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Endometrio sis Update ( Infertility )

Endometrio sis Update ( Infertility ). www.endometriozisdernegi.com. Dr.Engin Oral Cerrahpaşa Medical Faculty Department of Obstet & Gynecology Div of Reproductive Endocrinology. Pathophysiology of Pain and Infertility Associated with Endometriosis. Linda C. Giudice , 2010.

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Endometrio sis Update ( Infertility )

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  1. Endometriosis Update(Infertility) www.endometriozisdernegi.com Dr.Engin Oral Cerrahpaşa Medical Faculty Department of Obstet & Gynecology Div of Reproductive Endocrinology

  2. Pathophysiology of Pain and Infertility Associated with Endometriosis. Linda C. Giudice, 2010

  3. Effects of endometriosis on human reproduction Dominique de Ziegler,, 2010

  4. Soru • Hangisiendometriozis sıklığını azaltır • Müller anomalisi • Eksersiz • Kızıl saç • Alkol/kafein • Düşük doğum ağırlığı

  5. BRANDI S. MCLEOD, and MATTHEW G. RETZLOFF, 2010

  6. 2009

  7. Endometriosis-associated infertility: a decade’s trend study of womenfrom the Estrie Region of Quebec, Canada N: 6845 KRYSTEL PARIS & AZIZ ARIS, 2010

  8. Eijkemans et al., 2008

  9. Cumulative conception rates with untreated endometriosisrelated to disease grading, compared with normal conception rate N Minor Moderate Severe Kevin D. Jones, 2002

  10. Fertility in women with minimal endometriosis comparedwith normal women was assessed by means of a donorinsemination program in unstimulated cycles N: 51 N: 24 Roberto Matorras 2010

  11. Success in intrauterine insemination: the role of etiology • A total of 1,171 cyclesamong 532 infertile couples were retrospectively studied and the impact of different prognostic factors on pregnancy rate infive different etiology subgroups was analyzed. • Results. The pregnancy rate/cycle was highest (19.2%) among women withanovulatory infertility and lowest (11.9%) in endometriosis based infertility. KatjaAhinko-Hakamaa2007

  12. KOH + IUI • İleri evre endometrioziste KOH+IUI ‘ın etkinliğini gösteren RCT mevcut değil • KOH+IUI maksimum 3-4 siklusla sınırlanmalı (ESHRE Guidelines, Recommedationgrade A ,evidencelevel 1b)

  13. 2009 To develop a clinical tool that predicts pregnancy rates (PRs) in patients with surgically documented endometriosis who attempt non-IVF conception.

  14. Decreased anti-Mullerian hormone and altered ovarianfollicular cohort in infertile patients with mild/minimalendometriosis p:0.004 N:17 N:17 EE CC NadianeAlbuquerqueLemos, 2009

  15. Anti mullerian hormone serum levels in women with endometriosis:A case–controlstudy • 909 patients undergoing in vitro fertilisation/intracytoplasmic sperm injection(IVF/ICSI) treatment or consulting our specific endometriosis unit. • Mean AMH serum level was significantly lower in the study than in the control group (2.75+2.0 ng/ml vs.3.46+2.30 ng/ml, p0.001). • In women with mild endometriosis (rAFS I-II), the mean AMH level was almost equal to thecontrol group (3.28+1.93 ng/ml vs. 3.44+2.06 ng/ml; p0.61). • A significant difference in mean AMH serum level wasfound between women with severe endometriosis (rAFS III-IV) and the control group (2.38+1.83 ng/ml vs. 3.58+2.46 ng/ml; p 0.0001). OMAR SHEBL, 2009

  16. Effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization Benny Almog, 2010

  17. Soru • Endometriozise bağlı infertilitede cerrahi tedavi sonrası spontan gebelik şansı ne kadardır? (tüm evrelerde ve ilk 1 yıl içinde) • 10 • 25 • 50 • 70 • 90

  18. A comparison of histopathologic findings of ovariantissue inadvertently excised with endometrioma andother kinds of benign ovarian cyst in patientsundergoinglaparoscopyversuslaparotomy SaeedAlborzi, 2009

