+MRIOSP4SP PRACE ORYGINALNE ginekologia
Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis complicated by endometrioma
Objawy kliniczne i narzędzia diagnostyczne w niepłodności i wodniaku jajowodu u kobiet z zaawansowanym stadium endometriozy powikłanym torbielą endometrialną
$OL 1 Department of Obstetrics and Gynecology, Düzce University Faculty of Medicine, Düzce, Turkey 2 Department of Obstetrics and Gynecology, International Medicana Hospital, İstanbul, Turkey Abstract Objectives: The study included patients suffering from stage III-IV endometriosis complicated by an endometrioma (OMA). We investigated the association between age, presence of dysmenorrhea/dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility, as well as the risk of intraoperative detection of hydrosalpinx that was not suspected on pre-operative assessment. Materials and Methods: The study included patients with stage III-IV endometriosis complicated by OMA who underwent a laparoscopic or open surgery due to pre-diagnosis of infertility or adnexal mass. Results: Dysmenorrhea had statistically significant association with infertility (p=0.031). There was no statistically significant relation between age, dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility (p=0. 203, p=0.561, p=0.561 and p=0.668, respectively). No statistically significant relation was found between age, CA 125 level, dysmenorrhea, dyspareunia and detection of an unilateral/bilateral hydrosalpinx, that was not suspected on pre-operative assessment (p=0.179, p=0.295, p=0.895, p=0.424, respectively). There was an association between OMA size (p=0.023) and detection of unilateral/bilateral hydrosalpinx. Conclusions: Patients who desire to have children but suffer from severe dysmenorrhea must be preoperatively informed about the possibility of having stage III-IV endometriosis. Infertile patients who are about to undergo an operation, especially due to a large OMA, may turn out to have hydrosalpinx. These patients should be informed preoperatively about the possibility of having salpingectomy or the proximal tubal surgery for improving fertility. Key words: endometriosis / endometrioma / hydrosalpinx / infertility / Corresponding author: Ali Yavuzcan Department of Obstetrics and Gynecology, Duzce University School of Medicine, 81000, Konuralp,Duzce,-TURKEY Mobile: +90 (532) 634 54 31 Otrzymano: 06.05.2013 Zaakceptowano do druku: 30.07.2013 e-mail: [email protected] Nr 09/2013 © Polskie Towarzystwo Ginekologiczne 765 PRACE ORYGINALNE +MRIOSP4SP ginekologia Ali Yavuzcan et al. Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis... Streszczenie Cel: Do badania włączono pacjentki cierpiące na endometriozę w stopniu III-IV powikłaną torbielą endometrialną (OMA). Zbadano powiązania między wiekiem, obecnością bolesnego miesiączkowania/dyspareunii, przedoperacyjnym poziomem CA125, rozmiarem OMA w USG a niepłodnością. Oceniono również ryzyko śródoperacyjnego rozpoznania wodniaka jajowodu, którego nie podejrzewano przed operacją. Materiał i metoda: Do badania włączono pacjentki z III-IV stopniem endometriozy powikłanym OMA, które przeszły laparoskopię lub operację metodą otwartą z powodu niepłodności lub guza jajnika. Wyniki: Bolesne miesiączkowanie miało istotny związek z niepłodością (p=0,031). Nie znaleziono istotnego związku pomiędzy wiekiem, dyspareunia, przedoperacyjnym poziomem CA125, rozmiarem OMA w USG a niepłodnością (p=0,203; p=0,561; p=0,561 i p=0,424, odpowiednio). Rozmiar OMA miał istotny związek z rozpoznaniem jedno/ obustronnego wodniaka jajowodu (p=0,023). Wnioski: Kobiety, które chcą zajść w ciążę ale cierpią z powodu bolesnych miesiączek powinny być poinformowane przed operacją o możliwej endometriozie III-IV stopnia. Niepłodne pacjentki, które mają się poddać leczeniu operacyjnemu, zwłaszcza z powodu dużych torbieli endometrialnych, mogą w rzeczywistości mieć wodniaka jajowodu. Te pacjentki powinno się informować przed operacją o konieczności wykonania usunięcia jajowodu lub chirurgii proksymalnego odcinka jajowodu celem poprawy płodności. Słowa kluczowe: endometrioza / endometrioma / wodniak jajowodu / niepáodnoĞü / List of abbreviations: $FFRUGLQJWRWKH3ROLVK*\QHFRORJLFDO6RFLHW\([SHUW*URXSWKH endometrioma, OMA; revised endometriosis scoring of the American FRUUHODWLRQEHWZHHQWKHVWDJHRIHQGRPHWULRVLVDQGSDLQLQWHQVLW\ Fertility Society, R-AFS; in vitro fertilization, IVF; ultrasonography, USG; LVQRWDOZD\VSURSRUWLRQDO>@ deep infiltrating endometriosis, DIE; peritoneal superficial endometriosis, $Q LQFUHDVH LQ SUHJQDQF\ UDWHV LV REVHUYHG DIWHU SDWLHQWV SUP; nerve growth factor, NGF; protein gene product 9.5, PGP9.5. 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Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis... Table I. Demographics and characteristics. N=33(100%) Minimum Maximum Mean+/-Std. Dev. $JH 20 58 FDOHYHO VL]HRI20$ PP 25 84 G\VPHQRUUKHD G\VSDUHXQLD K\GURVDOSLQ[SRVLWLYH LQIHUWLOLW\SRVLWLYH 7RWDO PLOOLPHWHUVmm. Table II. Examination of the factors affecting infertility. infertile fertile p value* $JH G\VPHQRUUKHD 0.031 G\VSDUHXQLD &DOHYHO VL]HRI20$ PP PLOOLPHWHUVmm. Table III. Examination of the factors affecting detection of hydrosalpinx. hydrosalpinx hydrosalpinx p value* positive negative $JH G\VPHQRUUKHD G\VSDUHXQLD &DOHYHO VL]HRI20$ PP 0.023 PLOOLPHWHUVmm. 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Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis... DVVRFLDWHGZLWKDQRWKHUPDVV3UHRSHUDWLYH&$12OHYHOLVQRW 4. ASRM (1997): American Society for Reproductive Medicine: Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997, 67, 817–821. XVHIXOIRUWKHGLDJQRVLVRIK\GURVDOSLQ[LQDOOFLUFXPVWDQFHV> @ 5. Chapron C, Fauconnier A, Dubuisson J, [et al.]. Deep infiltrating endometriosis: relation between $FFRUGLQJWRWKHUHVXOWVRIRXUVWXG\WKHUHZDVQRVWDWLVWLFDOO\ severity of dysmenorrhea and extent of disease. Hum Reprod. 2003, 18, 760-766. VLJQL¿FDQW DVVRFLDWLRQ EHWZHHQ SUHRSHUDWLYHO\ PHDVXUHG &$ 6. Chapron C, Santulli P, de Ziegler D, [et al.]