Infertility in women with bowel endometriosis: first-line assisted reproductive technology results in satisfactory cumulative live-birth rates

Maignien, Chloé; Santulli, Piétro; Marcellin, Louis; Korb, Diane; Bordonné, Corinne; Dousset, B.; Chapron, Charles

doi:10.1016/j.fertnstert.2020.09.032

Cited by 24 publications

(14 citation statements)

References 86 publications

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“…We believe our results to be of interest for those colleagues inquiring whether women with severe deep endometriosis and pregnancy wish would benefit more from first-line ART to increase postoperative pregnancy rate. 16 Postoperative pregnancy rate was 66.7% in women F I G U R E 1 Kaplan-Meier curves of the probability of pregnancy after three types of surgery. Kaplan-Meier curves estimate the probability of not being pregnant postoperatively in women managed by cystectomy (red line), ablation using plasma energy (blue line), or drainage (green line).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy rate following endometriomas management by ablation using plasma energy, cystectomy and drainage: A three‐arm comparative study

Puşcaşiu

Mircea

Hennetier

et al. 2022

Intl J Gynecology & Obste

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Objective To compare differences in the postoperative pregnancy rate in women seeking to conceive and presenting with endometriomas larger than 3 cm in diameter, which were managed by ablation using plasma energy, cystectomy, or simple drainage. Methods A retrospective three‐arm comparative study based on prospective collection of data evaluating 363 patients, undergoing endometrioma cystectomy, ablation using plasma energy, or simple drainage. Results In this series, 204 (56.2%) patients underwent endometrioma ablation using plasma energy, 121 (33.3%) received cystectomy, and 38 (10.5%) had a simple drainage. Postoperative follow up was 50 ± 26 months. Overall postoperative pregnancy rate was 60.3%. The probability of being pregnant after cystectomy, ablation, and drainage was respectively 27%, 32%, and 16% at 12 months, with a statistically significant difference between pregnancy rates among the three arms (P = 0.015). Simple drainage was associated with a probability of conception over 50% after 2 years, mainly based on postoperative assisted reproductive technology. Conclusions We reveal good postoperative pregnancy rate after ablation using plasma energy or cystectomy for endometriomas. Surgical management should be carefully considered in women with endometriomas and pregnancy intention, because the postoperative pregnancy rate may be compared with that observed after first‐line assisted reproductive technology management.

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Section: Discussionmentioning

confidence: 99%

Pregnancy rate following endometriomas management by ablation using plasma energy, cystectomy and drainage: A three‐arm comparative study

Puşcaşiu

Mircea

Hennetier

et al. 2022

Intl J Gynecology & Obste

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“…Furthermore, assisted reproductive technology (ART) should be offered to infertile endometriosis patients who are unsuitable candidates for natural conception [20]. Previous surgery, advanced disease stage, and association with adenomyosis and ovarian and/or deep nodular endometriosis appear to be linked to poorer ART outcomes [21,22], but in vitro fertilization (IVF) is still the most effective strategy to manage infertility in these patients [20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Can Endometriosis-Related Oxidative Stress Pave the Way for New Treatment Targets?

Cacciottola

Donnez

Dolmans

2021

IJMS

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Endometriosis is a disease of reproductive age characterized by chronic pelvic pain and infertility. Its pathogenesis is complex and still partially unexplained. However, there is increasing evidence of the role of chronic inflammation, immune system dysregulation, and oxidative stress in its development and progression. The latter appears to be involved in multiple aspects of the disease. Indeed, disease progression sustained by a hyperproliferative phenotype can be related to reactive oxygen species (ROS) imbalance, as numerous experiments using drugs to counteract hyperproliferation have shown in recent years. Chronic pelvic pain is also associated with cell function dysregulation favoring chronic inflammation and oxidative stress, specifically involving macrophages and mast cell activation. Moreover, there is increasing evidence of a role for ROS and impaired mitochondrial function not only as deleterious effectors of the ovarian reserve in patients with endometriomas but also in terms of oocyte quality and, hence, embryo development impairment. Targeting oxidative stress looks to be a promising strategy to both curb endometriotic lesion progression and alleviate endometriosis-associated symptoms of chronic pain and infertility. More investigations are nevertheless needed to develop effective therapeutic strategies for clinical application.

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“…7 Choice of first-line treatment of infertility caused by endometriosis is often by assisted reproductive technologies (ART), such as in vitro fertilisation (IVF). 8 9 IVF has been shown to increase the fertility rate in these women, 10 but has no or in some cases even a detrimental effect on pain symptoms. 11 12 …”

Section: Introductionmentioning

confidence: 99%

EFFORT study: Comparing impact of operation and assisted reproductive technologies on fertility for women with deep infiltrating endometriosis – study protocol for a multicentre randomised trial

et al. 2022

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IntroductionDeep infiltrating endometriosis (DIE) affecting the rectum or sigmoid colon is associated with infertility, severe pain and decreased quality of life. As most women with DIE are young, many have a pregnancy intention. Treatment possibilities of endometriosis-associated infertility are surgery or assisted reproductive technologies (ART). However, no studies have compared the two interventions directly. Therefore, this study aims to determine the cumulative pregnancy rate (CPR) and the live birth rate (LBR) after first-line surgery compared with first-line ART for women with rectosigmoid DIE and a pregnancy intention.Methods and analysisMulticentre, parallel-group, randomised trial of women with rectosigmoid DIE and a pregnancy intention for at least 6 months in Aarhus, Denmark and Bordeaux, France. 352 women aged 18–38 years are randomised 1:1 to either surgical management (shaving, disc excision or segmental resection) or ART management (at least two in vitro fertilisation or intracytoplasmic sperm injection procedures if not pregnant after the first cycle). Women in the surgical intervention group will attempt to get pregnant by either spontaneous conception or ART, depending on the endometriosis fertility index score. Primary outcome measures are CPR and LBR at 18 months’ follow-up. Secondary outcomes are: Non-viable pregnancies, time to pregnancy, pain score, quality of life, complication rate, bowel and bladder function, endocrine and inflammatory profile, number of oocytes, blastocysts, frozen embryos and blastocyst morphology score within 18 months after either intervention.Ethics and disseminationConduct of this study is approved by the Danish National Committee on Health Research Ethics and Comité de Protection des Personnes Ile de France VIII. Study participants must sign an informed consent form. The results will be presented at national and international conferences and published in international peer-reviewed journals.Trial registration numberThis trial is registered at ClinicalTrials.gov (no. NCT04610710).Protocol versionThe Danish National Committee on Health Research Ethics: Fifth protocol version approved 7 September 2020 (no. 1-10-72-96-20). Comité de Protection des Personnes Ile de France VIII: Version 1.1 22JAN2021 the 9 March 2021.

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Infertility in women with bowel endometriosis: first-line assisted reproductive technology results in satisfactory cumulative live-birth rates

Cited by 24 publications

References 86 publications

Pregnancy rate following endometriomas management by ablation using plasma energy, cystectomy and drainage: A three‐arm comparative study

Pregnancy rate following endometriomas management by ablation using plasma energy, cystectomy and drainage: A three‐arm comparative study

Can Endometriosis-Related Oxidative Stress Pave the Way for New Treatment Targets?

EFFORT study: Comparing impact of operation and assisted reproductive technologies on fertility for women with deep infiltrating endometriosis – study protocol for a multicentre randomised trial

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