DOCSLIB.ORG

Endometrioma, Fertility, and Assisted Reproductive Treatments: Connecting the Dots

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Endometrioma, Fertility, and Assisted Reproductive Treatments: Connecting the Dots CE: Swati; GCO/300411; Total nos of Pages: 6; GCO 300411 REVIEW CURRENT OPINION Endometrioma, fertility, and assisted reproductive treatments: connecting the dots Gustavo N. Cecchinoa,b,c and Juan A. Garcı´a-Velascob,c Purpose of review Surgery has traditionally been the primary treatment option for endometriosis-related infertility of any phenotype. However, advances and refinements of assisted reproductive technologies (ART) permit a more conservative approach in many scenarios. This review summarizes the latest findings in the field of reproductive medicine, which have supported a paradigm shift towards more conservative management of ovarian endometrioma. Recent findings The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy. Conventional laparoscopic surgery is associated with significant risk of additional damage, and less invasive treatment approaches require further evaluation. With regard to infertile women with ovarian endometrioma who are scheduled for ART treatment, current data indicate that prior surgical intervention does not improve ART outcomes, and that controlled ovarian hyperstimulation (COH) does not affect quality of life or pain symptoms. Summary Reproductive medicine physicians frequently encounter patients with ovarian endometrioma. The current evidence does not support the postponement of infertility treatment in favour of surgery, except in cases with severe symptoms or to improve follicle accessibility. Although these patients may exhibit diminished ovarian response to COH, their endometrial receptivity, aneuploidy rates, and fertility outcomes are similar to healthy controls. Surgery for ovarian endometrioma provides no benefits in ART treatments. Keywords assisted reproductive techniques, endometriomas, endometriosis, infertility, IVF INTRODUCTION endometrioma management is challenging and con- Nearly 10% of women develop endometriosis dur- troversial, especially in the context of ART. For a long ing their reproductive years [1]. Although it is a time, surgery has been considered the primary treat- benign disease, endometriosis can negatively ment to overcome infertility in cases of ovarian impact a woman’s health and quality of life. endometrioma. However, advances in basic science Cross-sectional studies suggest a causal relationship and clinical evidence have supported a paradigm between endometriosis and infertility, although the shift, such that more conservative management is reported risk estimates widely vary [2]. A recent now recommended. analysis of a large ongoing prospective cohort of In the present review, we aim to assess the latest 58 427 women detected a two-fold increased risk of findings concerning fertility issues, endometrioma, infertility among lean women of less than 35 years and assisted reproduction. of age with laparoscopically confirmed endometri- osis. However, subgroup analyses of women over 35 years old or with a BMI of at least 25 kg/m2 did aDepartment of Gynecology, Federal University of Sa˜o Paulo, Sa˜o Paulo, not permit an unequivocal conclusion due to con- Sa˜o Paulo, Brazil, bDepartment of Gynecology and Obstetrics, Rey Juan & founding factors [3 ]. Carlos University and cIVIRMA Madrid, Madrid, Spain Patients struggling with endometriosis often Correspondence to Gustavo N. Cecchino, IVI-Madrid, Rey Juan Carlos pursue assisted reproductive technologies (ART) University, Madrid, Spain. Tel: +34 911 802 900; due to fertility issues. Ovarian endometrioma is the e-mail: [email protected] most prevalent phenotype, affecting about 20–40% Curr Opin Obstet Gynecol 2018, 30:000–000 of women with endometriosis [4,5]. Ovarian DOI:10.1097/GCO.0000000000000464 1040-872X Copyright ß 2018 Wolters Kluwer Health, Inc. All rights reserved. www.co-obgyn.com Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. CE: Swati; GCO/300411; Total nos of Pages: 6; GCO 300411 Reproductive endocrinology Some studies have included histopathological KEY POINTS analysis of surrounding cortical specimens obtained Endometriomas induce chronic molecular changes that during surgical ovarian endometrioma removal, negatively impact ovarian reserve and function. which has revealed decreased