls D, Sweet L, Muller A, Hyett J, Ullah S. Continuing Development and Initial Validation of a Questionnaire to Measure Sonographer Skill-Teaching Perceptions in Clinical Practice. J Med Ultrasound 2017; 25:82-89. [PMID: 30065465 PMCID: PMC6029322 DOI: 10.1016/j.jmu.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Medical ultrasound examinations are performed by diverse professional cohorts sonographers are one group. Little evidence exists regarding the teaching practices used in medical ultrasonography and their effectiveness. We report the continued development and validation of an instrument to measure sonographer skill-teaching practice perceptions (SonoSTePs). METHODS An online survey was administered to a convenience sample of sonographers who were employed in Queensland, Australia. This paper reports on the continued psychometric testing of the measurement tool. FINDINGS The 25-item scale demonstrated good internal reliability. Exploratory factor analysis generated four factors with acceptable internal reliability: Factor 1 (Skill execution feedback, Cronbach's α = 0.89), Factor 2 (Cognitive overload, Cronbach's α = 0.68), Factor 3 (Teach new skill, Cronbach's α = 0.70), and Factor 4 (Assist learners scanning, Cronbach's α = 0.67). The combined instrument value was 0.83. The weighted kappa of the test-retest items identified that the majority of items achieved an interrater level of agreement of ≥0.5. CONCLUSION Results indicate that the SonoSTePs instrument items and factors are underpinned by theories and principles related to teaching a complex psychomotor skill. The initial data suggest that the tool is both reliable and valid.
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Affiliation(s)
- Delwyn Nicholls
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Sydney Ultrasound for Women, Royal Prince Alfred Hospital, Sydney, Australia
| | - Linda Sweet
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Amanda Muller
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jon Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Shahid Ullah
- South Australian Health and Medical Research Institute, Adelaide, Australia
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[Surgical management of endometrioma: Result of French practice survey]. ACTA ACUST UNITED AC 2016; 45:936-941. [PMID: 27422679 DOI: 10.1016/j.jgyn.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/18/2016] [Accepted: 06/07/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES There are many national and international recommendations and guidelines for the management of patients with endometrioma. In this study, we aimed to evaluate the impact of these recommendations on the practice of French surgeons, and to assess their knowledge about the management of endometriomas. MATERIALS AND METHODS A self-questionnaire has been sent to the French members of the Society of Gynecologic Surgery and Pelvic (SCGP) in May 2015. RESULTS One hundred and forty-four members of the society (36 %) participated in the survey. Most of the practitioners (71 %) followed recommendations of the Collège National des Gynécologues Obstétriciens (CNGOF), 38 % followed the guidelines of European Society of Human Reproduction and Embryology (ESHRE). One hundred percent of the surgeons declared that they practice laparoscopy when a surgical removal of the endometrioma is indicated. About treatment with GnRH analogue, 38 % of the practitioners declared that they prescribe an add back therapy immediately after the surgery, 43 % at 3 months, and 14 % declared that they never prescribe this treatment. CONCLUSIONS French surgeons consider the recommendations are useful in their clinical practice; they primarily apply the guidelines of the CNGOF.
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Ouldamer L, Bendifallah S, Naoura I, Body G, Uzan C, Morice P, Ballester M, Daraï E. Nomogram to predict live birth rate after fertility-sparing surgery for borderline ovarian tumours. Hum Reprod 2016; 31:1732-7. [DOI: 10.1093/humrep/dew137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/19/2016] [Indexed: 12/23/2022] Open
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Abstract
PURPOSE OF REVIEW The effect of endometrioma on ovulatory function and ovarian reserve was unclear. Conflicting opinions exist regarding effect of endometrioma excision on ovarian reserve. RECENT FINDINGS Endometriomas do not seem to affect ovulatory function. Women with endometrioma have lower antral follicle count and serum anti-Müllerian hormone levels than age-matched healthy controls. There is high-quality evidence suggesting a significant decline in serum anti-Müllerian hormone levels following endometrioma excision. However, a similarly significant decline in antral follicle count is not demonstrated. Cauterization seems to be a contributing factor to ovarian damage and suturing the cyst bed could perhaps be a better alternative. SUMMARY It seems prudent to warn patients regarding loss of ovarian reserve following endometrioma excision. Surgeons should cautiously limit the use of cauterization following stripping of endometrioma. Well designed studies comparing effect of various haemostatic measures on ovarian reserve are needed.
