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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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Human Endometriosis Tissue Microarray Reveals Site-specific Expression of Estrogen Receptors, Progesterone Receptor, and Ki67. Appl Immunohistochem Mol Morphol 2020; 27:491-500. [PMID: 29629944 DOI: 10.1097/pai.0000000000000663] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most available therapies for endometriosis are hormone-based and generally broadly used without taking into consideration the ovarian hormone receptor expression status. This contrasts strikingly with the standard of care for other hormone-based conditions such as breast cancer. We therefore aimed to characterize the expression of ovarian steroid hormone receptors for estrogen alpha (ESR1), estrogen beta (ESR2), and progesterone (PGR) in different types of endometriotic lesions and eutopic endometrium from women with endometriosis and controls using a tissue microarray (TMA). Nuclear expression levels of the receptors were analyzed by tissue (ie, ectopic vs. eutopic endometrium) and cell type (ie, glands vs. stroma). Ovarian lesions showed the lowest expression of ESR1 and PGR, and the highest expression of ESR2, whereas the fallopian tube lesions showed high expression of the 3 receptors. Differences among endometria included lower expression of ESR1 and higher expression of ESR2 in stroma of proliferative endometrium from patients versus patients, and a trend towards loss of PGR nuclear positivity in proliferative endometrium from patients. The largest ESR2:ESR1 ratios were observed in ovarian lesions and secretory endometrium. The highest proportion of samples with >10% Ki67 positive nuclei was in glands of fallopian tube (54%) and extrapelvic lesions (75%); 60% of glands of secretory endometrium from patients had >10% Ki67 positivity compared with only 15% in controls. Our results provide a better understanding of endometriosis heterogeneity by revealing lesion type-specific differences and case-by-case variability in the expression of ovarian hormone receptors. This knowledge could potentially predict individual responses to hormone therapies, and set the basis for the application of personalized medicine approaches for women with endometriosis.
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Alammari R, Lightfoot M, Hur HC. Impact of Cystectomy on Ovarian Reserve: Review of the Literature. J Minim Invasive Gynecol 2017; 24:247-257. [DOI: 10.1016/j.jmig.2016.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 12/11/2022]
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Tokmak A, Yildirim G, Öztaş E, Akar S, Erkenekli K, Gülşen P, Yilmaz N, Uğur M. Use of Neutrophil-to-Lymphocyte Ratio Combined With CA-125 to Distinguish Endometriomas From Other Benign Ovarian Cysts. Reprod Sci 2015; 23:795-802. [DOI: 10.1177/1933719115620494] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Aytekin Tokmak
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Gulçin Yildirim
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Efser Öztaş
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Serra Akar
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Kudret Erkenekli
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Pınar Gülşen
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Nafiye Yilmaz
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Mustafa Uğur
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
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Raju R, Agarwal K, Abuzeid O, Joseph S, Ashraf M, Abuzeid MI. Pregnancy Outcomes After Endometrioma Excision in Patients Undergoing In Vitro Fertilization and Embryo Transfer: A Historical Cohort Study. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2015.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rubin Raju
- Department of Obstetrics and Gynecology, Michigan State University College of Human Medicine, Flint Campus, Flint, MI
| | - Komal Agarwal
- Department of Obstetrics and Gynecology, Michigan State University College of Human Medicine, Flint Campus, Flint, MI
| | | | | | - Mohammed Ashraf
- Department of Obstetrics and Gynecology, Michigan State University College of Human Medicine, Flint Campus, Flint, MI
- IVF Michigan PC, Rochester Hills, MI
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Michigan State University College of Human Medicine, Flint Campus, Flint, MI
| | - Mostafa I. Abuzeid
- Department of Obstetrics and Gynecology, Michigan State University College of Human Medicine, Flint Campus, Flint, MI
- IVF Michigan PC, Rochester Hills, MI
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Michigan State University College of Human Medicine, Flint Campus, Flint, MI
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Guo SW, Ding D, Shen M, Liu X. Dating Endometriotic Ovarian Cysts Based on the Content of Cyst Fluid and its Potential Clinical Implications. Reprod Sci 2015; 22:873-83. [PMID: 25676579 DOI: 10.1177/1933719115570907] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study was undertaken to test the hypotheses that, due to gradual accumulation of dead erythrocytes and their ingested products resulting from repeated hemorrhage, older endometriomas (whitish in color) contain chocolate fluid with higher iron content than younger (brownish/blackish in color) ones with concomitant higher collagen content and more adhesions. We recruited 30 premenopausal women with histologically confirmed ovarian endometriomas and collected samples of their endometriotic lesions and chocolate fluid and measured the viscosity, density, and the concentration of total bilirubin, ferritin, and free iron of the chocolate fluid. We also evaluated the lesion color and adhesion scores. In addition, we performed Masson trichrome and Picro-Sirius red staining on all endometriotic cysts and evaluated the extent of fibrosis in the lesions. We found that fluids taken from white-colored endometriomas had significantly higher concentration of total bilirubin, ferritin, and free iron, respectively, than black/brown-colored ones. In addition, older cysts had fluids that had significantly higher density and viscosity. Fluid density correlated positively with the concentrations of total bilirubin, ferritin, and free iron. Older lesions had significantly more collagen content and higher adhesion scores. Taken together, these data supports the notion that older cysts, having experienced more bleeding episodes, contain chocolate fluid that is higher in viscosity, density, and iron content and higher fibrotic content than younger ones. This provides another piece of evidence that endometriotic lesions are wounds that undergo repeated injury and repair, resulting ultimately fibrotic lesions that are resistant to hormonal treatment.
