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Wang RR, Su MH, Liu LY, Lai YY, Guo XL, Gan D, Zheng XY, Yang H, Yu SY, Liang FR, Wei W, Zhong Y, Yang J. Systematic review of acupuncture to improve ovarian function in women with poor ovarian response. Front Endocrinol (Lausanne) 2023; 14:1028853. [PMID: 36992800 PMCID: PMC10040749 DOI: 10.3389/fendo.2023.1028853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To determine the effect of acupuncture in treating poor ovarian response (POR). METHODS We searched MEDLINE (via PubMed), EMBASE, Allied and Complementary Medicine Database, CNKI, CBM, VIP database, Wanfang Database, and relevant registration databases from inception to January 30, 2023. In this review, both Chinese and English peer-reviewed literature were included. Only randomized controlled trials (RCTs) using acupuncture as an intervention for POR patients undergoing in vitro fertilization were considered. RESULTS Seven clinical randomized controlled trials (RCTs) were eventually included for comparison (516 women). The quality of included studies was generally low or very low. For the meta-analysis, seven studies showed that compared with controlled ovarian hyperstimulation (COH) therapy, acupuncture combined with COH therapy could significantly increase the implantation rate (RR=2.13, 95%CI [1.08, 4.21], p=0.03), the number of oocytes retrieved (MD=1.02, 95%CI [0.72, 1.32], p<0.00001), the thickness of endometrium (MD=0.54, 95%CI [0.13, 0.96], p=0.01), and the antral follicle count (MD=1.52, 95%CI [1.08, 1.95], p<0.00001), reduce follicle-stimulating hormone (FSH) levels (MD=-1.52, 95%CI [-2.41, -0.62], p=0.0009) and improve estradiol (E2) levels (MD=1667.80, 95%CI [1578.29, 1757.31], p<0.00001). Besides, there were significant differences in the duration of Gn (MD=0.47, 95%CI [-0.00, 0.94], p=0.05) between the two groups. However, no statistical variation was observed in improving clinical pregnancy rate (CPR), fertilization rate, high-quality embryo rate, luteinizing hormone (LH) value, anti-mullerian hormone (AMH) value, or reducing the dose of gonadotropin (Gn) values between the acupuncture plus COH therapy group and the COH therapy group. CONCLUSION Acupuncture combined with COH therapy is doubtful in improving the pregnancy outcome of POR patients. Secondly, acupuncture can also improve the sex hormone level of POR women, and improve ovarian function. Furthermore, more RCTs of acupuncture in POR are needed to be incorporated into future meta-analyses. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier CRD42020169560.
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Affiliation(s)
- Rong-Rong Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Meng-Hua Su
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Li-Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuan-Yuan Lai
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiao-Li Guo
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
| | - Di Gan
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
| | - Xiao-Yan Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Han Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Si-Yi Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fan-Rong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Wei
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
- *Correspondence: Wei Wei, ; Ying Zhong, ; Jie Yang,
| | - Ying Zhong
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
- *Correspondence: Wei Wei, ; Ying Zhong, ; Jie Yang,
| | - Jie Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
- Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, Chengdu, Sichuan, China
- *Correspondence: Wei Wei, ; Ying Zhong, ; Jie Yang,
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Impact of cystectomy versus ablation for endometrioma on ovarian reserve: a systematic review and meta-analysis. Fertil Steril 2022; 118:1172-1182. [PMID: 36334993 DOI: 10.1016/j.fertnstert.2022.08.860] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate whether cystectomy or ablation for endometrioma has less impact on ovarian reserve as evaluated by antral follicle count (AFC) and antimüllerian hormone (AMH) levels. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Patients with endometriomas undergoing cystectomy or ablation. INTERVENTION(S) All prospective studies comparing cystectomy with ablation for endometrioma in the PubMed, EMBASE, MEDLINE and Web of Science until April 3, 2022 were retrieved and reviewed. Medical treatment used as adjuvant therapy for the surgery was excluded. Two authors assessed eligibility and risk of bias independently. The statistical data were pooled using the Review Manager software. MAIN OUTCOME MEASURE(S) The changes of AMH levels and AFC values in cystectomy group and ablation group, including intergroup comparisons and intragroup comparisons. RESULT(S) Four randomized clinical trials and 2 prospective cohort studies were eligible for the meta-analysis, with a total of 294 patients. In the intergroup comparisons, preoperative AFC values were similar with low heterogeneity, but postoperative AFC values were significantly lower in cystectomy than ablation (mean differences [MD], -1.33; 95% credible interval, -2.15 to -0.51; I2 = 57%). In the intragroup comparisons of AFC values, sensitivity analyses showed a significant decrease in cystectomy (MD, -1.93; 95% credible interval, -2.40 to -1.45; I2 = 0%) at 6-month follow-up, compared with no reduction in ablation. The intragroup comparisons of AMH levels supported negative effects on ovarian reserve of both cystectomy (MD, -1.26; 95% credible interval, -1.64 to -0.88; I2 = 45%) and ablation (MD, -0.70; 95% credible interval, -1.07 to -0.32; I2 = 0%). CONCLUSION(S) Both ablation and cystectomy have significantly detrimental effects on ovarian reserve as evaluated by AMH, but the ablation causes relatively less damage to ovarian reserve as appraised by AFC. CLINICAL TRIAL REGISTRATION NUMBER CRD42020152823;PROSPERO (york.ac.uk).
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Friedrich L, Meyer R, Levin G. Management of adnexal mass: A comparison of five national guidelines. Eur J Obstet Gynecol Reprod Biol 2021; 265:80-89. [PMID: 34474226 DOI: 10.1016/j.ejogrb.2021.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/18/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES General gynecologists are often the first to face a newly diagnosed adnexal mass. Bothering mass symptoms, fertility issues, and the effect of a possible surgical intervention on fertility in term of mechanical factor and ovarian follicular reserve are all considerations that should be accounted for. This study summarizes and compares five different adnexal mass management guidelines, enabling clinicians to peruse consensus and controversy issues, thus choosing the optimal management method. DESIGN We retrieved, reviewed and compared the most recent national guidelines of adnexal mass management from the national societies of the United States (American College of Obstetricians and Gynecologists), England (the Royal College of Obstetricians and Gynecologists), Canada (the Society of Obstetricians and Gynaecologists of Canada), Australia (the Royal Australian College of General Practitioners), and France (French College of Gynaecologists and Obstetricians). RESULTS There is a broad consensus regarding the role of transvaginal ultrasound as part of the initial evaluation of an adnexal mass and the radiological characteristics suggesting it being malignant. The role of transabdominal ultrasound or doppler mode is controversial. The use of MRI in cases of indeterminate adnexal masses is widely accepted. Ultrasound-guided aspiration is generally not recommended. There is a broad consensus that CA-125 should not be used as an ovarian cancer disease screening tool, though its role in the initial evaluation of adnexal masses is controversial. Risk prediction models are generally accepted, particularly the 'International Ovarian Tumor Analysis simple rules' and the 'Risk of Malignancy Index'. CONCLUSION Adnexal mass management national guidelines, though similar, had noticeable variations in the content, references cited, and recommendations made. While this variation might raise a concern as to the reproducibility of synthesizing literature, it can help practitioners present all spectra of recommendations and available data.
