Effect Of Endometriosis Research Articles

Evolution of medical treatment for endometriosis: back to the roots?

Experimental evidence is accumulating to suggest that medicinal botanicals have anti-inflammatory and pain-alleviating properties and hold promise for treatment of endometriosis. Herein, we present a systematic review of clinical and experimental data on the use of medicinal herbs in the treatment of endometriosis. Although there is a general lack of evidence from clinical studies on the potential efficacy of medicinal herbs for the treatment of endometriosis-associated symptoms, our review highlights the anti-inflammatory and pain-alleviating mechanisms of action of herbal remedies. Medicinal herbs and their active components exhibit cytokine-suppressive, COX-2-inhibiting, antioxidant, sedative and pain-alleviating properties. Each of these mechanisms of action would be predicted to have salutary effects in endometriosis. Better understanding of the mechanisms of action, toxicity and herb-herb and herb-drug interactions permits the optimization of design and execution of complementary alternative medicine trials for endometriosis-associated pain. A potential benefit of herbal therapy is the likelihood of synergistic interactions within individual or combinations of plants. In this sense, phytotherapies may be analogous to nutraceuticals or whole food nutrition. We encourage the development of herbal analogues and establishment of special, simplified registration procedures for certain medicinal products, particularly herbal derivates with a long tradition of safe use.

Modes of application of gonadotropin-releasing hormone agonists for endometriosis treatment

Gonadotropin-releasing hormone (GnRH) agonists have gained extensive clinical use, ranging from reproduction to oncology. There are many clinically available GnRH agonists and these can be used via various methods of delivery, ranging from nasal application to daily subcutaneous injection and various forms of depot preparations. The depot preparations are available as once-monthly intramuscular or subcutaneous injections or 3-month depot moieties. In addition, there is also a 1-month subcutaneous implant available. However, the mode of action of all preparations is identical. The question arises of whether or not the mode of application is important for the treatment effects of endometriosis. Indeed, the course and extent of circulating serum estradiol level are different when comparing nasal with depot preparations. The serum estradiol concentration decreases more rapidly and distinctly with depot than with nasal preparations. Over a period of 24 weeks, the levels of serum estradiol remain higher under nasal GnRH agonist treatment, compared with the depot preparations. Histomorphological changes, such as gland diameter, gland area, cytoplasm and nuclear area, and stromal extension, change less with nasal GnRH agonist therapy than under depot GnRH-agonist treatment. This is also reflected in the spectrum and severity of side effects of nasal and depot preparations. Side effects were more prominent with depot preparations. In addition, bleeding/spotting control was better with the depot preparations. Furthermore, depot preparations had a lower recurrence rate and the time till recurrence was longer. In addition, subsequent surgical and/or medical treatments were significantly less often required with depot preparations (p < 0.05).

P-359: Comparison of in vitro fertilization (IVF) outcome in patients with endometriosis and patients with other infertility causes

The effect of endometriosis on IVF outcome is controversial. This study was designed to determine whether the diagnosis of endometriosis adversely affects the outcome of IVF, compared to other causes of infertility. Retrospective database analysis. All IVF cycles performed between April 2001 and March 2006 were analyzed. Of a total of 763 patients undergoing 945 IVF cycles, 66 patients had a diagnosis of endometriosis and underwent 86 IVF cycles. One of three protocols was employed: downregulation with or without birth control pills, short-microflare with birth control pill pretreatment, and antagonist. Outcomes of patients with endometriosis were compared with those of patients with other causes of infertility. Statistical analysis was performed with the student t test and the X2 test. As shown in the table below, we found no significant differences between patients with and without endometriosis in any of the variables analyzed. Specifically, there were no differences in the clinical pregnancy rate per cycle started and in the rate of pregnancy loss. The number of oocytes per retrieval and the fertilization rate were also not significantly different.Tabled 1 Our results suggest that the diagnosis of endometriosis per se does not worsen the prognosis for pregnancy in infertile patients undergoing IVF. Support: none

P-13: The Effect of Endometriosis on Pregnancy Outcome Following In Vitro Fertilization-Embryo Transfer (IVF-ET) in Women With Decreased EGG Reserve

P-13: The Effect of Endometriosis on Pregnancy Outcome Following In Vitro Fertilization-Embryo Transfer (IVF-ET) in Women With Decreased EGG Reserve

Effect of Endometriosis on Progesterone Secretion by Human Granulosa Cells: Role of Peritoneal Fluid

To determine the effect of peritoneal fluid of patients with and without endometriosis on in vitro progesterone production by granulosa cells of patients submitted to in vitro fertilization in order to evaluate the influence of factors present in peritoneal fluid on the follicular endocrine medium.

