Endometriosis Infertility Research Articles

MODERN APPROACHES TO THE TREATMENT OF ENDOMETRIOID CYSTS BEFORE CONTROLLED OVARIAN STIMULATION PROTOCOLS

The article is devoted to the current problem of endometriosis-associated infertility. In recent years, a great deal of information has been accumulated on the etiology, diagnosis and treatment of genital endometriosis and endometriosis-associated infertility. According to world studies, endometriosis remains one of the most pressing problems in modern gynecology. This is evidenced by statistics showing that the disease occurs in every 10 women of fertile age, and a total of 176 million women worldwide. Approximately 20–50 % of women included in this number have a problem of infertility. Hence, the problem of this disease is not only a medical but also a social problem.
 Conclusions. The tactics of treatment of patients with endometriosis who are planning a pregnancy and are included in the ART protocols are significantly different from the tactics of treatment of patients who believe that they have performed reproductive function.

Circular RNA expression profiling and bioinformatic analysis of cumulus cells in endometriosis infertility patients.

Aim: To explore the circular RNA (circRNA) profile in cumulus cellsfrom endometriosis-associated infertility patients. Methods: The expression of circRNAs was profiled by high-throughput sequencing. Sanger sequencing was performed to identify the backsplicing site. Six candidate circRNAs and their parental genes were measured in 30 samples by quantitative reverse transcription-polymerase chainreaction (qRT-PCR). Bioinformatics analysis was performed to predict the functions. Results: A total of 55 upregulated and 41 downregulated differentially expressed circRNAs were detected. Kyoto Encyclopedia of Genes and Genomes data indicated thatthese target genes were mainly involved in cumulus cellgrowth- and differentiation-related pathways. Hsa_circ_0072391, hsa_circ_0007299 and hsa_circ_0057799 were significantly increased, and hsa_circ_001533 was significantly decreased in endometriosis-associated infertility patients. Conclusion: The differentially expressed circRNAs might be potentially involved in pathophysiology of endometriosis-associated infertility.

Adenomyosis, a Predictor of Endometriosis Severity? a Pilot Study.

Study Objective Are sonographic features of adenomyosis associated with the three endometriosis phenotypes, superficial peritoneal endometriosis (SPE), ovarian endometrioma (OE) and deep infiltrative endometriosis (DE)? Design This retrospective cohort study analyses the presence of sonographic features of adenomyosis in reproductive age women with suspected endometriosis who underwent laparoscopic surgery at Liverpool Hospital during 2018-20 period. Setting N/A Patients or Participants 73 women of reproductive age with suspected endometriosis (pelvic pain or infertility). Interventions Women underwent a specialized transvaginal ultrasound (TVUS) by a single expert sonologist, to diagnose deep endometriosis and adenomyosis using the IDEA (International Deep Endometriosis Analysis) and MUSA (Morphological Uterus Sonographic Assessment) diagnostic criteria. All women underwent laparoscopic surgery within 6 months of the TVUS by an advanced laparoscopic surgeon, who documented intraoperative and histopathological findings. Measurements and Main Results The mean age was 35 years. 53/73 (73%) women had endometriosis at laparoscopy. 20/73 (27%) women had features of adenomyosis on TVUS with 14/20 of these women having endometriosis. 6/14 (43%) had DE with pouch obliteration, 7/14 (50%) had SPE and 1/14 (0.1%) had OE. Overall, the most common feature of adenomyosis at TVUS for women with endometriosis was heterogenous myometrium. Echogenic subendometrial lines was the most common TVUS feature for women with DE, whereas heterogenous myometrium was the most frequent TVUS features for women with SPE. An irregular interrupted junctional zone was the most common TVUS feature in women without endometriosis. Conclusion Women with adenomyosis at TVUS appear to be at high risk (70%) of concurrent endometriosis. 43% of women with adenomyosis at TVUS had advanced endometriosis (DE w pouch obliteration), with echogenic subendometrial lines the most common sonographic feature of adenomyosis. Further studies are needed to confirm whether specific features of adenomyosis at TVUS are associated with endometriosis phenotype, which in turn may aid in surgical planning for these women.

