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Ali MM, Awad Elderiny H, Shaaban Abdelgalil M, Mohamed Othman A. Is high-intensity focused ultrasound a magical solution to endometriosis? A systematic review. Proc AMIA Symp 2024; 37:625-637. [PMID: 38910796 PMCID: PMC11188790 DOI: 10.1080/08998280.2024.2352290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/23/2024] [Indexed: 06/25/2024] Open
Abstract
Background Endometriosis presents a significant challenge in gynecological endocrinology, affecting approximately 1 in 10 women of reproductive age. Abdominal wall endometriosis (AWE) and rectosigmoid deep infiltrating endometriosis (DIE) pose unique clinical complexities. High-intensity focused ultrasound (HIFU) has emerged as a novel alternative for treating these conditions, offering a noninvasive option with potential therapeutic benefits. Methods A systematic review was conducted following PRISMA guidelines to investigate the safety and efficacy of HIFU therapy for AWE and rectosigmoid DIE. The literature search encompassed databases from inception to January 20, 2024. Eligible studies included observational studies, case reports, and clinical trials evaluating HIFU treatment for endometriosis. Data extraction and risk of bias assessment were performed following established protocols. Results Fourteen studies were included, comprising 330 patients with AWE and 28 patients with rectosigmoid DIE. HIFU treatment demonstrated significant efficacy, with many patients experiencing complete remission, and clinical effectiveness. Reductions in lesion volume posttreatment were consistent across studies. However, safety concerns were noted, including pain at the treatment site, hematuria, and skin burns. Adverse effects underscored the importance of careful patient selection and monitoring during HIFU therapy. Conclusion HIFU therapy shows promise as a noninvasive approach for managing AWE and rectosigmoid DIE. While efficacy outcomes are encouraging, safety considerations warrant attention. Further research, particularly randomized controlled trials with larger sample sizes, is needed to validate findings and optimize treatment protocols.
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Affiliation(s)
- Mostafa Maged Ali
- Obstetrics and Gynecology Department, Fayoum General Hospital, Egyptian Ministry of Health and Population, Fayoum, Egypt
| | - Hind Awad Elderiny
- Samannoud Central Hospital, Ministry of Health, Gharbia Governorate, Cairo, Egypt
| | | | - Ahmed Mohamed Othman
- Clinical Research Department, Avicemer Contract Research Organization, Cairo, Egypt
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2
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Андреева ЕН, Артымук НВ, Веснина АФ, Зазерская ИЕ, Карахалис ЛЮ, Каткова НЮ, Пигарова ЕА, Сахаутдинова ИВ, Спиридонова НВ, Тапильская НИ, Хамошина МБ, Шереметьева ЕВ, Юренева СВ, Ярмолинская МИ. [Resolution of the national interdisciplinary council of experts "High-dose vitamin D (Devilam) in the practice of an obstetrician-gynecologist"]. PROBLEMY ENDOKRINOLOGII 2024; 70:103-116. [PMID: 38796767 PMCID: PMC11145572 DOI: 10.14341/probl13465] [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: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/28/2024]
Abstract
On March 28, 2024, the Council of Experts "High-dose vitamin D (Devilam) in the practice of obstetrician-gynecologist, gynecologist and endocrinologist" was held in Moscow with the participation of leading experts gynecologists, endocrinologists and obstetricians-gynecologists, during which new possibilities for the use of high-dose vitamin D in patients of various ages who need correction of existing vitamin D deficiency or insufficiency.
