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Thiel PS, Donders F, Kobylianskii A, Maheux-Lacroix S, Matelski J, Walsh C, Murji A. The Effect of Hormonal Treatment on Ovarian Endometriomas: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2024; 31:273-279. [PMID: 38190884 DOI: 10.1016/j.jmig.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To evaluate the effect of hormonal suppression of endometriosis on the size of endometriotic ovarian cysts. DATA SOURCES The authors searched MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov from January 2012 to December 2022. METHODS OF STUDY SELECTION We included studies of premenopausal women undergoing hormonal treatment of endometriosis for ≥3 months. The authors excluded studies involving surgical intervention in the follow-up period and those using hormones to prevent endometrioma recurrence after endometriosis surgery. Risk of bias was assessed with the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. The protocol was registered in PROSPERO (CRD42022385612). TABULATION, INTEGRATION, AND RESULTS The primary outcome was the mean change in endometrioma volume, expressed as a percentage, from baseline to at least 6 months. Secondary outcomes were the change in volume at 3 months and analyses by class of hormonal therapy. The authors included 16 studies (15 cohort studies, 1 randomized controlled trial) of 888 patients treated with dienogest (7 studies), other progestins (4), combined hormonal contraceptives (2), and other suppressive therapy (3). Globally, the decrease in endometrioma volume became statistically significant at 6 months with a mean reduction of 55% (95% confidence interval, -40 to -71; 18 treatment groups; 730 patients; p <.001; I2 = 96%). The reduction was the greatest with dienogest and norethindrone acetate plus letrozole, followed by relugolix and leuprolide acetate. The volume reduction was not statistically significant with combined hormonal contraceptives or other progestins. There was high heterogeneity, and studies were at risk of selection bias. CONCLUSION Hormonal suppression can substantially reduce endometrioma size, but there is uncertainty in the exact reduction patients may experience.
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Affiliation(s)
- Peter S Thiel
- Department of Obstetrics and Gynecology (Drs. Thiel, Kobylianskii, and Murji), Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada (Drs. Thiel, Kobylianskii, and Murji)
| | - Francesca Donders
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Quebec City, QC, Canada (Drs. Donders and Maheux-Lacroix)
| | - Anna Kobylianskii
- Department of Obstetrics and Gynecology (Drs. Thiel, Kobylianskii, and Murji), Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada (Drs. Thiel, Kobylianskii, and Murji)
| | - Sarah Maheux-Lacroix
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Quebec City, QC, Canada (Drs. Donders and Maheux-Lacroix)
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada (Matelski)
| | - Chris Walsh
- Library Services (Dr. Walsh), Mount Sinai Hospital, Toronto, ON, Canada
| | - Ally Murji
- Department of Obstetrics and Gynecology (Drs. Thiel, Kobylianskii, and Murji), Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada (Drs. Thiel, Kobylianskii, and Murji).
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Transvaginal Ultrasound vs. Magnetic Resonance Imaging (MRI) Value in Endometriosis Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12071767. [PMID: 35885670 PMCID: PMC9315729 DOI: 10.3390/diagnostics12071767] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Endometriosis is a widespread gynecological condition that causes chronic pelvic discomfort, dysmenorrhea, infertility, and impaired quality of life in women of reproductive age. Clinical examination, transvaginal ultrasonography (TVS), and magnetic resonance imaging (MRI) are significant preoperative non-invasive diagnosis procedures for the accurate assessment of endometriosis. Although TVS is used as the primary line for diagnosis, MRI is commonly utilized to achieve a better anatomical overview of the entire pelvic organs. The aim of this systematic review article is to thoroughly summarize the research on various endometriosis diagnosis methods that are less invasive. (2) Methods: To find relevant studies, we examined electronic databases, such as MEDLINE/PubMed, Cochrane, and Google Scholar, choosing 70 papers as references. (3) Results: The findings indicate that various approaches can contribute to diagnosis in different ways, depending on the type of endometriosis. For patients suspected of having deep pelvic endometriosis, transvaginal sonography should be the first line of diagnosis. Endometriosis cysts are better diagnosed with TVS, whereas torus, uterosacral ligaments, intestine, and bladder endometriosis lesions are best diagnosed using MRI. When it comes to detecting intestine or rectal nodules, as well as rectovaginal septum nodules, MRI should be the imaging tool of choice. (4) Conclusions: When diagnosing DE (deep infiltrative endometriosis), the examiner’s experience is the most important criterion to consider. In the diagnosis of endometriosis, expert-guided TVS is more accurate than routine pelvic ultrasound, especially in the deep infiltrative form. For optimal treatment and surgical planning, accurate preoperative deep infiltrative endometriosis diagnosis is essential, especially because it requires a multidisciplinary approach.
