Reproductive outcome in women with ovarian endometriosis retrospective analytical study Ppt Powerpoint Presentation slides Eduard Kucera, PhD, MD Medical Slideshow Retrospective Studies of Clinical Outcomes A Primer for Clinicians

Reproductive outcome in women with ovarian endometriosis retrospective analytical study

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Slide 1 :

Reproductive outcome in women with ovarian endometriosis - retrospective analytical study Kucera,E.1,2,3, Herman, H. 1,2 1. Institute for the Care of Mother and Child, Prague Czech republic 2. Institute for Postgraduate Medical Education , Prague Czech republic 3. Third Faculty of Medicine, Charles University, Prague, Czech republic

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Institute for the Care of Mother and Child Obstet.Gynecol. Dep. Prague, Czech republic

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ESHRE workshop 2006 in our dep. together with R. Campo, S. Chordts and others

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Ovarian endometrioma and infertility Origin and evolution of endometrioma - controversial Influence of endometrioma on fertility - controversial Therapy of endometrioma – the debate still open Reproductive outcome in women with ovarian endometriosis-retrospective analytical study

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Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Ovarian endometrioma and infertility

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Magnification (= 1 cm 10x) Less trauma Haemosthasis Abnormal tissue resection No ischaemia Irrigation Primum nihil nocere ! Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Principles of endoscopic surgery ( Canis 2001 )

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Endometrioma therapy - strategy Ovarian tissue sparing surgery Involvement of ovarian fossa with endometriotic leasions – resection of all leasions Current controversies during surgery: – adhaesion formation after surgery ? – reduction of follicules and ovarian volume after surgery – treat every endometrioma? – IVF first? Reproductive outcome in women with ovarian endometriosis-retrospective analytical study

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Ovarian endometrioma and infertility Reproductive outcome in women with ovarian endometriosis-retrospective analytical study

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Punction and drainage Destruction ( ablation ) of the lining Two – step surgery Surgical stripping with endometrial wall extirpation Endometrioma – different therapy&surgery Reproductive outcome in women with ovarian endometriosis-retrospective analytical study High recurrence

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Characteristics of the study group - results 2001 - 2004 115 cases with an endometrioma Retrospective study - questionary 70 infertile patients Average age 30,5 Reproductive outcome after laparoscopic surgery for ovarian endometriosis 2001 -2003 Reproductive outcome in women with ovarian endometriosis-retrospective analytical study

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Detachment from ovarian fossa EMO resection – tissue sparing Ovariopexis – temporary – permanent Resection of all endometriotic laesions – peritoneal cavity – pelvic side wall dissection – ureter - preparation Endometrioma – surgical therapy Reproductive outcome in women with ovarian endometriosis-retrospective analytical study

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Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Infertility patients No data Fertility not desired Endometrioma – study group of n =115 patients

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Results - characteristics 70 infertile patients operated during 2001 - 2004 Retrospective study - questionary Average age of all patients 30,5 y.( 22 – 39 ) Average size of endometrioma 5 cm ( 2 – 15 cm ) Resection of all visible leasions mandatory No pharmacological pretreatment Reproductive outcome after laparoscopic surgery for ovarian endometriosis 2001 -2003 Reproductive outcome in women with ovarian endometriosis-retrospective analytical study

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Retrospective study 2001 -2004 - materisals & methods Laparoscopic stripping in all cases Low wattage during bipolar coagulation Suture of the ovary in only few selected cases Laparoscopic ovariopexis temporary or permanent Laparoscopic pelvic side wall dissection if necessary Irrigation with Ringer lactate 500 ccm + 2500 units heparine sulphate after surgery Reproductive outcome in women with ovarian endometriosis-retrospective analytical study

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Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Laparoscopic stripping - I

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Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Laparoscopic stripping - II Identification of cleavage plane

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Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Laparoscopic stripping - III Low power coagulation

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Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Endometrioma – pelvic side wall dissection Laparoscopic ovariopexy

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Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Endometrioma – pelvic side wall dissection with ovariopexy and exstirpation of all endometrial focci

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Results - analysis Reproductive outcome in women with ovarian endometriosis-retrospective analytical study

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High pregnancy rate in study group – 55,7% High spontaneous conception rate in study group – 71,8% Endometrioma size, uni- or bilateral ovarian involvement and pregnancy ( NS ) Patients > 35 years – higher incidence of IVF vs. spont. conception P<0,05 Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Conclusions – part I

Slide 22 :

Conclusions – part II Reproductive outcome after laparoscopic surgery for ovarian endometriosis 2001 -2003 Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Increasing frequency of endometriosis Increasing frequency of ovarian endometriosis Surgery – the gold standard Ovarian tissue sparing surgery Ability to dissect retroperitoneal structures

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Reproductive outcome in women with ovarian endometriosis-retrospective analytical study Results – published data