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Affiliation(s)
- Lior Friedrich
- The Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Raanan Meyer
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; The Faculty of Medicine, Hebrew University, Jerusalem, Israel
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4
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Jang S, Kim KH, Jun JH, You S. Acupuncture for in vitro fertilization in women with poor ovarian response: a systematic review. Integr Med Res 2020; 9:100395. [PMID: 32322482 PMCID: PMC7160570 DOI: 10.1016/j.imr.2020.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/04/2022] Open
Abstract
Background Poor ovarian response (POR) is one reason for infertility. In vitro fertilization (IVF) is frequently used to help achieve pregnancy, and performing acupuncture before IVF may promote ovulation and reduce egg retrieval pain. The purpose of this systematic review was to evaluate the effectiveness of acupuncture on clinical pregnancy rates (CPR) after IVF in women with POR. Methods Eight electronic databases were searched in January 2020, and reference lists of retrieved articles and previous review articles were hand-searched. Randomized controlled trials (RCTs) using any type of acupuncture for women with POR undergoing IVF were considered. Risk of bias was assessed using the Cochrane risk of bias standards. Results Three RCTs were included in this review. CPR and the number of retrieved oocytes were measured in two studies, while the values of anti-Mullerian hormone (AMH) and antral follicle count (AFC) were only reported in one study. In two studies, CPR was higher in the intervention group than the control group [37.8 % vs 24.3 %]. We did not conduct a meta-analysis, as there was a high level of heterogeneity in interventions among the included trials. Conclusions This study suggests that acupuncture may improve CPR, AMH, AFC and the number of retrieved oocytes in women with POR undergoing IVF. However it is difficult to conclude that acupuncture is more effective than conventional treatment. Additionally, more clinical trials are needed to evaluate the effectiveness of acupuncture on CPR and other outcomes of POR. Study registration PROSPERO CRD42018087813; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018087813
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Affiliation(s)
- Soobin Jang
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kyeong Han Kim
- Department of Preventive Medicine, College of Korean Medicine, Woosuk University, Jeonju, Republic of Korea
| | - Ji Hee Jun
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sooseong You
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Corresponding author at: Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea.
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5
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Taheripanah R, Zamaniyan M, Meybodi MK, Amir-arjmand MH, Mansouri A, Taheripanah A, Malih N. Are intra follicular estradiol and oocytes quality in women undergoing assisted reproductive technology different between the right and left ovaries? An observational study. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100047. [PMID: 31403131 PMCID: PMC6687401 DOI: 10.1016/j.eurox.2019.100047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 04/13/2019] [Accepted: 05/10/2019] [Indexed: 12/03/2022] Open
Abstract
Objective Controlled Ovarian Stimulation (COS) for In-Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) is considered as an assisted reproduction technology. There are established structural and biological differences between both ovaries which may affect their responsiveness to COS. Whether the right or the left ovary responds superior to COS is a question which is unresolved in the literature. Study design The present study was conducted as a prospective observational to make a comparison between right and left ovaries’ oocytes based on oocyte quality and follicular fluid estradiol level. A total of 100 infertile women who had referred to Infertility and Reproductive Health Research center at Shahid Beheshti University of Medical Sciences, Tehran, Iran, were investigated. Results The total number of very good and good oocytes were 63.01% vs. 50.3%, and immature and interstitial oocytes were 36.99% vs. 49.6% in the right and the left ovaries, respectively. There were no significant differences between oocyte rates between the two ovaries (P > 0.05). Conclusion Good and very good quality oocytes and fertilization rate (P < 0.001) are higher in the right ovary compared with the left ovary; however, no significant difference was observed between the right and the left ovaries in oocyte yields and cleavage rates. Moreover, despite higher follicular estradiol levels in the left ovary, there was no relationship noticed between follicular fluid estradiol and oocyte quality among oocytes of each ovary.
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Affiliation(s)
- Robabeh Taheripanah
- Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Zamaniyan
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Infertility Center, Department of Obstetrics and Gynecology, Mazandaran University of Medical Sciences, Sari, Iran
- Corresponding author at: Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | | | | | - Ardalan Mansouri
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Taheripanah
- Department of Molecular and Cellular Sciences, Faculty of Advanced Sciences and Technology Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Narges Malih
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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6
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Wu CQ, Albert A, Alfaraj S, Taskin O, Alkusayer GM, Havelock J, Yong P, Allaire C, Bedaiwy MA. Live Birth Rate after Surgical and Expectant Management of Endometriomas after In Vitro Fertilization: A Systematic Review, Meta-Analysis, and Critical Appraisal of Current Guidelines and Previous Meta-Analyses. J Minim Invasive Gynecol 2018; 26:299-311.e3. [PMID: 30717864 DOI: 10.1016/j.jmig.2018.08.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 12/26/2022]
Abstract
Controversy exists regarding surgical management of endometriomas in infertile women before in vitro fertilization (IVF) because growing evidence indicates that surgery may impair the ovarian response. The objective of the present systematic review and meta-analysis was to compare surgical and expectant management of endometriomas regarding IVF outcomes. Prospective and retrospective controlled studies were found via the Cochrane Library, Embase, and MEDLINE databases. Thirteen studies (1 randomized controlled trial and 12 observational studies, N = 2878) were pooled, and similar live birth rates were observed in the surgically and expectantly managed groups (odds ratio = 0.83; 95% confidence interval [CI], 0.56-1.22; p = .98). The clinical pregnancy rates (odds ratio = 0.83; 95% CI, 0.66-1.05; p = .86), the number of mature oocytes retrieved, and the miscarriage rates were not statistically different between study groups. However, the total number of oocytes retrieved was lower in the surgery group (mean difference = -1.51; 95% CI, -2.60 to -0.43; p = .02). Findings suggest that surgical management of endometriomas before IVF therapy yields similar live birth rates as expectant management. However, future properly designed randomized controlled trials are warranted.
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Affiliation(s)
- Clara Q Wu
- Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, Saskatchewan, Canada (Dr. Wu)
| | - Arianne Albert
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada (Drs. Albert, Alfaraj, Taskin, Havelock, Yong, Allaire, and Bedaiwy)
| | - Sukainah Alfaraj
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada (Drs. Albert, Alfaraj, Taskin, Havelock, Yong, Allaire, and Bedaiwy)
| | - Omur Taskin
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada (Drs. Albert, Alfaraj, Taskin, Havelock, Yong, Allaire, and Bedaiwy)
| | - Ghadeer M Alkusayer
- Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Alkusayer); Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Kingdom of Saudi Arabia (Dr Alkusayer)
| | - Jon Havelock
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada (Drs. Albert, Alfaraj, Taskin, Havelock, Yong, Allaire, and Bedaiwy)
| | - Paul Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada (Drs. Albert, Alfaraj, Taskin, Havelock, Yong, Allaire, and Bedaiwy)
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada (Drs. Albert, Alfaraj, Taskin, Havelock, Yong, Allaire, and Bedaiwy)
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada (Drs. Albert, Alfaraj, Taskin, Havelock, Yong, Allaire, and Bedaiwy).
