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PubMed1990

Endometriosis 1990. Current treatment approaches.

Endometriosis is an extremely common gynaecological disease, affecting between 1 and 5% of women of reproductive age. Women with endometriosis typically present for medical care with one of more of the following problems: pelvic pain, infertility, or a large adnexal mass (an endometrioma). The primary treatment for an endometrioma is surgical. However, long term postoperative hormone therapy may be necessary to prevent new endometriomas from developing. There is no evidence that hormonal therapy of endometriosis will improve fecundability in women with endometriosis and infertility. Pelvic pain due to endometriosis can be successfully treated with hormonal agents in the majority of patients. Four basic hormonal regimens are currently available for the treatment of endometriosis: (a) danazol; (b) gonadotrophin-releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); gonadorelin] agonists; (c) progesterones (progestins); and (d) combined estrogens and progesterones. Randomised, controlled, clinical trials suggest that danazol and the GnRH agonists are equally effective in the treatment of endometriosis. However, the side effects caused by danazol and the GnRH agonists are markedly different. Danazol produces androgenic side effects including weight gain, hirsutism, acne, oily skin and deepening of the voice. GnRH agonists produce side effects due to hypoestrogenism, including hot flushes, osteoporosis and dry vagina. The ideal drug regimen for the treatment of endometriosis remains to be developed.

Endometriosis↗

PubMedDate not supplied

[Endometriosis and pain].

INTRODUCTION: The main symptoms of endometriosis are pain, adnexal tumor and infertility. Pelvic pain and dysmenorrhea are cardinal symptoms as well as pain upon defecation, suprapubic pain (dysuria), pain during coitus and during gynecologic examination. Pain can be caused by fibrotic reaction of the adjacent tissue, adhesions, prostaglandins produced both in endometrium inside the uterus and ectopic endometrium, and also by increased macrophages in the peritoneal fluid. MATERIAL AND METHODS: 500 infertile patients underwent the procedure of laparoscopy in order to determine the cause of infertility. The control group comprised 200 fertile women. The presence of pain in the small pelvis was compared in two groups of patients: with or without endometriosis. Correlation of pain with the stage of disease and location of endometriotic implants in the small pelvis has also been investigated. RESULTS: Endometriosis was diagnosed by laparoscopy in 26% of infertile and 5% of fertile women. The difference was statistically significant (p < 0.001). Dysmenorrhea was present in 46.92% of infertile women with endometriosis and in 48.68% of women without endometriosis. The difference was not statistically significant. Dysmenorrhea was present in 30% of fertile women and in realtion to infertile women, the difference was statistically significant (p < 0.05), no matter if they have endometriosis or not. In relation to stages of endometriosis (the revized classification of the American Fertility Society), there is no significant difference concerning dysmenorrhea. Dysmenorrhea occurred in the first stage in 48%, in the second stage in 44.19%, in the third stage in 50% and in the fourth stage in 44.44%. The correlation coefficient ranged from -8.85 to -0.89. The correlation existed, it was high, but negative. Sensitivity, specificity and prognostic value of symptoms of dysmenorrhea have been estimated in relation to endometriosis with following results: sensitivity was 47%, specificity 51% and the prognostic value i.e. the possibility of occurrence in patients with dysmenorrhea was 25%. Localization of endometriotic foci did not affect occurrence of pain symptoms.

Adult↗

PubMed1992

Histologic confirmation of endometriosis in different peritoneal lesions.

The aim of this study was to compare the macroscopic evaluation of peritoneal abnormalities suspected of endometriosis with the histologic examination of the tissue. Peritoneal biopsies from 152 patients investigated for gynecological problems (94) or undergoing tubal sterilization (58) were taken from macroscopically abnormal peritoneum, and examined for the presence of endometriosis. Endometriosis was histologically confirmed by the presence of both endometrioid glands and stroma. Endometriosis was confirmed in 78 of the patients (51%). If the diagnostic criteria were extended also to include endometrioid stroma lacking glands, but containing iron pigment and/or hemorrhage, 82 patients (54%) were positive for endometriosis. Endometriosis was histologically confirmed in 76% of pigmented lesions, in 57% of clear or red papules, in 12% of peritoneal pockets, and in 16% when only fibrosis or scarring was observed. Half of the samples with confirmed endometriosis exhibited cyclic activity. The reproducibility of the histologic evaluation was satisfactory. A high rate of negative biopsies emphasizes the need of taking biopsies from peritoneal lesions suspected of endometriosis for confirmation of the diagnosis.