follicular density and vascular abnormalities [13,14]. Indeed, up to Surgical excision of ovarian endometrioma by any 16% of such ovarian cortext specimens have exhib- technique clearly affects ovarian reserve, especially in ited a complete absence of follicles [13]. From a cases of bilateral and recurrent endometriomas. molecular perspective, the distinct detrimental Surgery performed prior to ART treatment does not events correlated with ovarian endometrioma could improve reproductive outcomes, but rather increases independently contribute to cytotoxicity-induced the time to pregnancy and the risks and costs. ovarian damage. Unsurprisingly, augmented oxida- COH does not affect quality of life or endometriosis- tive stress appears to play a key role [15]. Convincing related pain symptoms. evidence suggests that endometrioma is likely indu- ces a chronic decrease of ovarian reserve. Less invasive approaches to ovarian endometrioma treatment must be further evaluated in randomized clinical trials. CONCERNS ABOUT SURGICAL EXCISION OF ENDOMETRIOMAS Laparoscopic treatment of ovarian endometrioma was first described in 1986 [16]. Since then, laparo- IMPACT OF ENDOMETRIOMAS ON scopic cystectomy has become the gold standard OVARIAN FUNCTION AND RESERVE treatment for ovarian endometrioma with surgical Few studies have been focused on determining the indication [17,18]. Nevertheless, several aspects exact mechanisms through which endometriomas relating to surgical management of endometriomas presumably impair normal ovarian physiology. remain controversial, and the consequences to Early investigations suggested that ovarian endo- future fertility are not fully understood. metrioma was associated with reduced spontane- During the laparoscopic extirpation of endo- ous ovulation rates [6,7], with the ovulation rate metriotic ovarian cysts via the stripping technique, inversely proportional to the number of endo- over 50% of cases result in unintentional removal of metriotic ovarian cysts [7]. Importantly, these healthy ovarian parenchyma [19]. The amount of studies had a small sample size and involved ovarian tissue removed is directly proportional to patient monitoring for only a few ovulatory cycles. the endometrioma size [20]. This frequently leads to Leone Roberti Maggiore et al. [8] recently investi- follicle pool loss, mostly during hilar dissection, in gated a large prospective cohort, analysing over which primary and secondary follicles have been 1000 menstrual cycles. They reported similar ovu- observed in 85% of the specimens [21,22]. It remains latoryratesamongaffectedovariesregardlessof unclear whether these follicles are fully functional, the number and size of endometriomas. They also and if their capacity to grow is preserved in such a observed a high spontaneous pregnancy rate dur- fibrotic area. ing the follow-up period [8]. Thus, it is reasonable Investigations have shown no benefit of preop- to assume that ovulatory function is preserved in erative medical treatment compared with surgery cases of ovarian endometrioma. alone [23]. Moreover, presurgical medical therapy Accumulating evidence suggests that ovarian carries an independent risk of removing normal endometrioma alone may directly undermine ovar- ovarian tissue [24]. This risk is related to the sur- ian reserve. Prior to surgery, women with ovarian geon’s experience; however, even experienced spe- endometrioma show diminished serum anti- cialists cannot guarantee that ovarian reserve will Mullerian€ hormone (AMH) levels and antral follicle not be harmed [25,26]. count (AFC) compared with healthy counterparts, Regarding surgical technique, excisional therapy patients with tubal factor infertility, or patients with is preferred over drainage and ablation. Excisional other benign ovarian cysts [9,10]. Similarly, reduced therapy is superior in terms of lower rates of recur- AFC has been reported in endometrioma-contain- rence of both endometrioma and pain symptoms, as ing ovaries compared with the contralateral unaf- well as increased subsequent spontaneous pregnancy fected ovaries [11]. Conversely, Nieweglowska et al. rate [18]. At this time, we believe that conservative [12] reported that AMH levels were significantly laparoscopic excision is the best option for patients lower than normal only in cases of bilateral ovarian having a precise indication for surgery. Notably, a