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PubMed2003

[Correlation between CA-125 marker with the presence and severity of pelvic endometriosis].

BACKGROUND: Endometriosis affects at least 15% of infertile women. The diagnosis is made by direct visualization of implants either at laparoscopy or laparotomy. Elevation of plasma CA-125 levels has been associated with the presence of endometriosis. AIM: To search for a correlation between CA-125 and the presence of endometriosis and its severity, among infertile patients requesting a diagnostic laparoscopy. PATIENTS AND METHODS: A total of 117 women were prospectively enrolled in the study between May 2000 and March 2002. A serum sample for CA-125 was taken immediately before surgery and the value obtained was correlated with the presence or absence of endometriosis and the severity of the disease. RESULTS: Sixty nine patients had endometriosis (59%). Patients with severe endometriosis, or grade IV, showed statistically significant higher levels of CA-125 compared to women without endometriosis or with grades I, II or III of the disease. DISCUSSION: The overall sensibility of CA-125 in detecting patients with endometriosis was low, however, it worked better for patients with advanced disease. Considering the rather low cost and simplicity of the test, we believe that it should be included in the evaluation of infertile couples.

Adult↗

PubMed2003

[Clinical study about diagnosis and management on 10 women with rectovaginal endometriosis].

OBJECTIVE: To study the diagnosis and therapy of the rectovaginal endometriosis. METHODS: Descriptive retrospective study, between 1992 and 2002, 10 women with rectovaginal endometriosis were treated at the Peking Union Medical College Hospital. RESULTS: The average age were 40 years old. Six patients presented with rectal irritative symptom. Three of them complained about deep dyspareunia. Eight patients complained about mild to moderate dysmenorrhea. The recto-vaginal septum should be carefully palpated. None of these patients had either clinical or objective evidence of ovarian endometriosis, nor was there evidence of any obstructive lesions of the intestine or ureters. The CA(125) levels had a sensitivity of 20%. Ultrasonography failed to find the rectovaginal endometriotic nodules. Diagnosis of the rectovaginal endometriosis was based on symptoms, vaginal and rectal examination. The Revised American Fertility Society (rAFS) stages can not evaluate the grade of the endometriosis. Four patients were given leuprolide acetate depot at 3.75 mg, 1 ampule every 28 days, and treatment had a planned duration of 3 mouths. Follow-up evaluations were set 3 mouths later. The patients showed an improvement with respect to pain during the 3 mouths treatment course but had early pain recurrence after drug suspension. The endometriotic lesions showed a slight but reduction in size during therapy but had returned to original volume within 3 mouths after cessation of the gonadotropin-releasing hormone analog (GnRH-a) treatment. Finally, all patients required further treatment with a surgical solution. Six patients succeeded to remove the nodules by laparotomy. Four patients were failed to remove the total lesions by laparoscope and transvaginal section. CONCLUSIONS: The vaginal and rectal examination should be performed if the patients complained about tectal irritative symptom or dyspareunia. The rAFS stages had no strong association with the severity of the rectovaginal endometriosis. GnRH-a should not be considered a real therapeutic alternative to surgical treatment for patients with symptom endometriosis of rectovaginal septum. Laparotomy is efficient for the treatment of the rectovaginal endometriosis.

Adult↗

PubMed2003

[Establishment of animal models of endometriosis in rhesus monkeys].

OBJECTIVE: To establish animal models of endometriosis in rhesus monkeys and study the invasion mechanism of endometriosis. METHODS: Five female healthy rhesus monkeys with regular menstrual cycles were selected, of whom 4 were used for endometriosis model establishment and 1 for control. During the period of days 8-15 of menstruation, or 3-5 days after the midcycle estrogen peak, the endometrium was implanted into the pelvic cavity other than the uterus in the experimental group, and in the control group, the greater omentum was implanted instead. Exploratory laparotomy or laparoscopy was performed during the period between days 8 and 15 of menstruation in the second and the fourth month respectively after the implantation for observing the occurrence of endometriosis. RESULTS: In the experimental group, the implanted endometrium survived in the receptor site in 3 monkeys, 2 of whom were found to have chocolate cyst after the operation. Laparoscopy was again performed in the 2 monkeys with endometriosis 4 months after the operation, showing pelvic adhesion and growth of ectopic endometrium similar to the changes as observed two months after the operation. In comparison with the control, deteriorated mental states and dietary changes, along with body weight losses, occurred in the 3 models of endometriosis, and 2 of them later died of intussusception. CONCLUSIONS: Animal models of endometriosis can be established successfully in rhesus monkeys on the basis of the implantation theory, which, however, is influenced by individual differences between the animals. Heredity is an important factor in pathogenesis of endometriosis, and ectopic growth of the endometrium may severely impact the body function.