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Zhou F, Zhao F, Jin X, Li C, Zhang S. Factors affecting clinical outcomes after IVF-ET for infertile young patients with ovarian endometrioma: A 5-year retrospective cohort study. Medicine (Baltimore) 2022; 101:e29793. [PMID: 35777051 PMCID: PMC9239601 DOI: 10.1097/md.0000000000029793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to compare ovarian reserve function and outcomes after in vitro fertilization and embryo transfer (IVF-ET) for young women with pelvic endometriosis with or without ovarian endometrioma. We explored the main factors influencing pregnancy outcomes in young patients with endometrioma. A total of 619 patients ≤38 years of age who underwent IVF-ET in our reproductive center between January 2011 and December 2015 were recruited. Among these patients, 398 had pelvic endometriosis with ovarian endometrioma and 221 had pelvic endometriosis without ovarian endometrioma. Patients underwent ovulation induction during IVF-ET. The general conditions and clinical outcomes of IVF-ET treatment were compared. Key factors affecting the success of IVF-ET treatment for endometriomas were analyzed. During IVF-ET treatment, the numbers of retrieved oocytes and 2-pronuclei (2PN) embryos in all age groups (P < .01), and the number of 2PN high-quality embryos in patients under 30 years of age was lower in the pelvic endometriosis with ovarian endometrioma group than in the pelvic endometriosis alone group (P < .05). Logistic regression analysis showed the number of antral follicles, basal follicle-stimulating hormone (bFSH) levels, number of oocytes, number of 2PN embryos, and number of 2PN high-quality embryos were significantly related to the successful outcome of IVF-ET. Among these, the number of 2PN high-quality embryos was the only independent predictive factor. Ovarian endometrioma significantly impairs ovarian reserve function and ultimately affects the therapeutic efficacy of IVF-ET. Obtaining more 2PN high-quality embryos was important for IVF-ET treatment of young patients with ovarian endometriomas.
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Affiliation(s)
- Feng Zhou
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou 310016, China
| | - Fanxuan Zhao
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou 310016, China
| | - Xiaoying Jin
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou 310016, China
| | - Chao Li
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou 310016, China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Shaw Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou 310016, China
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Kizilkaya Y, Ibanoglu MC, Kıykac Altinbas S, Engin-Ustun Y. A prospective study examining the effect of dienogest treatment on endometrioma size and symptoms. Gynecol Endocrinol 2022; 38:403-406. [PMID: 35319333 DOI: 10.1080/09513590.2022.2053956] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE We aimed to determine the effect of dienogest on cyst volume, symptoms, and quality of life in patients with endometrioma. METHOD This prospective cohort study included 37 patients diagnosed with endometrioma and planned for medical treatment. Subjects were treated with a 3-month oral dose of dienogest 2 mg/day. Pre-treatment and post-treatment endometriosis measurements were assessed via 3D ultrasonography, pain symptoms via 100-mm visual analog scale (VAS), and quality of life via Short Form-36. RESULTS The mean age of the patients was 36.0 ± 6.6 years. The mean endometrioma volume was significantly reduced by 31% after treatment (26.7 ± 19.7 mm3) compared to the pre-treatment volume (17.4 ± 11.2 mm3, p < .001). Post-treatment VAS scores of dysmenorrhea, dyspareunia, and chronic pelvic pain VAS values were significantly decreased by 35.5% (p < .001), 37.5% (p < .001), and 38.5% (p < .001), respectively. The mean physical function score and mental health score significantly increased by 15% (p = .009) and 28% (p < .001), respectively. CONCLUSION Our findings showed dienogest treatment at oral doses of 2 mg/day for 3 months significantly reducing the size of endometrioma, reducing pain level, and increasing quality of life in women with endometriosis.
