Algorithm for overcoming infertility secondary to ovarian endometriotic cyst: a view of a reproductive specialist and a surgeon


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Aim. To investigate the demand and effectiveness of algorithms for the management of infertility using IVF and surgical methods in women with ovarian endometriotic cysts (OEC) on a case-by-case basis, taking into account the OEC manifestations and clinical presentations associated with age, ovarian reserve, and concomitant indications for IVF. Materials and methods. The study analyzed clinical spectrum OEC in 532 infertile women regarding the distribution of patients by age, ovarian reserve, and the presence of concomitant indications for IVF. The study compared the demand and effectiveness of three algorithms selected based on the OEC characteristics and clinical status affecting the reproductive potential. Results. The most popular algorithm (80.3%) for the management of infertility in women with OEC was IVF’s initial administration, which resulted in a cumulative pregnancy rate (PR) of 86.7%. Algorithms with the initial use of surgery to create conditions for spontaneous pregnancy or to prepare for urgent IVF were in demand in 11.4% and 8.3% of cases, respectively. They had 93.4% and 36.4% cumulative PR, respectively. Conclusion. The selection of the optimal algorithm for the management of infertility using IVF and surgical methods in women with OEC requires considering the age, ovarian reserve, and concomitant indications for IVF and the features of the detected OECs. The widespread use of cryopreservation technology allows the re-transfer of embryos without ovarian stimulation (thus reducing the program’s overall cost). It implies the possibility of continuing fertility treatment in cases of surgical menopause after OEC removal.

Full Text

Restricted Access

About the authors

Ksenia V. Krasnopolskaya

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: deti222@mail.ru
Corr. Member of the RAS, Professor, Head of the Department of Reproduction

Alexander A. Popov

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: gyn_endoscopy@mail.ru
Dr. Med. Sci., Professor, Head of the Department of Endoscopic Surgery

Anton A. Fedorov

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: gyn_endoscopy@mail.ru
Ph.D., Leading Researcher at the Department of Endoscopic Surgery

Irina Yu. Ershova

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: deti222@mail.ru
Ph.D., Researcher at the Department of Reproduction

References

  1. Reid S., Condous G. Endometriomas and pelvic endometriosis. In: Guerriero S., Martins W., Alcazar J., eds. Managing ultrasonography in human reproduction. Springer, Cham; 2017: 123-36. https://dx.doi.org/10.1007/978-3-319-41037-1_7.
  2. Maggiore U.L.R., Gupta J.K., Ferrero S. Treatment of endometrioma for improving fertility. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017; 209: 81-5. https://dx.doi.org/10.1016/j.ejogrb.2016.02.035.
  3. Sonmezer M., Ta§kin S. Fertility preservation in women with ovarian endometriosis. Womens Health. (Lond). 2015; 11(5): 625-31. https:// dx.doi.org/10.2217/whe.15.49.
  4. Gelbaya T.A., Gordts T, D’Hooghe T.M., Gergolet M., Nardo L.G. Management of endometrioma prior to IVF: compliance with ESHRE guidelines. Reprod. Biomed. Online. 2010; 21(3): 325-30. https://dx.doi. org/10.1016/j. rbmo.2010.04.023.
  5. Kuroda K., Ikemoto Y, Ochiai A., Ozaki R., Matsumura Y., Nojiri S. et al. Combination treatment of preoperative embryo cryopreservation and endoscopic surgery (Surgery-ART Hybrid Therapy) in infertile women with diminished ovarian reserve and uterine myomas or ovarian endometriomas. J. Minim. Invasive Gynecol. 2019; 26(7): 1369-75. https://dx.doi.org/10.1016/j. jmig.2019.02.008.
  6. Lessey B.A., Gordts S., Donnez O., Somigliana E., Chapron C., Garcia-Velasco J.A. et al. Ovarian endometriosis and infertility: in vitro fertilization (IVF) or surgery as the first approach? Fertil. Steril. 2018; 110(7): 1218-26. https://dx.doi.org/10.1016/j.fertnstert.2018.10.003.
  7. Muzii L., Di Tucci C., Di Feliciantonio M., Verrelli L., Galati G., Benedetti Panici P. Infertility associated with ovarian endometriomas: surgery or in-vitro fertilization? J. In Vitro Fertil. 2018; 1(1): 1-3. https:// dx.doi.org/10.36959/983/634.
  8. Краснопольская К.В. Лечение бесплодия при эндометриозе: взгляд репродуктолога. М.: МЕДпресс-информ; 2019. 112 c. [Krasnopolskaya K.V. Treatment of endometriosis-associated infertility: a view of the reproductologist. M.: MEDpress-inform; 2019. 112 p. (in Russian)].
  9. Tal R., Seifer D.B. Ovarian reserve testing: a user’s guide. Am. J. Obstet. Gynecol. 2017; 217(2): 129-40. https://dx.doi.org/10.1016/j.ajog.2017.02.027.
  10. Landolfo C., Froyman W., Bourne T., De Cock B., Testa A.C., Valentin L. et al. OC11.02: IOTA benign easy descriptors and ADNEX model integrated in a ‘traffic light system’ to guide the clinical management of adnexal pathology. Ultrasound Obstet. Gynecol. 2017; 50(Suppl. 1): 21-2. https://dx.doi. org/10.1002/uog.17623.
  11. Timmerman D., Van Calster B., Testa A., Savelli L., Fischerova D., Froyman W. et al. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis (IOTA) group. Am. J. Obstet. Gynecol. 2016; 214(4): 424-37. https://dx.doi.org/10.1016/j.ajog.2016.01.007.
  12. Краснопольская К.В., Назаренко Т.А. Клинические аспекты лечения бесплодия в браке. Диагностические и терапевтические программы с использованием методов восстановления естественной фертильности и вспомогательных репродуктивных технологий. Руководство. М.: ГЭ ОТАР-Медиа; 2013. 376 c.
  13. Краснопольская К.В., Сесина Н.И., Бадалян Г.В., Черкезов Я.А., Ивахненко В.Н., Назаренко Р.В. Медленное замораживание и витрификация эмбрионов. Сравнение эффективности. Проблемы репродукции. 2015; 21 (1): 48-53. [Krasnopolskaya K.V., Sesina N.I., Badalyan G.V., Cherkasov Ya. A., Ivahnenko V.N., Nazarenko R.V. Slow freezing and vitrification of embryos. Comparison of effectiveness. The problem of reproduction. 2015; 21 (1); 48-53. (in Russian)]. https://doi.org/10.17116/repro20152148-53.
  14. Ferrero S., Scala C., Tafi E., Racca A., Venturini P.L., Leone Roberty 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. https://dx.doi.org/10.1016/j.ejogrb.2017.04.003.
  15. Vignali M., Mabrouk M., Ciocca E., Alabiso G., Barbasetti di Prun A., Gentilini D. et al. Surgical excision of ovarian endometriomas: does it truly impair ovarian reserve? Long-term anti-Mullerian hormone (AMH) changes after surgery. J. Obstet. Gynaecol. Res. 2015; 41(11): 1773-8. https://dx.doi.org/10.1111/ jog.12830.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies