To operate or not to operate on women with deep infiltrating
endometriosis (DIE) before in vitro fertilization
(IVF)

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Deep infiltrating endometriosis (DIE) can cause infertility and pelvic pain. There is little evidence of a clear connection between DIE and infertility, and the absolute benefits of surgery for DIE have not been established. This paper aimed to review the current literature on the effect of surgery for DIE on fertility, pregnancy, and IVF outcomes. Clinicians should bear in mind that a comprehensive clinical history is useful to identify patients at risk for endometriosis, although many women remain asymptomatic. Imaging can be useful to plan surgery. The effect of surgery on the fertility of women with DIE remains unanswered due to the heterogeneous nature of the disease and the lack of trials with enough statistical power and adequate follow-up. Surgery is not recommended when the main goal is to treat infertility or to improve IVF results. Decisions should be tailored according to the individual needs of each woman. Patients must be provided information on the potential benefits, harm, and costs of each treatment alternative, while the medical team observes factors such as presence of pelvic pain, patient age, lesion location, and previous treatments. In this scenario, management by a multidisciplinary endometriosis team is a key step to achieving successful outcomes.

Related collections

Most cited references 44

Record: found
Abstract: found
Article: not found

Pathogenesis and pathophysiology of endometriosis.

Richard O Burney, Linda C Giudice (2012)

Originally described over three hundred years ago, endometriosis is classically defined by the presence of endometrial glands and stroma in extrauterine locations. Endometriosis is an inflammatory, estrogen-dependent condition associated with pelvic pain and infertility. This work reviews the disease process from theories regarding origin to the molecular basis for disease sequelae. A thorough understanding of the histopathogenesis and pathophysiology of endometriosis is essential to the development of novel diagnostic and treatment approaches for this debilitating condition. Copyright © 2012 American Society for Reproductive Medicine. All rights reserved.

0 comments Cited 448 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Endometriosis and infertility: pathophysiology and management.

Alan D. Ziegler, Charles Chapron, Bruno Borghese (2010)

Endometriosis and infertility are associated clinically. Medical and surgical treatments for endometriosis have different effects on a woman's chances of conception, either spontaneously or via assisted reproductive technologies (ART). Medical treatments for endometriosis are contraceptive. Data, mostly uncontrolled, indicate that surgery at any stage of endometriosis enhances the chances of natural conception. Criteria for non-removal of endometriomas are: bilateral cysts, history of past surgery, and altered ovarian reserve. Fears that surgery can alter ovarian function that is already compromised sparked a rule of no surgery before ART. Exceptions to this guidance are pain, hydrosalpinges, and very large endometriomas. Medical treatment-eg, 3-6 months of gonadotropin-releasing hormone analogues-improves the outcome of ART. When age, ovarian reserve, and male and tubal status permit, surgery should be considered immediately so that time is dedicated to attempts to conceive naturally. In other cases, the preference is for administration of gonadotropin-releasing hormone analogues before ART, and no surgery beforehand. The strategy of early surgery, however, seems counterintuitive because of beliefs that milder non-surgical options should be offered first and surgery last (only if initial treatment attempts fail). Weighing up the relative advantages of surgery, medical treatment and ART are the foundations for a global approach to infertility associated with endometriosis. Copyright 2010 Elsevier Ltd. All rights reserved.

0 comments Cited 184 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Consensus on current management of endometriosis.

Neil P Johnson, Lone Hummelshoj (2013)

Is there a global consensus on the management of endometriosis that considers the views of women with endometriosis? It was possible to produce an international consensus statement on the current management of endometriosis through engagement of representatives of national and international, medical and non-medical societies with an interest in endometriosis. Management of endometriosis anywhere in the world has been based partially on evidence-based practices and partially on unsubstantiated therapies and approaches. Several guidelines have been developed by a number of national and international bodies, yet areas of controversy and uncertainty remain, not least due to a paucity of firm evidence. A consensus meeting, in conjunction with a pre- and post-meeting process, was undertaken. A consensus meeting was held on 8 September 2011, in conjunction with the 11th World Congress on Endometriosis in Montpellier, France. A rigorous pre- and post-meeting process, involving 56 representatives of 34 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement. A total of 69 consensus statements were developed. Seven statements had unanimous consensus; however, none of the statements were made without expression of a caveat about the strength of the statement or the statement itself. Only two statements failed to achieve majority consensus. The statements covered global considerations, the role of endometriosis organizations, support groups, centres or networks of expertise, the impact of endometriosis throughout a woman's life course, and a full range of treatment options for pain, infertility and other symptoms related to endometriosis. This consensus process differed from that of formal guideline development. A different group of international experts from those participating in this process would likely have yielded subtly different consensus statements. This is the first time that a large, global, consortium, representing 34 major stake-holding organizations from five continents, has convened to systematically evaluate the best available current evidence on the management of endometriosis, and to reach consensus. In addition to 18 international medical organizations, representatives from 16 national endometriosis organizations were involved, including lay support groups, thus generating input from women who suffer from endometriosis.

0 comments Cited 146 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): JBRA Assist Reprod

Journal ID (iso-abbrev): JBRA Assist Reprod

Journal ID (publisher-id): jbra

Title: JBRA Assisted Reproduction

Publisher: Brazilian Society of Assisted Reproduction

ISSN (Print): 1517-5693

ISSN (Electronic): 1518-0557

Publication date (Print and electronic): Apr-Jun 2017

Publication date (Print): Apr-Jun 2017

Volume: 21

Issue: 2

Pages: 120-125

Affiliations

[1 ]Endometriosis Multidisciplinary Team, Mater Dei Hospital, Belo Horizonte, MG, Brazil

[2 ]Human Reproduction Center at Mater Dei Hospital, Belo Horizonte, MG, Brazil

[3 ]Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Brazil

[4 ]Endometriosis Multidisciplinary Team, Biocori Hospital, Belo Horizonte, MG, Brazil

Author notes

Corresponding author: Márcia Mendonça Carneiro, Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. E-mail: marciamc.ufmg@ 123456gmail.com

Article

DOI: 10.5935/1518-0557.20170027

PMC ID: 5473705

PubMed ID: 28609279

SO-VID: 277925de-dd9c-403c-b476-75ac7e6660b5

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 06 December 2016

Date accepted : 07 April 2017

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.