endometrioma, although a moderate effect was systematic review and meta-analysis by Deckers et al. observed in unilateral ovarian endometriosis. [27&] suggested that nonthermal haemostasis may 2 www.co-obgyn.com Volume 30 Number 00 Month 2018 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. CE: Swati; GCO/300411; Total nos of Pages: 6; GCO 300411 Endometrioma, fertility, and assisted reproductive treatments Cecchino and Garcı´a-Velasco minimize ovarian reserve damage, which is especially bilateral endometriomas, reduced preoperative relevant for couples with reproductive goals. Further AMH levels, and presence of normal ovarian tissue studies are needed to evaluate alternative haemo- in surgical specimen. It can also be presumed that static methods. repeated surgeries for recurrent endometriomas will In
Load more

Recommended publications
  • Do Endometriomas Grow During Ovarian Stimulation for Assisted Reproduction? a Three-Dimensional Volume Analysis Before and After Ovarian Stimulation
    Accepted Manuscript Title: Do endometriomas grow during ovarian stimulation for assisted reproduction? a three-dimensional volume analysis before and after ovarian stimulation Author: Ayse Seyhan, Bulent Urman, Engin Turkgeldi, Baris Ata PII: S1472-6483(17)30610-7 DOI: https://doi.org/10.1016/j.rbmo.2017.10.108 Reference: RBMO 1842 To appear in: Reproductive BioMedicine Online Received date: 8-7-2017 Revised date: 18-10-2017 Accepted date: 20-10-2017 Please cite this article as: Ayse Seyhan, Bulent Urman, Engin Turkgeldi, Baris Ata, Do endometriomas grow during ovarian stimulation for assisted reproduction? a three-dimensional volume analysis before and after ovarian stimulation, Reproductive BioMedicine Online (2017), https://doi.org/10.1016/j.rbmo.2017.10.108. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Short title: Endometrioma volume in IVF Do endometriomas grow during ovarian stimulation for assisted reproduction? A three-dimensional volume analysis before and after ovarian stimulation Ayse Seyhan,a Bulent Urman,a,b Engin Turkgeldi,c Baris Ata,b,* aAssisted Reproduction Unit of the American Hospital of Istanbul, Istanbul, Turkey b Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Comment [MD1]: Author: please provide full Turkey postal addresses for addresses a and b.
    [Show full text]
  • Management of Endometriosis
    Chapter 10 Management of Endometriosis Sajal Gupta , Avi Harlev , Ashok Agarwal , Mitali Rakhit , Julia Ellis-Kahana , and Sneha Parikh Treatment of endometriosis is broadly classifi ed into pharmacological and surgical methods. Because the etiology of the disease is not well established, none of the currently available treatments can prevent or cure endometriosis. Rather, treatment is aimed mainly at providing symptom relief or improving fertility rates [ 1 ]. Therefore, one should consider how treatment options affect pain levels and infertility when investigating whether endometriosis treatment improves quality of life. Medical therapy is usually started as an empirical treatment, mainly proposed as a temporary aid for pain management [ 2 ]. The effect of pharmacological treatment on fertility is minimal. The surgical approach aims to address both pain and fertility. Surgical treatment is the treatment of choice for ovarian endometriomas, mostly due to the ineffectiveness of pharmacological therapy in these cases. Nevertheless, ovar- ian surgery reduces the ovarian reserve and its long-term implications are not yet well-known [ 3 , 4 ]. 10.1 Pharmacological Treatment Several pharmacological agents including oral contraceptives, danazol, GnRH ago- nists, progestogens, anti-progestogens, non-steroidal anti-infl ammatory agents and aromatase inhibitors have been used to treat endometriosis [ 5 ]. In many cases, chronic pelvic pain, a major endometriosis symptom, is the reason for the initiation of empirical treatment even before endometriosis is diagnosed [ 2 ]. The following section will summarize the pharmacological treatments for endometriosis. © The Author(s) 2015 95 S. Gupta et al., Endometriosis: A Comprehensive Update, SpringerBriefs in Reproductive Biology, DOI 10.1007/978-3-319-18308-4_10 96 10 Management of Endometriosis 10.1.1 Hormonal Therapies 10.1.1.1 Oral Contraceptives Combined estrogen-progestogen contraceptive pills are commonly used to control endometriosis-related pelvic pain and dysmenorrhea [ 6 ].