. Ovarian endometrioma: severe pelvic pain is 12 OHYHO S 2 DQG WKH SUHVHQFH RI XQLODWHUDOELODWHUDO associated with deeply infiltrating endometriosis. Hum Reprod. 2012, 27, 702-711. 7. Basta A, Brucka A, Górski J, [et al.]. The statement of Polish Society’s Experts Group concerning K\GURVDOSLQ[ diagnostics and methods of endometriosis treatment. Ginekol Pol. 2012, 83, 871-876. ,Q PDQ\ FDVHV HYHQ DQ H[SHULHQFHG VRQRJUDSKHU LV QRW 8. Sagoskin A, Lessey B, Mottla G, [et al.]. Salpingectomy or proximal tubal occlusion of unilateral DEOHWRFRUUHFWO\GLIIHUHQWLDWHDK\GURVDOSLQ[IURPRWKHUDGQH[DO hydrosalpinx increases the potential for spontaneous pregnancy. Hum Reprod. 2003, 18, 2634- 2637. SDWKRORJLHV >2@ 8OWUDVRXQG H[DPLQHUV PD\ PLVGLDJQRVH 9. Alcázar J, Guerriero S, Mínguez J, [et al.]. Adding cancer antigen 125 screening to gray scale 1 RI K\GURVDOSLQJHV >2@ 7KHUH LV DOZD\V WKH ULVN RI sonography for predicting specific diagnosis of benign adnexal masses in premenopausal ¿QGLQJ D K\GURVDOSLQ[ LQ SDWLHQWV ZLWK IHUWLOLW\ SUREOHPV DQG women: is it worthwhile? J Ultrasound Med. 2011, 30, 1381-1386. 10. Benjaminov O, Atri M. Sonography of the abnormal fallopian tube. AJR Am J Roentgenol. 2004, DGYDQFH VWDJHG HQGRPHWULRVLV VWDJH ,,,,9 :H H[DPLQHG 183,737-742. WKH UHODWLRQVKLS EHWZHHQ FOLQLFDO SURSHUWLHV DQG WKH ULVN RI 11. American College of Obstetricians and Gynecologists. Sexual dysfunction. Technical bulletin no. LQWUDRSHUDWLYHGHWHFWLRQRIDK\GURVDOSLQ[WKDWZDVQRWVXVSHFWHG 211. Int J Gynecol Obstet. 205, 51, 265-277. RQ SUHRSHUDWLYH DVVHVVPHQW ,W ZDV VKRZQ LQ RXU VWXG\ WKDW 12. French L. Dysmenorrhea. American Family Physician. 2005, 71, 285–292. 13. Chapron C, Pietin-Vialle C, Borghese B, [et al.]. Associated ovarian endometrioma is a marker DJH G\VPHQRUUKHD DQG G\VSDUHXQLD V\PSWRPV GLG QRW KDYH for greater severity of deeply infiltrating endometriosis. Fertil Steril. 2009, 92, 453–457. D VWDWLVWLFDOO\ VLJQL¿FDQW UHODWLRQ WR WKH ULVN RI K\GURVDOSLQ[ 14. Anaf V, Chapron C, El Nakadi I, [et al.]. Pain, mast cells, and nerves in peritoneal, ovarian, and GHWHFWLRQ S 1 S S 2UHVSHFWLYHO\ EXWWKHVL]H deep infiltrating endometriosis. Fertil Steril. 2006, 86, 1336–1343. RI20$RQSUHRSHUDWLYHVRQRJUDSK\KDGDQDVVRFLDWLRQZLWKWKH 15. Zhang X, Yao H, Huang X, [et al.]. Nerve fibres in ovarian endometriotic lesions in women with ovarian endometriosis. Hum Reprod. 2010, 25, 392–397. ULVNRILQWUDRSHUDWLYHGHWHFWLRQRIK\GURVDOSLQ[ S 2 7KHUH 16. A Committee Opinion The Practice Committee of the American Society for Reproductive DUHWZRW\SHVRISDWKRSK\VLRORJLFDOSDWKZD\VIRUWKHIRUPDWLRQ Medicine Birmingham, Alabama. Endometriosis and Infertility. Fertil Steril. 2012, 98, 591–598. RI K\GURVDOSLQ[ LQ HQGRPHWULRVLV ,QWUDOHVLRQDO KHPRUUKDJH 17. Parihar M, Mirge A, Hasabe R. Hydrosalpinx functional surgery or salpingectomy? The importance of hydrosalpinx fluid in assisted reproductive technologies. J Gynecol Endosc Surg. DQG ¿EURVLV GHYHORSLQJ LQ IXQFWLRQDO VHURVDO RU VXEVHURVDO 2009, 1, 12-16. HQGRPHWULRWLF LPSODQWV OHDGLQJ WR WKH IRUPDWLRQ RI SHULWXEDO 18. Vercellini P, Trespidi L, De Giorgi O, [et al.]