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Affiliation(s)
- Е. Н. Андреева
- Национальный медицинский исследовательский центр эндокринологии; Российский университет медицины
| | | | - А. Ф. Веснина
- Национальный медицинский исследовательский центр эндокринологии
| | - И. Е. Зазерская
- Национальный медицинский исследовательский центр им. В. А. Алмазова
| | | | - Н. Ю. Каткова
- Приволжский исследовательский медицинский университет
| | - Е. А. Пигарова
- Национальный медицинский исследовательский центр эндокринологии
| | | | | | - Н. И. Тапильская
- Научно-исследовательский институт акушерства, гинекологии и репродуктологии имени Д.О. Отта
| | | | | | - С. В. Юренева
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени В.И. Кулакова
| | - М. И. Ярмолинская
- Научно-исследовательский институт акушерства, гинекологии и репродуктологии имени Д.О. Отта
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3
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de Koning R, Blikkendaal MD, de Sousa Lopes SMC, van der Meeren LE, Cheng H, Jansen FW, Lashley EELO. Histological analysis of (antral) follicle density in ovarian cortex tissue attached to stripped endometriomas. J Assist Reprod Genet 2024; 41:1067-1076. [PMID: 38438769 PMCID: PMC11052973 DOI: 10.1007/s10815-024-03058-0] [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: 09/20/2023] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
PURPOSE When resecting endometriomas with the stripping technique, in the majority of cases, a thin line of adjacent ovarian cortex is attached to the endometrioma. In this study, we performed histological analysis to determine (antral) follicle density in the ovarian cortex tissue attached to stripped endometriomas and assessed patient- and surgical characteristics that could affect this. METHODS Histological slides of previously removed endometriomas were assessed. Follicles in the attached ovarian tissue were classified according to maturation, and follicular density was determined. Immunofluorescent staining of antral follicles in a subset of endometriomas was also performed. RESULTS In 90 out of 96 included endometriomas (93.7%), ovarian tissue attached to the cyst wall was observed. One thousand nine hundred forty-four follicles at different maturation stages were identified (3 follicles/mm3). Follicle density was negatively associated with age (p < 0.001). Antral follicles (< 7-mm diameter) were present in the ovarian tissue attached to 35 endometriomas (36.5%) derived from younger patients compared to endometriomas where none were detected (30 versus 35 years, p = 0.003). Antral follicle density was 1 follicle/mm3. Based on immunofluorescence, healthy antral follicles were identified in two out of four examined endometriomas. CONCLUSIONS Ovarian tissue attached to stripped endometriomas holds potential as a non-invasive source for antral follicles. In theory, application of IVM could be an interesting alternative FP option in young patients with endometriomas who undergo cystectomy in order to transform the surgical collateral damage to a potential oocyte source. Our results encourage future research with fresh tissue to further assess the quality and potential of these follicles. TRIAL REGISTRATION Clinical Trials.gov Identifier: B21.055 (METC LDD), date of registration 12-08-2021, retrospectively registered.
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Affiliation(s)
- Rozemarijn de Koning
- Department of Gynaecology and Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
- Endometriose Centrum, Haaglanden Medical Centre, Den Haag, The Netherlands.
- Nederlandse Endometriose Kliniek, Reinier de Graaf Hospital, Delft, The Netherlands.
| | - Mathijs D Blikkendaal
- Endometriose Centrum, Haaglanden Medical Centre, Den Haag, The Netherlands
- Nederlandse Endometriose Kliniek, Reinier de Graaf Hospital, Delft, The Netherlands
| | | | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hui Cheng
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynaecology and Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eileen E L O Lashley
- Department of Gynaecology and Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
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4
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Zhao C, Wang Y, Shao Y. A Bioequivalence Trial of Dienogest in Healthy Chinese Participants Under Fed Conditions. Clin Pharmacol Drug Dev 2024; 13:140-145. [PMID: 37743573 DOI: 10.1002/cpdd.1324] [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: 06/25/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023]
Abstract
This trial was a randomized, open-label, single-dose, 2-treatment, 2-period, crossover study to evaluate the pharmacokinetic (PK) profile, bioequivalence, and safety of test formulation and reference formulation of 2-mg dienogest tablets in healthy Chinese participants. Eligible participants were randomly administered a single 2-mg dose of either the test formulation or the reference formulation orally under fed conditions, followed by a 1-week washout period and the administration of the other formulation. Samples of blood were collected until 48 hours following administration. The main PK parameters were calculated using noncompartmental analysis techniques. The main PK parameters included maximum plasma concentration, area under the plasma concentration-time curve (AUC) from time zero to the last quantifiable concentration, and AUC from time zero to infinity. The bioequivalence of test and reference dienogest tablets was determined if the 90% confidence intervals of the geometric mean ratio of the test to reference formulations were within the predefined range of 80%-125%. The safety assessment included incidence of adverse events and serious adverse events and others. Twenty-four healthy Chinese participants were enrolled in this trial. The geometric mean ratios of maximum plasma concentration, AUC from time zero to the last quantifiable concentration, and AUC from time zero to infinity between the 2 formulations, and corresponding 90% confidence intervals, all fell within the range of 80%-125% under fed conditions. The test and reference dienogest tablets were well tolerated, and no severe adverse events were reported in the trial. It was shown that the test and the reference dienogest tablets were bioequivalent and well tolerated under fed conditions in healthy Chinese female participants.