Adolescent↗

PubMed1996

The prevalence of spontaneous endometriosis in the baboon (Papio anubis, Papio cynocephalus) increases with the duration of captivity.

BACKGROUND: It is not known whether stress affects the prevalence of endometriosis in women. Baboons with spontaneous endometriosis may be interesting models to study the human disease. For baboons, living in captivity is a period of chronic stress without continuous exposure to pregnancy. This study was done to compare the prevalence of endometriosis between baboons recently captured in the wild and those living in captivity for several years. METHODS: A diagnostic laparoscopy was performed for screening endometriosis and obtaining biopsies in 104 female baboons including animals that had been captured in the wild less than 1 year ago (n=52, Group I), primates that had been living in captivity for one to two years (n=30, Group II) and animals that had been captured for more than two years (n=22, Group III). RESULTS: The prevalence of clinical and biopsy-proven endometriosis in all baboons was 17% and 12%, respectively. Clinical endometriosis was found more frequently in group III (32%) than in group II (17%) or group I (11%). The prevalence of biopsy-proven endometriosis was also significantly higher in group III (27%) than in groups I and II combined (8%, p=0.03). CONCLUSIONS: The results indicate that the prevalence of endometriosis increases with the time spent in captivity. This trend may be explained by more menstrual cycles uninterrupted by pregnancy in captive than in wild baboons, and possibly also by age-related factors or by captivity-associated stress.

Age Factors↗

PubMed2004

[P450Arom and estrogenic microenvironment of eutopic endometria in endometriosis].

BACKGROUND: Endometriosis, a common gynecologic disorder characterized by endometrial glands and stroma outside the uterus, is diagnosed by direct visualization of peritoneal and ovarian implants during laparoscopy. AIM: To study the estrogenic microenvironment in eutopic endometria of women with and without endometriosis. PATIENTS AND METHODS: Eutopic endometria, obtained during laparoscopy from 23 women with endometriosis and 20 fertile cyclic women undergoing tubal sterilization, was studied. P450Arom mRNA expression (RT-PCR) was measured. Also, P450Arom activity was assessed measuring testosterone conversion to estradiol and the concentration of this last hormone in cultured endometrial explants. RESULTS: Age and body mass index was similar in both groups studied. Seventy nine percent of endometria from women with endometriosis and in 29.4% from control group expressed P450Arom mRNA (p <0.01). The intensity of the band was higher in secretory endometria from women with endometriosis when compared to controls (p <0.01), but it was similar during the proliferative phase. Estradiol secretion to the culture media by proliferative endometria explants from women with endometriosis was 3-fold higher than secretory endometria (p <0.01) and endometria from control women in both phases. P450Arom activity, in the presence of testosterone, was 7-fold higher in endometrial cultures from women with endometriosis, when compare with the basal culture (p <0.01). However, in endometrial explant cultures from control women, this activity was not statistical different. CONCLUSIONS: These results indicate that in women with endometriosis, the microenvironment in the endometria is estrogenic as a consequence of an increased expression and activity of the P450Arom.

Aromatase↗

PubMed2003

CD10 is helpful in detecting occult or inconspicuous endometrial stromal cells in cases of presumptive endometriosis.