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Tomassetti C, Adamson D, Arici A, Canis M, Hompes P, Hummelshoj L, Mol BW, Nardo L, Rombauts L, D’Hooghe T. EndoART: A proposed randomized controlled trial on endometriomas in assisted reproductive technologies, comparing the effect of no intervention, surgery, and prolonged GnRH downregulation on pregnancy rates. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518784236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Clinical management of endometriomas, prior to starting treatment with assisted reproductive technologies (ART), has since long been a matter of debate. Whereas cystectomy has been advocated in the past, recently more evidence has emerged on the potential negative effect of surgery on ovarian reserve. Parallel to this, prolonged downregulation with GnRH-a (gonadotropin-releasing hormone agonists) has been described to improve ART pregnancy rates in women with endometriosis. However, none of these strategies have been assessed in a large randomized controlled trial. The aim of the EndoART study is to assess whether ovarian surgery or prolonged GnRH-a downregulation result in higher pregnancy rates after ART compared to no intervention in women with endometrioma(s). Methods/design: A parallel randomized multi-center trial has been designed to compare ART pregnancy rates in three different treatment groups: no intervention, ovarian surgery, and prolonged hormonal suppression by GnRH-a prior to ART. The primary outcome measure studied is the clinical pregnancy rate with fetal heart-beat within 6 months after initiation of a fresh ART cycle. Secondary outcome measures studied include live birth rate after one initiated fresh ART cycle, cumulative clinical pregnancy rate with fetal heart-beat and live birth rates (after one fully completed ART cycle: initiated fresh + eventual associated frozen embryo transfer cycles), ART–specific data (e.g. number of oocytes, number of good quality embryos), complications, pelvic pain, and quality of life. Conclusion: This trial may answer the most frequently asked questions by both women with endometriosis and physicians: how do you treat endometrioma in women prior to treatment with ART?
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Affiliation(s)
- Carla Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Organ Systems, KU Leuven, Leuven, Belgium
| | - David Adamson
- Palo Alto Medical Foundation Fertility Physicians of Northern California, East Palo Alto, CA, USA
| | - Aydin Arici
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynaecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Michel Canis
- Department of Gynaecological Surgery, CHU Estaing, Clermont-Ferrand, France
- CICE (Centre International de Chirurgie Endoscopique), Faculty of Medicine, Clermont-Ferrand, France
| | - Peter Hompes
- Vrije Universiteit Medical Center, Center for Reproductive Medicine, Amsterdam, The Netherlands
| | | | - Ben-Willem Mol
- The Robinson Research Institute, School of Medicine, University of Adelaide, The South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | | | - Thomas D’Hooghe
- Department of Development and Regeneration, Organ Systems, KU Leuven, Leuven, Belgium
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Nickkho-Amiry M, Savant R, Majumder K, Edi-O'sagie E, Akhtar M. The effect of surgical management of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and meta-analysis. Arch Gynecol Obstet 2018; 297:1043-1057. [PMID: 29344847 PMCID: PMC5849664 DOI: 10.1007/s00404-017-4640-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/22/2017] [Indexed: 01/13/2023]
Abstract
Objective To assess the impact of surgical management of endometrioma on the outcome of assisted reproduction treatment (ART). Design A systematic review and meta-analysis. Setting Department of reproductive medicine at teaching university hospital, UK. Patients Subfertile women with endometrioma undergoing ART. Interventions Surgical removal of endometrioma or expectant management. Main outcome measures Clinical pregnancy rate, pregnancy rate, live birth rate, number of oocytes retrieved and number of embryos available and ovarian response to gonadotrophins. Results An extensive search of electronic databases for articles published from inception to September 2016 yielded 11 eligible studies for meta-analysis. Meta-analysis was conducted comparing surgery versus no treatment of endometrioma. There were no significant differences in pregnancy rate per cycle, clinical pregnancy rate and live birth rate between women who underwent surgery for endometrioma and those who did not. Conclusion Current evidence suggests that women with endometriosis-related infertility have similar cycle outcomes to other patients going through ART. It is pertinent for clinicians to assess the risks of surgical intervention on ovarian reserve prior to initiating therapy.
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Affiliation(s)
- M Nickkho-Amiry
- University Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK.
| | - R Savant
- Central Manchester Foundation Trust, Manchester, UK
| | - K Majumder
- Central Manchester Foundation Trust, Manchester, UK
| | | | - M Akhtar
- Central Manchester Foundation Trust, Manchester, UK
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Pastore LM, Christianson MS, Stelling J, Kearns WG, Segars JH. Reproductive ovarian testing and the alphabet soup of diagnoses: DOR, POI, POF, POR, and FOR. J Assist Reprod Genet 2017; 35:17-23. [PMID: 28971280 DOI: 10.1007/s10815-017-1058-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/20/2017] [Indexed: 12/26/2022] Open
Abstract
There are large variations in the number of oocytes within each woman, and biologically, the total quantity is at its maximum before the woman is born. Scientific knowledge is limited about factors controlling the oocyte pool and how to measure it. Within fertility clinics, there is no uniform agreement on the diagnostic criteria for each common measure of ovarian reserve in women, and thus, studies often conflict. While declining oocyte quantity/quality is a normal physiologic occurrence as women age, some women experience diminished ovarian reserve (DOR) much earlier than usual and become prematurely infertile. Key clinical features of DOR are the presence of regular menstrual periods and abnormal-but-not-postmenopausal ovarian reserve test results. A common clinical challenge is counseling patients with conflicting ovarian reserve test results. The clinical diagnosis of DOR and the interpretation of ovarian reserve testing are complicated by changing lab testing options and processing for anti-mullerian hormone since 2010. Further, complicating the diagnostic and research scenario is the existence of other distinct yet related clinical terms, specifically premature ovarian failure, primary ovarian insufficiency, poor ovarian response, and functional ovarian reserve. The similarities and differences between the definitions of DOR with each of these four terms are reviewed. We recommend greater medical community involvement in terminology decisions, and the addition of DOR-specific medical subject-heading search terms.
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Affiliation(s)
- Lisa M Pastore
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook University, Stony Brook, NY, 11794-8091, USA.
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Stelling
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook University, Stony Brook, NY, 11794-8091, USA
- Reproductive Specialists of NY, Mineola, NY, USA
| | - William G Kearns
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- AdvaGenix Lab, Rockville, MD, USA
| | - James H Segars
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Ferrero S, Scala C, Tafi E, Racca A, Venturini PL, Leone Roberti Maggiore U. Impact of large ovarian endometriomas on the response to superovulation for in vitro fertilization: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2017; 213:17-21. [DOI: 10.1016/j.ejogrb.2017.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/26/2016] [Accepted: 04/01/2017] [Indexed: 12/20/2022]
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11
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Safety of Hemostatic Sutures for Hemostasis of the Ovarian Bed After Endometriotic Ovarian Cystectomy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Osemwenkha A, Osaikhuwuomwan J. Transabdominal follicular aspiration in an in vitro fertilization cycle: experiences with an unusual but necessary intervention in a resource-limited setting. Clin Exp Reprod Med 2016; 43:54-7. [PMID: 27104159 PMCID: PMC4838583 DOI: 10.5653/cerm.2016.43.1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/02/2016] [Accepted: 02/06/2016] [Indexed: 11/09/2022] Open
Abstract
Controlled ovarian hyperstimulation is one of the major steps of in vitro fertilization. The inaccessibility or non-visualization of developing follicles on transvaginal sonography (the preferred imaging method) may be misjudged as a poor response, resulting in cycle cancellation. It is necessary to scrupulously appraise proxy indicators for ovarian response, such as estradiol levels, endometrial thickness, and other individual clinical characteristics. This can prompt meticulous transabdominal ultrasound follicular monitoring and oocyte retrieval with the goal of averting cycle cancellation and improving treatment outcomes.
