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PubMed1989

[Treatment of endometriosis associated infertility].

During the last 13 years, 2,080 infertile patients were subjected to diagnostic laparoscopy. The mean age was 32.3 and their mean infertility period was 6.0 years. Of these, 1,263(60.7%) patients were diagnosed to have endometriosis: 587(46.5%) were stage I (R-AFS), 348(27.6%) were stage II, 184(14.6%) were stage III and 144(11.4%) were stage IV. The age and the infertility period were almost the same among the stage of the disease. The overall pregnancy rate was 34.6%, after minimum 2 month follow up. The presence of endometriosis did not affect the prognosis of infertility: 34.2% pregnancy rate for patients with endometriosis, and 35.3% for those without endometriosis. There was an inverse relationship between the stage of the disease and the subsequent pregnancy rate: 37.8% for stage I, 34.8% for stage II, 32.1% for stage III and 20.8% for stage IV. But statistical significant difference was observed only between stage I and II, and stage IV. To elucidate the mechanism of endometriosis associated infertility, peritoneal fluid volume, intratubal sperm transport (peritoneal sperm recovery test), and phagocytosis of sperm in the tube and in the peritoneal fluid were examined in more than 1,000 cases. However, no positive relationship was found between the disease and these parameters. Fimbrial microbiopsy also revealed that endometriosis did not affect the ciliation index of the fimbria, nor changed the fine surface structure. Patients with minimal-mild disease were first managed expectantly for one year after laparoscopy: The pregnancy rate was 36.1% for stage I, and 29.7% for stage II. Ninety-eight patients who failed to conceive by expectant management were put on danazol therapy (600 mg/day, for 6 months). However, the results were very disappointing. Of 44 patients with stage I disease, only 3(6.8%) achieved a pregnancy, and none of 54 stage II patients conceived so far. Moreover, second-look laparoscopy revealed that danazol had no effect on the eradication of minimal-mild endometriosis. The patients with stage I-II disease were then treated exclusively by electrocautery at the time of initial laparoscopy: The pregnancy rate was 30.8% (57/185) for stage I, and 23.8% (25/105) for stage II. At second-look laparoscopy, 45.5% (10/22) of stage I and 73.7% (14/19) of stage II were disease free or improved, although the pregnancy rate was not so good as expected.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMedDate not supplied

Spontaneous abortion rate in patients with endometriosis treated with progesterone.

Several reports suggest that women with endometriosis have a higher risk of spontaneous abortions when left untreated; however, these studies did not control for the presence of possible luteal phase defects. This study was designed to document the frequency of spontaneous abortions in women with endometriosis and ovulation defects treated prophylactically with progesterone, compared with similar patients without endometriosis. All the women had late luteal phase endometrial biopsies dating perfectly normal. Our findings show an increase in the rate of spontaneous abortions (25.7%) in women with endometriosis as compared with the entire group (3.8%). However, when the result for the group with endometriosis is compared with the subgroup of patients at diagnostic laparoscopy not showing endometriosis, the results are similar (30%). We conclude that when properly matched groups are compared, there is no increased risk of spontaneous abortions in women with endometriosis. Since we perform laparoscopies only in women failing to conceive after a reasonable number of seemingly normal cycles, the apparently high incidence of abortions in this group may be secondary to other factors that not only may lengthen the time needed for conception but also increase the abortion risk after conception.

Abortion, Spontaneous↗

PubMed1987

Surgical treatment of endometriosis via laser laparoscopy and videolaseroscopy.

The CO2 laser has been used laparoscopically for the removal of endometriotic implants, drainage of endometriomas, and lysis of adnexal adhesions in 102 patients. These patients were followed for a period ranging from 12 to 18 months, during which there were 62 pregnancies including 9 spontaneous abortions and 1 elective termination of a pregnancy. The rates of conception after surgery were as follows: 75% for patients with mild endometriosis (stage I/American Fertility Society), 62% for patients with moderate endometriosis (stage II/AFS), 42.1% for patients with severe endometriosis (stage III/ASF) and 50% for patients with extensive endometriosis (stage IV/AFS). Standard treatment of infertility associated with endometriosis includes both medical (danazol, oral contraceptives, progestins) and surgical (laparotomy, laparoscopy), or combined approaches. This study reports on the CO2 laser used laparoscopically in the treatment of endometriosis associated with infertility. Of 102 patients presenting with infertility attributed to endometriosis, 60.7% conceived within 24 months following laser laparoscopy. In this patient group, no immediate or subsequent laparotomy was required prior to achieving conception, nor was hormonal therapy enacted during the postsurgical study period.