The effect of endometriosis, cycle stage, lymphocyte suppression and pregnancy on CA-125 levels in peritoneal fluid and serum in baboons

Serum CA-125 during the mid-follicular phase has been reported to be a clinically useful and reproducible marker in the diagnosis of advanced endometriosis in women. This study was undertaken to document the effect of the menstrual cycle, pregnancy and lymphocyte suppression on CA-125 levels in peritoneal fluid (PF) and serum in baboons with a normal pelvis and baboons with endometriosis. CA-125 levels were measured in 264 serum samples that were serially obtained during one menstrual cycle from 10 animals with and without endometriosis. In addition, CA-125 levels were determined in 204 archived samples (serum, n = 112 and PF, n = 92) obtained from 32 female baboons with or without endometriosis. The CA-125 assays were performed by radioimmunoassay using kits from Centocor (Malvern, PA, USA). Serum CA-125 levels were at their highest during menstruation and decreased progressively during the follicular and luteal phase. PF CA-125 levels were increased during the follicular phase in baboons with a normal pelvis, but no cyclic changes were observed in animals with endometriosis. Serum CA-125 levels were unaffected by induction, lymphocyte suppression or pregnancy. Induction of endometriosis resulted in increased PF CA-125 levels, whereas lymphocyte suppression or pregnancy had no effect. In baboons, serum CA-125 originates mainly from eutopic endometrium whereas the main source of PF CA-125 seems to be the peritoneum or ectopic endometrium. The baboon appears to be a valid model to further study the relationship between endometriosis and CA-125.

Effect of endometriosis on IVF/ICSI outcome: stage III/IV endometriosis worsens cumulative pregnancy and live-born rates

Women with endometriosis often need IVF to conceive-most women need several cycles of treatment. To evaluate the impact of moderate to severe endometriosis on cumulative IVF outcome, we carried out an observational study on 98 consecutive women who underwent IVF or ICSI treatment and had endometriosis diagnosed by laparoscopy or laparotomy and classified as minimal to mild endometriosis (American Society for Reproductive Medicine I/II) (n = 31) or moderate to severe endometriosis (American Society for Reproductive Medicine III/IV) (n = 67). The reference group consisted of 87 consecutive women with tubal infertility. The main outcome measures were cumulative pregnancy and live birth rates. There was a significantly lower pregnancy rate per fresh embryo transfer after pooled cycles (1-4) among women with stage III/IV endometriosis (22.6%) compared to stage I/II group (40.0%) or tubal infertility (36.6%). After 1-4 IVF/ICSI treatments, including frozen embryo transfer, 56.7% of the women with stage III/IV endometriosis were pregnant and 40.3% gave birth. The corresponding values were 67.7/55.8% when endometriosis was stage I/II and 81.6/43.7% in the controls respectively. Stage III/IV endometriosis means a worse prognosis for IVF/ICSI treatments compared to milder stages or tubal factors. Lower implantation and multiple pregnancy rates offer some support to our practice to continue two embryo transfers in this group.

Adenomyosis: what is the impact on fertility?

This review is timely and relevant for several reasons. The incidence of adenomyosis begins to rise from the mid-thirties. Moreover, more women are delaying their first pregnancy until later in their thirties or forties, and consequently adenomyosis is encountered more frequently in the fertility clinic during diagnostic work-up. Furthermore, it is difficult to diagnose adenomyosis before surgery, because there are no pathognomonic signs, symptoms or physical findings. Finally, reference data are very limited. This review refers to adenomyosis of the uterus as a factor in female infertility. The clinical presentation of adenomyosis uteri is also reviewed, as well as animal and human studies concerning the effect of adenomyosis in female infertility. Different treatment options are discussed, especially those referring to patients who wish to maintain their fecundity. Uterine adenomyosis remains a fairly frequent and debilitating disease that will be encountered with increasing incidence in the infertile female population. While spectacular advances have been made in recent years in the non-invasive diagnosis of the condition, non-surgical treatment options for infertile patients with adenomyosis arise but need to be confirmed in larger series.

Endometriosis has no effect on ART results after ICSI procedure

The effects of endometriosis on ART results remain controversial. Many studies suggested reduced fertilization rate after traditional IVF in endometriosis patients. The purpose of this study was to compare ART results after ICSI procedure in patients with endometriosis to those with tubal factors.

Management of endometriosis in fertility patients

The management of endometriosis in fertility patients remains empiric. Adverse effects on every reproductive component have been reported. How to counsel couples regarding treatment and the effects of endometriosis on fertility is still uncertain.