Animals↗

PubMed2003

[Physiopathology and therapeutic management of stage I and II endometriosis].

Stage I and II endometriosis is defined by a r-AFS score respectively ranging from 1 to 5 and from 6 to 15. This mild, superficial endometriosis is a very common pathology occurring in infertile women. Nevertheless, these women with stage I/II endometriosis have usually few pelvic pain. This review summarizes the recent literature concerning new data on the pathogenesis of peritoneal endometriosis and its clinical management. Retrograde menstruation, peritoneal adhesion of shed endometrial tissue, and outgrowth of endometrial cells, glands and stroma, are essential elements in the pathogenesis of endometriosis according to Sampson's classic implantation theory. Nevertheless, exact pathophysiology of endometriosis remains unknown. Superficial endometriotic lesions observed by laparoscopy have to be treated. Surgical procedure is not difficult for stage I and II of endometriosis. Surgical procedure remains controversial. Carbon dioxide (CO2) Laser can be used for laparoscopic destruction of endometriosis. Newer procedures, such as SurgiTouch (Lumenis), are more effective in vaporization and decrease the risk thermal damage of contiguous structures. The monopolar scissors can also be used in order to excise the peritoneal endometriotic lesions. Medical treatment may be usefull if surgical treatment is not complete or if the pelvic cavity is hypervascularized. In these cases, Gonadotropin-Releasing Hormone agonists (Gn-RHa) are the most common and effective treatment.;

Endometriosis↗

PubMed2004

The prevalence of endometriosis among African-American and African-indigenous women.

Endometriosis is gynaecological disorder, characterized by the growth of endometrial tissue outside the uterine cavity. It is the most common cause of pelvic pain and occurs in 20-25% of women with infertility. Although Sampson first described endometriosis in 1927, studies on the prevalence of endometriosis among African women are still lacking. The current thinking is that endometriosis rarely affects women from the African origin. However, in African-American women in the USA, endometriosis is one of the commonest indications for major gynaecological surgery and hysterectomy, and is associated with long hospital stay and high hospital charges. There is also some evidence that endometriosis is more commonly found in African-American patients from private practice than in African-American patients treated in public hospitals. The prevalence of endometriosis in African-indigenous women with infertility seems low, possibly due to a different life style (early pregnancy, increased risk for PID and blocked Fallopian tubes) and due to lack of laparascopic facilities and specific training of African gynecologists to diagnose ascites caused by endometriosis appear to be more frequently observed in African-indigenous of African-American women than in women with other ethnic backgrounds.

Black or African American↗

PubMed2004

Implications of the diagnosis of endometriosis on the success of infertility treatment.

PURPOSE: Endometriosis is a clinically very heterogeneous disorder and its implications on the resolution of infertility are not clear. METHODS: Clinical data of 783 consecutive infertile couples were retrospectively analyzed in three groups: A--with minimal/mild endometriosis: B--with moderate/severe endometriosis; C--without endometriosis. Subgroups of groups A and C with unexplained infertility were also compared. RESULTS: Endometriosis was found in 349 patients (44.6%)--263 in group A and 86 in group B. Group C comprised 434 patients. Overall pregnancy rates were 57.0% for group A, 48.8% for B and 55.8% for C (not statistically different). Of couples in groups A, B, C, respectively, 39.2%, 51.1% and 39.2% needed IVF (B vs C - p = 0.042; B vs A - p = 0.059). Of couples in group A 45.6% that underwent IVF achieved a pregnancy by this technique; corresponding numbers were 43.2% for group B and 46.5% for C. Overall pregnancy rates in couples with unexplained infertility in groups A (n = 116) and C (n = 110) were respectively, 58.6% and 56.4%; IVF was needed in 40.5% and 32.7% of those couples, and the cumulative pregnancy rates resulting from IVF were 40.4% and 47.2% (NS). CONCLUSION: The diagnosis of endometriosis had no influence on the successful resolution of infertility although moderate/severe endometriosis was related to a greater need for IVF. Couples with unexplained infertility had similar pregnancy rates either in the presence or in the absence of minimal/mild endometriosis.