Adult↗

PubMed1988

Enzyme-linked immunosorbent assay of CA-125 in serum of patients with endometriosis: efficacy in diagnosis.

We used an enzyme-linked immunosorbent assay to quantify CA-125, a cancer antigen, in serum of patients with endometriosis. Concentrations of CA-125 in 103 patients with untreated endometriosis significantly (P less than 0.005) exceeded those for 31 controls with no evidence of disease: 9.1 (SD 12.3) vs 2.2 (SD 3.2) arb. units/mL. Values for patients with treated endometriosis were lower (2.3, SD 2.6, arb. units/mL, n = 9) than those for patients with untreated endometriosis. The mean concentrations of CA-125 in different stages of untreated endometriosis were 4.8 (SD 4.5), 7.1 (SD 9.9), 9.8 (SD 13.2), and 10.8 (SD 13.0) arb. units/mL for Stages I, II, III, and IV, respectively. The differences between controls and each stage were statistically significant (for all stages: P less than 0.05). We also assayed serum sampled from controls and patients with untreated endometriosis during menstruation (Group A) and during nonmenstruation (Group B). The efficacy of the present assay for concentrations of CA-125 in serum of patients with endometriosis was greater for Group B than for Group A. Evidently, determination of CA-125 in serum by the present assay may assist in such diagnosis.

Adult↗

PubMed1987

[Ultrasonographic diagnosis of cul-de-sac endometriosis].

Fifty-six women with endometriosis were examined for cul-de-sac endometriosis by ultrasonography and laparoscopy. Ultrasonographic cul-de-sac findings were classified into 3 groups; i.e. Group A (n = 21): no remarkable findings, Group B (n = 16): several nodular hyperechoic or cystic hypoechoic areas, and Group C (n = 19): multiple nodular or cystic areas and/or discontinuation of the contour of the posterior uterine wall. Laparoscopic cul-de-sac findings were classified into 3 groups; i.e. Group alpha (n = 6): no endometriosis, Group beta (n = 28): minimal or mild endometriosis, and Group gamma (n = 22): advanced endometriosis with or without cul-de-sac obliteration. Over-all coincidence of both findings was 50%. The rate of coincidence was significantly higher (p less than 0.05) in Group gamma (15/22) than in Group beta (9/28). This indicates that the diagnosis of minimal or mild cul-de-sac endometriosis by means of ultrasonography is difficult but that ultrasonography might be useful in diagnosing advanced cul-de-sac endometriosis.

Culdoscopy↗

PubMed1987

Pelvic endometriosis.

The recent heightened interest in endometriosis has led to remarkable progress in the elucidation of the pathophysiology of this enigmatic disease. Presently, it is not clear why some individuals with endometriosis develop infertility and pelvic pain, whereas others with a similar degree of disease do not. Several tantalizing clues have been extracted from studies of the molecular pathogenesis, immunology, and biochemistry of endometriosis. Investigations are now under way to determine the specific relevance to infertility of macrophage aggregation; prostaglandin and related metabolite production by endometriotic lesions and macrophages; specific factors released by endometriosis that might directly impair ovum pick-up, fertilization, embryo transfer, or implantation; and ovulatory dysfunction including luteal phase deficiency and LUFS. There are probably a host of potential mechanisms of infertility in endometriosis; additional research should enable us to determine their regulatory features and to formulate effective clinical intervention. We now have a broader array of options for the treatment of endometriosis than ever before. However, most of the extant reported clinical experience consists of case reports and limited series of patients without the use of controls, follow-up intervals, and appropriate statistical analysis. The diverse course and presentation of the disease have limited our ability to develop a staging system that provides consistent scoring among different clinicians and appropriate relative emphasis on the various manifestations of the disease. Some additional resolution will be necessary to assess the relative contribution to infertility by fresh and recurrent lesions, endometriomas, and adhesions. These problems are now in sharp focus, and data should be available in the future giving us an accurate appraisal of the clinical effectiveness of danazol, gestrinone, GnRH analogues, conservative surgery, laparoscopic surgery including use of the laser, IVF-ET, and GIFT. Also, it is anticipated that potentially fertile patients with endometriosis might be identified so that they could avoid therapy altogether.