    [Show full text]
  • Hyperactivation of Dormant Primordial Follicles in Ovarian Endometrioma Patients
    160 6 REPRODUCTIONREVIEW Hyperactivation of dormant primordial follicles in ovarian endometrioma patients Sachiko Matsuzaki1,2 and Michael W Pankhurst3 1CHU Clermont-Ferrand, Service de Chirurgie Gynécologique, Clermont-Ferrand, France, 2Université Clermont Auvergne, Institut Pascal, UMR6602, CNRS/UCA/SIGMA, Clermont-Ferrand, France and 3Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand Correspondence should be addressed to S Matsuzaki; Email: [email protected] Abstract Serum anti-Müllerian hormone (AMH) levels decrease after surgical treatment of ovarian endometrioma. This is the main reason that surgery for ovarian endometrioma endometriosis is not recommended before in vitro fertilization, unless the patient has severe pain or suspected malignant cysts. Furthermore, it has been suggested that ovarian endometrioma itself damages ovarian reserve. This raises two important challenges: (1) determining how to prevent surgical damage to the ovarian reserve in women with ovarian endometrioma and severe pain requiring surgical treatment and (2) deciding the best treatment for women with ovarian endometrioma without pain, who do not wish to conceive immediately. The mechanisms underlying the decline in ovarian reserve are potentially induced by both ovarian endometrioma and surgical injury but the relative contribution of each process has not been determined. Data obtained from various animal models and human studies suggest that hyperactivation of dormant primordial follicles caused by the local microenvironment of ovarian endometrioma (mechanical and/or chemical cues) is the main factor responsible for the decreased primordial follicle numbers in women with ovarian endometrioma. However, surgical injury also induces hyperactivation of dormant primordial follicles, which may further reduce ovarian reserve after removal of the endometriosis.
    [Show full text]
  • Gynecologic Adenomyosis and Endometriosis: Key Imaging Findings, Mimics, and Complications Saro B
    Volume 38 • Number 7 March 31, 2015 Gynecologic Adenomyosis and Endometriosis: Key Imaging Findings, Mimics, and Complications Saro B. Manoukian, MD, Nicholas H. Shaheen, MD, and Daniel J. Kowal, MD After participating in this activity, the diagnostic radiologist should be better able to utilize ultrasound and MR imaging to help differentiate between gynecologic adenomyosis and endometriosis given their divergent management despite their signifi cant overlap in symptoms. Adenomyosis of the Uterus CME Category: Women’s Imaging Subcategory: Genitourinary Adenomyosis of the uterus represents heterotopic endome- Modality: MRI trial glands and stroma in the myometrium with adjacent smooth muscle hypertrophy. The pathogenesis of uterine adenomyosis involves endometrial migration via a basement Key words: Adenomyosis, Endometriosis, Ovarian membrane defect or through lymphatic or vascular channels.1 Endo metrioma Women age 40 to 50 years usually are affected. Although patients with uterine adenomyosis are usually asymptomatic, Adenomyosis and endometriosis are gynecologic processes symptoms may include pelvic pain, menorrhagia, and dys- with characteristic pathophysiologic, clinical, and imaging menorrhea. Risk factors for uterine adenomyosis include prior differences. Although adenomyosis refers to the presence of uterine trauma or surgery, multiparity, and hyperestrogene- heterotopic endometrial glands and stroma within the myo- mia. Imaging is important because superfi cial uterine adeno- metrium, endometriosis involves the presence of endometrial
    [Show full text]
  • Pregnancy Outcomes After Endometrioma Excision in Patients Undergoing in Vitro Fertilization and Embryo Transfer: a Historical Cohort Study
    JOURNAL OF GYNECOLOGIC SURGERY Volume 31, Number 4, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/gyn.2015.0013 Pregnancy Outcomes After Endometrioma Excision in Patients Undergoing In Vitro Fertilization and Embryo Transfer: A Historical Cohort Study Rubin Raju, MD,1 Komal Agarwal, MD,1 Omar Abuzeid, MD,2 Salem Joseph, BS,2 Mohammed Ashraf, MD,1–3 and Mostafa I. Abuzeid, MD1–3 Abstract Objective: The objective of the study was to examine the effect of endometrioma excision on pregnancy outcomes in women with advanced-stage endometriosis who underwent in vitro fertilization and embryo transfer (IVF-ET). Design: This is a historical cohort study. Materials and Methods: We compared the pregnancy outcomes of 141 women undergoing IVF-ET. The study group consisted of 25 patients who had stage III/IV endometriosis and endometrioma excision (group 1). The control groups included 40 patients who had stage III/ IV endometriosis, but no endometrioma and who underwent ovariolysis (group 2) and 76 patients with tubal factors infertility who underwent tubal surgery (group 3). After surgery up to two IVF-ET cycles in each group were analyzed. Results: Our study showed that the mean total dose of gonadotropin administered in IVF-ET cycle I was higher in group 1 compared with groups 2 and 3 ( p = 0.03). Otherwise, there was no significant difference in the ovarian responses among the three groups. There was a statistically significant increase in clinical pregnancy rate per cycle in the endometrioma group (69.7%) versus the ovariolysis group (48.1%) and tubal factor group (48.0%).