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Affiliation(s)
- Sun-Wei Guo
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Ding Ding
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Minhong Shen
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xishi Liu
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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Colón-Díaz M, Báez-Vega P, García M, Ruiz A, Monteiro JB, Fourquet J, Bayona M, Alvarez-Garriga C, Achille A, Seto E, Flores I. HDAC1 and HDAC2 are differentially expressed in endometriosis. Reprod Sci 2012; 19:483-92. [PMID: 22344732 DOI: 10.1177/1933719111432870] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Epigenetic mechanisms have been ascribed important roles in endometriosis. Covalent histone modifications at lysine residues have been shown to regulate gene expression and thus contribute to pathological states in many diseases. In endometriosis, histone deacetylase inhibition (HDACi) resulted in reactivation of E-cadherin, attenuation of invasion, decreased proliferation of endometriotic cells, and caused lesion regression in an animal model. This study was conducted to assess basal and hormone-regulated gene expression levels of HDAC1 and HDAC2 (HDAC1/2) in cell lines and protein expression levels in tissues. Basal and steroid hormone-regulated HDAC1/2 gene expression levels were determined by quantitative polymerase chain reaction in cell lines and tissues. Protein levels were measured by immunohistochemistry (IHC) in tissues on an endometriosis tissue microarray (TMA). Basal HDAC1/2 gene expression levels were significantly higher in endometriotic versus endometrial stromal cells, which was confirmed by Western blot analysis. Estradiol (E2) and progesterone (P4) significantly downregulated HDAC1 expression in endometrial epithelial cells. Levels of HDAC2 were upregulated by E2 and downregulated by E2 + P4 in endometrial stromal cells. Hormone modulation of HDAC1/2 gene expression was lost in the endometriotic cell line. Immunohistochemistry showed that HDAC1/2 proteins were expressed in a substantial proportion of lesions and endometrium from patients, and their expression levels varied according to lesion localization. The highest proportion of strong HDAC1 immunostaining was seen in ovarian, skin, and gastrointestinal lesions, and of HDAC2 in skin lesions and endometrium from patients with endometriosis. These studies suggest that endometriosis etiology may be partially explained by epigenetic regulation of gene expression due to dysregulations in the expression of HDACs.
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Affiliation(s)
- Maricarmen Colón-Díaz
- Department of Microbiology, Ponce School of Medicine and Health Sciences, Ponce, PR 00731, USA
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Vercellini P, Somigliana E, Vigano P, Abbiati A, Barbara G, Fedele L. 'Blood On The Tracks' from corpora lutea to endometriomas. BJOG 2009; 116:366-71. [PMID: 19187368 DOI: 10.1111/j.1471-0528.2008.02055.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To detect a direct transition from a haemorrhagic corpus luteum to an endometriotic cyst by serial transvaginal ultrasonographic scans. DESIGN Prospective observational study. SETTING An academic tertiary care and referral centre for women with endometriosis. POPULATION One hundred and nine women younger than 40 years, with regular menstrual cycles, undergoing first-line surgery for endometriomas, and not wanting postoperative oral contraception. METHODS Three-monthly transvaginal ultrasonography during the luteal phase for 2 years after surgery. MAIN OUTCOME MEASURE Sonographic identification of progression from a haemorrhagic corpus luteum to a recurrent endometriotic cyst. RESULTS A haemorrhagic corpus luteum was identified in 13 women. Serial ultrasonographic scans demonstrated transition to an endometriotic cyst in 11 (85%) instances and resorption in two. A unilateral endometriotic cyst without previous detection of a cystic corpus luteum was observed in 14 women. CONCLUSIONS Bleeding from a corpus luteum appears to be a critical event in the development of endometriomas.
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Fernando S, Breheny S, Jaques AM, Halliday JL, Baker G, Healy D. Preterm birth, ovarian endometriomata, and assisted reproduction technologies. Fertil Steril 2009; 91:325-30. [DOI: 10.1016/j.fertnstert.2008.01.096] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 01/29/2008] [Accepted: 01/29/2008] [Indexed: 11/16/2022]
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Hsieh CL, Shiau CS, Lo LM, Hsieh TT, Chang MY. Effectiveness of ultrasound-guided aspiration and sclerotherapy with 95% ethanol for treatment of recurrent ovarian endometriomas. Fertil Steril 2008; 91:2709-13. [PMID: 18571165 DOI: 10.1016/j.fertnstert.2008.03.056] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 03/19/2008] [Accepted: 03/24/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of transvaginal ultrasound aspiration and ethanol sclerotherapy in patients with recurrent ovarian endometriomas. DESIGN Retrospective study. SETTING Teaching hospital affiliated with Chang Gung University, Taipei. PATIENT(S) Patients (n = 108) with recurrent ovarian endometriomas >or=3 cm. INTERVENTION(S) Preoperative evaluation of previous pathology, midcycle serum CA-125 level, and color Doppler ultrasonography to exclude possibility of malignancies. After aspiration, sclerotherapy with 95% ethanol irrigation of the cystic cavity was performed (group 1, n = 78, 0-10 minutes of retention; group 2, n = 30, ethanol left in situ [retention]). MAIN OUTCOME MEASURE(S) Ultrasonography was performed at 3, 6, 9, and 12 months to determine persistence and size of cysts and the number of antral follicles. Pelvic pain score was also determined at those time points. RESULT(S) The 1-year recurrence rate for group 2 patients was significantly lower than for group 1 patients (13.3% vs. 32.1%). Antral follicle count was increased and pain score was decreased in both groups to a similar level. No significant change in CA-125 was observed. CONCLUSION(S) Ultrasound-guided sclerotherapy with 95% ethanol is an effective therapy for ovarian endometriomas. Retention of ethanol is more effective than irrigation only.
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Affiliation(s)
- Chia-Lin Hsieh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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Abstract
The optimal conservative treatment for endometriotic cysts is unclear, particularly when treated laparoscopically. We performed a systematic analysis of the published literature on ovarian endometrioma especially focused on comparing laparoscopic cystectomy with laparoscopic drainage and coagulation of the cyst with regard to evaluating advantage and disadvantage of each method. We observed that cystectomy was superior in terms of risk of recurrent symptoms, cyst, reoperation, pregnancy: this was true in both prospective and retrospective studies previously published. Given the evidence available, excision of cyst wall in endometrioma is strongly recommended especially in infertile patients.
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Affiliation(s)
- Saeed Alborzi
- Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran.
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Busacca M, Chiaffarino F, Candiani M, Vignali M, Bertulessi C, Oggioni G, Parazzini F. Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol 2006; 195:426-32. [PMID: 16890551 DOI: 10.1016/j.ajog.2006.01.078] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 01/17/2006] [Accepted: 01/20/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study was undertaken to analyze the frequency and the determinants of long-term clinically detectable recurrence rate of deep, ovarian, and pelvic endometriosis. STUDY DESIGN The clinical data of 1106 women with first diagnosis of endometriosis observed between 1979 and 2001 were collected. RESULTS The 4-year recurrence rate was 24.6%, 17.8%, 30.6% and 23.7%, respectively, for cases of ovarian, pelvic, deep, and ovarian and pelvic endometriosis (P < .05). The recurrence rates decreased in all groups (with the exception of ovarian endometriosis) in the class age 34 years or older, these findings were significant (P < .05). Radicality was associated with lower recurrence rates in all the groups. A pregnancy after diagnosis was associated with a reduced risk of recurrence. CONCLUSION The study shows that the recurrence rates of endometriosis were higher in case of deep endometriosis and that the risk factors for recurrence were similar among women with endometriosis at different sites.
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Affiliation(s)
- Mauro Busacca
- Clinica Ostetrico Ginecologica, Università di Milano, Ospedale Macedonio Melloni, Milano, Italy
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Demirol A, Guven S, Baykal C, Gurgan T. Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study. Reprod Biomed Online 2006; 12:639-43. [PMID: 16790114 DOI: 10.1016/s1472-6483(10)61192-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The study was conducted to investigate the effect of conservative surgery of ovarian endometriomas before an ICSI cycle. Ninety-nine patients with endometriomas who were referred to an intracytoplasmic sperm injection (ICSI) cycle were enrolled in the study. The patients were prospectively randomized into two groups; group I (49 patients) underwent conservative ovarian surgery before the ICSI cycle and group II (50 patients) underwent the ICSI cycle directly. The stimulation was started 3 months after the operation in group I and directly in group II. In the ovarian surgery group, stimulation was significantly longer (14.0 days in group I and 10.8 days in group II; P = 0.001), total recombinant FSH dose was significantly higher (4575 IU in group I and 3675 IU in group II; P = 0.001), and mean number of mature oocytes was significantly lower (7.8 in group I and 8.6 in group II; P = 0.032). There was no difference in terms of fertilization (86% in group I and 88% in group II), implantation (16.5% in group I and 18.5% in group II) and pregnancy rates (34% in group I and 38% in group II). Ovarian surgery resulted in longer stimulation, higher FSH requirement and lower oocyte number, but fertilization, pregnancy and implantation rates did not differ between the groups.
