Fertility preservation in women with ovarian endometriosis

The effectiveness of antioxidant therapy (vitamin C) in an experimentally induced mouse model of ovarian endometriosis

Objectives:

This study investigates the therapeutic effect of vitamin C on the development of endometrial lesions and fecundity disorders in the ovarian induction model of mouse endometriosis.

Methods:

Ovarian endometriosis was surgically induced in 14 NMRI female mice (treatment group, N = 7) and (control group, N = 7). Three days after the second surgery (to assess endometriotic implant), the mice were randomized into two intervention groups: control (placebo) and treatment (50 mg/kg vitamin C every two days orally for four weeks) groups. In the oestrus phase, the mice were sacrificed. In macroscopic assessment, endometriotic implants were evaluated in size, volume, weight, growth score and adhesion score. The microscopic assessment examined the ovarian tissue (the number of antral follicles, corpus luteum and atretic follicles) and endometriotic lesion (histologic and trichrome fibrosis scores).

Results:

Post-treatment implant volume, growth score, adhesion extent score and adhesion severity score were significantly lower in the treatment group (vitamin C) in comparison with the control group (placebo) (p < 0.0001). The difference between the median weight of endometriotic implants, epithelialization of implant tissue, trichrome fibrosis scores and follicle number in the two groups (treatment and control) was statistically significant (p < 0.05). Atretic follicles were significantly decreased after vitamin C therapy (p < 0.05). Although the numbers of corpus luteum seemed to be more preserved in specimens from the control group, there was no statistical significance between the two groups’ histological scores.

Conclusion:

As a result, we may imply that vitamin C has a significant effect on reducing the induction and growth of endometrial implants, improving the fecundity function of ovaries, and consequently prevention of endometriosis-associated cancers. Further research is needed to improve targeted interventions resulting in the prevention and treatment of human endometriosis.

Clinical and pathological features of women with adnexal masses admitted as emergency cases to the Gynaecology Department of West Kazakhstan University

AIM OF THE STUDY

To detect the clinical and pathological features of women with adnexal masses (AMs) admitted as emergency cases to the Gynaecology Department of West Kazakhstan University.

MATERIAL AND METHODS

A retrospective analysis of the data of women with AMs admitted as an emergency cases to the Gynaecology Department of West Kazakhstan University. The collected data include: age, age of menarche and age of menopause, presenting symptoms, admission criteria - either self-referral or refereed from another department, ultrasound findings, associated pregnancy, associated pathology of the female genital tract, and post-operative histological results of surgically excised AMs (gold standard).

RESULTS

77.04% (245/318) of the studied AMs were found in the reproductive age group. The main causes for surgical intervention for the studied AMs was ruptured ovarian cyst in 27.1% or adnexal torsion in 9.7%. The available histological results of the surgically managed AMs showed the following: functional ovarian cyst in 36.2% (115/318), benign ovarian neoplasms (BONs) in 18.55% (59/318), and borderline malignant ovarian tumours in 0.63% (2/318). 44.34% of the studied AMs were associated with pregnancy, 49.3% with chronic tubo-ovarain diseases such as salpingo-oophoritis, 14.8% with cervical pathology and pelvic inflammatory diseases, 11.3% with uterine leiomyomas, and 4.4% with endometrial hyperplasia.

CONCLUSIONS

AMs were more common in the reproductive age group (77.04%), and 44.34% of the studied AMs were associated with pregnancy. The main causes of surgical intervention for the studied AMs were ruptured ovarian cyst in 27.1% or adnexal torsion in 9.7%.

The Role of Fertility Preservation in Women with Endometriosis: A Systematic Review

OBJECTIVE

To summarize the available evidence concerning fertility preservation techniques in the context of women with endometriosis.

DATA SOURCES

We searched for studies published between 1984 and 2019 on endometriosis and Assisted Reproductive Technology outcomes. We searched MEDLINE and PubMed and performed a manual search of reference lists within identified studies.

METHODS OF STUDY SELECTION

A total of 426 articles were identified, and 7 studies were eligible to be included for the systematic review. We included all published studies, excluding reviews, case reports, and animal studies.

TABULATION, INTEGRATION, AND RESULTS

Despite a significant increase in the number of studies addressing fertility preservation over the study period, we found a relative lack of evidence addressing the use of fertility preservation techniques in women with endometriosis. The studies identified included 2 case reports, 1 histological science study, and 4 retrospective cohort studies.

CONCLUSION

Women with endometriosis may benefit from fertility preservation techniques. However, there currently is a paucity of data in this population, especially when compared with other indications for fertility preservation. Although much knowledge can be translated from the oncofertility discipline, we have identified and discussed endometriosis-related changes to ovarian reserve and oocyte health that justify further well-designed research to confirm that fertility preservation outcomes are similar for women with endometriosis.

[Endometriosis and fertility preservation: CNGOF-HAS Endometriosis Guidelines]

Fertility preservation (FP) techniques are progressing rapidly these past few years thanks to the oocyte vitrification. Indication of FP techniques is now extended to non-oncological situation that may induce risk of premature ovarian failure. Ovarian endometriosis can lead to premature ovarian failure and further infertility due to the high risk of ovarian cysts recurrence and surgery. To date, there is no cohort study regarding FP and endometriosis as well as no recommendation. Our purpose is to review the arguments in favor of FP in this specific area and to elaborate strategies according to each clinical form.