BACKGROUND: Previous studies have shown that CD10 is a marker for normal, ectopic, and neoplastic endometrial stromal cells. However, its value in confirming a diagnosis of presumptive endometriosis has not been extensively studied. OBJECTIVE: To assess the reactivity of CD10 in a series of cases of presumptive endometriosis and to establish the potential usefulness of this antibody in confirming the diagnosis. DESIGN: We studied hematoxylin-eosin sections and immunoreactivity of CD10 in 20 cases diagnosed as "suspicious for," "suggestive of," or "compatible with" endometriosis as well as in 12 cases of lesions that may be confused with endometriosis (3 endosalpingioses, 3 mesothelial hyperplasias, 3 ovarian follicular cysts, and 3 hemorrhagic corpora lutea). RESULTS: Routine sections from cases of presumptive endometriosis showed glands lacking a distinct cuff of endometrial stromal cells because of atrophy or because of changes secondary to hemorrhage, inflammation, fibrosis, and/or cystic dilatation. In a few cases, the distinction between endometrial and ovarian stroma could not be assessed with certainty. CD10 immunostaining confirmed the diagnosis in 17 (85%) of the cases, as it strongly stained endometrial stromal cells that were not apparent on hematoxylin-eosin sections. All sections from lesions that may simulate endometriosis were CD10-. CONCLUSION: CD10 is helpful in detecting occult or inconspicuous ectopic endometrial stromal cells and in distinguishing endometriosis from its potential mimickers. We recommend its use to confirm or exclude the presence of endometrial stromal cells in cases of presumptive endometriosis and in lesions that may be mistaken for this entity.

Biomarkers, Tumor↗

PubMed2000

The pathophysiology of endometriosis-associated infertility: follicular environment and embryo quality.

Several retrospective analyses of IVF and oocyte donation programmes, performed to gain clinical knowledge of the factors implicated in the aetiology of endometriosis-associated infertility, have demonstrated that the quality of the embryo is affected in patients with endometriosis. To understand the mechanisms of this alteration, the endocrine, paracrine and autocrine conditions induced during folliculogenesis in women with and without endometriosis were investigated. The first approach was to study ovarian steroid secretion in women undergoing IVF. Progesterone concentrations in follicular fluid increased with the severity of the disease and an increase in progesterone accumulation in vitro was observed in basal and hCG-stimulated granulosa cell cultures. It is proposed that the pattern of progesterone secretion may be related to changes in the release of cytokines by ovarian and white blood cells. Hence, a second trial measured interleukin 1 (IL-1), IL-6 and vascular endothelial growth factor (VEGF) concentrations in serum, follicular fluid and granulosa cell cultures. IL-6 concentrations in serum were higher in the natural cycles of women with endometriosis than in women in the control group, and were modulated by ovarian stimulation, decreasing significantly in serum from stimulated cycles. In addition, IL-6 concentrations were higher in the follicular fluid of women with endometriosis than in those in the control group and IL-6 was released in higher amounts by granulosa luteal cells of patients with endometriosis. VEGF was accumulated in lower concentrations in the follicular fluid of patients with endometriosis. These observations indicate that infertility in patients with endometriosis may be related to alterations within the follicle which, in turn, result in oocytes and embryos of lower quality, as demonstrated in the IVF programme. In addition, these embryos have a reduced ability to implant, as observed in the oocyte donation model. These alterations may be induced by functional changes in the process of folliculogenesis that affect steroid synthesis, as well as by cytokine release by ovarian and blood cells.

Embryo Transfer↗

PubMed2000

Infertility treatment by in vitro fertilization in patients with minimal or mild endometriosis.