    [Show full text]
  • Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility
    Journal of Clinical Medicine Article Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility Dean Decter 1 , Nissim Arbib 1,2, Hila Markovitz 1,3, Daniel S. Seidman 1,3 and Vered H. Eisenberg 1,3,* 1 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; [email protected] (D.D.); [email protected] (N.A.); [email protected] (H.M.); [email protected] (D.S.S.) 2 Meir Medical Center, Department of Obstetrics and Gynecology, Kfar Saba 4428164, Israel 3 Sheba Medical Center, Endometriosis Center, Department of Obstetrics and Gynecology, Ramat Gan 5262100, Israel * Correspondence: [email protected]; Tel.: +972-52-6668254 Abstract: We compared the prevalence of ultrasound signs of adenomyosis in women with en- dometriosis who underwent surgery to those who were managed conservatively. This was a ret- rospective study of women evaluated at a tertiary endometriosis referral center who underwent 2D/3D transvaginal ultrasound. Adenomyosis diagnosis was based on the presence of at least three sonographic signs. The study group subsequently underwent laparoscopic surgery while the control group continued conservative management. Statistical analysis compared the two groups for demo- graphics, symptoms, clinical data, and sonographic findings. The study and control groups included 244 and 158 women, respectively. The presence of any, 3+, or 5+ sonographic signs of adenomyosis was significantly more prevalent in the study group (OR = 1.93–2.7, p < 0.004, 95% CI; 1.24–4.09). After controlling for age, for all findings but linear striations, the OR for having a specific feature was ≥ Citation: Decter, D.; Arbib, N.; higher in the study group.
    [Show full text]
  • Differential Diagnosis of Endometriosis by Ultrasound
    diagnostics Review Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge Marco Scioscia 1 , Bruna A. Virgilio 1, Antonio Simone Laganà 2,* , Tommaso Bernardini 1, Nicola Fattizzi 1, Manuela Neri 3,4 and Stefano Guerriero 3,4 1 Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; [email protected] (M.S.); [email protected] (B.A.V.); [email protected] (T.B.); [email protected] (N.F.) 2 Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, VA, Italy 3 Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; [email protected] (M.N.); [email protected] (S.G.) 4 Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy * Correspondence: [email protected] Received: 6 October 2020; Accepted: 15 October 2020; Published: 20 October 2020 Abstract: Ultrasound is an effective tool to detect and characterize endometriosis lesions. Variances in endometriosis lesions’ appearance and distorted anatomy secondary to adhesions and fibrosis present as major difficulties during the complete sonographic evaluation of pelvic endometriosis. Currently, differential diagnosis of endometriosis to distinguish it from other diseases represents the hardest challenge and affects subsequent treatment. Several gynecological and non-gynecological conditions can mimic deep-infiltrating endometriosis. For example, abdominopelvic endometriosis may present as atypical lesions by ultrasound. Here, we present an overview of benign and malignant diseases that may resemble endometriosis of the internal genitalia, bowels, bladder, ureter, peritoneum, retroperitoneum, as well as less common locations. An accurate diagnosis of endometriosis has significant clinical impact and is important for appropriate treatment.
