M053 Evidence‐based Therapy for Infertility Associated With Early Stage Endometriosis

Gad, Mohamed S.; Badroui, M.H.H.

doi:10.1016/s0020-7292(12)61247-8

Cited by 13 publications

(12 citation statements)

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“…35 Their results demonstrated a significantly higher pregnancy rate in patients treated with laparoscopic excision or ablation compared with diagnostic laparoscopy (30% vs 17%). 35 Two additional randomized controlled trials demonstrated improved pregnancy rates after ablation/excision of endometriosis compared with diagnostic laparoscopy (28% vs 23% 37 and 24% vs 28% 38 ); however, the results of the latter study were not statistically significant. 38 Both studies had small sample sizes (20 and 38 patients, respectively) and lacked statistical power.…”

Section: Surgical Treatment For Endometriosis and Its Effects On Ovarmentioning

confidence: 97%

“…38 Both studies had small sample sizes (20 and 38 patients, respectively) and lacked statistical power. 37,38 In addition, none of the 3 studies evaluated excision and ablation separately. A 2014 Cochrane Review pooled the results of these 3 randomized trials and found a significant benefit of laparoscopic surgery for improving live birth or ongoing pregnancy rate, with a number needed to treat of 8, 39 assuming that all patients at laparoscopy have endometriosis.…”

Section: Surgical Treatment For Endometriosis and Its Effects On Ovarmentioning

confidence: 99%

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Fertility Preservation in Women With Endometriosis

Llarena

Flyckt

2019

Clin Med�Insights�Reprod�Health

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Infertility affects 30% to 50% of women with endometriosis. Women with endometriosis are at risk of decreased ovarian reserve, both because of the pathophysiology of the disease and iatrogenic injury resulting from surgical intervention. Fertility preservation must occur at multiple levels, including careful selection of surgical candidates, avoidance of repeat procedures, and meticulous surgical technique. Fertility preservation with oocyte or ovarian tissue cryopreservation may be considered on an individual basis for women with endometriosis, particularly those at risk of bilateral ovarian injury, such as women with bilateral endometriomas.

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Section: Surgical Treatment For Endometriosis and Its Effects On Ovarmentioning

confidence: 97%

Section: Surgical Treatment For Endometriosis and Its Effects On Ovarmentioning

confidence: 99%

Fertility Preservation in Women With Endometriosis

Llarena

Flyckt

2019

Clin Med�Insights�Reprod�Health

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“…A first pivotal RCT conducted on infertile patients with stages I and II endometriosis demonstrated a significant improvement in the ongoing pregnancy rate and live birth rate in women who underwent diagnostic laparoscopy and ablation of lesions compared to those who received diagnostic only laparoscopy (Marcoux et al ., 1997). However, two subsequent smaller RCTs failed to confirm these findings (Parazzini, 1999; Gad and Badroui, 2012). Noteworthy, the most recent study (Gad and Badroui, 2012) was presented at the International Federation of Gynecology and Obstetrics in Rome in 2012, but to date has not been published.…”

Section: The 10 ‘Don’ts’ In Endometriosis Managementmentioning

confidence: 99%

“…However, two subsequent smaller RCTs failed to confirm these findings (Parazzini, 1999; Gad and Badroui, 2012). Noteworthy, the most recent study (Gad and Badroui, 2012) was presented at the International Federation of Gynecology and Obstetrics in Rome in 2012, but to date has not been published.…”

Section: The 10 ‘Don’ts’ In Endometriosis Managementmentioning

confidence: 99%

When more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement

Alio¹,

Angioni²,

Arena³

et al. 2019

Human Reproduction Open

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A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen–progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate–severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen–progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen–progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources.

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“…Because it is unknown until the time of surgery which infertility patients have endometriosis, assuming a prevalence of 30% in the infertility population, the number needed to treat to gain one pregnancy is 40 (24). Among two additional randomized controlled studies, both showed increased pregnancy rates after ablation/excision of endometriosis compared to diagnostic laparoscopy [28% vs. 23% (29) and 24% vs. 18% (30)]; however, in the latter study, the results did not reach statistical significance (30). Both studies were small (20 and 38 patients, respectively) and underpowered.…”

Section: Surgical Treatment Of Endometriosis-associated Infertilitymentioning

confidence: 99%

Strategies to Preserve and Optimize Fertility for Patients with Endometriosis

Llarena

Flyckt

2017

Journal of Endometriosis and Pelvic Pain Disorders

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month in normal couples to 2%-5% per month in women with endometriosis (8, 9). This review will focus on mechanisms of infertility and strategies for preserving and optimizing fertility in endometriosis patients. Mechanisms of infertility There are multiple proposed mechanisms of infertility associated with endometriosis. First, anatomic distortion due to pelvic adhesions may prevent ovum capture and fertilization. Second, inflammatory cytokines, prostaglandins, and metalloproteinases may alter ovarian, tubal and endometrial function, resulting in abnormal folliculogenesis or failure of fertilization or implantation. Additionally, peritoneal fluid high in cytokines, inflammatory mediators, and macrophages may be toxic to sperm and reduce embryo survival (2, 10-13). Furthermore, abnormalities of the eutopic endometrium, including progesterone resistance, may result in implantation failure. Studies detailing the gene expression profiles of the endometrium in women with and without endometriosis show that several genes influenced by progesterone are dysregulated during implantation, when levels of progesterone in the endometrium are highest (1, 14). Although it is well established that advanced endometriosis decreases fertility due to distorted pelvic anatomy, it remains controversial whether women with early-stage endometriosis have impaired fertility. Studies of women with endometriosis who have undergone in vitro fertilization (IVF) provide mixed data. A 2002 meta-analysis of women undergoing IVF reported pregnancy rates among women with endometriosis that were half those of women with tubal factor infertility. Additionally, women with endometriosis showed a decreased response to gonadotropin stimulation, as well as lower fertilization and implantation rates compared to

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M053 Evidence‐based Therapy for Infertility Associated With Early Stage Endometriosis

Cited by 13 publications

References 0 publications

Fertility Preservation in Women With Endometriosis

Fertility Preservation in Women With Endometriosis

When more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement

Strategies to Preserve and Optimize Fertility for Patients with Endometriosis

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