PURPOSE: To estimate the clinical effectiveness of in vitro fertilization treatment in patients with minimal or mild endometriosis (stages I and II) in comparison to the patients with tubal infertility in terms of fertilization, pregnancy and livebirth rates. METHODS: Retrospective analysis of the outcome of IVF-ET in 612 cycles of the patients with endometriosis (389 stimulated with HMG/HCG and 223 co-treated with GnRH-a) and in 7,339 cycles of the patients with tubal infertility (5,520 stimulated with HMG/HCG and 1,819 co-treated with GnRH-a). RESULLTS: Regardless of the type of ovarian stimulation, the fertilization rate per treated cycle was practically the same in both groups (endometriosis 81.4% vs tubal infertility 84.2%; p = 0.07). However, in the endometriosis group the pregnancy rate was higher (25.3% vs 18.9%; p = 0.000), and so was the livebirth rate (19.0% vs 14.2%; p = 0.003). Considering the type of ovarian stimulation, the fertilization rate in the endometriosis group was almost the same in the HMG/HCG (81.2%) and in the GnRH-a co-treated cycles (81.6%), and did not differ from that in the tubal infertility group (83.6% in the HMG/HCG vs 85.9% in the GnRH-a cycles). In the GnRH-a co-treated cycles the pregnancy rate and the livebirth rate were not significantly higher in the endometriosis group than in the tubal infertility group (27% and 20.2% vs 22.2% and 17.5%). In the HMG/HCG stimulated cycles the pregnancy rate was significantly higher in the endometriosis than in the tubal infertility group (24.3% vs 17.7%; p = 0.004), and so was the livebirth rate (18.4% vs 13.0%; p = 0.008). CONCLUSION: In patients with minimal or mild endometriosis the IVF-ET procedure is at least as effective as in patients with tubal infertility.

Adult↗

PubMed1975

The role of surgery in the management of endometriosis.

Surgery has a specific and realistic place in the management of endometriosis. In the presence of an ovarian mass, diagnosis to rule out neoplasm is mandatory. Therapeutic surgery is carried out for the relief of pain when there is known symptomatic endometriosis or to provide improved chances of a successful gestation when there is infertility. The use of hormones preoperatively has not been routine but seems to be logical when there is extensive and significant scarring. It would seem appropriate to attempt to preserve childbearing function in those patients who are young and desirous of this. In older patients or those in whom the childbearing is complete, it seems unwise to leave behind diseased tissue that can require a subsequent operation. Conservative surgical treatment for infertility related to endometriosis has about a 40 percent chance of successful pregnancy; such conservative treatment carries a 10 to 12 percent risk of subsequent reoperation. The rate of malignancy in endometriosis is low. Intestinal tract endometriosis is uncommon. Bowel preparation is recommended if bowel surgery is anticipated because of the endometriosis. Urinary tract endometriosis is even more uncommon with the exception of the extrinsic pressure and scarring secondary to extensive pelvic endometriosis. tsurgical treatment seems to be of more value than hormone therapy when other organs are involved.

Diagnosis, Differential↗

PubMed1999

[Clinical discussion of the relationship between endometriosis and epithelial ovarian cancer].

OBJECTIVE: To analyse the relationship between endometriosis and epithelial ovarian cancer. METHODS: We analyzed retrospectively the 20 cases associated with endometriosis in 371 cases of epithelial ovarian cancer, and these 20 cases were also compared with the left 351 cases not associated with endometriosis(including endomtriod carcinoma 38 cases and clear cell carcinoma 39 cases). RESULTS: Among 20 cases, endomtriod carcinoma and clear cell carcinoma were most frequently associated with endometriosis, with 11 cases and 7 cases respectively, there was also 1 case of gland carcinoma and 1 case of serous papillary carcinoma. Cases of carcinomas associated with endometriosis had higher pathological grade and 5-year survival probability (Kaplan-Meier method) than those cases not associated with endometriosis. CONCLUSIONS: There is a close relationship between endometriosis and ovarian endomtriod carcinoma and clear cell carcinoma, the malignant transformation of endometriosis foci may be an important origin of them. Drug therapy is recommended for endomtriosis after the operation. In the treatment of endomtriod carcinoma and clear cell carcinoma, progestin can be used as an accessory method.

Adenocarcinoma, Clear Cell↗

PubMed2001

[Application of IVF in women with endometriosis].

Application of IVF at women with endometriosis after pharmacological and surgical therapy hold out hopes to possession of child. Endometriosis occurs three times more often in the patients with primary sterility than in patients with secondary sterility. The presence of a small endometriosis does not reduce the success of the IVF therapy. The women with endometriosis who undergo IVF treatment have similar prospect in compensate with women with tubal sterility. IVF improve fertility in women with mild or minimal endometriosis. But at women after IVF the presence of endometriomas is associated with increased rates of early pregnancy losses. Women with endometriosis marking often antinuclear antibodies and antiphospholipid antibodies than women without endometriosis. To evaluate the 15% of infertile women have endometriosis.