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Affiliation(s)
- Chunyan Zhao
- The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Yuxia Wang
- R&D Center, Beijing Biote Pharmaceutical Co., Ltd., Beijing, China
| | - Yanhua Shao
- R&D Center, Beijing Biote Pharmaceutical Co., Ltd., Beijing, China
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5
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Tabatabaei F, Tahernia H, Ghaedi A, Bazrgar A, Khanzadeh S. Diagnostic significance of neutrophil to lymphocyte ratio in endometriosis: a systematic review and meta-analysis. BMC Womens Health 2023; 23:576. [PMID: 37936116 PMCID: PMC10631181 DOI: 10.1186/s12905-023-02692-7] [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] [Received: 03/28/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The purpose of this systematic review and meta-analysis was to compile existing evidence on the significance of the NLR in predicting endometriosis in order to aid clinical decision-making and outcomes. METHODS We searched ProQuest, Web of Science, and PubMed for related studies published before January 2, 2023. Standardized mean difference (SMD) with a 95% confidence interval (CI) was reported for each outcome. Because a significant level of heterogeneity was found, we used the random-effects model to calculate pooled effects. We used Newcastle-Ottawa Scale (NOS) for quality assessment. RESULTS Overall, 18 article with were included in the analysis. A random-effect model revealed that patients with endometriosis had elevated levels of NLR compared to healthy controls (SMD = 0.79, 95% CI = 0.33 to 1.25, P < 0.001). Patients with endometriosis had elevated levels of NLR compared to those with other benign tumors (SMD = 0.85, 95% CI = 0.17 to 1.53, P = 0.014). In addition, NLR level of patients with stage III and IV endometriosis was not different from that of patients with stage I and II endometrioma (SMD = 0.30, 95% CI = -0.14 to 0.74, P = 0.18). However, NLR level was not different between endometriosis patients with and without peritoneal lesions (SMD = -0.12, 95% CI = -0.34to 0.10, P = 0.28), between patients with and without endometrioma (SMD = 0.20, 95% CI = -0.15 to 0.55, P = 0.26) and between endometriosis patients with and without deep lesions (SMD = 0.04, 95% CI = -0.20 to 0.28, P = 0.72). The pooled sensitivity of NLR was 0.67 (95% CI = 0.60-0.73), and the pooled specificity was 0.68 (95% CI, 0.62-0.73). CONCLUSIONS NLR might be utilized in clinics as a possible predictor to help clinicians diagnose endometriosis in affected women.