Adult↗

PubMed2004

[Relationship between endometriosis and glutathione S-transferase M1, T1 genes of the Uygurs and Hans in Xinjiang].

OBJECTIVE: To examine the association between glutathione S-transferase (GST)M1, T1 null genotypes and endometriosis of the Uygurs and Hans in Xinjiang. METHODS: The polymerase chain reaction method was used to detect the presence or absence of the GSTM1 and GSTT1 genes in genomic DNA from the Uygurs (107 controls and 41 cases) and the Hans (105 controls and 80 cases) in Xinjiang. RESULTS: The frequencies of the GSTM1-null genotype, GSTT1-null genotype, combined GSTM1-null and GSTT1-null genotype in endometriosis of the Uygurs (51.2%, 36.6%, 24.4%) were not significantly different from those in controls (53.2%, 29.9%, 13.1%). Similarly, no statistically significant difference was observed in the frequency of GSTM1-null genotype in cases of endometriosis of the Hans (56.8%) compared with the controls (51.8%), but the frequencies of GSTT1-null genotype, combined GSTM1-null and GSTT1-null genotype in endometriosis of the Hans (73.7%, 42.5%) were significantly different from those in controls (44.3%, 22.8%). When comparing the Uygurs with the Hans, we found no significant difference in the frequencies of GSTM1-null genotype, GSTT1-null genotype, combined GSTM1-null and GSTT1-null genotype between the two control populations, neither in the frequencies of the GSTM1-null genotype, combined GSTM1-null and GSTT1-null genotype between the two endometriosis populations. However, the frequency of GSTT1-null genotype in cases of the Hans (73.7%) was significantly higher than that in cases of the Uygurs (36.6%). CONCLUSIONS: No evidence was found to suggest an association between GSTM1-null genotype and endometriosis in the Hans and Uygurs. An association was found between GSTT1-null genotype and endometriosis in the Hans, but not in the Uygurs. The two nationalities have different genetic predisposing factors to the development of endometriosis.

Adult↗

PubMedDate not supplied

Comparison of the effects of leuprorelin acetate and danazol treatments on serum CA-125 levels in women with endometriosis.

OBJECTIVE: To investigate the effects of danazol and leuprorelin acetate on CA-125 levels during treatment for endometriosis. PATIENTS AND METHODS: Fifty women with laparoscopically diagnosed and treated endometriosis, and 50 women without pelvic disease as a control group. Following surgical treatment, 35 women with endometriosis were divided into two groups. The first group (20 women) received 200 mg danazol three times daily for 6 months; the second group (15 women) received 3.75 mg leuprorelin acetate depot every 28 days for 6 months. Serum CA-125 levels were measured before medical treatment, during the last 15 days of the 6-month treatment course, and 3 months after treatment. RESULTS: Serum CA-125 levels were significantly higher in women with endometriosis than in women in the control group. Before treatment, CA-125 levels in patients with stage III/IV endometriosis were significantly higher than those in stage I/II endometriosis. Six months of danazol or leuprorelin acetate depot treatment decreased serum CA-125 levels. Three months after stopping danazol, CA-125 levels remained significantly lower than pretreatment levels. On the other hand, 3 months after stopping leuprorelin acetate, CA-125 levels returned to pretreatment levels. CONCLUSIONS: (a) Danazol and leuprorelin acetate are equally effective in the treatment of endometriosis. (b) Moreover, the results support the view that the determination of CA-125 levels may assist in evaluating progress of endometriosis treatment.

Adult↗

PubMed2004

[Study of tissue morphology and vascular endothelial growth factor and matrix metalloproteinase-9 gene expressions in nude mouse endometriosis model].