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Affiliation(s)
- Abieyuwa Osemwenkha
- Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin City, Nigeria
| | - James Osaikhuwuomwan
- Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin City, Nigeria
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Iwase A, Nakamura T, Kato N, Goto M, Takikawa S, Kondo M, Osuka S, Mori M, Kikkawa F. Anti-Müllerian hormone levels after laparoscopic cystectomy for endometriomas as a possible predictor for pregnancy in infertility treatments. Gynecol Endocrinol 2016; 32:293-7. [PMID: 26597472 DOI: 10.3109/09513590.2015.1114078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We assessed the associations between preoperative and postoperative serum anti-Müllerian hormone (AMH) levels and parameters of endometriosis and endometriomas surgery with the success of infertility treatments after cystectomy. Seventeen out of 54 patients got pregnant during the infertility treatments. In these patients, the median interval from surgery to conception was 16.3 months. The serum AMH levels 1-year postoperatively were significantly higher in the pregnant group compared to the non-pregnant group (3.44 ± 1.78 versus 2.17 ± 2.24 ng/ml, p = 0.049). The median interval from surgery to recurrence was 34.4 months, and no significant differences were found in the serum AMH levels at any time point between the recurrence and non-recurrence groups. Serum AMH levels 1 year after laparoscopic cystectomy for endometriomas may predict the success of postoperative infertility treatments, but not a recurrence of endometriomas.
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Affiliation(s)
- Akira Iwase
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan and
- b Department of Maternal and Perinatal Medicine , Nagoya University Hospital , Nagoya , Japan
| | - Tomoko Nakamura
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan and
| | - Nao Kato
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan and
| | - Maki Goto
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan and
| | - Sachiko Takikawa
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan and
| | - Mika Kondo
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan and
| | - Satoko Osuka
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan and
| | - Masahiko Mori
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan and
| | - Fumitaka Kikkawa
- a Department of Obstetrics and Gynecology , Nagoya University Graduate School of Medicine , Nagoya , Japan and
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Patrizio P, Vaiarelli A, Levi Setti PE, Tobler KJ, Shoham G, Leong M, Shoham Z. How to define, diagnose and treat poor responders? Responses from a worldwide survey of IVF clinics. Reprod Biomed Online 2015; 30:581-92. [PMID: 25892496 DOI: 10.1016/j.rbmo.2015.03.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 02/26/2015] [Accepted: 03/03/2015] [Indexed: 01/14/2023]
Abstract
Poor responders represent a significant percentage of couples treated in IVF units (10-24%), but the standard definition of poor responders remains uncertain and consequently optimal treatment options remain subjective and not evidence-based. In an attempt to provide uniformity on the definition, diagnosis and treatment of poor responders, a worldwide survey was conducted asking IVF professionals a set of questions on this complex topic. The survey was posted on www.IVF-worldwide.com, the largest and most comprehensive IVF-focused website for physicians and embryologists. A total of 196 centres replied, forming a panel of IVF units with a median of 400 cycles per year. The present study shows that the definition of poor responders is still subjective, and many practices do not use evidence-based treatment for this category of patients. Our hope is that by leveraging the great potential of the internet, future studies may provide immediate large-scale sampling to standardize both poor responder definition and treatment options.
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Affiliation(s)
| | - Alberto Vaiarelli
- Centre for Reproductive Medicine, Vrije University Brussels, Belgium
| | - Paolo E Levi Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Research Hospital Fertility Center, Rozzano, Milan 20084, Italy
| | - Kyle J Tobler
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gon Shoham
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Zeev Shoham
- Department of Obstetrics and Gynaecology, Kaplan Medical Center, Rehovot, Israel; Hadassah Medical School, Jerusalem, Israel
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Yu HT, Huang HY, Lee CL, Soong YK, Wang CJ. Side of ovarian endometrioma does not affect the outcome of in vitro fertilization/intracytoplasmic sperm injection in infertile women after laparoscopic cystectomy. J Obstet Gynaecol Res 2014; 41:717-21. [PMID: 25511776 DOI: 10.1111/jog.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/03/2014] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to assess the impact of the laterality of ovarian endometrioma on pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in infertile patients undergoing laparoscopic cystectomy. MATERIAL AND METHODS A total of 103 IVF/ICSI cycles in patients who had undergone laparoscopic cystectomy for unilateral endometriomas were reviewed retrospectively from January 2005 through December 2009. There were 41 cycles where laparoscopic cystectomy had been carried out for right endometriomas and 62 cycles after left-side surgery. Primary outcome measures were ovarian reserve and ovarian response. Secondary outcome measures were the implantation rate, clinical pregnancy rate, and live birth rate. RESULTS There was no difference among the two groups with regard to antral follicle count, number of oocytes retrieved, the dosage of gonadotrophin, estradiol level on human chorionic gonadotrophin day, good-quality embryos for transfer, and fertilization rate. The clinical pregnancy rate and live birth rate were similar between the two groups; however, the implantation rate was significantly lower in the cycles with left-side ovarian endometrioma compared to the right counterpart (10.1% vs 20.2%; P = 0.015). CONCLUSION There were no associations among the laterality of ovarian endometrioma, ovarian reserve and ovarian response in IVF/ICSI cycles. However, left ovarian endometrioma after laparoscopic cystectomy may impair implantation rate as compared to right ovarian endometrioma.
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Affiliation(s)
- Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve. Int J Reprod Med 2014; 2014:581451. [PMID: 25763403 PMCID: PMC4334044 DOI: 10.1155/2014/581451] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 11/17/2022] Open
Abstract
We examined whether treatment with minimum-dose stimulation (MS) protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS) protocol. A retrospective cohort study was performed comparing IVF and pregnancy outcomes between MS and HS gonadotropin-antagonist protocol for patients with poor ovarian reserve (POR). Inclusion criteria included patients with an anti-Müllerian hormone (AMH) ≤8 pmol/L and/or antral follicle count (AFC) ≤5 on days 2-3 of the cycle. Patients from 2008 exclusively had a HS protocol treatment, while patients in 2010 had treatment with a MS protocol exclusively. The MS protocol involved letrozole at 2.5 mg over 5 days, starting from day 2, overlapping with gonadotropins, starting from the third day of letrozole at 150 units daily. GnRH antagonist was introduced once one or more follicles reached 14 mm or larger. The HS group received gonadotropins (≥300 IU/day) throughout their antagonist cycle. Clinical pregnancy rate was significantly higher in the MS protocol compared to the HS protocol (P = 0.007). Furthermore, the live birth rate was significantly higher in the MS group compare to the HS group (P = 0.034). In conclusion, the MS IVF protocol is less expensive (lower gonadotropin dosage) and resulted in a higher clinical pregnancy rate and live birth rate than a HS protocol for poor responders.
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Saito N, Okuda K, Yuguchi H, Yamashita Y, Terai Y, Ohmichi M. Compared with Cystectomy, Is Ovarian Vaporization of Endometriotic Cysts Truly More Effective in Maintaining Ovarian Reserve? J Minim Invasive Gynecol 2014; 21:804-10. [DOI: 10.1016/j.jmig.2014.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 01/12/2023]
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Unlü C, Yıldırım G. Ovarian cystectomy in endometriomas: Combined approach. J Turk Ger Gynecol Assoc 2014; 15:177-89. [PMID: 25317047 DOI: 10.5152/jtgga.2014.1111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 11/22/2022] Open
Abstract
Endometrioma is one of the most frequent adnexal masses in the premenopausal population, but the recommended treatment is still a subject of debate. Medical therapy is inefficient and can not be recommended in the management of ovarian endometriomas. The general consensus is that ovarian endometriomas larger than 4 cm should be removed, both to reduce pain and to improve spontaneous conception rates. The removal of ovarian endometriomas can be difficult, as the capsule is often densely adherent. While the surgical treatment of choice is surgical laparoscopy, for conservative treatment, the preferred method is modified combined cystectomy. Cystectomy can be destructive for the ovary, whereas ablation may be incomplete, with a greater risk of recurrence. To the best of our knowledge, the modified combined technique seems to be more efficient in the treatment of endometriomas.