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Affiliation(s)
- Yasemin Kizilkaya
- Department of Gynecology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Mujde Can Ibanoglu
- Department of Gynecology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Sadiman Kıykac Altinbas
- Department of Gynecology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Department of Gynecology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Lupean RA, Ștefan PA, Lebovici A, Csutak C, Rusu GM, Mihu CM. Differentiation of Endometriomas from Hemorrhagic Cysts at Magnetic Resonance: The Role of Quantitative Signal Intensity Measurements. Curr Med Imaging 2021; 17:524-531. [PMID: 33115394 DOI: 10.2174/1573405616999201027211132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/26/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Endometriomas and functional hemorrhagic cysts (FHCs) are a common gynecological encounter. OBJECTIVE This study aimed to assess the diagnostic efficiency of magnetic resonance imaging (MRI) using signal intensity measurements in differentiating endometriomas from FHCs. METHODS Forty-six patients who underwent pelvic MRI examinations (endometriomas, n=28; FHCs, n=18) were retrospectively included. The "T2 shading" sign was evaluated subjectively and quantitatively by measuring the T1-T2 signal intensity difference and calculating the percentage of signal decrease between T1 and T2-weighted sequences. The resulted values, along with the measurement of the Apparent Diffusion Coefficient (ADC) and the signal intensity on three diffusion- weighted sequences (DWI) (b50, b400, and b800), were compared between groups by using the Mann-Whitney U test. Also, the receiver operating characteristic analysis was performed for the statistically significant results (P<0.016), and the area under the curve (AUC) was also calculated. RESULTS The two quantitative assessment methods showed similar efficiency in detecting endometriomas (P<0.001; sensitivity, 100%; specificity, 81.82%; AUC>0.86), outperforming the classic subjective evaluation of the "T2 shading" sign (sensitivity, 92.86%; specificity, 66.67%). ADC (P=0.52) and DWI measurements (P=0.49, P=0.74, and P=0.78) failed to distinguish between the two entities. CONCLUSION The quantitative analysis and interpretation of the "T2 shading" sign can significantly improve the differential diagnosis between endometriomas and FHCs.
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Affiliation(s)
- Roxana-Adelina Lupean
- Histology, Morphological Sciences Department, "Iuliu Hațieganu" University of Medicine and Pharmacy; Louis Pasteur street, number 4, Cluj-Napoca, 400349, Cluj, Romania
| | - Paul-Andrei Ștefan
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Csaba Csutak
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Georgeta Mihaela Rusu
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Carmen Mihaela Mihu
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
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Chen J, Huang D, Zhang J, Shi L, Li J, Zhang S. The effect of laparoscopic excisional and ablative surgery on ovarian reserve in patients with endometriomas: A retrospective study. Medicine (Baltimore) 2021; 100:e24362. [PMID: 33607770 PMCID: PMC7899828 DOI: 10.1097/md.0000000000024362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023] Open
Abstract
This study investigates the effect of 2 laparoscopic methods on ovarian reserve in patients of reproductive age with endometriomas.This was a retrospective study performed at a tertiary medical center from Jan 1st to Dec 31st, 2016. Laparoscopic cystectomy (group 1, 46 patients) and laparoscopic ovarian drainage and ablation with bipolar coagulation at low power (group 2, 30 patients) were performed to treat endometriomas larger than 3 cm. Anti-Müllerian hormone was used to assess ovarian reserve before and after surgery.There were no statistically significant differences in patients' baseline clinical characteristics, endometriotic stage, operative time, and follow-up time between the groups. The mean serum anti-Müllerian hormone concentration decreased significantly from 4.25 ng/ml to 3.40 ng/ml in group 1 compared with 4.47 ng/ml to 3.95 ng/ml in group 2 (P = .04). Pregnancy rates were 71.05% in group 1 and 73.08% in group 2, with a mean follow-up of 30.40 months and 32.35 months (P > .99), respectively. Although there was no statistical significance, the recurrence rate in group 1 was lower than that in group 2 (4.35% vs 16.67%, respectively; P = .11). The mean diameter of recurrent cysts was 1.75 cm in group 1 and 1.54 cm in group 2 (P = .13).Appropriate laparoscopic electrocautery of the endometrioma wall with a bipolar instrument may be a valid alternative to traditional laparoscopic cystectomy, with less effects on ovarian reserve.