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Sönmezer M, Taşkın S. Fertility preservation in women with ovarian endometriosis. ACTA ACUST UNITED AC 2015; 11:625-31. [PMID: 26344549 DOI: 10.2217/whe.15.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Murat Sönmezer
- Department of Obstetrics & Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Salih Taşkın
- Department of Obstetrics & Gynecology, Ankara University School of Medicine, Ankara, Turkey
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Ata B, Turkgeldi E, Seyhan A, Urman B. Effect of Hemostatic Method on Ovarian Reserve Following Laparoscopic Endometrioma Excision; Comparison of Suture, Hemostatic Sealant, and Bipolar Dessication. A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2015; 22:363-72. [DOI: 10.1016/j.jmig.2014.12.168] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
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Yeung P. The Laparoscopic Management of Endometriosis in Patients with Pelvic Pain. Obstet Gynecol Clin North Am 2014; 41:371-83. [DOI: 10.1016/j.ogc.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Coccia ME, Rizzello F, Barone S, Pinelli S, Rapalini E, Parri C, Caracciolo D, Papageorgiou S, Cima G, Gandini L. Is there a critical endometrioma size associated with reduced ovarian responsiveness in assisted reproduction techniques? Reprod Biomed Online 2014; 29:259-66. [DOI: 10.1016/j.rbmo.2014.04.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
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Srebnik N, Miron-Shatz T, Rolison JJ, Hanoch Y, Tsafrir A. Physician recommendation for invasive prenatal testing: the case of the 'precious baby'. Hum Reprod 2013; 28:3007-11. [PMID: 24045783 DOI: 10.1093/humrep/det354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do clinicians manage pregnancies conceived by assisted reproductive technologies (ART) differently from spontaneous pregnancies? SUMMARY ANSWER Clinicians' decisions about prenatal testing during pregnancy depend, at least partially, on the method of conception. WHAT IS KNOWN ALREADY Research thus far has shown that patients' decisions regarding prenatal screening are different in ART pregnancies compared with spontaneous ones, such that ART pregnancies may be considered more valuable or 'precious' than pregnancies conceived without treatment. STUDY DESIGN, SIZE AND DURATION In this cross-sectional study, preformed during the year 2011, 163 obstetricians and gynecologists in Israel completed an anonymous online questionnaire. PARTICIPANTS, SETTING, METHODS Clinicians were randomly assigned to read one of two versions of a vignette describing the case of a pregnant woman. The two versions differed only with regard to the method of conception (ART; n = 78 versus spontaneous; n = 85). Clinicians were asked to provide their recommendations regarding amniocentesis. MAIN RESULTS AND THE ROLE OF CHANCE The response rate among all clinicians invited to complete the questionnaire was 16.7%. Of the 85 clinicians presented with the spontaneous pregnancy scenario, 37 (43.5%) recommended amniocentesis. In contrast, of the 78 clinicians presented with the ART pregnancy scenario, only 15 (19.2%) recommended the test. Clinicians were 3.2 (95% confidence interval [CI]: 1.6-6.6) times more likely to recommend amniocentesis for a spontaneous pregnancy than for an ART pregnancy. LIMITATIONS AND REASONS FOR CAUTION The study is limited by a low response rate, the relatively small sample and the hypothetical nature of the decision, as clinician recommendations may have differed in an actual clinical setting. WIDER IMPLICATIONS OF THE FINDINGS Our findings show that fertility history and use of ART may affect clinicians' recommendations regarding amniocentesis following receipt of screening test results. This raises the question of how subjective factors influence clinicians' decisions regarding other aspects of pregnancy management. STUDY FUNDING AND COMPETING INTEREST There was no funding source to this study. The authors declare no conflicts of interest.