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Affiliation(s)
- Cihat Unlü
- Department of Obstetrics and Gynecology, Acıbadem University, Bakırköy Acıbadem Hospital, İstanbul, Turkey
| | - Gazi Yıldırım
- Department of Obstetrics and Gynecology, Yeditepe University Hospital, İstanbul, Turkey
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Shah DK, Mejia RB, Lebovic DI. Effect of Surgery for Endometrioma on Ovarian Function. J Minim Invasive Gynecol 2014; 21:203-9. [DOI: 10.1016/j.jmig.2013.09.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 09/20/2013] [Accepted: 09/21/2013] [Indexed: 11/27/2022]
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20
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One-year follow-up of serum antimüllerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertil Steril 2013; 100:516-22.e3. [DOI: 10.1016/j.fertnstert.2013.03.032] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 11/22/2022]
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Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab 2012; 97:3146-54. [PMID: 22723324 DOI: 10.1210/jc.2012-1558] [Citation(s) in RCA: 307] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Endometriomas are mainly treated surgically. However, there has been concern over the potential damaging effect of this surgery on ovarian reserve. OBJECTIVE The aim of this meta-analysis was to investigate the impact of surgery for endometriomas on ovarian reserve as determined by serum anti-müllerian hormone (AMH). DATA SOURCES MEDLINE, PubMed, and Embase were searched electronically. STUDY SELECTION All prospective cohort studies that analyzed changes of serum AMH concentrations after surgical treatment of endometriomas were eligible. Twenty-one studies were identified, of which eight were selected for meta-analysis. DATA EXTRACTION Two reviewers performed the data extraction independently. DATA SYNTHESIS Pooled analysis of 237 patients showed a statistically significant decrease in serum AMH concentration after ovarian cystectomy (weighted mean difference -1.13 ng/ml; 95% confidence interval -0.37 to -1.88), although heterogeneity was high. Sensitivity analysis for studies with a preoperative serum AMH level of 3.1 ng/ml or greater improved heterogeneity but also still showed a significant postoperative fall in serum AMH (weighted mean difference -1.52 ng/ml, 95% confidence interval -1.04 to -2). CONCLUSION The results of this study suggest a negative impact of excision of endometriomas on ovarian reserve as evidenced by a significant postoperative fall in circulating AMH.
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Affiliation(s)
- Francesca Raffi
- University of Nottingham, Medical School, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3DT, United Kingdom.
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22
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Surgical treatment of ovarian endometriomas: state of the art? Fertil Steril 2012; 98:556-63. [DOI: 10.1016/j.fertnstert.2012.06.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/15/2012] [Accepted: 06/15/2012] [Indexed: 11/23/2022]
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Madani T, Ashrafi M, Yeganeh LM. Comparison of different stimulation protocols efficacy in poor responders undergoing IVF: a retrospective study. Gynecol Endocrinol 2012; 28:102-5. [PMID: 22263965 DOI: 10.3109/09513590.2011.579206] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare the efficacy of different stimulation protocols on pregnancy outcomes in poor responders undergoing in vitro fertilization (IVF). MATERIALS AND METHODS This was a retrospective study to compare the efficacy of four different protocols including gonadotropin-releasing hormone (GnRH) agonist (long, short and miniflare) and GnRH antagonist on pregnancy outcomes in poor responders. This investigation was performed on 566 poor respond patients who were candidates for IVF. Main outcome measures included the total number of oocytes and mature oocytes retrieved, pregnancy rates, implantation and overall cancellation rates which were compared between four mentioned groups. RESULTS Number of follicles >18 mm on hCG day were significantly higher in GnRH-a long versus GnRH antagonist, GnRH-a short and GnRH-a miniflare protocols. The mean number of oocytes and mature oocytes retrieved were significantly higher in GnRH-a long versus miniflare (4.7 ± 3.05 versus 3.26 ± 2.9 and 3.69 ± 3.1 versus 2.65 ± 2.2, respectively). There were no significant differences in implantation, pregnancy and overall cancellation rates between four groups. CONCLUSION The present study suggests that the application of four different protocols in poor respond patients seem to have similar efficacy in improving clinical outcomes such as implantation, pregnancy rates and cancellation rate even though GnRH-a long protocol yielded more retrieved oocytes and mature oocytes compared to GnRH-a miniflare protocol.
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Affiliation(s)
- Tahereh Madani
- Department of Endocrinology and Female Infertility, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. tmadani @royaninstitute.org
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Abstract
PURPOSE OF REVIEW To evaluate different surgical options for the treatment of endometriomas. A heated debate is currently under way between advocates of excisional surgery and the ablative approach. With papers increasingly focusing on ovarian reserve after endometrioma surgery, a review was mandatory. RECENT FINDINGS Excisional and ablative surgery are well known procedures. This paper describes a combined technique that allows preservation of ovarian volume and antral follicle count. The question of postoperative ovarian reserve is widely discussed and the risk of malignancy is addressed. SUMMARY Some previously published reviews have probably too hastily concluded that excision is a better option than ablation. They failed to analyze the ovarian reserve, which is often significantly decreased after excisional surgery.This manuscript clearly explains the crucial importance of preserving the ovarian blood supply, as well as the ovarian cortex containing all primordial follicles, during surgery.
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Bourdel N, Roman H, Mage G, Canis M. Chirurgie des endométriomes ovariens : de la physiopathologie à la prise en charge pratique pré-, per- et postopératoire. ACTA ACUST UNITED AC 2011; 39:709-21. [DOI: 10.1016/j.gyobfe.2011.07.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/28/2011] [Indexed: 11/25/2022]
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26
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Lee SL, Chang CY, Chen PH, Lu CH, Chang CC. A cumulative strategy of GnRH agonist, clomiphene citrate, and GnRH antagonist in a patient with recurrent endometriosis and repeated aspiration. Taiwan J Obstet Gynecol 2011; 50:366-9. [DOI: 10.1016/j.tjog.2011.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2010] [Indexed: 10/15/2022] Open
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Abstract
OBJECTIVE With the advent of evidence-based medicine, much of the complex testing that infertile couples used to undergo is no longer recommended as part of the routine evaluation. Examples of tests no longer implemented include the postcoital test, Rubin test of tubal patency, endometrial biopsy, sperm antibody testing, and the zona-free hamster test. The role of routine diagnostic laparoscopy and hysteroscopy is also reviewed. CONCLUSIONS In 2010, the simplicity of the current evaluation of couples presenting with infertility is essential information for patients to know at the initial visit. Ideally, it can help alleviate anxiety and provide patients with a road-map during a visit that is often associated with stress and high emotions. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this educational activity, the obstetrician/gynecologist should be better able to assess the current recommendations for evaluating infertile couples; examine the various ways to assess ovarian reserve, the uterine cavity, and fallopian patency; and appraise the controversy surrounding diagnostic surgery.