Endometriosis↗

PubMed1987

[A study on the diagnosis and treatment of the infertile patient with endometriosis externa by scoring].

Though the conservative treatment of infertility associated with endometriosis has undergone a significant evolution, clinical diagnostic problems still remain. In order to evaluate the efficacy and diagnostic value of the non-surgical scoring method, personal histories, symptoms, signs, hysterosalpingographic findings and routine infertility test results for 63 patients with endometriosis diagnosed laparoscopically were compared with those of 63 controls. 8 findings specific to endometriosis and the scores were as follows: Dysmenorrhea (1), dyspareunia (3), retroverted uterus (3), cul-de-sac nodularities (3), atonic (1) and marginal irregularity (1) of uterus, and perifimbrial adhesion (2) in hysterosalpingography, and unexplained infertility (2). The results obtained retrospectively revealed that the probability of endometriosis was seen in the cases in which the total scores ranged 0-4, 5-8, and 9-16; the incidence being approximately 10%, 60%, and 90% respectively. These results were confirmed by a prospective study. After completing a course of treatment, the pregnancy rate was 55% in patients with endometriosis. This fertility rate was higher than that of controls (23%). Thus, infertile women whose total scores ranged 0-4, 5-8, and 9-16 will be required to undergo re-examination of other sterility factors other than endometriosis, diagnostic laparoscopy and treatment for endometriosis, respectively.

Antigens, Neoplasm↗

PubMed1986

An endometrial antibody assay in the clinical diagnosis and management of endometriosis.

Coded serum samples from 11 normal fertile men and 17 fertile women without endometriosis (control groups) and 41 women with endometriosis were tested blindly for the presence of endometrial antibodies by use of a passive hemagglutination assay. Endometrial antibodies were either absent or present in low baseline titers in the serum samples from the control group. In contrast, 17 of the 23 (74%) patients with untreated endometriosis had elevated titers of endometrial antibodies in their serum. Of the 18 patients treated with danazol, endometrial antibodies were absent in 7 women who showed a good response at repeat laparoscopy, whereas 4 of 5 women with a poor response had significantly positive titers of antibodies. Six patients treated with danazol did not have repeat laparoscopy, but were found to have endometrial antibody titers in the baseline control range. Endometrial antibody titers in women with a good response to danazol were significantly lower than those in women with untreated endometriosis or with a poor response to danazol (P = 0.003). No correlation was observed between the antibody titers and the stage of endometriosis. The results suggest that the assay for serum endometrial antibodies may prove to be a clinically useful, noninvasive aid in the diagnosis of endometriosis. Sequential determination of endometrial antibody titers may be helpful in assessing the efficacy of pharmacologic therapy for endometriosis and evaluating the cases of patients with possible recurrence of the disease.

Antibodies↗

PubMed1987

Endometriosis and mullerian anomalies.

Although numerous etiologies for endometriosis have been proposed, it is clear that retrograde menstruation and cell-mediated lymphocytotoxicity each play a significant role in the disease's development. A comprehensive theory of pathogenesis of endometriosis holds that development of the disorder depends upon amount of retrograde menstruation and the ability of the immune response to remove the debris. To test this theory, 64 women with mullerian anomalies and intra-abdominal surgery were evaluated for the presence or absence of endometriosis, patency of tubes, hematocolpos or hematometra, and outflow obstruction. Results demonstrated that endometriosis was present in ten of 13 women with functioning endometrium, patent tubes, and outflow obstruction, whereas it could be identified in only 16 of 43 women with no obstruction (77 versus 37%, P less than .01). Similarly, eight of nine women with hematocolpos or hematometra had endometriosis, while only 18 of 47 with functioning endometrium but no hematometra/hematocolpos had it (89 versus 38%, P less than .01). None of the eight women without endometrium had endometriosis. These data support the concept that an increase in retrograde menstruation will increase the likelihood of endometriosis.

Endometriosis↗

PubMed1984

Endometriosis and corpus luteum function. Is there a relationship?

More than 100 years after the first description of endometriosis, the pathophysiology of the disorder still remains an enigma. In addition to infertility, an increased frequency of clinically apparent spontaneous abortions (32% vs. 8-15% in the normal population and 19% in the infertile one) has been found in women with endometriosis and secondary infertility. Treatment of endometriosis with conservative surgery, danazol or both results in a frequency of spontaneous abortion within the range of the normal population's. Although the factors involved in the pathophysiology of endometriosis are probably multiple, abnormal corpus luteum function is a common mechanism that might explain both the infertility and the spontaneous abortions. Several studies suggested a relationship between endometriosis and corpus luteum function, which may be mediated by prostaglandins. However, not all the data have been supportive. We developed a hypothetical scheme (modified from Drake) that outlines possible mechanisms of endometriosis mediated by the adverse effects of increased prostaglandins. Further investigation of this scheme may provide new information about the pathophysiology of endometriosis.

Abortion, Spontaneous↗

PubMed1994

[Endometriosis--the features of its clinical characteristics].

The authors present the clinica; characterization to 100 women that operate in the Institute in Obstetrics and Gynaecology with histological diagnosis endometriosis, compare with 20 women, operate on the occasion of myoma uteri. The authors find that endometriosis happen more often than endometriosis externa (69%). The both most frequently are in combination with myoma uteri (68% and 52%). In the combination with Ca are a little (3%) with Ca corporis uteri. Sterility has in 14% on cases with endometriosis interna and twice more (32%) in the cases with endometriosis externa. Hypermenorrhea occurs in 43% on the cases and dysmenorrhea--in 25%. Asymptomatic endometriosis occurs in 68% on the cases. In conclusion the endometriosis is a unique disease with no characteristics symptomatic, that help us no much for the exact diagnosis.

Adult↗

PubMed1995

[Personal characteristics as risk factors of endometriosis].

203 patients with pelvic endometriosis, all Beijing resident, were collected from the Peking Union Medical College Hospital and the Beijing Obstetrical and Gynecological Hospital. The diagnosis of endometriosis was confirmed by pathological examination of surgical specimens in 186 patients and by aspiration of chocolate substance under laparoscopy in 17. Two population controls, age matched +/- 1 year, were randomly selected for each patient from the same residential area, after careful pelvic examinations and ultrasonographies. A questionnaire for any possible risk factors to endometriosis was developed and with this questionnaire a face to face interview for each subject was carried out by the trained interviewers. All interviews were tape recorded and calculated in a AST 386 computer. The continuous logistic regression for matched sites was used to obtain a maximum likelihood point and to control the potential confounding effects of selected variables. Relative risk (RR) substituted for odds ratio together with the 95% confidence intervals was estimated. All the results were adjusted for the variables of the model including some relevant factors of menstruation, pregnancy and contraception. An increased risk for endometriosis was found to be related to women who had a higher level of education. Even it was adjusted for age of first marriage and pregnancy, gravidity, parity, contraception and all other variables of the model, the relative risk was 1.84 for endometriosis. Therefore, it is the education level itself that plays a true role in development of endometriosis. Although there was a trend in risk for endometriosis in height, it was statistically insignificant.(ABSTRACT TRUNCATED AT 250 WORDS)

ABO Blood-Group System↗

PubMed1995

Interleukin-8 concentrations are elevated in peritoneal fluid of women with endometriosis.

OBJECTIVE: To investigate the presence of interleukin-8 (IL-8), a macrophage-derived angiogenic factor, in peritoneal fluid (PF) of women with and without endometriosis. DESIGN: Case-control study. SETTING: University hospital. PATIENTS: Eighteen women with laparoscopic findings of mild to severe endometriosis, and nine women with no visual evidence of pelvic pathology. MAIN OUTCOME MEASURES: Peritoneal fluid IL-8 levels were determined using an ELISA. Interleukin-8 concentrations were compared among women with and without endometriosis. Correlation between PF IL-8 concentration and endometriosis stage was investigated. RESULTS: Interleukin-8 was detectable in the PF of a majority of women (67%). Interleukin-8 concentrations were higher in the PF of women with endometriosis than in matched normal controls. A significant correlation between PF IL-8 concentration and endometriosis stage was noted. CONCLUSIONS: We hypothesize that IL-8 is an important angiogenic factor that contributes to the pathogenesis of endometriosis by promoting the neovascularization of ectopic endometrial implants.