Effect of endometriosis on in vitro fertilization

Objective: To investigate the IVF outcome for patients with endometriosis. Design: Meta-analysis. Setting: Academic research center. Patient(s): A MEDLINE search and review of the literature were performed. Patients were classified by level of endometriosis, and controls were classified according to the indication for IVF. Intervention(s): Bivariate analysis and multivariate logistic regression was used to estimate overall effect and control for confounding. Main Outcome Measure(s): Pregnancy rates, fertilization rate, implantation rates, and numbers of oocytes retrieved. Result(s): Twenty-two published studies were included in the overall analysis. The chance of achieving pregnancy was significantly lower for endometriosis patients (odds ratio, 0.56; 95% confidence interval, 0.44–0.70) when compared with tubal factor controls. Multivariate analysis also demonstrated a decrease in fertilization and implantation rates, and a significant decrease in the number of oocytes retrieved for endometriosis patients. Pregnancy rates for women with severe endometriosis were significantly lower than for women with mild disease (odds ratio, 0.60; 95% confidence interval, 0.42–0.87). Conclusion(s): Patients with endometriosis-associated infertility undergoing IVF respond with significantly decreased levels of all markers of reproductive process, resulting in a pregnancy rate that is almost one half that of women with other indications for IVF. These data suggest that the effect of endometriosis is not exclusively on the receptivity of the endometrium but also on the development of the oocyte and embryo.

Quality of life following radical excision of recto-vaginal endometriosis associated with complete obliteration of the posterior cul de sac

Objective: To evaluate the reproducibility of symptom relief following radical laparoscopic excision of nodular recto-vaginal endometriosis in a group of British women using a similar questionnaire to that of a large American series.Design: 28 patients who were undergoing radical laparoscopic excision of recto-vaginal disease were asked to complete a questionnaire with a five point pain scale prior to surgery and one year post surgery.Materials/Methods: Patients referred to a specialist pelvic pain clinic with symptoms and signs of recto-vaginal endometriosis were asked to complete a questionnaire rating their symptoms on a five point ranked ordinal scale. They completed a further questionnaire one year post surgery. All patients had histologically proven disease.Results: See table. TableChanges in pain scores.SymptomNo of ptsBetterSameWorseP valueDyspareunia2817 (61%)11 (39%)00.0001Dyschezia2817 (61%)11 (39%)00.0001Constipation2810 (36%)18 (64%)00.0001Pelvic pain2821 (75%)07 (25%)0.0001Menstrual pain2821 (75%)6 (21%)1 (4%)0.0001Backache2815 (53%)13 (47%)00.0001 Open table in a new tab Conclusions: Good symptom relief was obtained, similar to the results of the American series with an improvement in quality of life. This data will be presented in detail during the presentation. Realtime data collection allows for rapid collection and analysis of patient data identifying both efficacy of treatment and possible complications, early in any treatment cycle. 1. Redwine DB, Wright JT: Symptom relief following radical laparoscopic conservative surgery for complete obliteration of the cul de sac due to endometriosis: Fertility and Sterility (in press). 2. Garry R, Clayton R, Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG: an International Journal of Obstetrics & Gynaecology 2000;107:44–54. 3. Stata Corp, College Station, Texas, USA.Supported By: No support. Objective: To evaluate the reproducibility of symptom relief following radical laparoscopic excision of nodular recto-vaginal endometriosis in a group of British women using a similar questionnaire to that of a large American series. Design: 28 patients who were undergoing radical laparoscopic excision of recto-vaginal disease were asked to complete a questionnaire with a five point pain scale prior to surgery and one year post surgery. Materials/Methods: Patients referred to a specialist pelvic pain clinic with symptoms and signs of recto-vaginal endometriosis were asked to complete a questionnaire rating their symptoms on a five point ranked ordinal scale. They completed a further questionnaire one year post surgery. All patients had histologically proven disease. Results: See table. Conclusions: Good symptom relief was obtained, similar to the results of the American series with an improvement in quality of life. This data will be presented in detail during the presentation. Realtime data collection allows for rapid collection and analysis of patient data identifying both efficacy of treatment and possible complications, early in any treatment cycle. 1. Redwine DB, Wright JT: Symptom relief following radical laparoscopic conservative surgery for complete obliteration of the cul de sac due to endometriosis: Fertility and Sterility (in press). 2. Garry R, Clayton R, Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG: an International Journal of Obstetrics & Gynaecology 2000;107:44–54. 3. Stata Corp, College Station, Texas, USA. Supported By: No support.

The effect of endometriosis on implantation rates in blastocyst ART cycles

Objective: The question of whether endometriosis effects implantation rates in IVF-ET cycles has been evaluated in a number of studies over the last decade. In this study, we utilize blastocysts as a way to measure implantation rates because the quality of blastocysts transferred does not vary as much as day 3 embryos.