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Oh HK, Sin JI, Kim JH, Hong SY, Lee TS, Choi YS. Effect of age and stage of endometriosis on ovarian follicular loss during laparoscopic cystectomy for endometrioma. Int J Gynaecol Obstet 2011; 114:128-32. [PMID: 21683953 DOI: 10.1016/j.ijgo.2011.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 02/05/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify the risk factors associated with inadvertent follicular loss during laparoscopic cystectomy for endometrioma. METHODS Between April 2008 and April 2010, 114 patients who underwent laparoscopic cystectomy for endometrioma were enrolled in the study. Clinical data were collected, together with a retrospective review of medical records. Ovarian follicular loss and the thickness of the cystic wall removed were evaluated by pathologic slide review. RESULTS Ovarian follicular loss was more frequently observed among younger patients (P < 0.001) and those with stage 3 endometriosis than among those with stage 4 (P = 0.027), in addition to having an inverse correlation with age (P < 0.001). The thickness of the removed ovarian tissue correlated with inadvertent follicular loss (P < 0.001); however, there was no correlation between any clinical parameter tested and the thickness of the removed ovarian tissue. There was a correlation between ovarian follicular loss and the thickness of the removed ovarian tissue among patients younger than 40 years (P < 0.001), but not among patients aged 40 years or older (P = 0.123). CONCLUSION Ovarian follicular loss was more common among younger patients and patients with lower-stage endometriosis. The thickness of the removed ovarian tissue did not differ among patients, despite varying clinical factors.
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Affiliation(s)
- Hoon-Kyu Oh
- Department of Pathology, School of Medicine, Catholic University of Daegu, Daegu, Korea
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29
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Almog B, Tulandi T. Reply of the Authors. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Retto G, Santoro G, Sturlese E, De Dominici R, Villari D, Retto A, Palmara V. Efficacy of laparoscopic stripping for ovarian cysts: histological and clinical findings. J Obstet Gynaecol Res 2011; 37:547-52. [PMID: 21349125 DOI: 10.1111/j.1447-0756.2010.01389.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The aim of our study was to evaluate the efficacy of the laparoscopic stripping technique on benign ovarian masses with respect to healthy ovarian tissue. MATERIAL AND METHODS Seventy-six patients between 14 and 40 years of age were enrolled after receiving a diagnosis of mono-lateral ovarian cyst and underwent laparoscopic surgery for cyst excision with the stripping technique. Histological observations of these specimens were then performed and graded on a semiquantitative scale. RESULTS The 76 samples included 36 endometriotic cysts, 18 dermoid cysts, 12 serous cysts, and 10 mucinous cysts. Only 26 of the endometriomas showed histological evidence of healthy ovarian tissue that, however, differed morphologically from normal ovarian tissue. CONCLUSION The laparoscopic stripping technique used for the excision of different ovarian cysts is a practice that safeguards the organ.
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Affiliation(s)
- Giovanni Retto
- Department of Gynaecology, Obstetrics and Physiopathology of the Human Reproduction, A.O.U. Policlinic G. Martino, University of Messina, Via Consolare Valeria, Messina, Italy
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Almog B, Shehata F, Sheizaf B, Tan SL, Tulandi T. Effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization. Fertil Steril 2011; 95:525-7. [DOI: 10.1016/j.fertnstert.2010.03.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/23/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
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Hayasaka S, Arai M, Ugajin T, Nabeshima H, Utunomiya H, Yokomizo R, Yuki H, Terada Y, Murakami T, Yaegashi N. Comparing Ovarian Reserves After Laparoscopic Excision of Ovarian Endometriotic Cysts and Ovarian Nonendometriotic Cysts. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2009.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shinichi Hayasaka
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Maiko Arai
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Tomohisa Ugajin
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiroshi Nabeshima
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiroki Utunomiya
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Rei Yokomizo
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiromithu Yuki
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | | | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
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Effects of excision of ovarian endometrioma on the antral follicle count and collected oocytes for in vitro fertilization. Fertil Steril 2010; 94:2340-2. [DOI: 10.1016/j.fertnstert.2010.01.055] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/14/2010] [Accepted: 01/21/2010] [Indexed: 11/15/2022]
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Management of endometrioma prior to IVF: compliance with ESHRE guidelines. Reprod Biomed Online 2010; 21:325-30. [DOI: 10.1016/j.rbmo.2010.04.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 02/21/2010] [Accepted: 04/13/2010] [Indexed: 11/22/2022]
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Saeki A, Matsumoto T, Ikuma K, Tanase Y, Inaba F, Oku H, Kuno A. The Vasopressin Injection Technique for Laparoscopic Excision of Ovarian Endometrioma: A Technique to Reduce the Use of Coagulation. J Minim Invasive Gynecol 2010; 17:176-9. [DOI: 10.1016/j.jmig.2009.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 10/29/2009] [Accepted: 11/04/2009] [Indexed: 10/19/2022]
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36
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A comparison of histopathologic findings of ovarian tissue inadvertently excised with endometrioma and other kinds of benign ovarian cyst in patients undergoing laparoscopy versus laparotomy. Fertil Steril 2009; 92:2004-7. [DOI: 10.1016/j.fertnstert.2008.09.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Revised: 09/02/2008] [Accepted: 09/04/2008] [Indexed: 11/19/2022]
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Depalo R, Cavallini A, Lorusso F, Bassi E, Totaro I, Marzullo A, Bettocchi S, Selvaggi L. Apoptosis in normal ovaries of women with and without endometriosis. Reprod Biomed Online 2009; 19:808-15. [DOI: 10.1016/j.rbmo.2009.09.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The impact of electrocoagulation on ovarian reserve after laparoscopic excision of ovarian cysts: a prospective clinical study of 191 patients. Fertil Steril 2009; 92:1428-1435. [DOI: 10.1016/j.fertnstert.2008.08.071] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 08/05/2008] [Accepted: 08/07/2008] [Indexed: 11/23/2022]
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Tsujioka H, Inoue Y, Emoto M, Sadamori R, Shirota K, Hachisuga T, Kawarabayashi T. The efficacy of preoperative hormonal therapy before laparoscopic cystectomy of ovarian endometriomas. J Obstet Gynaecol Res 2009; 35:782-6. [DOI: 10.1111/j.1447-0756.2009.01017.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG. The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 2009; 92:75-87. [DOI: 10.1016/j.fertnstert.2008.05.049] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 05/07/2008] [Accepted: 05/15/2008] [Indexed: 10/21/2022]
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Donnez J, Lousse JC, Jadoul P, Donnez O, Squifflet J. Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery. Fertil Steril 2009; 94:28-32. [PMID: 19361793 DOI: 10.1016/j.fertnstert.2009.02.065] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 02/16/2009] [Accepted: 02/20/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe and evaluate a new technique of laparoscopic treatment of endometriomas that combines excisional and ablative surgery. DESIGN Descriptive and prospective study. SETTING Gynecology research unit in a university hospital. PATIENT(S) Fifty-two women under 35 years of age presenting for infertility and/or pelvic pain with endometriomas larger than 3 cm were included in the study. None had undergone any surgery for endometriosis. INTERVENTION(S) A large part of the endometrioma wall was first excised according to the cystectomy technique. After this first step, CO(2) laser was used to vaporize the remaining 10%-20% of the endometrioma wall close to the hilus. MAIN OUTCOME MEASURE(S) The feasibility of this new technique was assessed. Ovarian volume and antral follicle count (AFC) were compared between operated ovaries and nonoperated ovaries of patients with endometriosis and controls (women with male factor infertility). RESULT(S) The combined technique was possible in all cases. The volume of the ovary after the combined technique was similar to that of the contralateral normal ovary, as well as to that observed in infertile women without endometriosis presenting for male factor infertility. The AFC on day 2-5 showed the same number of antral follicles in all subgroups. Histopathology of the excised part of the endometrioma revealed the presence of follicles in only one case (2%). The pregnancy rate was 41% at a mean follow-up of 8.3 months. Recurrence of a small endometrioma was observed in only one case (2%). CONCLUSION(S) The combined technique (stripping and ablation) has proved not to be deleterious to the ovary.
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Affiliation(s)
- Jacques Donnez
- Department of Gynecology, Université Catholique de Louvain, Brussels, Belgium.
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Ebert AD, Hollauer A, Fuhr N, Langolf O, Papadopoulos T. Laparoscopic ovarian cystectomy without bipolar coagulation or sutures using a gelantine–thrombin matrix sealant (FloSeal©): first support of a promising technique. Arch Gynecol Obstet 2009; 280:161-5. [DOI: 10.1007/s00404-009-0985-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
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Lan KC, Huang FJ, Lin YC, Kung FT, Lan TH, Chang SY. Significantly superior response in the right ovary compared with the left ovary after stimulation with follicle-stimulating hormone in a pituitary down-regulation regimen. Fertil Steril 2009; 93:2269-73. [PMID: 19200958 DOI: 10.1016/j.fertnstert.2008.12.123] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 11/19/2008] [Accepted: 12/22/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the differences between the right and left ovarian responses in patients undergoing standard in vitro fertilization (IVF) treatment. DESIGN Prospective, observational study. SETTING A university hospital in Taiwan. PATIENT(S) Seven hundred eighty-nine consecutive patients undergoing IVF or intracytoplasmic sperm injection. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The number of oocytes retrieved, fertilization rates, number of grade 1 zygotes and number of embryos produced, embryo arrest-free rate, and mean number of top-quality embryos on the day of transfer. RESULT(S) The number of follicles > or = 16 mm in diameter on day 2.5 versus 2.2 of human chorionic gonadotropin (hCG) administration, the number of follicles > or = 10 mm in diameter on hCG day 6.5 versus 6.1, the number of oocytes (3.6 vs. 3.0), the percentage fertilization (79.9 vs. 74.6%), and the mean number of mature oocytes and grade 1 zygotes (2.3 vs. 1.8 and 1.79 vs. 0.93, respectively), and the mean available number of top-quality embryos on transfer day 1.39 versus 0.73 were all statistically significantly greater in the right compared with the left ovary; however, the pregnancy and implantation rates were similar. CONCLUSION(S) There are statistically significant differences between the right and left ovarian responses in IVF patients with healthy ovaries, and the right ovarian responses are superior to the left ovarian responses.
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Affiliation(s)
- Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Niaosung Hsiang, Kaohsiung, Taiwan.
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Zhen XM, Qiao J, Li R, Wang LN, Liu P. The clinical analysis of poor ovarian response in in-vitro-fertilization embryo-transfer among Chinese couples. J Assist Reprod Genet 2008; 25:17-22. [PMID: 18202912 DOI: 10.1007/s10815-007-9187-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 11/14/2007] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To explore the prevalence, predictor of clinical pregnancy and possible aetiology of poor ovarian response (POR) in in vitro fertilization-embryo transfer (IVF-ET) in Chinese. METHODS A total of 4,600 retrieval oocyte cycles were finished between July 1, 2004 and April 30, 2006. Poor ovarian responses were observed in 426 patients of 472 cycles undergoing IVF, which were selected on the same retrieve oocyte day as the control group. The outcome of IVF-ET and the common markers of ovarian reserve were compared. RESULTS The patients had previous ovarian surgery in 64 cycles of 472 poor ovarian response cycles. The group with poor ovarian response has significant differences in comparison with the control group in age (36.6 +/- 4.2 vs 33.3 +/- 4.04), ovarian surgeries (13.6 vs 2.8%), dose of gonadotrophin (58.5 +/- 15.8 vs 40.6 +/- 17.0), fertilization rate (71.5 vs 86%) and pregnancy rate (14.8 vs 36.7%). In the group with poor ovarian responses, clinical pregnancy rate declined significantly in women aged >40 years than in those aged < or = 40 years (2.8 vs 18.5%, P < 0.001). The age, basal serum follicle stimulating hormone (FSH), basal serum luteinizing hormone (LH), basal oestradiol (E2) concentrations, FSH to LH ratio and the antral follicle count (AFC) are the common markers of ovarian reserve in our center. We found that there were significant differences in age, basal FSH, FSH-to-LH ratio and the antral follicle count. But no statistical significant differences were observed in basal oestradiol concentration and basal serum LH when comparing the two groups. Binary logistic regression analysis was used to study the relation among age, FSH, LH, E2, AFC and clinical pregnancy, and the age (odds ratio, 0.863; 95% confidence interval, 0.805-0.925; p = 0.000) was the only variable selected. CONCLUSION Our data show that the prevalence of poor ovarian response in Chinese is 11.9%. Previous ovarian surgery is associated with poor ovarian responses. The pregnancy rate of women with poor ovarian response is low in IVF-ET, especially the decline in clinical pregnancy rate of women aged >40 years became accelerated. Correct identification of those who are at risk for POR prior to stimulation is helpful in tailoring the best stimulation protocol to individual patients. Chronological age significantly improved the prediction of clinical pregnancy of poor ovarian responders.
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Affiliation(s)
- X M Zhen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100083, China
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Vicino M, Resta L, Scioscia M, Marzullo A, Ceci O, Bettocchi S. Correlation between serum levels of CA 125 and follicular loss after laparoscopic cystectomy in women with ovarian endometrioma. J Minim Invasive Gynecol 2007; 14:223-7. [PMID: 17368261 DOI: 10.1016/j.jmig.2006.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2006] [Revised: 09/30/2006] [Accepted: 10/07/2006] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVE To preoperatively predict follicular loss after laparoscopic cystectomy of ovarian endometriomas. DESIGN Case-control study. (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Seventy-six women with ovarian endometrioma and 41 patients with nonendometriotic ovarian cysts who underwent laparoscopy. INTERVENTIONS Sonographic findings and serum levels of CA 125 and CA 19.9 were recorded. MEASUREMENTS AND MAIN RESULTS Considered parameters were compared with a histologic score, on the basis of the presence and morphologic features of follicles on the normal ovarian tissue adjacent to the cyst wall surgically removed. Serum levels of CA 125 and CA 19.9 were increased in patients with ovarian endometrioma (p <.001 and p <.01, respectively). Capsule wall thickness, presence of fibrosis, and follicles in the tissue surrounding the capsule were significantly increased in the study group (p <.01). CA 125 serum level was directly correlated to the histologic score (r = 0.46, p <.05) and to cyst diameter (r = 0.12, p = .01), whereas no correlation was found between CA 19.9 or cyst diameter and follicular score. CONCLUSIONS Our data suggest that the ovarian tissue inadvertently removed along with the endometrioma wall by laparoscopic stripping is due to pericystic fibrosis. Serum levels of CA 125 represent a useful parameter to predict follicular loss before surgery.
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Affiliation(s)
- Mario Vicino
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
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Palomba S, Falbo A, Del Negro S, Russo T, Zullo F. Use of oral contraceptives in infertile patients: A descriptive review. Gynecol Endocrinol 2006; 22:537-46. [PMID: 17135032 DOI: 10.1080/09513590601005672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In the past and currently, there are several applications of oral contraceptives (OCs) in the field of infertility. The aim of the present descriptive review is to analyze the old and new uses of OCs in infertile patients undergoing simple or multiple ovulation-induction programs. Available data seem to indicate that OCs given before treatment could be effective in patients who are resistant to clomiphene citrate and in poor responders. In addition, the use of OCs is useful for scheduling in vitro fertilization programs downregulated with gonadotropin-releasing hormone-antagonists.
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Affiliation(s)
- Stefano Palomba
- Department of Obstetrics & Gynecology, University Magna Graecia, Catanzaro, Italy.