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Affiliation(s)
- Fatemeh Tabatabaei
- Department of Obstetrics and Gynaecology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Gynaecologic Laparoscopic Surgeries, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shokoufeh Khanzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
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Samami E, Shahhosseini Z, Khani S, Elyasi F. Pain-focused psychological interventions in women with endometriosis: A systematic review. Neuropsychopharmacol Rep 2023; 43:310-319. [PMID: 37366616 PMCID: PMC10496056 DOI: 10.1002/npr2.12348] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/08/2023] [Accepted: 04/30/2023] [Indexed: 06/28/2023] Open
Abstract
AIMS As a chronic inflammatory disease, endometriosis (EMS) is often associated with pain affecting different aspects of women's lives. Up to now, a wide variety of interventions have been implemented to alleviate pain in patients with this condition, including pharmacological, surgical, and rarely non-pharmacological ones. Against this background, this review aimed to investigate pain-focused psychological interventions among EMS women. METHODS A systematic review of the articles published in this field was conducted through a comprehensive search on the databases of Scopus, PubMed, MEDLINE, Web of Science, ScienceDirect, the Cochrane Library, PsycINFO, Google Scholar, and Scientific Information Database (SID). The quality of studies was then assessed by the Jadad Scale. RESULTS In total, 10 articles were entered into this systematic review. The findings further revealed that the pain-focused psychological interventions in patients with EMS were cognitive-behavioral therapy (CBT) (n = 2), mindfulness therapy (n = 4), yoga (n = 2), psychoeducation (n = 1), and progressive muscle relaxation (PMR) training (n = 1). Besides, the findings established that all the given interventions had improved and reduced pain in women living with this condition. Moreover, five articles were of good quality based on the Jadad Scale. CONCLUSION The study results demonstrated that all the listed psychological interventions had affected pain relief and improvement in women suffering from EMS. Considering the limited number of studies in this field and the fact that there were only five articles endowed with good quality, more high-quality studies could provide stronger evidence to support the implementation of the mentioned interventions influencing pain in patients.
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Affiliation(s)
- Elahe Samami
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
| | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research CenterMazandaran University of Medical SciencesSariIran
| | - Soghra Khani
- Sexual and Reproductive Health Research CenterMazandaran University of Medical SciencesSariIran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction InstituteMazandaran University of Medical SciencesSariIran
- Department of Psychiatry, Faculty of MedicineMazandaran University of Medical SciencesSariIran
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7
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Oreja-Guevara C, Rabanal A, Rodríguez CH, Benito YA, Bilbao MM, Gónzalez-Suarez I, Gómez-Palomares JL. Assisted Reproductive Techniques in Multiple Sclerosis: Recommendations from an Expert Panel. Neurol Ther 2023; 12:427-439. [PMID: 36746871 PMCID: PMC10043068 DOI: 10.1007/s40120-023-00439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is mainly diagnosed in women of reproductive age. However, there is a paucity of guidelines jointly prepared by neurologists and gynaecologists on managing women with MS and the desire for motherhood. Therefore, in this review we propose recommendations for such cases, with an particular focus on those requiring assisted reproductive techniques (ART). METHODS A group of seven MS experts (4 neurologists and 3 gynaecologists) came together for three discussion sessions to achieve consensus. RESULTS The recommendations reported here focus on the importance of early preconception counselling, the management of disease-modifying therapies before and during ART procedures, important considerations for women with MS regarding ART (intrauterine insemination, in vitro fertilisation and oocyte cryopreservation) and the paramount relevance of multidisciplinary units to manage these patients. CONCLUSIONS Early preconception consultations are essential to individualising pregnancy management in women with MS, and an early, well-planned, spontaneous pregnancy should be the aim whenever possible. The management of women with MS and the desire for motherhood by multidisciplinary units is warranted to ensure appropriate guidance through the entire pregnancy.
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Affiliation(s)
- Celia Oreja-Guevara
- Department of Neurology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain. .,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.
| | - Aintzane Rabanal
- Human Reproduction Unit, Obstetrics and Gynaecology Department, Biocruces Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | | | - Yolanda Aladro Benito
- Department of Neurology, Research Institute, Hospital Universitario de Getafe, Madrid, Spain
| | - Mar Mendibe Bilbao
- Neuroscience Department, Biocruces Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | | | - José Luis Gómez-Palomares
- Wilson Fertiliy-Balearic Center for In Vitro Fertilization CEFIVBA-Wilson Fertility, Mallorca, Spain
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8
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Sänger N, Menabrito M, Di Spiezo Sardo A, Estadella J, Verguts J. Fertility preservation counselling for women with endometriosis: a European online survey. Arch Gynecol Obstet 2023; 307:73-85. [PMID: 35829767 DOI: 10.1007/s00404-022-06616-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital is a strategy to preserve fecundity. METHODS An online survey was sent to reproductive specialists and gynecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients. RESULTS Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis. CONCLUSIONS To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.