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Affiliation(s)
- Naama Srebnik
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, the Hebrew University, Jerusalem 91031, Israel
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Uncu G, Kasapoglu I, Ozerkan K, Seyhan A, Oral Yilmaztepe A, Ata B. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod 2013; 28:2140-5. [PMID: 23624580 DOI: 10.1093/humrep/det123] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Do the presence of endometriomas and their laparoscopic excision lead to a decrease in ovarian reserve as assessed by serum anti-Müllerian hormone (AMH) levels? SUMMARY ANSWER Both the presence and excision of endometriomas cause a significant decrease in serum AMH levels, which is sustained 6 months after surgery. WHAT IS KNOWN ALREADY No previous comparison of serum AMH levels between women with and without endometrioma has been reported. However, studies have suggested a decline in serum AMH levels 1-3 months after endometrioma excision but long-term data are needed. STUDY DESIGN, SIZE, DURATION A prospective cohort study including 30 women with endometrioma >2 cm were age matched with 30 healthy women without ovarian cysts. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with endometrioma underwent laparoscopic excision with the stripping technique. Serum AMH level and antral follicle count (AFC) were determined preoperatively, 1 and 6 months after surgery. Correlation analyses were undertaken in order to identify determinants of surgery-related change in ovarian reserve. MAIN RESULTS AND THE ROLE OF CHANCE Compared with controls at baseline, women with endometrioma had lower AMH levels (4.2 ± 2.3 versus 2.8 ± 2.2 ng/ml, respectively, P = 0.02) and AFC (14.7 ± 4.1 versus 9.7 ± 4.8, respectively, P < 0.01). Serum AMH levels were further decreased 6 months after surgery (2.8 ± 2.2 versus 1.8 ± 1.3 ng/ml, P = 0.02), while AFC remained unchanged (9.7 ± 4.8 versus 10.4 ± 4.2, P = 0.63). The rate of decline in AMH was not correlated with age, laterality of endometrioma, cyst diameter or the number of primordial follicles on the surgical specimens. The preoperative serum AMH level was positively correlated with the rate of decline in serum AMH after surgery (r = 0.47, P = 0.02). LIMITATIONS, REASONS FOR CAUTION The absence of a non-treated group of women with endometriomas as a further control prevents comment on the presence of a progressive decline in ovarian reserve related to endometrioma per se. The sample size may be too small for detection of factors correlated with the extent of ovarian damage. WIDER IMPLICATIONS OF THE FINDINGS While the findings are mostly in agreement with previous studies, the present study is the first to show that the presence of endometrioma per se is associated with a decrease in ovarian reserve. The extent of surgery-related decline in ovarian reserve is not predictable using preoperative or perioperative factors. It may be prudent to measure AMH levels preoperatively and delay/avoid surgical excision as far as is possible if subsequent fertility is a concern. Additional studies are required to further investigate whether the endometrioma-related decline in ovarian reserve per se is progressive in nature and whether it exceeds the surgery-related decline. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Research Fund of the Uludag University School of Medicine. The authors have no conflict of interest associated with this study.
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Affiliation(s)
- Gurkan Uncu
- Department of Obstetrics and Gynecology, Uludag University School of Medicine, Gorukle, Bursa 16059, Turkey
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Villain C, Wyen H, Ganzera S, Marjanovic G, Lefering R, Ansorg J, Gaidzik PW, Haubold N, Neugebauer EA. Early analgesic treatment regimens for patients with acute abdominal pain: a nationwide survey among general surgeons. Langenbecks Arch Surg 2013; 398:557-64. [PMID: 23443818 DOI: 10.1007/s00423-013-1063-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Early pain relief in patients with acute nontraumatic abdominal pain in emergency departments has been discussed for years. Some randomized trials have addressed this issue but conclusive data are lacking. In this study, we assessed the current treatment practice in German hospitals in order to evaluate the necessity of a further clinical trial. METHODS An online survey containing 27 questions was sent to general and visceral surgeons at attending level using a mailing list provided by the Professional Board of German Surgeons (BDC) using a standard interview software. The questionnaire collected demographic data, current treatment policies about frequency of early analgesia, types of pain medication, and opinions about their use and effects. RESULTS Four hundred ninety-five completed questionnaires were returned. Many surgeons were cautious about early analgesia in the emergency department. Forty-five percent of the surgeons would provide analgesia prior to diagnosis to the majority of patients. Within the departments, differing opinions existed regarding the analgesic treatment (41 %). Thirty-two percent of all the respondents knew about a false diagnosis after early analgesia. There was heterogeneity in the estimation of the impact of pain medication on masking of clinical symptoms. A randomized controlled trial would be supported by the majority of respondents. As influencing factors for withdrawing early analgesia, we found the examiner being over 40 years of age (p < 0.05), low experience with the clinical picture of acute abdominal pain (p < 0.05), high estimation of the masking of clinical findings (p < 0.001), and knowing about a false diagnosis after early analgesia (p < 0.001) to be significant. CONCLUSION Discordance in the analgesic treatment regimens in patients with acute abdominal pain still exists in German hospitals. The topic remains subject of frequent discussions. More high quality data are needed before a clear guideline can be given for implementation in clinical routine management.
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Affiliation(s)
- C Villain
- Department of Trauma Surgery, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany.
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