OBJECTIVE: To establish an experimental endometriosis model using nude mouse as a xenographic host for relative biological behavior study of endometriosis. METHODS: Nude mice of experimental group were implanted with the late secretory endometrium of patients with endometriosis (n = 24) or without endometriosis (n = 24) into pelvic and abdominal cavities. Nude mice of control group (n = 3) were implanted with the greater omentum. Nude mice were killed at 5, 15 and 30 d randomly to observe the growth of endometriotic lesions. The morphological changes of endometriotic lesions from different sources and at different time points of growth were examined by light microscopy and electron microscopy; the expressions of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) of eutopic endometrium and endometriotic lesions were detected by RT-PCR method, and the expressions of steroid hormone receptors by immunohistochemistry method. RESULTS: Endometriotic lesions were found from 5 d with rich blood supply, endometrial glands and stroma under light microscope. And the adhesion to mouse tissues became more severe with time. Under electron microscope, proliferation and infiltration of inflammatory cells were most striking at 15 d. At 30 d the organellae of gland cells were disappeared and there was nuclear chromatin aggregation with apoptosis tendency, but secretory granules still could be seen. The expressions of VEGF and MMP-9 mRNA were increased in endometriotic lesions compared with eutopic endometrium (P < 0.05), and were strongest at 15 d (EM group: 1.11 +/- 0.13/1.00 +/- 0.11; NEM group: 1.10 +/- 0.11/0.99 +/- 0.08) and decreased at 30 d (EM group: 0.85 +/- 0.11/0.77 +/- 0.13; NEM group: 0.86 +/- 0.14/0.76 +/- 0.11). Immunochemistry revealed the positive rate of estrogen and progestogen receptors at 30 d (EM group: 4/8 and 4/8; NEM group: 5/8 and 4/8) was lower than that at 5 d (EM group: 7/8 and 7/8; NEM group: 8/8 and 7/8) and 15 d (EM group: 7/8 and 7/8; NEM group: 7/8 and 8/8), and the expressions of steroid hormone receptors were mostly weak. There was no differences in expression of VEGF and MMP-9 mRNA, estrogen and progestogen between endometriotic lesions implanted with normal endometrium and endometrium from patients with endometriosis. CONCLUSIONS: The nude mouse is an appropriate model for the study of the early phase of endometriosis, and the genesis and development of endometriotic lesions are similar to that of human endometriosis. Endometriosis is associated with multiple factors.

Animals↗

PubMed2005

[Correlative factors analysis of recurrence of endometriosis after conservative surgery].

OBJECTIVE: To determine the correlative factors with recurrence of endometriosis after conservative surgery. METHODS: A cohort study was performed on 285 patients who had a minimum of 36 months of follow-up after conservative surgery for endometriosis. All patients underwent clinical interview, physical examination and ultrasonography. The factors measured included: age at surgery, age at onset of disease, gravidity, parity, tenderness nodule at cul-de-sac (yes/no), uterus mobility (movable/fixed), serum CA(125) level, type of operation (laparoscopy/laparotomy), history of operation for endometriosis (yes/no), side of endometrioma (left/right/bilateral), intraoperative revised classification American Fertility Society (r-AFS) scores, post-operative r-AFS scores, highest post-operative temperature, post-operative adjuvant therapy, post-operative gravidity and parity. The recurrent rate and its predictive factors were evaluated and the univariate, multivariate COX regression and Kaplan-Meier analyses were performed to determine the predictive factors for recurrence of endometriosis. RESULTS: The related factors and their odds ratio (OR) by univariate analysis were as follows: history of endometriosis surgery, 13.630 (P < 0.01); nodules with tenderness at cul-de-sac, 6.133 (P < 0.01); post-operative administration of clomiphene, 5.173 (P < 0.01); left endometrioma, 4.503 (P < 0.01); bilateral endometrioma, 3.709 (P < 0.01); post-operative r-AFS scores, 1.831 (P < 0.01); post-operative gravidity, 0.392 (P < 0.05); post-operative administration of progesterone for 6 months, 0.472 (P < 0.01); laparoscopic surgery, 0.567 (P < 0.05); pre-operative parity, 0.640 (P < 0.05); pre-operative gravidity, 0.759 (P < 0.05); age at onset of disease, 0.912 (P < 0.01) and age at surgery, 0.932 (P < 0.05). Meanwhile, the related factors and their odds ratio (OR) by multivariate COX analysis were as follows: history of endometriosis surgery, 8.219 (P < 0.01); bilateral endometrioma, 6.369 (P < 0.01); left endometrioma, 2.682 (P < 0.05); tenderness nodules at cul-de-sac, 2.154 (P < 0.05); post-operative administration of clomiphene, 1.860 (P < 0.05); post-operative r-AFS scores, 1.188 (P < 0.01); post-operative gravidity, 0.253 (P < 0.01); post-operative administration of progesterone for 6 months, 0.518 (P < 0.05); age at surgery, 0.937 (P < 0.01). CONCLUSIONS: The risk factors for recurrence of endometriosis include a history of endometriosis surgery, bilateral endometrioma, left endometrioma, tenderness nodules at cul-de-sac, post-operative administration of clomiphene, post-operative r-AFS scores,whereas the protective factors include the post-operative gravidity, post-operative adjuvant therapy and age at surgery.