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Affiliation(s)
- Nicole Sänger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marco Menabrito
- Gedeon Richter Plc/PregLem S.A., 41A Route de Frontenex, 1207, Geneva, Switzerland
| | - Attilio Di Spiezo Sardo
- Department of Public Health, University Federico II of Naples, Corso Umberto I, 80131, Naples, Italy
| | - Josep Estadella
- Department of Obstetrics and Gynecology, Hospital de La Santa Creu I Sant Pau-Universitat Autònoma de Barcelona, Carrer de Sant Quintí 89, 08025, Barcelona, Spain
| | - Jasper Verguts
- Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium. .,University Hasselt, Martelarenlaan 42, 3500, Hasselt, Belgium.
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9
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Heng FW, Shorey S. Experiences of endometriosis‐associated infertility among women and their partners: A qualitative systematic review. J Clin Nurs 2022; 31:2706-2715. [DOI: 10.1111/jocn.16145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine Level 2, Clinical Research Centre National University of Singapore Singapore City Singapore
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10
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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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11
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Endometriosis Scarring-A Potential Etiology for Spontaneous Hemoperitoneum in Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:998-1000. [PMID: 33798766 DOI: 10.1016/j.jogc.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Endometriosis is a common condition characterized by the accumulation of dense adhesions and scar tissue around the pelvic organs, which can lead to complications. Disruption of endometriotic scar tissue is rare but can lead to spontaneous intraperitoneal hemorrhage in pregnancy. CASE We present the case of a patient admitted for signs of labour at 40 weeks gestation. At emergency cesarean delivery for cord prolapse, the patient was found to have a massive intraperitoneal bleed. Mechanical disruption of endometriotic scar tissue during positioning for an epidural may have been the precipitating event, as the symptoms of spontaneous hemorrhage, including hypotension and pain, appeared immediately afterward. CONCLUSION Without the cord prolapse, cesarean delivery would have been delayed and the spontaneous hemorrhage might have been missed. This case report alerts obstetricians to have a high index of suspicion for spontaneous hemorrhage in pregnant patients with a history of advanced-stage endometriosis, as this event can be life-threatening to mother and baby.
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12
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Necula D, Gmuer A, Mathis J. The impact of endometriosis on the outcome of assisted reproductive techniques: role of fertility preservation. Horm Mol Biol Clin Investig 2021; 43:113-121. [PMID: 33691349 DOI: 10.1515/hmbci-2020-0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/18/2021] [Indexed: 11/15/2022]
Abstract
Endometriosis is one of the most common diseases associated with infertility. It requires different therapeutic approaches, depending on the type, whether superficial, ovarian or deep endometriotic nodules, clinical presentation, age or origin of infertility. Patients with endometriosis should be considered a group of high-risk for infertility and any intervention should be planned taking this consideration into account. For many years, surgery was the only tool in improving fertility outcomes. Nowadays, it remains the gold standard for the treatment of endometriosis, but it should be carefully used because of its harmful potential, leading to premature ovarian insufficiency and further infertility. With the development of modern assisted reproductive techniques (ART), which can offer better results in terms of fertility, the role of surgery progressively decreased. Nowadays, therapeutic approach is complex and multidisciplinary teams should be guiding individual treatment for each woman. Options include medical treatment, surgery, in vitro fertilization (IVF) or oocytes/embryo/ovarian tissue cryopreservation. There is a constant effort in developing diagnostic scores, in order to predict risk of infertility and create standard of practice, offering a long-term approach in terms of fertility preservation and quality of life.