Modified Ubess and CA-125 Endometriosis Severity Prediction Model Protocol

Study Objective The Ultrasound-Based Endometriosis Staging System (UBESS) has demonstrated accuracy in predicting the laparoscopic skill required for maximum cytoreductive endometriosis surgery. However, UBESS does not account for the need for ureterolysis, an advanced laparoscopic skill, nor does it differentiate between isolated peritoneal disease and no disease. The Modified-UBESS and Ca-125 endometriosis severity prediction model aims to account for these short-falls by incorporating ultrasound (ovarian fixation, endometrioma, uterosacral endometriosis) and biochemical (Ca-125) markers to improve the prediction of intraoperative ureterolysis and isolated peritoneal disease, thereby improving the UBESS accuracy in predicting surgical complexity. Design This prospective study assesses the diagnostic accuracy of the endometriosis severity prediction model in predicting the ASRM endometriosis stage (American Society of Reproductive Medicine) and AGES laparoscopic skill (Australasian Gynaecological Endoscopy & Surgery) required for maximum cytoreductive surgery for women with suspected endometriosis undergoing laparoscopic surgery at Liverpool, Campbelltown and Nepean Hospital over a 5-year period. Setting N/A Patients or Participants 200 women of reproductive age with suspected endometriosis (chronic pelvic pain and/or infertility) will be recruited. Interventions Participants will undergo a standardised history and Ca-125, followed by a 5 domain TVUS (transvaginal ultrasound) by an expert sonologist. Women will be assigned a modified UBESS score, which incorporates the likelihood of requiring ureterolysis. All women will undergo laparoscopic surgery within 6 months of their TVUS and Ca-125, with ASRM stage and AGES skill recorded. Measurements and Main Results The diagnostic accuracy of our model in predicting the ASRM stage and AGES skill required for maximum cytoreductive surgery will be calculated. Conclusion If this study demonstrates that our model is effective in preoperatively predicting the ASRM stage and AGES skill required for maximum cytoreductive endometriosis surgery, after external validation, it can be implemented worldwide to reduce the risks and health care costs associated with multiple laparoscopic surgeries for women with suspected endometriosis.

Antimüllerian Hormone and Oxidative Stress Biomarkers as Predictors of Successful Pregnancy in Polycystic Ovary Syndrome, Endometriosis and Tubal Infertility Factor

Oxidative stress in the follicular fluid (FF) is thought to be responsible for the abnormal development of oocytes. In our study patients with polycystic ovarian syndrome (PCOS), endometriosis, and tubal infertility factor (TIF), and healthy women with a male factor of infertility, were prospectively enrolled. From each patient, a sample of individual FF was collected from a dominant follicle. Concentration levels of TAS, 8-IP, 8-OHdG, and AMH were determined. In women with PCOS, we found significantly lower values of oxidative stress markers in the FF. 8-IP and TAS levels were lower in the FF of women with endometriosis. In women with TIF, we also found significantly lower values of all tested markers in the FF, except for 8-OHdG and AMH. We wanted to see whether the biomarker measured in the FF in an individual diagnosis could predict a successfully obtained embryo from this particular follicle. The FF 8-OHdG result in PCOS patients stood out and proved to be a good predictive marker of matured and fertilized oocytes in these patients. Further research is needed to be able to apply the acquired knowledge in improving the outcome of IVF procedures.

A retrospective study of a novel non-umbilical laparoscopic entry port in thin patients\u2014Jain point

BackgroundTo bring forth a novel non-umbilical entry port in case of thin patient.MethodsThis is a retrospective study carried out at Vardhman Trauma and Laparoscopy Centre on thin patients from 2011 to 2019. Out of 7324 patients operated between 1 January 2011 and 31 December 2019 at this hospital, 398 met the criteria for thin patients (BMI < 18.5 kg/m2).ResultsA total of 398 patients who underwent laparoscopy surgery through the Jain point were classified as thin (BMI < 18.5 kg/m2) patients. Infertility evaluation hystero-laparoscopy (30.40%), endometriosis (17.08%), and myomectomy (13.32%) followed by genital tuberculosis (11.5%) and ovarian tumors (4.01%) were the most common indications for surgery. None of the thin patients operated had any major vascular or bowel injury.ConclusionThe Jain point can be an alternative non-umbilical primary entry port in thin patients especially when conventional techniques are contraindicated.

Effect of genital endometriosis on fertility and gestation course

Hypothesis/aims of study. Endometriosis is a multifactorial, chronic and recurring condition that has a multifaceted negative impact on womens fertility. The aim of the study was to assess the effect of genital endometriosis on the female reproductive system and pregnancy using the literature.&#x0D; Study design, materials and methods. The review was performed by analyzing the articles published mainly over the last 5 years and deposited in PubMed Central, ScienceDirect, and Cyberleninka bibliographic databases.&#x0D; Results. Current data for the management of patients with endometriosis, pathogenetic and pathophysiological mechanisms of infertility, and complications arising during pregnancy in patients with endometriosis are presented in this review article.&#x0D; Conclusion. In patients with endometriosis, individualized management of the disease, full periconceptional multivitamin supplementation and the developed strategy of prenatal care should be taken to overcome infertility and to prevent or minimize the risk of complications associated with pregnancy.