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Differentiation of Endometriomas from Ovarian Hemorrhagic Cysts at Magnetic Resonance: The Role of Texture Analysis. ACTA ACUST UNITED AC 2020; 56:medicina56100487. [PMID: 32977428 PMCID: PMC7598287 DOI: 10.3390/medicina56100487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: To assess ovarian cysts with texture analysis (TA) in magnetic resonance (MRI) images for establishing a differentiation criterion for endometriomas and functional hemorrhagic cysts (HCs) that could potentially outperform their classic MRI diagnostic features. Materials and Methods: Forty-three patients with known ovarian cysts who underwent MRI were retrospectively included (endometriomas, n = 29; HCs, n = 14). TA was performed using dedicated software based on T2-weighted images, by incorporating the whole lesions in a three-dimensional region of interest. The most discriminative texture features were highlighted by three selection methods (Fisher, probability of classification error and average correlation coefficients, and mutual information). The absolute values of these parameters were compared through univariate, multivariate, and receiver operating characteristic analyses. The ability of the two classic diagnostic signs ("T2 shading" and "T2 dark spots") to diagnose endometriomas was assessed by quantifying their sensitivity (Se) and specificity (Sp), following their conventional assessment on T1-and T2-weighted images by two radiologists. Results: The diagnostic power of the one texture parameter that was an independent predictor of endometriomas (entropy, 75% Se and 100% Sp) and of the predictive model composed of all parameters that showed statistically significant results at the univariate analysis (100% Se, 100% Sp) outperformed the ones shown by the classic MRI endometrioma features ("T2 shading", 75.86% Se and 35.71% Sp; "T2 dark spots", 55.17% Se and 64.29% Sp). Conclusion: Whole-lesion MRI TA has the potential to offer a superior discrimination criterion between endometriomas and HCs compared to the classic evaluation of the two lesions' MRI signal behaviors.
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Rius M, Gracia M, Ros C, Martínez-Zamora MÁ, deGuirior C, Quintas L, Carmona F. Impact of endometrioma surgery on ovarian reserve: a prospective, randomized, pilot study comparing stripping with CO 2 laser vaporization in patients with bilateral endometriomas. J Int Med Res 2020; 48:300060520927627. [PMID: 32527167 PMCID: PMC7294500 DOI: 10.1177/0300060520927627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To assess ovarian reserve through antral follicle count (AFC) and ovarian volume (OV) determination after decapsulation (stripping technique) or CO2 laser vaporization in the surgical treatment of patients with bilateral ovarian endometriomas. Methods This prospective, randomized, blinded, self-controlled pilot study was set in a tertiary university hospital between January 2017 and December 2017, and included consecutive patients with bilateral ovarian endometriomas ≥3 cm. The study was registered with ClinicalTrials.gov under the title ‘Impact on ovarian reserve according to the type of ovarian endometrioma excision: laser versus conventional cystectomy’; NCT 03826355. For each patient, the endometrioma on one side was randomly selected to undergo CO2 laser vaporization and the contralateral endometrioma to undergo laparoscopic decapsulation. Results A total of 16 patients were included. There were no statistically significant between-group differences in OV and AFC levels at baseline. At the 6-month follow-up, OV and AFC levels were significantly higher in the laser-treated group versus the stripping technique. Conclusion Lower OV and AFC levels following excisional surgery for endometrioma versus CO2 laser vaporization suggest a higher impact on ovarian reserve after the stripping procedure.
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Affiliation(s)
- Mariona Rius
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Ros
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Cristian deGuirior
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lara Quintas
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Munrós J, Martínez-Zamora MA, Tàssies D, Reverter JC, Rius M, Gracia M, Ros C, Carmona F. Total Circulating Microparticle Levels After Laparoscopic Surgical Treatment for Endometrioma: A Pilot, Prospective, Randomized Study Comparing Stripping with CO 2 Laser Vaporization. J Minim Invasive Gynecol 2018; 26:450-455. [PMID: 29803597 DOI: 10.1016/j.jmig.2018.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 01/17/2023]
Abstract
STUDY OBJECTIVE To evaluate serial generation of microparticles (MPs) after laparoscopic stripping or CO2 laser vaporization in the surgical treatment of patients with ovarian endometrioma (OE). DESIGN A prospective, randomized, blinded, pilot study (Canadian Task Force classification I). SETTING Tertiary care university hospital from December 2014 to July 2016. PATIENTS Thirty women with unilateral OE undergoing laparoscopic surgery. INTERVENTION Patients were randomly selected to undergo either CO2 laser vaporization (L group) or laparoscopic stripping (S group) of OE. MEASUREMENTS AND MAIN RESULTS Blood samples were collected before surgery and at 2 hours, 24 hours, 1 month, and 3 months after surgery. An MP generation curve after OE surgery was created. MP generation was greater in the S group than in the L group at all time points evaluated. The MP generation curve showed a significantly higher area under the curve after excisional surgery (p <.05). CONCLUSION The higher MP levels in the S group suggest an increased inflammation and procoagulant response after this procedure.