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Affiliation(s)
- Daniel Necula
- Gynecology and Obstetrics Unit, Biel/Bienne Hospital, Biel, Switzerland
| | - Andrea Gmuer
- Gynecology and Obstetrics Unit, Biel/Bienne Hospital, Biel, Switzerland
| | - Jérôme Mathis
- Gynecology and Obstetrics Unit, Biel/Bienne Hospital, Biel, Switzerland
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13
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Jiang D, Nie X. Effect of endometrioma and its surgical excision on fertility (Review). Exp Ther Med 2020; 20:114. [PMID: 32989392 DOI: 10.3892/etm.2020.9242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/31/2020] [Indexed: 01/06/2023] Open
Abstract
Endometrioma is the cystic lesion of ovaries originating from endometrial glands and stroma; it is identified in 17-44% of patients with endometriosis. Numerous existing studies have reported the association between endometrioma and infertility. However, an absolute cause-effect association requires further confirmation. Available evidence has suggested that ovarian reserve may be impaired by spatial occupation influences, local reaction or both, affecting the reproductive health of females. Given the increased focus on the pathophysiological mechanisms of endometrioma, surgical excision has commonly been considered to avoid further ovarian damage. However, the potential adverse effect of this surgery on the ovarian reserve has recently become a focal point. Whether or not surgical excision can facilitate subsequent conception in young females planning to be pregnant is controversial. As shown in the present review on the effects of endometrioma and its removal in females requiring assisted reproductive technology, prior surgery for endometrioma may not improve assisted fertility results and may further decrease the number of oocytes retrieved in the affected females. Subsequent studies are needed to ascertain the optimal management of infertility in the setting of endometriomas.
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Affiliation(s)
- Danni Jiang
- Graduate School, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Xiaocui Nie
- Department of Gynecology, Shenyang Women's and Children's Hospital, Shenyang, Liaoning 110011, P.R. China
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La Rosa VL, Barra F, Chiofalo B, Platania A, Di Guardo F, Conway F, Di Angelo Antonio S, Lin LT. An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being. J Psychosom Obstet Gynaecol 2020; 41:93-97. [PMID: 31466493 DOI: 10.1080/0167482x.2019.1659775] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: Women with endometriosis represent a significant proportion of all outpatient gynecological consultations. Endometriosis is a benign chronic condition characterized by the spreading of endometrial-like tissue outside the uterus. A correlation between endometriosis and infertility has been strongly underlined in the literature about the topic: recent data suggest that up to 50% of women with infertility may suffer from this disease. The aim of this brief commentary is to focus the attention on the importance of a multidisciplinary approach for patients with endometriosis, including an accurate psychological and sexological counselling.Materials and Methods: We propose a brief point of view about a multidisciplinary approach in the treatment of endometriosis and associated infertility.Results and conclusions: Endometriosis is associated to a worse quality of life. Women with endometriosis also report higher levels of psychological conditions such as anxiety and depression. For this reason, an integrative approach is strongly advisable in order to improve social functions and mental health of these women and their partners. This may allow a more correct therapeutic management of these patients, reducing the potential negative impact of the disease on the mental wellbeing of the couple.