Adult↗

PubMed1994

Treatment of deeply infiltrating endometriosis.

Deep endometriosis has been defined as endometriosis infiltrating deeper than 5 mm under the peritoneum. A model for the development and propagation of endometriosis is presented. Subtle and non-pigmented lesions are suggested to occur intermittently in all women. Infiltration occurs generally to a few millimeters of depth only, and these lesions become typical, burnt out lesions. In some 20% of women, severe endometriosis develops either as deeply infiltrating disease or as cystic ovarian disease. Arguments are given to consider deep endometriosis and cystic ovarian endometriosis as two specific entities of endometriotic disease. A possible causal relationship with dioxin pollution is discussed. Diagnosis of deep endometriosis is made by clinical examination and palpation during surgery. Clinical examination during menstruation and CA-125 concentrations in plasma are useful to help in the diagnosis of smaller deep lesions. Surgical excision can be carried out by laparoscopy, laparotomy or vaginally using sharp dissection, electrosurgery or with the use of a CO2 laser. Excision is the treatment of choice because of a high pregnancy rate, a complete cure of pain in most women, and a low recurrence rate. Medical treatment is probably less effective to treat infertility, but highly effective in relieving pelvic pain. Medical therapy, by luteinizing hormone-releasing hormone agonists, danazol, or gestrinone, also seems useful as a pretreatment for surgery. The choice of treatment will therefore depend on the local expertise with minimal invasive surgery, certainly if a first excision has been incomplete and pain symptoms recur.

Endometriosis↗

PubMed1994

[Reproductive activities as a risk factor of endometriosis].

A case-control study, involving 203 cases of pelvic endometriosis and 406 randomly selected and age-matched community controls, was conducted. The results were as following: 1) A decreased risk for endometriosis was found to be related to pregnancy. The relative risk was 0.34 for para 1 and 0.08 for para 2 or more. A similar tendency was also showed in the analysis of gravidity, but this protective effect totally disappeared after adjustment for parity. Therefore, it may be revealed that it is the parity but not the gravidity which protects the women against the endometriosis. 2) There was an increased risk of 15.35 for endometriosis in women with infertility. 3) No relation emerged with age at first pregnancy to the occurrence of endometriosis as indicated in the literature. 4) The frequency of induced abortion was 42.4% in the cases and that was 63.7% in the controls. The association with the risk of the disease adjusted for education, menstruation, parity and contraception was not significant by a attentive stratification the data. 5) Two groups were relatively similar with respect to recorded condom and oral contraceptive use. However, more cases than controls did not use any contraception or only used rhythm method and coitus interruptus, and more controls than cases used an intrauterine device. The results of multivariate analysis did not approve of opinion that IUD is a risk factor of endometriosis. The results did not negate the likelihood of diminished chance of developing endometriosis in women with using oral contraceptives.

Adult↗

PubMed1994

[Clinical significance of galactosyltransferase associated with tumor (GAT), a new tumor marker for ovarian cancer--with special reference to the discrimination between ovarian cancer and endometriosis].

We examined GAT, a newly developed tumor marker, in serum samples collected from 1,503 females in six institutions: 387 healthy females, 1,052 patients with gynecological diseases including 311 ovarian cancers, and 64 with nongynecological diseases. Based on the mean value + 2 SD for the healthy females, the cut-off value was set at 16 U/ml. The positive rate of GAT was 2.6% for the healthy females, 7.1% for patients with benign ovarian tumor, 5.6% for those with endometriosis, 47.9% for those with ovarian cancers, 9.3% for those with cervical cancer, and 13.3% for those with endometrial cancer. The false-positive rate of GAT for endometriosis was very low compared with that of the other markers such as CA 125, CA 602, CA 54/61, CA 72-4, STN, SLX examined in this study. The positive predictive value between ovarian cancer and endometriosis was the highest with GAT among the evaluated markers. In the cases in which the CA 125 (CA 602) value is relatively low, discrimination between ovarian cancer and endometriosis is difficult, because these cases include many patients with endometriosis. GAT showed the highest positive predictive value in such cases, so GAT proved to play a complementary role with CA 125 (CA 602). Combination assay with GAT and CA 54/61/CA 72-4/STN or SLX showed higher diagnostic efficiency between ovarian cancer and endometriosis. These results suggest the usefulness of GAT for discrimination between ovarian cancer and endometriosis.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1993

Immunosuppressive activity of peritoneal fluid in women with endometriosis.