Effect of GnRH agonist before IVF on outcomes in infertile endometriosis patients: a randomized controlled trial

Research questionDoes 3-months of gonadotrophin releasing hormone agonist (GnRHa) treatment before IVF improve clinical pregnancy rate in infertile patients with endometriosis? DesignSingle-blind, placebo-controlled clinical trial of 200 infertile women with endometriosis assigned to use GnRHa (study group) or placebo (control group) for 3 months before IVF. Clinical, embryological outcomes and stimulation parameters were analysed. Clinical pregnancy rate was the primary endpoint. In a subgroup of 40 patients, follicular fluid levels of oestradiol, testosterone and androstendione were measured. Gene expression profile of CYP19A1 was analysed in cumulus and mural granulosa cells. ResultsImplantation or clinical pregnancy rate were not significantly different between the two groups. Clinical pregnancy rates were 25.3% and 33.7% in the study and control groups, respectively (P = 0.212). Cumulative live birth rate was not significantly different: 22.0% (95% CI 13.0 to 31.0) in the study group and 33.7% (95% CI 24.0 to 44.0) in the control group (P = 0.077). Ovarian stimulation was significantly longer and total dose of gonadotrophins significantly higher in the study group (both P < 0.001). Serum oestradiol levels on the day of HCG were significantly lower in the study group (P = 0.001). Cancellation rate was significantly higher in the study group (P = 0.042), whereas cleavage embryos were significantly more numerous in the control group (P = 0.023). No significant differences in the expression of CYP19A1 gene in mural or cumulus granulosa cells or steroid levels in follicular fluid between the two groups were observed, but testosterone was significantly lower in the study group (P < 0.001). ConclusionThree-months of GnRHa treatment before IVF does not improve clinical pregnancy rate in women with endometriosis.

REASONS FOR ENDOMETRIOSIS-ASSOCIATED INFERTILITY

This article discusses the causes and mechanisms of the occurrence of infertility in endometriosis within the framework of versions and contraversions. The magnitude of the described problem is noted not only from a medical, but also from a socio-economic perspective. Four main factors of endometriosis-associated infertility were identified: tubal-peritoneal, ovarian, embryonic and endometrial. Given the inconsistency of scientific data, the need for further research is noted.

Parameters of cytokine balance and vascular-epithelial growth factor depending on level of vitamin D in patients with external genital endometriosis

The study was performed to find association between some cytokine status indicators, level of vascular endothelial growth factors and vitamin D in women with infertility and external genital endometriosis (EGE) in order to increase the effectiveness of its treatment. The low vitamin D status in the dynamics was determined in 240 patients aged 25 to 35 years with EGE planning pregnancy by determining the level of 25 (OH) D in the blood serum using the chemiluminescent method. Interleukin status (IL-1β, IL-6, IL-4), TNF-α, VEGFR-1 in blood serum was determined using enzyme-multiple immunoassay. The results of the studies revealed an increased level of IL-6, IL-1β and TNF-α in groups with low vitamin D content. In normal vitamin D significantly lower levels of vascular endothelial growth factor (VEGFR-1 ) in the blood serum were registered. Pregnancy rates were higher in groups with normal 25(OH)D levels in the blood serum. The mean serum VEGFR-1 level in pregnant women who became pregnant on their own was 1.3–1.5 times lower.

Negative Sliding Sign during Dynamic Ultrasonography Predicts Low Endometriosis Fertility Index at Laparoscopy