Antibodies, Antinuclear↗

PubMed2001

Effectiveness of postoperative adjuvant therapy in improving reproductive outcome of endometriosis-associated infertility.

BACKGROUND AND PURPOSE: Treatment of endometriosis-associated infertility has not yet become standardized. Various protocols including surgical treatment, medical therapy, and a combination of both have been suggested but their use remains controversial. The objective of the present study was to determine whether postoperative adjuvant therapy for endometriosis is effective in improving reproductive outcome. METHODS: Medical records of infertile patients with newly diagnosed endometriosis treated in a university teaching hospital during a 50-month period were reviewed. After exclusion of patients with other major infertility factors, a total of 209 patients were included in the retrospective analysis. These patients were divided into those receiving (n = 78) or not receiving (n = 131) peri- or postoperative adjuvant medical therapy. The adjuvant therapies included danazol (n = 62), gonadotropin releasing hormone analogues (n = 11), progestins (n = 3), oral contraceptives (n = 1), and mixed treatment (n = 1). RESULTS: The pregnancy rate was lower in those receiving adjuvant therapy, although this result was not significant (32.1% vs 45.8%; p = 0.05). When patients using postoperative danazol therapy were considered alone, the pregnancy rate in patients receiving adjuvant therapy was significantly lower than that in patients not receiving it (p = 0.047). When the stage of endometriosis was considered, the pregnancy rate in patients receiving adjuvant therapy was again lower than in those not receiving it in patients with minimal or mild endometriosis (42.9% vs 60%; p = 0.043). However, in patients with moderate or severe endometriosis, the pregnancy rate was not different in the two groups (31% vs 36%; p = 0.56). Postoperative assisted reproductive techniques (ART) including controlled ovarian hyperstimulation/intrauterine insemination (COH/IUI) and in vitro fertilization (IVF) were effective in improving the pregnancy rates for all patients (53.9% with ART vs 33.1% without; p = 0.003) and for patients with advanced endometriosis (47.7% with ART vs 27.2% without; p = 0.016). CONCLUSIONS: Our results suggest that postoperative adjuvant therapy is ineffective in improving reproductive outcome in patients with either early (minimal or mild) or advanced (moderate and severe) endometriosis. This finding suggests that if fertility is the goal of treatment, adjuvant therapy may be unnecessary after surgery. In contrast, our data suggest that empirical ART, including COH/IUI or IVF, may be a better alternative to improve the pregnancy outcome after surgery.

Adult↗

PubMed2001

Increased nitric oxide in peritoneal fluid from women with idiopathic infertility and endometriosis.

OBJECTIVE: To verify whether nitric oxide in peritoneal fluid is associated with endometriosis and infertility. STUDY DESIGN: Twenty-five women with idiopathic infertility and 38 with endometriosis were recruited, and 18 cases of uterine myomata and 2 cases of ovarian cyst served as controls. Peritoneal fluid samples were aspirated from the pouch of Douglas during laparoscopy or laparotomy. Metabolites of nitric oxide (nitrite and nitrate) in peritoneal fluid were determined by a method using nitrate reductase and the Griess reaction. RESULTS: Peritoneal concentrations of nitrate/nitrite in both infertile women (42.02 +/- 12.98 mmol/L) and patients with endometriosis (41.75 +/- 16.42 mmol/L) were significantly higher than that in controls (33.96 +/- 13.07, P < .05 for both). No significant difference in peritoneal nitrate/nitrite level was found between infertile women and patients with endometriosis (P > .5). Peritoneal levels of nitrate/nitrite were comparable among patients with endometriosis at different stages (P > .5). Patients with endometriosis had more peritoneal fluid than controls and idiopathic infertile women, while controls and idiopathic infertile women had comparable amounts of peritoneal fluid. CONCLUSION: An increased peritoneal level of nitric oxide is a common alteration in endometriosis, endometriosis-associated infertility and idiopathic infertility and may be associated with the pathogenesis of these diseases.