    [Show full text]
  • Ovarian Endometrioma
    Review Review Ovarian endometrioma: Expert Review of Obstetrics & Gynecology guidelines for selection of © 2013 Expert Reviews Ltd cases for surgical treatment 10.1586/EOG.12.75 or expectant management 1747-4108 Expert Rev. Obstet. Gynecol. 8(1), 29–55 (2013) 1747-4116 Molly Carnahan, Ovarian endometrioma is a benign, estrogen-dependent cyst found in women of reproductive Jennifer Fedor, age. Infertility is associated with ovarian endometriomas; although the exact cause is unknown, Ashok Agarwal and oocyte quantity and quality are thought to be affected. The present research aims to analyze Sajal Gupta* current treatment options for women with ovarian endometriomas, discuss the role of fertility preservation before surgical intervention in women with ovarian endometriomas and present Center for Reproductive Medicine, guidelines for the selection of cases for surgery or expectant management. This review analyzed Glickman Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, the factors of ovarian reserve, cyst laterality, size and location, patient age and prior surgical Desk A19, Cleveland, OH 44195, USA procedures. Based on these factors, the authors recommend three distinct treatment pathways: *Author for correspondence: reproductive surgery to achieve spontaneous pregnancy following treatment, reproductive Tel.: +1 216 444 8182 surgery to enhance IVF outcomes and expectant management with IVF. Fax: +1 216 445 6049 [email protected] KEYWORDS: endometriosis • expectant management • fertility preservation • in vitro fertilization • laparoscopic surgery • ovarian endometrioma • ovarian reserve • stimulation protocols Endometriosis is a benign, estrogen-dependent Cause of ovarian endometrioma gynecological disease characterized by endome- Ovarian endometrioma, a subtype of endo- trial tissue located outside the uterus. The disease metriosis, affects 17–44% of women with endo- affects approximately 5–10% of women of repro- metriosis [4,5].
    [Show full text]
  • Giant Abdominal Wall Endometrioma: a Case Report
    Open Access Case Report DOI: 10.7759/cureus.12766 Giant Abdominal Wall Endometrioma: A Case Report Batool M. Alsamahiji 1 , Mohammed A. Albaqshi 1 , Areej J. Alolayan 2 , Hassan A. Alzayer 2 , Mohammad A. Alalwan 1 , Hind M. Faqeeh 3 , Fatimah A. Al Zaher 3 , Afnan M. Maashi 3 , Ammar A. Aljeshi 4 1. College of Medicine, King Fahd Hospital of the University, Al-Khobar, SAU 2. College of Medicine, Medical University of Warsaw, Warsaw, POL 3. College of Medicine, Jazan University, Jazan, SAU 4. College of Medicine, Arabian Gulf University, Manama, BHR Corresponding author: Fatimah A. Al Zaher, [email protected] Abstract Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. Endometriosis may involve a wide spectrum of anatomic locations, but it typically involves pelvic locations. We report the case of a 45-year-old woman who presented with a history of abdominal pain and swelling. She first noticed the swelling eight months prior to presentation, and it had gradually progressed in size. The patient reported that the swelling increased in size during menses. Physical examination revealed a well-defined firm mass to the right of the midline. The mass had a smooth surface but limited mobility after abdominal wall muscle contraction, suggesting an infiltration of the underlying muscular structures. The findings demonstrated by computed tomography of the abdomen confirmed the diagnosis of abdominal wall endometrioma. The patient underwent successful resection of the lesion with complete resolution of her symptoms. Categories: Obstetrics/Gynecology Keywords: endometrioma, abdominal pain, cesarean section Introduction Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity.
    [Show full text]
  • Pelvic Endometriosis in a Patient with Primary Amenorrhea
    Pelvic Endometriosis in a Patient with Primary Amenorrhea Tavasoli, Fatemeh (M.D.)1; Hafizi, Leili (M.D.)1*; Aalami, Mahboobeh (B.Sc.)2 1. Department of Obstetrics and Gynecology, Faculty of Medicine, Mashad University of Medical Sciences, Mashad, Iran. 2. Department of Midwifery, Faculty of Nursing and Midwifery, Mashad University of Medical Sciences, Mashad, Iran. Abstract Introduction: Endometriosis is a disease defined by extra-uterine extension of endometrial glands and stroma. It usually occurs in women of reproductive age and in dependent sites of the pelvis. Theoretically, it is believed that the ectopic implantation of endometrial tissue occurs following retrograde menstruation. However, as the disease has rarely been seen in men, prepubertal girls or in unusual sites of body, other theories like coelomic metaplasia have been suggested. However, the very low prevalence rates of such cases have prevented those theories of being fully accepted. This is a case report of pelvic endometriosis in a patient with primary amenorrhea, presented as a proof for coelomic metaplasia or induction theory. Case Presentation: A 19-year old virgin girl was referred to Imam Reza Hospital in Mashad with complaints of primary amenorrhea and an abdominal mass. She had not experienced menstrual bleeding upon receiving a combination of estrogen and progesterone. Her past medical history Downloaded from http://www.jri.ir was not noticeable except for the operation she had underwent for intestinal tuberculosis 10 years earlier, which could explain the reason for her amenorrhea. She had a normal pattern of sexual hair growth, breast development and external genitalia on examination. She also had a large pelvic mass at the level of umbilicus, which had caused compression of both ureters as demonstrated by an intravenous pyelogram (IVP).