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Yazbeck C, Madelenat P, Sifer C, Hazout A, Poncelet C. Endométriomes ovariens : effet de la kystectomie laparoscopique sur la réponse ovarienne en fécondation in vitro. ACTA ACUST UNITED AC 2006; 34:808-12. [PMID: 16920378 DOI: 10.1016/j.gyobfe.2006.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 07/05/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the follicular response to controlled ovarian hyperstimulation (COH) in IVF-ET cycles after laparoscopic ovarian cystectomy for large endometriomas. PATIENTS AND METHODS In the set of a retrospective controlled study, the medical records of 113 infertile women who underwent IVF-ET cycles after laparoscopic surgery were reviewed. The study group (A) consisted of 63 patients with severe pelvic endometriosis and endometrioma excision. The control group (B) consisted of 50 infertile patients with mild or minimal endometriosis. Interventions were laparoscopic ovarian cystectomy in the study group, and COH in both groups. RESULTS Groups A and B were not different in terms of epidemiologic data. The total numbers of recruited follicles (9.1+/-3.3 vs 10.6+/-4.2; P = 0.001), mature follicles (> or =16 mm) (4.2+/-1.7 vs 4.8+/-2.2; P = 0.04), mature oocytes retrieved (5.8+/-3.8 vs 7.4+/-4.6; P = 0.02), and fertilization rate (48.9+/-34.9 vs 61.8+/-32.1%; P = 0.02) observed in group A were lower than those observed in group B, respectively. While the mean number of rFSH ampoules (75 IU) was increased in group A (38.1+/-20.4) compared to group B (29.3+/-16.4; P = 0.004), cumulative pregnancy rates were similar in both groups (27.5+/-8.8% vs 37.2+/-10.6%; P = 0.37). DISCUSSION AND CONCLUSIONS Ovarian response was reduced during IVF-ET cycles in patients with history of severe endometriosis and laparoscopic excision of endometriomas compared to women with mild or minimal endometriosis without ovarian surgery.
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Affiliation(s)
- C Yazbeck
- Service de gynécologie-obstétrique et médecine de la reproduction, maternité Aline-de-Crépy, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
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Exacoustos C, Zupi E, Amadio A, Amoroso C, Szabolcs B, Romanini ME, Arduini D. Recurrence of endometriomas after laparoscopic removal: sonographic and clinical follow-up and indication for second surgery. J Minim Invasive Gynecol 2006; 13:281-8. [PMID: 16825067 DOI: 10.1016/j.jmig.2006.03.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 02/24/2006] [Accepted: 03/08/2006] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE This study involved patients who, after laparoscopic surgery, had recurrence of endometriomas detected by sonography. The aim of this study was to evaluate the role of transvaginal sonography (TVS) in the management of recurrent endometriomas and to establish ultrasonographic criteria that would direct the therapy toward additional surgery versus medical or expectant management. DESIGN Retrospective analysis of 62 reproductive-age women who showed recurrence of endometriomas on TVS after laparoscopic removal of an ovarian endometrioma by the stripping technique (Canadian Task Force classification II-1). SETTING Obstetrics and Gynecology Department, University of Rome Tor Vergata. PATIENTS Sixty-two patients with recurrent endometriomas after first-line treatment with laparoscopy. INTERVENTIONS Ultrasonographic follow-up and/or second surgery. MEASUREMENTS AND MAIN RESULTS Recurrence of an ovarian endometrioma was defined as the presence of ovarian cysts with the typical sonographic criteria of endometriomas and a diameter of more than 10 mm. The clinical and sonographic postoperative follow-up period lasted from 6 to 97 months (median 24.6) after the first procedure. Of 62 patients with recurrent endometriomas, 50 had recurrence on the treated ovary, 7 on the contralateral untreated ovary, and 5 on both the treated and untreated ovaries. Recurrence of endometriomas was associated with symptoms (pain or infertility) in 47 patients (76%), while the remaining 15 (24%) were asymptomatic. Of the 47 symptomatic patients with recurrence detected by TVS, a second procedure was performed in 15. Second surgery in these patients was indicated by the larger size of the recurrent cysts, a poor response to medical treatment, the presence on TVS of pelvic adhesions and nodules of deep endometriosis, and overall progression of the disease. Symptomatic patients who did not undergo a second procedure (32) had smaller recurrent endometriomas. However of the 31 symptomatic patients with large recurrent endometriomas (>3 cm), only 45% had repeat surgery. CONCLUSION Recurrent endometriomas, as detected by TVS, can remain asymptomatic and do not necessarily progress in size with or without medical treatment. The decision to reoperate depends less on the endometrioma's size than on symptoms, in particular severe pain, and failure of medical treatment. However such patients are also more likely to have signs of deep nodules and adnexal/bowel adhesions and larger endometriomas on TVS scan, thus predisposing them to require a second procedure.
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Affiliation(s)
- Caterina Exacoustos
- Obstetrics and Gynecology Department, Università degli Studi di Roma Tor Vergata, Rome, Italy
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Busacca M, Riparini J, Somigliana E, Oggioni G, Izzo S, Vignali M, Candiani M. Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. Am J Obstet Gynecol 2006; 195:421-5. [PMID: 16681984 DOI: 10.1016/j.ajog.2006.03.064] [Citation(s) in RCA: 208] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2005] [Revised: 02/01/2006] [Accepted: 03/18/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was undertaken to determine the frequency of postsurgical ovarian failure in patients undergoing laparoscopic excision of bilateral endometriomas. STUDY DESIGN Patients who had been operated on for bilateral ovarian endometriosis between January 1995 and December 2003 and who were younger than 40 years at the time of surgery were contacted by telephone and interviewed. RESULTS A total of 126 patients were recruited. Mean +/- SD age of patients at the time of surgery was 30.4 +/- 4.3 years. Postsurgical ovarian failure was documented in 3 cases, corresponding to a rate of 2.4% (95% CI 0.5%-6.8%). In all cases, this complication occurred immediately after surgery. CONCLUSION Patients who had been operated on for bilateral endometriomas have a low but definite risk of premature ovarian failure occurring immediately after surgery.
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Affiliation(s)
- Mauro Busacca
- Department of Obstetrics and Gynecology, Ospedale Macedonio Melloni, Milan, Italy
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Somigliana E, Infantino M, Benedetti F, Arnoldi M, Calanna G, Ragni G. The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins. Fertil Steril 2006; 86:192-6. [PMID: 16716316 DOI: 10.1016/j.fertnstert.2005.12.034] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 12/11/2005] [Accepted: 12/11/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To clarify whether the presence of ovarian endometriomas is associated with a reduced responsiveness to ovarian hyperstimulation. DESIGN Observational study. SETTING University teaching hospital. PATIENT(S) Women selected for in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) cycles who were found to have unilateral ovarian endometriomas and who did not undergo previous ovarian surgery. INTERVENTION(S) Ovarian hyperstimulation using gonadotropins. MAIN OUTCOME MEASURE(S) Number of codominant follicles (mean diameter >15 mm) in the affected and in the contralateral intact gonads. RESULT(S) Thirty-six patients were enrolled. They underwent 56 IVF-ICSI cycles. The number of codominant follicles in the intact and affected ovaries were 4.0 +/- 2.2 and 3.0 +/- 1.7, respectively (P=.01). This difference corresponded to a mean reduction (95% confidence interval [CI]) of 25% (6%-44%). This deleterious effect was more evident in women with larger cysts, in those with more than one cyst, and in those who were more responsive to ovarian hyperstimulation. CONCLUSION(S) The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins.
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Affiliation(s)
- Edgardo Somigliana
- Infertility Unit, Department of Obstetrics, Gynecology and Neonatology, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy.
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