Adult↗

PubMed2001

[bcl-2 and p53 protein expressions in the malignant transformation of ovarian endometriosis].

OBJECTIVE: To study the impact of bcl-2 and p53 protein expressions on the malignant transformation of ovarian endometriosis. METHODS: Immunohistochemical technique was used to detect the bcl-2 and p53 protein expressions in: endometriosis (Group I, 22 patients), atypical hyperplasia of ectopic ovarian endometrial glands (Group II, 14 patients) and endometriosis with malignant change (Group III, 22 patients). RESULTS: The positive bcl-2 protein expression rate of Group III was apparently higher than that of Group I (P < 0.05); The positive bcl-2 protein expression rate of Group II was clearly higher than that of Group I(P < 0.01). The positive p53 protein expression rate of Group III was higher than that of Group II (P < 0.01) and Group I (P < 0.01); In Group III, the positive p53 protein expression rate was higher in the malignant transformation area than in the endometriosis area (P < 0.05); In Group III, the positive bcl-2 protein expression rate in the endometriosis area was higher than that of Group I (P < 0.05); In Group II, the positive bcl-2 protein expression rate in the endometriosis area was higher than that of Group I (P < 0.01); However, the bcl-2 and p53 protein expressions were not related to the menopause, stage of disease or the survival (P > 0.05), nor were they related to the malignant transformation area in Group III (P > 0.05). CONCLUSION: It is possible that the overexpressions of bcl-2 protein or p53 protein play an important role in the malignant transformation of ovarian endometriosis. The bcl-2 protein (+) or p53 protein (+) endometriosis may signify a precancerous lesion.

Adult↗

PubMedDate not supplied

[Intestinal endometriosis. Three new cases and review of the literature].

OBJECTIVE: The study was undertaken to identify some features of the intestinal endometriosis such as symptoms, helpful investigations, pattern of distribution and surgical management. PATIENTS: Three consecutive cases, observed during a sixteen month period, are reported. The most frequent symptoms were chronic pelvic and abdominal pain, dysmenorrhea, alterated bowel habit and menorrhagia. The diagnosis of intestinal endometriosis was incidental in all but one case admitted for an intestinal subocclusive syndrome in patient with a past history of pelvic endometriosis previously documented by laparoscopy. RESULTS: All patients presented a sigmoid localization of endometriosis with different degree of stenosis and underwent sigmoid resection, followed by a resolution of abdominal symptoms. DISCUSSION: Although the exact frequency of intestinal endometriosis is difficult to know because of the lack of specific symptoms and reliable investigations, it has been estimated that implants to the bowel may occur in 3%-37% of women affected by endometriosis. The sigmoid colon is the most common site of localization. The main symptoms are pelvic pain, dysmenorrhea, infertility and diarrhoea or constipation; rarely patients present bowel occlusion due to stenosis (less than 15% of the cases) or cyclic rectal bleeding. CONCLUSION: Generally, intestinal endometriosis is not suspected preoperatively in those patients without a past history of this condition; however an accurate diagnosis can be provided throughout laparoscopy, before open surgery. The hormonal therapy is not successful in alleviating moderate to severe obstructive symptoms. Thus surgery still remains the most effective treatment for advanced intestinal endometriosis.

Adult↗

PubMed2002

[Intestinal endometriosis causing subacute ileus. Experience in three cases].