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Affiliation(s)
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Francesca Conway
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Di Angelo Antonio
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Navarria-Forney I, Bénard J, Mazloum A, Aerts L, Pluchino N, Streuli I. A web-based survey of reproductive awareness and choices in women with endometriosis. Eur J Obstet Gynecol Reprod Biol 2020; 251:106-113. [PMID: 32497984 DOI: 10.1016/j.ejogrb.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Our aim was to study fertility issues, attitudes towards reproductive techniques and fertility preservation options in women of reproductive age with endometriosis. STUDY DESIGN In 2018 we conducted a web-based survey on fertility issues in women aged 18-40 years with endometriosis. Participants were recruited via advertisements on social media and local endometriosis support groups. Participants completed a self-developed online questionnaire evaluating the following dimensions: sociodemographic, medical data, parental project, knowledge and attitudes toward endometriosis and fertility, means used to access information, and reproductive choices. RESULTS The majority of women (96 %) worried about the impact of endometriosis on their fertility. Approximately half of them (52 %) reported having received sufficient information concerning the effect of endometriosis on fertility from their doctor, whereas 31 % had discussed fertility issues with their doctor but desired further information. In contrast, only a minority (27 %) of women considered themselves well-informed on fertility preservation options. Information given by specialists on endometriosis and reproduction was considered most useful. Information mediated through patient support groups was also highly rated, whereas information given by the general gynecologist was less highly rated. The majority of women would consider assisted reproductive techniques (74 %) or adoption (70 %) in case of infertility. Interestingly, 72 % of women would undergo oocyte vitrification for fertility preservation, whereas only 37 % would resort to oocyte donation. CONCLUSION This is the first survey to address the topic of fertility issues from the patient's perspective in women with endometriosis. The vast majority of women attach great importance to a discussion about fertility possibilities and only a minority of women consider themselves well-informed. Our results highlight the importance of addressing the issue of fertility in women with endometriosis. Special attention should be given to information and counselling about fertility preservation options since most women consider their knowledge on the topic insufficient. Knowledge and attitudes to counsel endometriosis patients on fertility issues and fertility preservation options should be included in the training curricula of gynecologists. Adequate information on reproductive aging, risk factors for infertility, and reproductive choices, including oocyte vitrification, should be incorporated into follow-up visits for endometriosis patients.
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Affiliation(s)
- I Navarria-Forney
- Reproductive Medicine Unit, Division of Gynaecology, Geneva University Hospitals and the Faculty of Medicine of University of Geneva, Switzerland
| | - J Bénard
- Reproductive Medicine Unit, Division of Gynaecology, Geneva University Hospitals and the Faculty of Medicine of University of Geneva, Switzerland
| | - A Mazloum
- Division for Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals and the Faculty of Medicine of University of Geneva, Switzerland
| | - L Aerts
- Department of Paediatrics, Gynaecology and Obstetrics, Division of Gynaecology, Geneva University Hospitals and the Faculty of Medicine of University of Geneva, Switzerland
| | - N Pluchino
- Department of Paediatrics, Gynaecology and Obstetrics, Division of Gynaecology, Geneva University Hospitals and the Faculty of Medicine of University of Geneva, Switzerland
| | - I Streuli
- Reproductive Medicine Unit, Division of Gynaecology, Geneva University Hospitals and the Faculty of Medicine of University of Geneva, Switzerland.
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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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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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Streuli I, Benard J, Hugon-Rodin J, Chapron C, Santulli P, Pluchino N. Shedding light on the fertility preservation debate in women with endometriosis: a swot analysis. Eur J Obstet Gynecol Reprod Biol 2018; 229:172-178. [DOI: 10.1016/j.ejogrb.2018.08.577] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 01/21/2023]
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Bozzaro C. Is egg freezing a good response to socioeconomic and cultural factors that lead women to postpone motherhood? Reprod Biomed Online 2018. [PMID: 29530402 DOI: 10.1016/j.rbmo.2018.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In western societies, a growing number of women are currently turning to social egg freezing, a technique that makes it possible to freeze oocytes and thus preserve female reproductive possibilities. The current ethical debate has focused on normative aspects concerning the question of whether social egg freezing empowers women's reproductive autonomy. Due to this narrow focus on autonomy, deeper questions concerning the socio-economic conditions and cultural factors that lead women to delay reproduction, to feel pressured by their biological clock, and thus to consider social egg freezing have not yet received sufficient attention and analysis. The aim of this study was to broaden the ethical debate by focusing on whether social egg freezing is a good response to the socioeconomic and cultural constraints that lead women to postpone motherhood, and therefore whether it can be seen as a means of achieving what in virtue ethics is known as a 'good life'. I will argue that while social egg freezing can be seen as a means to empower women to adapt to current socioeconomic constraints, it is not an adequate response to cultural factors, as these cannot be solved by simply extending a woman's fertility.
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Affiliation(s)
- Claudia Bozzaro
- Department of Medical Ethics and History of Medicine, Albert-Ludwigs-University, Stefan-Meierstr. 26, 79104, Freiburg, Germany.
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