Adult↗

PubMedDate not supplied

[Inguinal endometriosis].

This study was conducted from September 2000 to September 2004 on 8 cases of inguinal canal endometriosis. All the patients presented an inguinocrural tumefaction of variable size. In 3 cases (symptomatic endometriosis), the patient's medical history yielded a preoperative diagnosis. In the other 5 cases (asymptomatic endometriosis) we obtained an incidental intraoperative diagnosis. In 2 of these, concomitant frank inguinocrural disease further hampered the preoperative diagnosis, while in the other 3 cases we were oriented towards an inguinal adeno-lymphatic disease. We found no signs of neoplastic transformation in our case series. The histological examination confirmed the diagnosis of endometriosis in all 8 cases, without any atypical cellular signs. From an analysis of the literature we deduced that the worldwide incidence of endometriosis is about 10% of the female population, though it is known that in the vast majority of cases there are few or no symptoms. Even today, despite the routine use of advanced diagnostic and surgical procedures, endometriosis foci are very often identified only incidentally owing to the greater incidence of asymptomatic or paucisymptomatic forms. The aim of our study is to stress the difficulty in diagnosing asymptomatic endometriosis and, above all, to suggest that, in the presence of a concomitant hernial pathology in a woman of child-bearing age, the diagnostic hypothesis of endometriosis should never be disregarded.

Adnexal Diseases↗

PubMed2005

[Influences of gonadotropin releasing hormone agonist treatment on nitric oxide synthase expression in women with endometriosis and infertility].

OBJECTIVE: To explore the expression of endothelial and inducible nitric oxide synthase (eNOS and iNOS) in the eutopic endometria of patients with endometriosis and infertility, and to detect the effect of gonadotropin releasing hormone agonist (GnRH-a) therapy on their expressions. METHODS: Immunohistochemistry and Western immunoblot assay were used to screen eNOS and iNOS expression in endometria of patients with stage III to IV endometriosis and infertility without (30 cases, endometriosis group) and with GnRH-a treatment (18 cases, treatment group), and of 19 patients with carcinoma in situ of the cervix (control group). Using electrochemiluminescence immunoassay, serum estradiol (E(2)) or progesterone (P) concentrations were assayed. RESULTS: eNOS was localized predominantly to the endometrial glandular epithelium, luminal epithelium, and microvascular endothelium. iNOS staining was light, and it, when present, was predominantly found in glandular epithelium and stromal cells. By Western immunoblot analysis, iNOS was not detected. During the early-, mid-, and late-proliferative phases, and the early-, mid-, and late-secretory phases, endometrial eNOS protein relative levels were 0.30 +/- 0.04, 0.40 +/- 0.03, 0.49 +/- 0.03, 0.43 +/- 0.04, 0.55 +/- 0.04 and 0.48 +/- 0.03 in endometriosis group, 0.22 +/- 0.03, 0.37 +/- 0.03, 0.45 +/- 0.04, 0.35 +/- 0.05, 0.50 +/- 0.03 and 0.41 +/- 0.00 in treatment group, and 0.21 +/- 0.03, 0.33 +/- 0.03, 0.45 +/- 0.04, 0.40 +/- 0.03, 0.47 +/- 0.05 and 0.41 +/- 0.03 in control group, respectively. Eutopic endometria in endometriosis group showed higher levels of eNOS protein than that of the control group, but a significant difference was found only in early-, mid-proliferative phases and mid-, late-secretory phases (P < 0.05). Compared with endometriosis group, endometrial eNOS levels in treatment group were reduced, but a significant difference was found only in early proliferative phase and early-, mid-secretory phases (P < 0.05). A significant positive correlation was found between serum E(2) or P concentrations and endometrial expression of eNOS (P < 0.01). CONCLUSIONS: The higher endometrial expression of eNOS in patients with stage III to IV endometriosis may be related to the pathogenesis of endometriosis and the associated subfertility. The expression of eNOS is markedly reduced by administration of GnRH-a.