  19. Excision of endometriotic cyst wall may cause lossof functional ovarian tissue N:46 Umut Dilek, 2006

  20. The impact of electrocoagulation on ovarian reserveafter laparoscopic excision of ovarian cysts:a prospective clinical study of 191 patients • 191 patients with benign ovarian cysts undergoing ovarian cystectomy. • When comparing the bipolar group and ultrasonic scalpel group with the suture group, a statisticallysignificant increase of the mean FSH value was found in bilateral-cyst patients at 1-, 3-, 6-, and 12-month follow-up evaluations and in unilateral-cyst patients at the 1-month follow-up evaluation. • Statistically significant decreasesof basal antral follicle number and mean ovarian diameter were found during the 3-, 6-, 12-month follow-upevaluations as well as statistically significant decreases of peak systolic velocity at all of the follow-up evaluations. • Conclusion(s): Electrocoagulation after laparoscopic excision of ovarian cysts is associated with a statistically significantreduction in ovarian reserve, which is partly a consequence of the damage to the ovarian vascular system. Chang-ZhongLi, 2009

  21. Analysis of risk factors for the removalof normal ovarian tissue duringlaparoscopiccystectomyforovarianendometriosis • A total of 121 patients who had histologically confirmed ovarian endometriosis and 56 control patients who had other histologicallyconfirmed benign cysts were included • Normal ovarian tissue adjacent to the cyst wall was detected in 71 patients (58.7%) with endometriosis, whereas normalovarian tissue was removed from only three patients (5.4%) with other benign cysts. • A significant factor that was independently associatedwith the removal of normal ovarian tissue with ovarian endometriosis was pre-operative medical treatment SachikoMatsuzaki1,2009

  22. IVF-ICSI outcome in womenoperated on forbilateralendometriomas. • 68 cases (bilat. cystectomy)- 136 controls • the number of follicles (P = 0.006), oocytes retrieved (P = 0.024) and embryos obtained (P = 0.024) were significantly lower. • The clinical pregnancy rate per started cycle in cases and controls was 7% and 19% (P = 0.037) • CONCLUSIONS: IVF outcome is significantly impaired in women operated on for bilateral ovarian endometriomas. EdgardoSomigliana1, 2008

  23. P¨ aiviH¨arkki, 2010

  24. Results of studies comparing IVF-ET with second-line surgery in infertile women with recurrent moderate to severe endometriosis P. Vercellini , 2009

  25. Tekrarlayan Endometriozis ve İnfertilite;Cerrahi Primer cerrahi sonrası spontan gebelik 236/577 (% 41) Sekonder cerrahi sonrası spontan gebelik 28/124 (% 23)

  26. Tekrarlayan Endometriozis ve İnfertilite;Cerrahi Laparotomiile yapılan cerrahi sonrası spontan gebelik % 12 – 47 (%27) Laparoskopi ile yapılan cerrahi sonrası spontan gebelik % 22 - 42 (%25)

  27. Endometrioma and IVF GPP http://guidelines.endometriosis.org

  28. Endometriosis-associatedinfertility: surgeryandIVF, a comprehensive therapeutic approach 825 patients Pedro N Barri, 2010

  29. DoesControlledOvarianHyperstimulationin Women with a History of EndometriosisInfluenceRecurrence Rate? • retrospective cohort study of 592 patients submitted to laparoscopy for endometriosis, 177 withinfertility-related endometriosis who underwent a periodic ultrasound follow-up after laparoscopy were selected. • Women who started ART after laparoscopy (n90) were compared with the control group, who did notundergo ART (n87). • Recurrence of endometriosis was defined as the presence of endometriotic lesions observedthroughTV-US. • During a long-term TV-US follow-up (1–15 years), 40 (22.6%) recurrences were observed. • Patientssubmitted to ART showed a cumulative recurrence rate similar to that of the control group (28.6% and 37.9% • respectively, p0.471). Maria ElisabettaCoccia, 2010

  30. Soru • SART sonuclarına göre endometriozisli olgularda canlı doğum oranları nedir ? (2005-2007) • 18-22 • 25-28 • 32-34 • 38-41 • 45-47

  31. SART-2005

  32. SART-2006

  33. SART-2007

  34. Algorithm for management of infertility associated with endometriosis Dominique de Ziegler,, 2010

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