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References - I 1. Adamson,G.D.,Nelson,H.P.:Surgical treatment of endometriosis. Obstet.Gynecol.Clin.North Am.,24,1997,375-409. 2.Bateman,B.G.,Kolp,L.A.,Mills,S.:Endoscopic versus laparotomy management of endometriomas.Fertil.Steril., 62,1994,690-695. 3.Beretta,P.,Franchi,M.,Ghezzi,F. et al.:Randomised clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil.Steril.,70,1998,1176-1180. 4.Busacca, M., Vignali,M.: Ovarian endometriosis: from pathogenesis to surgical treatment. Curr.Opin.Obstet.Gynecol.,15, 2003,321-326. 5.Busacca, M.,Marana,R. ,Caruana,P. et al.: Recurrence of ovarian endometrioma after laparoscopic excision. Am.J.Obstet.Gynecol.,180,1999,519-523. 6.Canis,M.,Mage,M.,Wattiez,A.et al.: Second-look laparoscopy after laparoscopic cystectomy of large ovarian endometriomas.Fertil.Steril.,58,1992,617-619. 7.Canis,M., Botchorishvili,S.,Tamburek,S. et al.: Adhesion prevention in the surgical treatment of pelvic endometriosis. Gynaec. Endoscopy,10,2001,99-106. 8.Canis,M., Mage,G.,Wattiez,A. et al.: The ovarian endometrioma: why is it so poorly managed? Laparoscopic treatment of large ovarian endometrioma : why such a long learning curve? Hum.Reprod.,18, 2003,5-7. 9.Daniell,J.F.,Kurtz,B.R.,Gurley,L.D.: Laser laparoscopic management of large endometriomas. Fertil.Steril.,55,1991,692-695. 10.Darwish,A.M., Amin,A.F.,AbdelAleem,M.A.,Youseff,M.A.: Laparoscopic management of benign adnexal masses: experience in a developing country. Gyn.Endoscopy,10,2001,159-165. 11.Donnez,J.,Nisolle,M., Gillet, M. et al.: Large ovarian endometriomas. Hum.Reprod., 11,1996,641-646. 12. Dover,R.W.,Torode,H.:Endometriomas : review of modern management. Gynaec. Endoscopy,9,2001,219-226. 13.Exacoustos,C.,Zupi,F., Amadio,A. et al.: Laparoscopic removal of endometriomas: sonographic evaluation of residual functioning ovarian tissue.Am.J.Obstet.Gynecol., 191,2004,68-72. 14.Fayez,J.A.,Vogel,M.F.:Comparison of different treatment methods of endometriomas by laparoscopy. Obstet.Gynecol.,78,1991,660-665. 15.Garcia-Velasco,J.A., Mahutte,N.G.,Corona,J. et al.: Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study. rates. Fertil.Steril.,81, 2004,1194-1197. 16.Gurgan,T.,Urman Hitler Yarali,H.:Adhesion formation and reformation after laparoscopic removal of ovarian endometriomas. J.Am.Assoc.Gynecol.Laparosc.,3,1996,389-392. 17.Hemmings,R.,Bissonnette,F.,Bouzayen,R.: Result of laparoscopic treatments of ovarian endometriomas: laparoscopic ovarian fenestration and coagulation. Fertil. Steril.,70,1998,527-529. 18. Jones,K.D.,Sutton,C.:Endometriotic ovarian cysts: the case for ablative laparoscopic surgery. Gynaec. Endoscopy, 10,2001,281-287.

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References - II 19.Jones,K.D.,Sutton,C.J.: The ovarian endometrioma: why is it so poorly managed? Indicators from anonymus survey. Hum.Reprod., 17, 2002, 845-849. 20.Kucera,E., Keckstein,J.,Turyna,R. et al.: Laparoscopic ovariopexy– modality of ovarian endometriosis treatment. Ces.Gynek., 69, 2004, 303-306. 21.Martin,D.C.,O´Conner,D.T.: Surgical management of endometriosis-associated pain. Obstet.Gynecol.Clin.North Am.,30,2003,151-162. 22.Maouris,P.,Brett,L.: Endometriotic ovaria cysts: the case for excisional laparoscopic surgery. Gynaec.Endoscopy,11,2002, 231-234. 23.Marconi,G.,Vilela,M.,Quintana,R., et al.: Laparoscopic ovarian cystectomy of endometriomas does not affect the ovarian response to gonadotropin stimulation. Fertil.Steril.,78,2002, 876-881. 24.Marrs,R.P.: The use of potassium-titanyl-phosphate laser for laparoscopic surgery in the treatment of ovarian endometrioma.Am.J.Obstet.Gynecol.,164,1991,1622-1628. 25.Montamino,G.,Porpora,M.G.,Montamino,M. et al.: Laproscopic treatment of ovarian endometrioma. One year follow-up. Clin.Exp.Obstet.Gynaec.,23,1996,70-72. 26.Muzzi,L.,Bianchi,A.,Croce,C. et al.: Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure?Fertil.Steril.,77,2002,609-614. 27.Musawi,D.A.,Thompson,J.N.: Adhesion prevention:state of the art.Gynaec.Endoscopy, 10,2001,123-130. 28.Somigliana,E., Ragni,G.,Benedetti,F. et al.: Does laparoscopic excision of endometriotic ovarian cysts significantly affect ovarian reserve? Insights from IVF cycles. Hum.Reprod., 18,2003,2450-2453. 29.Sutton, C.J.G.:Endometriosis. Infert.Reprod.Med.Clin. North Am.,6,1995,591-613. 30. Telles de Sousa,I.D., Reis, F.J.C.,Garcia, S.B. et al.: Adhesion formation after uterine horn resection in rabbit model: comparative study of laparoscopic procedure vs. laparotomy. Gynaec.Endoscopy, 11,2002,365-369. 31.Trehan,A.K.: Temporary ovarian suspension, Gynaec. Endoscopy,11,2002,309-314. 32. Wong,Y.M.,Amer,S.,Li, T.C.et al.: Laparoscopic management of ovarian cysts.Gynaec. Endoscopy,9,2000,79-90.

Slide 26 :

Thank You Reproductive outcome in women with ovarian endometriosis-retrospective analytical study ekucera@seznam.cz

	ekucera@seznam.cz 1 Years ago. Category: Research

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