OBJECTIVE: To investigate the immunosuppressive effect of peritoneal fluid and follicular fluid on both natural killer-mediated cytotoxicity and phytohemagglutinin-induced lymphocyte proliferation. METHODS: The peritoneal fluid of women with endometriosis was compared to both fertile and infertile control fluids. Lymphocytes were pretreated for 2 or 20 hours with peritoneal or follicular fluids, and their cytotoxicity toward K562 tumor cells was measured. We also investigated the phytohemagglutinin-induced stimulation of lymphocytes cocultured with peritoneal or follicular fluid. RESULTS: Peritoneal fluid from women with endometriosis had a significantly greater immunosuppressive effect on natural killer-mediated cytotoxicity and on phytohemagglutinin stimulation of lymphocytes compared to peritoneal fluid of fertile women without endometriosis (P < .01 and P < .05, respectively). Using the peritoneal fluid of infertile women without endometriosis, these differences were significant only when compared to women with severe endometriosis. Inhibition of the natural killer activity increased when the incubation period was prolonged from 2 to 20 hours (P < .04). There was no correlation between the immunosuppressive effect of peritoneal fluid and the volume of peritoneal fluid, the day of the menstrual period, or estradiol, progesterone, prostaglandin E2, or prostaglandin F2 alpha levels. In peritoneal fluid, the factor responsible for inhibition of natural killer activity was not removed with charcoal treatment. In follicular fluid, on the other hand, the inhibition of natural killer activity decreased significantly after treatment with charcoal. CONCLUSION: Natural killer activity is suppressed by the peritoneal fluid of women with severe endometriosis; this may be important in the pathogenesis of endometriosis. The factor responsible for the inhibition of natural killer activity in peritoneal fluid is different from that in follicular fluid.

Ascitic Fluid↗

PubMed1996

Serial laparoscopies over 30 months show that endometriosis in captive baboons (Papio anubis, Papio cynocephalus) is a progressive disease.

OBJECTIVE: To test the hypothesis that spontaneous endometriosis is a progressive disease in baboons. DESIGN AND SETTING: Prospective cohort study, Institute of Primate Research, Nairobi, Kenya. PARTICIPANTS: Twelve baboons with histologically proven spontaneous endometriosis. INTERVENTIONS: Fifty-four serial laparoscopies (4.2 +/- 1.9 per animal, range 1 to 7) were performed after 1 to 3 months (n = 2), 4 to 6 months (n = 1), 7 to 9 months (n = 6), 10 to 12 months (n = 17), 13 to 15 months (n = 7), 16 to 18 months (n = 1), 19 to 21 months (n = 8), 22 to 24 months (n = 8), 25 to 27 months (n = 2), and 30 to 32 months (n = 2). MAIN OUTCOME MEASURE: During each laparoscopy the pelvis was examined for the presence of endometriosis. The number, size, and type of endometriotic implants were noted on a pelvic map and both endometriosis score and stage were calculated. Remodeling was defined as a change in laparoscopic appearance (typical, subtle, suspicious) of an individual endometriotic lesion. Data were analyzed by a signed rank test. RESULTS: Endometriosis was progressive as shown by the significant increase in the number and surface of lesions and in endometriosis scores after 24 months. The total number of endometriotic lesions after 24 months consisted of 69% new (and mostly subtle) implants, 10% remodeled lesions, and 21% unchanged implants. CONCLUSIONS: This study demonstrated that endometriosis in captive baboons undergoing repeated laparoscopies is a dynamic and moderately progressive disease with periods of development and regression and active remodeling between different types of lesions.

Animals↗