Development of an Endometriosis Quality-of-Life Instrument

In Brief OBJECTIVE To describe a new disease-specific questionnaire with established measurement properties that addresses the dimensions of health-related quality of life considered important to women with endometriosis. METHODS The Endometriosis Health Profile-30 was developed in three stages. Stage 1 included open-ended exploratory interviews with 25 women to generate the items on the questionnaire. Stage 2 was an 87-item questionnaire administered in a postal survey to identify the most salient dimensions of health-related quality of life. In stage 3, the reliability and validity of the questionnaire were evaluated. RESULTS The final instrument contained a core questionnaire with 30 items and five scales: pain, control and powerlessness, emotional well-being, social support, and self-image. Six modular parts consisting of 23 questions were also developed and measured the areas of sexual intercourse, work, relationship with children, feelings about the medical profession, treatment, and infertility. All the scales achieved high internal reliability, with Cronbach's α coefficient ranging from 0.83 to 0.93 (core questionnaire) and 0.79 to 0.96 (modules). The intraclass correlation coefficients to evaluate the test-retest reliability were high (range 0.88–0.98, P < .001). Content validity was demonstrated as the questionnaire was developed from interviews of patients rather than existing literature and clinical scales. Construct validity was assessed by correlating the Endometriosis Health Profile-30 scales with the relevant Short Form-36 scales. High correlations for all comparisons were found (−0.41 to −0.73). CONCLUSION The Endometriosis Health Profile-30 is a reliable, valid, patient-generated instrument to measure the health-related quality of life of women with endometriosis. Its application in various health care settings will provide new and valuable information on the effect of endometriosis on health-related quality of life from the patients' perspective. The Endometriosis Health Profile-30 is a reliable and valid patient-generated instrument to measure the health-related quality of life of women with endometriosis.

Development of an endometriosis quality-of-life instrument: The Endometriosis Health Profile-30

Objective: To describe a new disease-specific questionnaire with established measurement properties that addresses the dimensions of health-related quality of life considered important to women with endometriosis. Methods: The Endometriosis Health Profile-30 was developed in three stages. Stage 1 included open-ended exploratory interviews with 25 women to generate the items on the questionnaire. Stage 2 was an 87-item questionnaire administered in a postal survey to identify the most salient dimensions of health-related quality of life. In stage 3, the reliability and validity of the questionnaire were evaluated. Results: The final instrument contained a core questionnaire with 30 items and five scales: pain, control and powerlessness, emotional well-being, social support, and self-image. Six modular parts consisting of 23 questions were also developed and measured the areas of sexual intercourse, work, relationship with children, feelings about the medical profession, treatment, and infertility. All the scales achieved high internal reliability, with Cronbach’s α coefficient ranging from 0.83 to 0.93 (core questionnaire) and 0.79 to 0.96 (modules). The intraclass correlation coefficients to evaluate the test-retest reliability were high (range 0.88–0.98, P < .001). Content validity was demonstrated as the questionnaire was developed from interviews of patients rather than existing literature and clinical scales. Construct validity was assessed by correlating the Endometriosis Health Profile-30 scales with the relevant Short Form-36 scales. High correlations for all comparisons were found (−0.41 to −0.73). Conclusion: The Endometriosis Health Profile-30 is a reliable, valid, patient-generated instrument to measure the health-related quality of life of women with endometriosis. Its application in various health care settings will provide new and valuable information on the effect of endometriosis on health-related quality of life from the patients’ perspective.

The Effect of Endometriosis on Implantation: Results from the Wilford Hall Medical Center In Vitro Fertilization and Embryo Transfer Program

The Effect of Endometriosis on Implantation: Results from the Wilford Hall Medical Center In Vitro Fertilization and Embryo Transfer Program

The Effect of Endometriosis on IVF Outcome

The Effect of Endometriosis on IVF Outcome

The effect of endometriosis and its radical laparoscopic excision on quality of life indicators at 4 and 12 months post-operative

The effect of endometriosis and its radical laparoscopic excision on quality of life indicators at 4 and 12 months post-operative

Is the endometrium or oocyte/embryo affected in endometriosis?

One of the most puzzling problems of endometriosis is determining which mechanisms link this spectrum of conditions to infertility. There is conflicting evidence about the effect of endometriosis on the endometrium and on oocyte/embryo quality. Clinical studies reveal that implantation rates seem to be lower in women with endometriosis, while spontaneous abortion rates show variable results which are difficult to interpret due to the design of the studies. Biochemical markers (integrins and other cell adhesion molecules), morphological markers (pinopodes), apoptosis and ultrasound studies confirm that not only does the endometrium from women with endometriosis behave differently from the endometrium of women without endometriosis, but ectopic endometrium also behaves differently from eutopic endometrium. Data from oocyte donation programmes suggest that oocyte quality may be hampered in women with endometriosis. Recent reports have focused on the molecular mechanisms that may be altered, such as ovarian steroid production, or inadequate luteal function. In this review, we analyse the most recent literature dealing with the different mechanisms which affect the endometrium and oocyte/embryo quality and which thereby might cause infertility.

R-050. Effect of endometriosis on ICSI results in couples with male factor infertility

R-050. Effect of endometriosis on ICSI results in couples with male factor infertility