. Endometriosis and pelvic pain: relation to disease DGKHVLRQVDQGK\GURVDOSLQ[$FFRUGLQJWRDQRWKHUGHIDXOWWKHRU\ stage and localization. Fertil. Steril. 1996, 65, 299-304. WKHLQWUDOXPLQDOWXEDOHQGRPHWULRWLFWLVVXHFDXVHVK\GURVDOSLQ[ 19. Dubuisson J, Pont M, Roy P, [et al.]. Female sexuality after surgical treatment of symptomatic deep pelvic endometriosis. Gynecol Obstet Fertil. 2013, 41, 38-44. E\ REVWUXFWLQJ SDVVDJHV HVSHFLDOO\ LQ LQWUDPXUDO DQG LVWKPLF 20. Laumann E, Paik A, Rosen R. Sexual dysfunction in the United States: prevalence and DUHDE\OHDGLQJWRWKHGLVUXSWLRQRIQRUPDOWXEDOIXQFWLRQ>2@ predictors. JAMA. 1999, 281, 537–544. 'RQQH]HWDOGHVFULEHGWKDWDGKHVLRQVZHUHWKHFDXVHVRI20$ 21. Patrelli T, Berretta R, Gizzo S, [et al.]. CA 125 serum values in surgically treated endometriosis patients and its relationships with anatomic sites of endometriosis and pregnancy rate. Fertil E\ VKHGGLQJ RI DFWLYH VXSHU¿FLDO LPSODQWV >2@ 3UREDEO\ DV Steril. 2011, 95, 393-396. WKH DFWLYH HQGRPHWULRWLF OHVLRQ NQRZQ DV 20$ HQODUJHV LW 22. Vercellini P, Somigliana E, Viganò P, [et al.]. Surgery for endometriosis-associated infertility: a GHWHULRUDWHVWKHWXEDOVWUXFWXUH pragmatic approach. Hum Reprod. 2009, 24, 254-269. 23. Almog B, Shehata F, Sheizaf B, [et al.]. Effects of ovarian endometrioma on the number of Conclusions oocytes retrieved for in vitro fertilization. Fertil Steril. 2011, 95, 525-527. 24. Timor-Tritsch I, Monteagudo A, Tsymbal T. Three-dimensional ultrasound inversion rendering 'HVSLWH WKH ORZ QXPEHU RI VWXG\ SDUWLFLSDQWV ZH ZHUH technique facilitates the diagnosis of hydrosalpinx. J Clin Ultrasound. 2010, 38, 372-376. DEOH WR ¿QG WKDW G\VPHQRUUKHD ZDV DVVRFLDWHG ZLWK LQIHUWLOLW\ 25. Sokalska A, Timmerman D, Testa A, [et al.]. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses. Ultrasound Obstet Gynecol. LQ SDWLHQWV GLDJQRVHG ZLWK DGYDQFHGVWDJH HQGRPHWULRVLV 2009, 34, 462-470. 7KH ULVN RI K\GURVDOSLQ[ GHWHFWLRQ QRW GLDJQRVHG RQ SUH 26. Clement P. Diseases of the peritoneum. In: Blaustein’s pathology of the female genital tract. 2nd RSHUDWLYHDVVHVVPHQWZDVOLQNHGZLWKWKHVL]HRI20$3DWLHQWV ed. Ed. Blaustein A. New York, NY: Springer-Verlag.1984, 729–789. 27. Donnez J, Nisolle M, Gillet N,[et al.]. Large ovarian endometriomas. Hum Reprod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eferences 1. D’Hooghe T, Mohali A, Sims P, [et al.]. Why we need a noninvasive diagnostic test for minimal to mild endometriosis with a high sensitivity. Gynecol Obstet Invest. 2006, 62, 136–138. 2. Hassa H. Endometriosis-İnfertilite ilişkisi ve tedavi sınırları. J Turk Soc Obstet Gynecol. 2004, 3,181-187. 3. Jasović V, Jasović-Siveska E. Success rate of intra uterine insemination in patients with unknown infertility. Vojnosanit Pregl. 2012, 69, 301-307. Nr 09/2013 © Polskie Towarzystwo Ginekologiczne 769