Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?

Pregnancy after laparoscopic surgery for endometriosis: How long should we wait? A retrospective study involving a long-term follow up at a university endometriosis center

OBJECTIVE

To find the factors that influence the time until pregnancy after laparoscopic intervention and to evaluate the proper time to start assisted reproductive therapy (ART).

METHODS

This is a retrospective analysis that includes a prospective evaluation of patients with infertility and with a diagnosis of endometriosis. A subgroup of patients who desired to be pregnant after laparoscopic intervention (102 patients) was followed up for 36-197 months after the surgery.

RESULTS

In this study, 71 (69.9%) and 60 (58.8%) of the patients achieved pregnancy and live birth, respectively. In the group of patients who became pregnant, the duration of infertility was significantly lower (2.7 ± 2.1 years vs. 4.7 ± 3.2 years). The median time until pregnancy after laparoscopic intervention was 8 months (the average was 10 months). After 38 months, no pregnancy occurred.

CONCLUSION

In the group of patients with endometriosis and infertility, the first 12 months were the optimal time for pregnancy. For women with revised American Society for Reproductive Medicine classification of endometriosis (rASRM) stages I and II, spontaneous pregnancy can probably be delayed for up to 24 months, but in patients with rASRM stages III and IV, ART may be considered after 12 months. The gynecologist must be careful about the timing of further interventions after the operation.

Peripheral blood subpopulations of Bregs producing IL-35 in women with endometriosis

PROBLEM

Interleukin 35 (IL-35) is involved in the pathogenesis of endometriosis by suppressing immunoreaction and promoting endometrial cell proliferation. It may also be an essential cytokine in forming the immunosuppressive functions of regulatory B lymphocytes (Bregs). The involvement of Bregs in the pathogenesis of endometriosis has not been previously investigated. In this study, we determined the frequencies of different Breg subpopulations, namely, B10, immature B-cells, and plasmablasts, and their abilities to produce IL-35 in women with endometriosis compared to healthy women.

METHODS

The frequencies of different subpopulations of Bregs producing IL-35 were measured in the peripheral blood of women with endometriosis (total pool), women with deep infiltration endometriosis (DIE), women with ovarian endometriosis, and healthy women as a control by flow cytometry.

RESULTS

We observed a decrease in the percentage of B10 cells and plasmablasts in women with endometriosis and an increase in the percentage of these Breg populations producing IL-35 in the same experimental group. Interestingly, we also revealed that women with DIE had increased percentages of B10 cells and plasmablasts producing IL-35.

CONCLUSION

Taken together, our findings are the first to reveal the frequencies of different subpopulations of Bregs producing IL-35 in women with endometriosis. The results suggest that IL-35 expression in B lymphocytes could be used as a peripheral marker of endometriosis; however, further studies are needed.

[Assessment of neuropathic pain among women with suspected endometriosis based on two specific surveys]

OBJECTIVES

A significant proportion of women with suspected endometriosis present neuropathic pain. The aim of this study is to assess this prevalence and the relevance of specific tests used.

METHODS

This is a single-center retrospective study in the CHI of Poissy Saint Germain en Laye with patients who were referred for suspected endometriosis and who benefited from evaluation of neuropathic pain by two distinct questionnaires. The PAINdetect was evaluated by a series of 7 questions scored from 0 to 5 with a positive test if score>18. For the DN4, 7 binary questions were asked and 3 other questions were related to the clinical examination with a positivity threshold reached if score≥4 and in the absence of clinical examination if score≥3.

RESULTS

From November 2020 to June 2022, 57 patients were examined with a prevalence of neuropathic pain (one of the two test positive) evaluated at 36.8%. PAINdetect and DN4 positivity rates were at 26.8% and 30.9%. A discordance was found in 14.8% of cases with a kappa coefficient calculated at 0.63. There was a significant association between radiological examination and neuropathic pain with more neuropathic pain when the radiological examination was negative (P=0.03). The myofascial syndrome was present in only 59.5% of the patients and wasn't associated with neuropathic pain (P=1.00).

CONCLUSION

Prevalence of neuropathic pain in case of suspected endometriosis appears to be high. This need to be confirmed in a multicenter study with also assessment of the validity of the two diagnostic tests.