1
|
Grigoriadis G, Daniilidis A, Merlot B, Stratakis K, Dennis T, Crestani A, Chanavaz-Lacheray I, Roman H. Surgical treatment of deep endometriosis: Impact on spontaneous conception. Best Pract Res Clin Obstet Gynaecol 2024; 93:102455. [PMID: 38181664 DOI: 10.1016/j.bpobgyn.2024.102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
Deep endometriosis (DE) is the most severe form of endometriosis and is commonly associated with infertility. Surgical treatment of DE appears to increase chances of spontaneous conception in appropriately selected patients wishing to conceive. Identifying, however, the exact impact of DE, and its surgical removal, on natural conception is highly challenging. The surgical approach should be favoured in symptomatic patients with pregnancy intention. Limited data from infertile patients suggest that outcomes may not differ from patients without known infertility. Complex DE surgery carries a risk of serious complications, therefore, it should be performed in centers of expertise. Such complications may, however, not have a significant negative impact on fertility outcomes, according to limited available data. Data on obstetric outcomes of spontaneous conceptions after DE surgery are too scarce. In asymptomatic, infertile patients the debate between primary surgery or Artifial Reproductive Technology is ongoing, until randomized studies report their results.
Collapse
Affiliation(s)
| | - Angelos Daniilidis
- 1st Department in Obstetrics and Gynecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643, Thessaloniki, Greece
| | - Benjamin Merlot
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark
| | - Konstantinos Stratakis
- 1st Surgical Department, Peripheral General Hospital Giorgos Gennimatas, 11527, Athens, Greece
| | - Thomas Dennis
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Adrien Crestani
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Isabella Chanavaz-Lacheray
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Horace Roman
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark.
| |
Collapse
|
2
|
Daniilidis A, Angioni S, Di Michele S, Dinas K, Gkrozou F, D’Alterio MN. Deep Endometriosis and Infertility: What Is the Impact of Surgery? J Clin Med 2022; 11:jcm11226727. [PMID: 36431203 PMCID: PMC9693611 DOI: 10.3390/jcm11226727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
In women with deep endometriosis, the spontaneous fertility rate might range from 2 to 10%. The optimal management of these women is still an area of debate. Therefore, this review aims to explore the literature on the impact of deep endometriosis surgery on reproductive outcomes and pregnancy rates in women with and without prior infertility. A total of 392 articles were identified through database searching. Twenty-three studies were eligible to be included in the review. A total of 1548 women were identified, 814 of whom became pregnant, with a mean pregnancy rate of 52.6% (95% CI 49.7-63%). Our review suggests that surgery may improve fertility outcomes. Due to the variability in the studies, it is impossible to stratify fertility outcomes of surgery by the localization of deep endometriosis. More investigations are needed to determine whether surgical management should be first-intention or limited to the failure of medically assisted reproduction treatment.
Collapse
Affiliation(s)
- Angelos Daniilidis
- Department of Obstetrics and Gynecology, Hippokratio Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece
- Correspondence: (A.D.); (M.N.D.); Tel.: +39-07051093399 (M.N.D.)
| | - Stefano Angioni
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
| | - Stefano Di Michele
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
| | - Konstantinos Dinas
- Department of Obstetrics and Gynecology, Hippokratio Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece
| | - Fani Gkrozou
- University Clinic in Obstetrics and Gynecology, University of Ioannina, 451 10 Ioannina, Greece
| | - Maurizio Nicola D’Alterio
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
- Correspondence: (A.D.); (M.N.D.); Tel.: +39-07051093399 (M.N.D.)
| |
Collapse
|
3
|
Dirou C, Fondin M, Pabic EL, Moawad G, Dion L, Nicolas F, Duros S, Bauville E, Coiffic J, Pizzoferrato AC, Béraud E, Levêque J, Lavoué V, Nyangoh Timoh K. Association of Preoperative Enzian Score with Postoperative Fertility in Patients with Deep Pelvic Endometriosis. J Gynecol Obstet Hum Reprod 2022; 51:102408. [PMID: 35588972 DOI: 10.1016/j.jogoh.2022.102408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 03/12/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Endometriosis is a chronic inflammatory disease with a negative impact on fertility. The Enzian classification provides a precise description of deep pelvic endometriotic lesions, especially in the retroperitoneal area, from preoperative pelvic MRI scans. However, it is not known if it is correlated with postoperative fertility. STUDY OBJECTIVE To determine if there is an association between the preoperative Enzian score and postoperative fertility after deep pelvic endometriosis surgery. DESIGN We conducted a descriptive, retrospective study using information from the ENDOREN database. SETTING This was a retrospective study at the Department of Obstetrics and Gynecology at Rennes University Hospital (France) from January 2013 to May 2019 PATIENTS AND INTERVENTIONS: We used information from the ENDOREN database that included all women who underwent surgery for deep endometriosis and wish to conceive. This surgery was intended in a view to achieve a complete removal of endometriosis. MEASUREMENTS The Enzian score was calculated from preoperative MRI scans, and total, spontaneous, and after In Vitro Fertilization (IVF) live births and pregnancies outcomes were collected from the patients'computerized medical records. Univariate and multivariate analysis was performed. RESULTS Sixty-eight patients were included. The live-birth rate was 35% (24/68). According to the Enzian classification, 25 patients (35%) were classified in compartment A, 64 patients (94%) in compartment B, and 27 (40%) in compartment C. In multivariate analysis, positive predictor of live birth was single Enzian B score (OR=4.7[1.21; 18.81], p=0.03), negative predictors were uterine adenomyosis and a history of endometriosis surgery. In multivariate analysis, positive predictor of spontaneous live birth was EFI score ≥7 (OR =22.434; CI [1.138; 442.190]). In multivariate analysis, positive predictor was Enzian A score (OR=15.9[2.2; 114.7], p=0.006), and negative predictors was uterine adenomyosis and Enzian B score (OR=0.01[0; 0.495], p=0.02) for live birth after IVF. CONCLUSION The present retrospective study cannot strongly conclude about fertility and correlation with Enzian score because the groups are too small. However, it seems that when solely the compartment B is involved by endometriosis, complete full removal of endometriosis leads to better post-operative live births results. Other studies must be done to determine if Enzian classification based on preoperative pelvic MRI could be clinical value in the decision-making strategy for managing infertile patients with deep pelvic endometriosis.
Collapse
Affiliation(s)
- Charlotte Dirou
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; University 1, Rennes, France
| | - Maxime Fondin
- Department of Radiology, Rennes University Hospital, France; University 1, Rennes, France
| | - Estelle Le Pabic
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; University 1, Rennes, France
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; Rennes, University 1, IRSET, Rennes, France; University 1, Rennes, France
| | - Florence Nicolas
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France
| | - Solène Duros
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France
| | - Estelle Bauville
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France
| | - Jean Coiffic
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France
| | | | - Eugénie Béraud
- Department of Radiology, Rennes University Hospital, France
| | - Jean Levêque
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; University 1, Rennes, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; Rennes, University 1, IRSET, Rennes, France; University 1, Rennes, France
| | - Krystel Nyangoh Timoh
- Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; University 1, Rennes, France.
| |
Collapse
|