Extracts from "Clinical Evidence": Endometriosis

Abstract

American Fertility Society scores for size and number of deposits; recurrence rates; time between stopping treatment and recurrence; rate of adverse effects of treatment. In women with pain: relief of pain, assessed by visual analogue scale and subjective improvement. In women with subfertility: cumulative pregnancy rate, live birth rate. In women undergoing surgery: ease of surgical intervention (rated as easy, average, difficult, or very difficult).

Laparoscopic Excision of Endometrioma

“…Most experts would agree that if there is an endometrioma of 4 cm or greater that a laparoscopic excision be performed before an anticipated in vitro fertilization cycle to decrease the potential risk of infection and improve access to follicle. 24,26 Postoperative follow-up after laparoscopic ovarian endometrioma excision were studied retrospectively. Recurrence was defined as the presence of endometrioma more than 2 cm in size, detected by ultrasonography within 2 years of surgery.…”

“…The reviewers searched the cochrane menstrual disorders and subfertility group specialised register of trials, 24 the cochrane register of controlled trials, 25 medline (1966-august 2007), embase 26 and reference lists of articles, the handsearching of relevant journals and conference proceedings and by the cochrane menstrual disorders and subfertility group trials register is based on regular searches of medline.…”

“…26 About 20% of women do not report any improvement after surgery. 14 No randomised controlled trials have compared laser versus electrosurgical removal of endometriosis, and only one small trial, with inconclusive results, compared excision versus ablation.…”

“…16,26 Even with experienced laparoscopic surgeons, the cumulative rate of recurrence after five years is nearly 20%. 17 Another study reported recurrence of dysmenorrhea in almost a third of women within one year of laparoscopic surgery in women who received no other treatment.…”

“…25 Finally for the health care system, endometriosis imposes considerable costs; direct costs of surgical therapy are estimated at US$5805 and for medical treatments US$2418. 26 The indirect costs of time away from employment, the burden of pain and its impact on quality of life are also recognized. Surgical treatment of endometriosis may be effective in relieving dysmenorrhea, dyspareunia, nonmenstrual pelvic pain and dyschesia.…”