Adult↗

PubMed2006

[Expression of interleukin1-alpha, beta and interferon-gamma in macrophages from endometrium of women with endometriosis].

OBJECTIVE: To assess interleukin (IL)-1alpha, beta and interferon (IFN) gamma expression in macrophages in eutopic and ectopic endometrium of women with endometriosis. METHODS: In situ hybridization was used to examine the expression of IL-1alpha and beta and IFN-gamma in macrophages from eutopic and ectopic endometrium of 40 women with endometriosis and 15 control women. Eutopic endometrial samples were histologically classified into proliferative and secretary phases. Cervical polyp tissue was used as positive control. RESULTS: Expression of IL-1alpha and beta in macrophages from eutopic and ectopic endometrium of women with endometriosis were significantly higher than that in the control group (P < 0.05). Both gene expression in macrophages from ectopic endometrium was higher than that in eutopic endometrium of patients with endometriosis (P < 0.05). The expressions of the two genes were significantly increased in secretory phase of endometrium when compared to that in proliferative phase (P < 0.05). There was no difference in IFN-gamma expression in macrophages of endometium between patients with endometriosis and control (P > 0.05). No cycle dependent variation of the gene expression in the macrophages was found either in endometriosis group or in control group. CONCLUSION: There is a significant increase in the expression of IL-1alpha and beta in macrophages of endometriosis. IL-1 and activated macrophages may play an important role in the development and progression of endometriosis.

Adult↗

PubMed2006

[Intestinal tract endometriosis].

Pelvic endometriosis in 3-37% of cases involves the intestinal tract, mainly sigmoid colon and rectum. In clinical practice endometriosis of the intestinal tract is rarely diagnosed and usually after long-lasting symptoms. During 3 years we treated only 2 women with this disease and therefore we want to report this seldom disorder. One woman had been diagnosed as having had rectal endometriosis before she was admitted to the hospital and the other one was admitted because of complications after laparoscopic treatment of pelvic endometriosis. In spite of typical signs of intestinal tract endometriosis, the proper diagnosis was made after several years of symptoms in one woman and in the second female histopathology of removed sigmoid colon because of its lesion finally revealed endometriosis. Laparoscopy seems to be the best diagnostic method of intestinal endometriosis and its treatment is to remove the involved part of the bowel together with endometriotic foci and surrounding tissues. Cyclical intestinal endometriosis symptoms correlating with menstrual cycle should always draw our attention to this rare disorder.

Adult↗

PubMed1989

[Relationship between luteal function and prolactin in infertile women with endometriosis].

Luteal function in 44 infertile women with endometriosis were studied with reference to prolactin (PRL) and compared with 34 unexplained infertile women without endometriosis. To assess luteal function, serum progesterone (P4) levels were measured on the 3rd, 7th and 10th days of the luteal phase. On the 7th day, serum estradiol (E2) levels and PRL levels were also determined. The response of PRL secretion to TRH was examined at 30 and 60 after following TRH (500 micrograms, im.) administration. The incidence of hyperprolactinemia (basal PRL level greater than or equal to 25 ng/ml) and latent hyperprolactinemia (peak PRL level in TRH challenge test greater than or equal to 150 ng/ml) were 19% and 31%, respectively, in the endometriosis group and 14% and 33%, respectively in the control group. At the midluteal stage, serum P4 levels in endometriosis group were decreased significantly (p less than 0.05), whereas no difference was found between the serum E2 levels in the endometriosis group and the control. In the endometriosis group, there was no correlation between P4 and E2 levels and abnormal secretion of PRL such as hyperprolactinemia and latent hyperprolactinemia. These results indicate the close association of endometriosis with an inadequate luteal phase. However, it seems that the aberrant secretion of PRL has no relation to the impared luteal function in endometriosis.

Adult↗

PubMed1988

[Endometriosis and fertilization in vitro. Apropos of 40 cycles].