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Affiliation(s)
- Jordina Munrós
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria-Angeles Martínez-Zamora
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dolors Tàssies
- Department of Hemotherapy and Hemostasis, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Juan Carlos Reverter
- Department of Hemotherapy and Hemostasis, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Meritxell Gracia
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Ros
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Carmona
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Shi LB, Zhou F, Zhu HY, Huang D, Jin XY, Li C, Dai Y, Pan YB, Zhang SY. Transforming growth factor beta1 from endometriomas promotes fibrosis in surrounding ovarian tissues via Smad2/3 signaling†. Biol Reprod 2017; 97:873-882. [DOI: 10.1093/biolre/iox140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/09/2017] [Indexed: 01/16/2023] Open
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Tao X, Chen L, Ge S, Cai L. Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis. PLoS One 2017; 12:e0177426. [PMID: 28574993 PMCID: PMC5456033 DOI: 10.1371/journal.pone.0177426] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/27/2017] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To explore the effects of conservative surgery for endometriomas on ovarian responsiveness during assisted reproductive technology (ART) and provide reproductive and gynecological doctors with a more reliable reference program for the treatment of endometriomas. METHODS A literature search was performed by searching the PubMed, Embase, Cochrane Library, Web of Science and Science Direct databases. Studies with inter- and intra-patient comparisons of ovarian responses and oocyte quality between operated and unoperated ovaries and that met the inclusion criteria were retrieved, and the data from the outcome measures were extracted and pooled for this meta-analysis. RESULTS Twenty-one published studies (2649 ART cycles) were included. The total amount of gonadotropin (Gn) used (inverse variance (IV):0.48; 95% confidence interval (CI): [0.13, 1.82], P = 0.0007) was significantly increased in the women with endometriomas who had a history of cystectomy. The estrogen (E) level on the day of hCG administration (IV: -0.29; 95% CI: [-0.41, -0.17], P<0.00001), the number of mature or dominant follicles (IV: -1.17; 95% CI: [-1.51, -0.82], P<0.00001) and the total number of oocytes retrieved (IV: -1.78; 95% CI: [-2.38, -1.17], P<0.00001) were significantly decreased in the women with endometriomas who had a history of cystectomy. The duration of stimulation (IV: 0.02; 95% CI: [-0.09, 0.13], P = 0.77), the total number of formed embryos (IV: -0.06; 95% CI: [-0.17, 0.04], P = 0.25), the pregnancy rate(IV:0.98;95%CI[0.82,1.18], P = 0.83) and the live birth rate(IV:0.93;95%CI[0.70,1.23], P = 0.61)were not statistically different between the two groups. Similar intra-patient results were found in the number of mature or dominant follicles (IV: -0.88; 95% CI: [-1.25, -0.52], P<0.00001) and the total number of oocytes retrieved (IV: -3.48; 95% CI: [-4.77, -2.19], P<0.00001). CONCLUSION ART might be a better therapeutic method for ovarian endometrioma-related infertility than cystectomy.
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Affiliation(s)
- Xin Tao
- Center for Reproductive Medicine, the Third Affiliated Hospital of Sun-Yet Sen University, Guangzhou, Guangdong Province, China
| | - Lei Chen
- Center for Reproductive Medicine, the Third Affiliated Hospital of Sun-Yet Sen University, Guangzhou, Guangdong Province, China
| | - Shuqi Ge
- Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun-Yet Sen University, Guangzhou, Guangdong Province, China
| | - Lisi Cai
- Center for Reproductive Medicine, the Third Affiliated Hospital of Sun-Yet Sen University, Guangzhou, Guangdong Province, China
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Retreatment Rates Among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy. J Womens Health (Larchmt) 2017; 26:644-654. [DOI: 10.1089/jwh.2016.6043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Endometrioma in Adolescents and Future Reproductive Health. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/je.5000267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There continues to be debate over the nature and progression of ovarian endometriomas in adolescence due to the possibility that they may have a different origin and to the impossibility to be able to predict progress. The hypothesis of a different origin traces its roots in the phenomenon called “neonatal menstruation” (NUB), occurring in approximately 5% of newborn. The retrograde shedding of neonatal endometrium may contain progenitor cells and stroma that may lie dormant under the peritoneal surface until being activated when estrogens begin to rise. In teenagers, ovarian endometriomas are often preceded by highly angiogenic implants in the fossa ovarica, with adhesion formation resulting in the invagination of the ovarian cortex and the creation of a pseudocyst. Use of imaging techniques makes it possible to diagnose even small endometriomas. This is vital to their management, since there is evidence that the disease in an adolescent represents a severe condition, with tendency to progression. In addition, if intervention is decided, the first surgical procedure can determine the ultimate outcome of her reproductive life, because there is a significantly higher risk of inadvertently removing ovarian tissue in the presence of an endometrioma than of other ovarian pathologies. For this reason, techniques avoiding additional trauma to the ovary should be preferred and those who wish to become pregnant should attempt conception as soon as possible; if pregnancy is not sought, hormonal therapy is strongly advised. Finally, young age at diagnosis may constitute a pivotal factor in considering fertility preservation.