We present three rare cases of intestinal endometriosis. The patients were treated at the Endometriosis Clinic of the 1st Dept. of Obstetrics and Gynecology of the Semmelweis University, Budapest. Their main symptom besides the classic symptoms of endometriosis (dysmenorrhea, dyspareunia, pelvic pain) was the catamenial haematochesia--a subacute obstruction which became more intensive in the perimenstrum and needed medical treatment but no surgical intervention. Because of the recurrent complaints, after detailed check-up and biopsy of the obstructing intestinal endometriosis, anterior resection of the rectum was performed with endocoagulation or extirpation of other endometriosis implants of the pelvis. Depending on the severity of pre or postoperative complaints patients underwent a GnRH-analogue therapy for six months. In one patient because of the patient's age, and extensive retrocervical-deep endometriosis causing serious dyspareunia--the resection was performed with additional hysterectomy and adnexectomy (TAH). Recently the patient is on monophasic hormone replacement therapy. In the two other patients after a second-look laparoscopy with testing the lumen of the tubes treatment was started for the induction--because of infertility. We give an overview of the frequency, incidence and possible pathomechanism of pelvic endometriosis. We describe the modern diagnostic and therapeutic tools of pelvic endometriosis.

Adult↗

PubMed2003

The association of minimal and mild endometriosis without adhesions and infertility with therapeutic strategies.

INTRODUCTION: Mild endometriosis may be present in fertile or infertile women. When present in infertile women it could be merely an innocent bystander, and some other problem could be causing the difficulty in conceiving, or it may in some way be directly responsible for the infertility problem. Sometimes to achieve a pregnancy, only these other infertility factors need to be treated with no specific treatment for the endometriosis per se. However there are some data suggesting that sometimes treating the endometriosis surgically may be helpful. METHODS: The pregnancy outcome in women with probable endometriosis vs those without this entity (based on serum CA-125 levels) was compared with treatment rendered only to correcting ovulatory defects with no specific treatment rendered to the endometriotic lesions during the first six months of therapy. Another study evaluated the efficacy of laparoscopic removal of endometriosis vs leaving the lesions untouched on pregnancy outcome in women who failed to conceive after at least eight months of all infertility factors corrected. RESULTS: No difference in pregnancy outcome was found in women with probable endometriosis vs none after six months of correcting ovulation defects. However, for the minority not conceiving after such therapy removing the endometriosis surgically significantly improved fertility rates in the next eight months. CONCLUSIONS: The probable presence of endometriosis based on symptoms, signs, or serologic evidence should prompt careful evaluation and treatment of subtle ovulatory problems, e.g., luteal phase defects and luteinized unruptured follicle syndrome. Therapeutic strategies for those women failing to conceive after 6-8 months of conservative therapy could be laparoscopic removal of observed endometriotic implants or consideration of in vitro fertilization.

CA-125 Antigen↗

PubMed2003

The association of minimal and mild endometriosis without adhesions and infertility with therapeutic strategies.

INTRODUCTION: Mild endometriosis may be present in fertile or infertile women. When present in infertile women it could be merely an innocent bystander, and some other problem is causing the difficulty in conceiving, or it may in some way be directly responsible for the infertility problem. Sometimes to achieve a pregnancy, only these other infertility factors need to be treated with no specific treatment for the endometriosis per se. However there are some data suggesting that sometimes treating the endometriosis surgically may be helpful. METHODS: The pregnancy outcome in women with probable endometriosis vs those without this entity (based on serum CA-125 levels) was compared with treatment rendered only to correcting ovulatory defects with no specific treatment rendered to the endometriotic lesions during the first six months of therapy. Another study evaluated the efficacy of laparoscopic removal of endometriosis vs leaving the lesions untouched on pregnancy outcome in women who failed to conceive after at least eight months of all infertility factors corrected. RESULTS: No differences in pregnancy outcome were found in women with probable endometriosis vs those without after six months of correcting ovulation defects. However, for the minority who did not conceive after such therapy, removing the endometriosis surgically significantly improved fertility rates in the next eight months. CONCLUSIONS: The probable presence of endometriosis based on symptoms, signs, or serologic evidence should prompt careful evaluation and treatment of subtle ovulatory problems, e.g., luteal phase defects and luteinized unruptured follicle syndrome. Therapeutic strategies for those women failing to conceive after six to eight months of conservative therapy could be laparoscopic removal of observed endometriotic implants or consideration of in vitro fertilization.

CA-125 Antigen↗