The physiopathology and the role of endometriosis in infertility is still unclear. The use of in vitro fertilization (IVF) could be a good model for the understanding of etio-pathology and treatment when fecundity is desired. We compare results of IVF procedure in patients with endometriosis after ovulation induction with clomiphene-HMG (group 1) and Gn-Rh analog's short administration using regimen and HMG (group 2). Forty cycles have been conducted for 18 patients. Mean duration of infertility is 6.9 years and mean age of patients is 34.8 years. We observed no difference in terms of results of ovulation induction in Gr 1 or in Gr 2 compared with IVF patients without endometriosis and after the same treatment regimen, except a non significant decrease in the number of recovered oocytes. As for IVF patients without endometriosis, the use of Gn Rh analogs permits an improvement of results in terms of suppression of spontaneous premature LH surge, and increase of number of follicles and cleaved embryos. The fertilization and cleavage rates are not affected by the presence of endometriosis when compared to IVF patients without endometriosis. The number of recovered oocytes decreases with the severity of endometriosis (RAFS classification), but the pregnancy rate is not affected. Overall Third trimester pregnancy rate is 12.5% per induction cycle and 21.7% per embryo transfer. We may conclude that the presence of endometriosis does not affect the quality of the oocyte and is not a cause of exclusion in an IVF program.

Adult↗

PubMed1995

Short-term Lupron or danazol therapy for pelvic endometriosis.

OBJECTIVE: To compare the efficacy of a 3-month trial of leuprolide acetate (LA; Lupron; TAP Pharmaceuticals, Deerfield, IL) versus danazol (Danocrine; Scenofi Winthrup Pharmaceuticals, New York, NY) therapy on laparoscopically proven endometriosis. DESIGN: Endometriosis severity was assessed at the time of laparoscopy and patients were randomized to receive 0.1 mg SC LA (n = 22) or 800 mg danazol orally (n = 18) daily for 3 months. A second laparoscopy and/or laparotomy was performed to assess the change in the extent of endometriosis and for surgical therapy. SETTING: Private practice at a university-affiliated hospital. PATIENTS: Forty patients with mild, moderate, or severe endometriosis. Ten patients were excluded. INTERVENTION: Three-month treatment randomly assigned to either LA or danazol. MAIN OUTCOME MEASURES: Prospective measurement of American Fertility Society endometriosis scores and size of ovarian endometriomata before and after therapy via laparoscopy. RESULTS: The mean endometriosis score including adhesions decreased significantly from 36 +/- 4.9 to 29 +/- 5.0 (mean +/- SEM) with LA and from 34 +/- 6.4 to 29 +/- 6.5 with danazol. The mean laparoscopic endometriosis score not including adhesions decreased from 27 +/- 3.5 to 22 +/- 3.4 with LA and 22 +/- 3.5 to 19 +/- 3.1 with danazol. Seven of 18 (39%) endometriomata responded to LA and 6 of 15 (40%) endometriomata responded to danazol. CONCLUSION: We conclude that both danazol and LA will reduce endometriosis scores after a 3-month course of therapy. Larger clinical trials are needed to compare short courses of therapy with the more established 6-month trials. A 3-month versus a 6-month course of therapy offers obvious benefits including decreased cost and decreased side effects.

Danazol↗

PubMed1995

[Pelvic pain and external endometriosis. Physiopathology and treatment].

New data on the pathophysiology of pain associated with endometriosis are available. The predominant role of deep endometriosis has been stressed. In multivariate analysis, superficial endometriosis and even adhesions and ovarian cysts do not appear to be related with pain. Deep endometriosis is usually located posterior to the vagina and cervix, involving the pouch of Douglas, the rectovaginal septum and the uterosacral ligaments. In such cases, pelvic examination shows a painful induration or a nodule in this area. The anterior cul-de-sac and the lateral pelvic wall may also be involved. Two histological and clinical aspects may be observed: deep endometriosis arising under the peritoneal surface, or adenomyosis arising from the uterine cervix. Only complete surgical excision may be curative, but recurrences may occur after surgery. Hormonal therapy is only suspensive. However, surgical therapy involves a significant risk of complication. Surgery for deep endometriosis may be one of the most difficult gynecologic operations. It should be performed only by experienced surgeons, with skills in oncological dissections of the pelvis. The guidelines for therapy are thus clear. Superficial endometriosis does not cause pain and should not be treated by itself; symptomatic relief of pain may be obtained by therapeutic amenorrhea or by the placebo effect of surgery. Endometriomas are managed in the same way as all organic ovarian cysts. Adhesions are lysed if infertility is associated with pain, or to gain access to the retroperitoneal area. Etiologic therapy is acceptable only in case of deep endometriosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Endometriosis↗