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Thomsen LH, Schnack TH, Buchardi K, Hummelshoj L, Missmer SA, Forman A, Blaakaer J. Risk factors of epithelial ovarian carcinomas among women with endometriosis: a systematic review. Acta Obstet Gynecol Scand 2016; 96:761-778. [DOI: 10.1111/aogs.13010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Line H. Thomsen
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Tine H. Schnack
- Gynecologic and Obstetric Department; Rigshospitalet University Hospital of Copenhagen; Copenhagen Denmark
| | | | | | - Stacey A. Missmer
- Department of Obstetrics; Gynecology and Reproductive Biology College of Human Medicine; Michigan State University; Boston MA USA
- Department of Epidemiology; Harvard T.H. Chan School of Public Health; Boston MA USA
| | - Axel Forman
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
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Taniguchi F, Sakamoto Y, Yabuta Y, Azuma Y, Hirakawa E, Nagira K, Uegaki T, Deura I, Hata K, Harada T. Analysis of pregnancy outcome and decline of anti-Müllerian hormone after laparoscopic cystectomy for ovarian endometriomas. J Obstet Gynaecol Res 2016; 42:1534-1540. [DOI: 10.1111/jog.13081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/15/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Fuminori Taniguchi
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Yasuko Sakamoto
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Yuko Yabuta
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Yukihiro Azuma
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Eriko Hirakawa
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Kei Nagira
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Takashi Uegaki
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Imari Deura
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Koukichi Hata
- Department of Nursing; The University of Shimane; Izumo Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
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Coelho Neto MA, Martins WP, Lima MLS, Barbosa MAP, Nastri CO, Ferriani RA, Navarro PA. Ovarian response is a better predictor of clinical pregnancy rate following embryo transfer than is thin endometrium or presence of an endometrioma. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:501-505. [PMID: 25914103 DOI: 10.1002/uog.14884] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To examine whether endometrial thickness and the presence of endometrioma are independent predictors of clinical pregnancy rate or simply associated with poor ovarian response (POR). METHODS This was a retrospective cohort study assessing the first cycle of all women undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in a university hospital in Brazil between January 2011 and December 2012. Only the first cycle of each woman within the study period was considered. Women over 40 years of age and those who used clomiphene citrate during controlled ovarian stimulation (COS) or did not undergo embryo transfer were excluded from analysis. POR was defined as ≤ three oocytes retrieved and a thin endometrium was defined as endometrial thickness ≤ 7.0 mm on the day of human chorionic gonadotropin (hCG) administration. We performed a multiple regression analysis to identify which of the following parameters were independent predictors of clinical pregnancy: age, number of oocytes retrieved, endometrial thickness or the presence of endometrioma. RESULTS Within the study period, 787 women began COS, but 270 were excluded from analysis. Among the 517 women analyzed, those who achieved pregnancy were younger and yielded more oocytes. The proportion of POR was higher in women with a thin endometrium (17/57 (29.8%) vs 80/460 (17.4%); P = 0.03) and in women with endometrioma (15/39 (38.5%) vs 82/478 (17.2%); P = 0.002). The results of regression analysis showed that only age and the number of oocytes retrieved were independent predictors of pregnancy. Additionally, we observed higher clinical pregnancy rates in women with a thin endometrium from whom ≥ seven oocytes were retrieved (11/25 (44.0%)) compared to women with normal endometrial thickness (99/241 (41.1%)). Considering only women from whom ≥ four oocytes were retrieved, we observed reasonable pregnancy rates in those with a thin endometrium (14/40 (35.0%)) and in those with endometrioma (9/24 (37.5%)). CONCLUSION Both a thin endometrium and the presence of endometrioma are associated with POR but are not important independent predictors of clinical pregnancy. Good pregnancy rates can be observed when these conditions are present in women with a good ovarian response.
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Affiliation(s)
- M A Coelho Neto
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - M L S Lima
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - M A P Barbosa
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - C O Nastri
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - R A Ferriani
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - P A Navarro
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
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