    [Show full text]
  • Effect of Endometrioma and Its Surgical Excision on Fertility (Review)
    EXPERIMENTAL AND THERAPEUTIC MEDICINE 20: 114, 2020 Effect of endometrioma and its surgical excision on fertility (Review) DANNI JIANG1 and XIAOCUI NIE2 1Graduate School, Dalian Medical University, Dalian, Liaoning 116044; 2Department of Gynecology, Shenyang Women's and Children's Hospital, Shenyang, Liaoning 110011, P.R. China Received February 11, 2020; Accepted July 31, 2020 DOI: 10.3892/etm.2020.9242 Abstract. Endometrioma is the cystic lesion of ovaries origi‑ 6. Treatment of endometrioma for improving fertility nating from endometrial glands and stroma; it is identified in 7. Conclusions 17‑44% of patients with endometriosis. Numerous existing studies have reported the association between endometrioma and infertility. However, an absolute cause‑effect association 1. Introduction requires further confirmation. Available evidence has suggested that ovarian reserve may be impaired by spatial occupation Ovarian endometrioma (OMA) is a clinical phenotype influences, local reaction or both, affecting the reproductive affecting 17‑44% of females with endometriosis (1). Although health of females. Given the increased focus on the pathophys‑ the underlying pathogenesis of OMA remains to be elucidated, iological mechanisms of endometrioma, surgical excision has three major theories were developed to expound the origin of commonly been considered to avoid further ovarian damage. endometriomas. According to Hughesdon, endometriomas However, the potential adverse effect of this surgery on the are pseudocysts that accumulate from menstrual debris by ovarian reserve has recently become a focal point. Whether bleeding from active implants located at the site of inver‑ or not surgical excision can facilitate subsequent conception sion (2). Nisolle and Donnez proposed an additional theoretical in young females planning to be pregnant is controversial.
    [Show full text]
  • Impact of Ovarian Endometrioma on Assisted Reproduction Outcomes
    RBMOnline - Vol 13 No 3. 2006 349–360 Reproductive BioMedicine Online; www.rbmonline.com/Article/2320 on web 12 June 2006 Article Impact of ovarian endometrioma on assisted reproduction outcomes Dr Gupta is a Fellow in Obstetrics, Gynecology and Andrology at the Reproductive Research Center, Cleveland Clinic Foundation, Cleveland, USA. She graduated from the Lady Hardinge Medical College, New Delhi, India and in 1992 completed a residency in Obstetrics and Gynecology at the University of Delhi. From 1996 to 2001 she was a faculty member in the Department of Reproductive Endocrinology and Infertility at the National Institute of Health and Family Welfare, Delhi, India. Her current research interests include studies on the role of oxidants and antioxidants in the pathophysiology of female reproduction, cryopreservation of gametes and assisted reproduction. Dr Sajal Gupta Sajal Gupta1,3, Ashok Agarwal1, Rishi Agarwal1, J Ricardo Loret de Mola2 1Reproductive Research Centre, Glickman Urological Institute and the Department of Obstetrics–Gynecology, Cleveland Clinic Foundation; 2Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, MacDonald Women’s Hospital, University Hospitals, Cleveland, OH, USA 3Correspondence: Tel: +1 216 4449485; Fax: +1 216 4456049; e-mail: [email protected] Abstract The effects of ovarian endometrioma on fertility outcomes with IVF and embryo transfer have been causally related to poor outcomes. The objective of this meta-analysis was to evaluate the ovarian reserve and ovarian responsiveness to ovarian stimulation and assisted reproduction outcomes in patients with ovarian endometrioma. The odds for clinical pregnancy were not affected signifi cantly in patients with ovarian endometrioma compared with controls, with an overall odds ratio of 1.07 from three studies [95% CI: (0.63, 1.81), P = 0.79].
    [Show full text]