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Affiliation(s)
- Aygül Demirol
- Clinic Women Health, Infertility and IVF Centre, Cankaya Caddesi, no. 20/3, Ankara, Turkey.
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Littman E, Giudice L, Lathi R, Berker B, Milki A, Nezhat C. Role of laparoscopic treatment of endometriosis in patients with failed in vitro fertilization cycles. Fertil Steril 2005; 84:1574-8. [PMID: 16359945 DOI: 10.1016/j.fertnstert.2005.02.059] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Revised: 02/14/2005] [Accepted: 02/14/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report our experience in patients with previous IVF failures who conceived after laparoscopic treatment of endometriosis. DESIGN Retrospective case series. SETTING Tertiary center IVF and endoscopy programs. PATIENT(S) Infertility patients with history of prior IVF failures. INTERVENTION(S) Laparoscopic evaluation and treatment of endometriosis by the same surgeon. MAIN OUTCOME MEASURE(S) Occurrence of conception after laparoscopic treatment of endometriosis. RESULT(S) Of 29 patients with prior IVF failures, 22 conceived after laparoscopic treatment of endometriosis, including 15 non-IVF pregnancies and 7 IVF pregnancies. CONCLUSION(S) In the absence of tubal occlusion or severe male factor infertility, laparoscopy may still be considered for the treatment of endometriosis even after multiple IVF failures.
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Affiliation(s)
- Eva Littman
- Department of Gynecology and Obstetrics, Stanford University Medical Center, Stanford, California, USA
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Garcia-Velasco JA, Mahutte NG, Corona J, Zúñiga V, Gilés J, Arici A, Pellicer A. Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case–control study. Fertil Steril 2004; 81:1194-7. [PMID: 15136074 DOI: 10.1016/j.fertnstert.2003.04.006] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2003] [Revised: 04/30/2003] [Accepted: 04/30/2003] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate whether conservative surgery on ovarian endometriomas before an IVF cycle improves fertility outcomes. DESIGN Retrospective, matched case-control study. SETTING Two academic IVF programs. PATIENT(S) One hundred eighty-nine women with endometriomas who underwent IVF treatment: 56 women proceeded directly to IVF, and 133 first underwent conservative ovarian surgery. INTERVENTION(S) Controlled ovarian hyperstimulation and IVF-ET. MAIN OUTCOME MEASURE(S) Response to gonadotropins, fertilization, implantation, and pregnancy rates. RESULT(S) Aside from lower peak E(2) levels on the day of hCG and a higher total FSH dose in women previously operated for an endometrioma, no significant differences were found between the two groups in the different IVF variables analyzed. CONCLUSION(S) Laparoscopic cystectomy for endometriomas before commencing an IVF cycle does not improve fertility outcomes. Proceeding directly to controlled ovarian hyperstimulation in women with asymptomatic ovarian endometriomas might reduce the time to pregnancy, the costs of treatment, and the hypothetical complications of laparoscopic surgery. Conversely, conservative surgical treatment of ovarian endometriomas in symptomatic women does not impair IVF or intracytoplasmic sperm injection success rates.
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Maouris P, Brett L. Endometriotic ovarian cysts: the case for excisional laparoscopic surgery. ACTA ACUST UNITED AC 2003. [DOI: 10.1046/j.1365-2508.2002.00565.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW This review analyzes the literature on ovarian endometrioma, examining the controversies on pathogenesis, malignant transformation and surgical therapy. RECENT FINDINGS Recent literature reflects the necessity of clearly defining the ethiologic and pathologic factors that determine the origin of ovarian endometriosis and explain the increase in the condition with the prospect of developing effective prevention therapy. The possibility that ovarian endometriomas undergo malignant transformation is widely reported in the literature. Recent studies underline the importance of detecting histological differences in endometriosis (hyperplasia and atypia) and several studies of molecular biology support the theory of genetic alterations interfering with malignant transformation of ovarian endometriosis. SUMMARY The surgical approach must take into account all this information and, when the therapy is conservative, complete excision of the disease must be laparoscopically performed without affecting the healthy ovarian tissue.
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Affiliation(s)
- Mauro Busacca
- Department of Obstetrics and Gynecology, University of Milan, Milan, Italy.
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