Endometriosis fertility index (EFI) is a robust tool to predict the pregnancy rate in patients with endometriosis who are attempting non-in vitro fertilization conception. However, EFI calculation requires laparoscopy. Newly established imaging techniques such as sliding sign, which is used to diagnose pouch of Douglas obliteration, could provide a promising alternative. The objective of this study was to investigate the practicality of using ultrasound data to predict a low EFI (score ≤6). Observational study from a prospective registry (Endometriosis Pelvic Pain Interdisciplinary Cohort, clinicaltrials.gov #NCT02911090). Analyzed data were captured from December 2013 to June 2017. Tertiary referral center at British Columbia Women's Hospital. We analyzed data for 2583 participants from the Endometriosis Pelvic Pain Interdisciplinary Cohort. In this cross-sectional study, we included 86 women aged <40 years. Dynamic ultrasonography for the sliding sign testing and EFI calculation during laparoscopic surgery. Logistic regression was used to obtain receiver operating characteristic area under the curve (AUC) for the prediction models. Significance was p <.05. Patients with a negative sliding sign were older and had severe endometriosis and longer duration of infertility. Patients with a negative sliding sign had significantly lower total EFI scores and lower surgical factors scores than patients with a positive sliding sign. Logistic regression showed that a negative sliding sign and EFI historic factors score can predict an EFI score ≤6 (sensitivity = 87.9%, specificity = 81.1%, AUC = 0.93 [95% confidence interval, 0.88-0.98]). Adding the diagnosis of endometrioma to the previous prediction model resulted in AUC = 0.95 (95% confidence interval, 0.90-0.995), sensitivity = 84.8%, and specificity = 92.5%. The sliding sign could be a potential alternative to the EFI surgical factors, and it could be used in combination with EFI historic factors and the diagnosis of endometrioma to predict an EFI score ≤6 for patients who are not scheduled for immediate surgery.

Endometriosis, sexuality and satisfaction: A pilot study on women with and without infertility

Summary Objectives The aim of this study was to explore whether women with endometriosis-related infertility had poorer psychological, sexual and relational scores compared with endometriosis without infertility. Methods Seventy-one endometriosis women (32 with associated infertility and 39 without) completed a survey assessing sexual functioning, relational satisfaction, anxiety and quality of life. Results Both groups scored clinical in sexual functioning and anxiety. Comparing to infertile women, fertile participants obtained worse scores in all areas assessed except for anxiety. Conclusions Beyond our expectations, infertile endometriosis women showed to feel more understood and supported than the others. Possible explanations and implications are discussed.

Elucidating Decorin\u2019s role in the preovulatory follicle

BackgroundDCN (decorin) is a proteoglycan known to be involved in regulating cell proliferation, collagen fibril organization and migration. In our global transcriptome RNA-sequencing approach to systematically identify new ovulation-associated genes, DCN was identified as one of the highly regulated genes. We therefore hypothesize that DCN may have a role in ovulatory processes such as cell migration and proliferation.AimTo characterize the expression, regulation and function of the proteoglycan DCN in the human ovarian follicles during the preovulatory period.MethodsThe in-vivo expression of DCN mRNA in mural (MGCs) and cumulus (CGCs) granulosa cells was characterized using quantitative RT-PCR and western blot.A signaling study was performed by treating human MGCs cultures with gonadotropins and different stimulators and inhibitors to determine their effect on DCN expression by qRT- PCR and elucidate the pathways regulating these proteins.In a functional study, KGN granulosa cell line was used to study cell migration with a scratch assay.ResultsDCN mRNA expression was significantly higher in MGCs compared to CGCs. DCN mRNA was significantly higher in CGCs surrounding mature metaphase II (MII) oocytes compared to CGCs of germinal vesicle (GV) and metaphase I (MI) oocytes.hCG significantly increased DCN mRNA and protein expression levels in cultured MGCs. Using signal transduction activators and inhibitors, we demonstrated that DCN induction by LH/hCG is carried out via PKA, PKC, ERK/MEK, and PI3K pathways.We showed that DCN expression is also induced in high-density cell cultures, in a dose-dependent pattern. In addition, progesterone induced a significant increase in DCN secretion to the media. MGCs from follicles of endometriosis patients exhibited reduced (about 20% of) mRNA transcriptions levels compared to MGCs follicles of control patients. More significantly, we found that DCN has an inhibiting effect on KGN cell migration.ConclusionsOur study indicates that DCN is a unique ovulatory gene.Our findings support the hypothesis that DCN plays an important new role during the preovulatory period and ovulation, and stress its involvement in endometriosis infertility. A better understanding of DCN role in ovulation and endometriosis may provide treatment for some types of infertility.

Identifying Mechanisms of Endometriosis-Associated Reduced Fecundity in a Rat Model: Novel Insights toward Understanding Human Infertility.

The existence of endometriosis has been known since at least the nineteenth century, yet the lack of understanding of causes of infertility and therefore inadequate treatment approaches in endometriosis creates a significant challenge in reproductive medicine. Women worldwide suffer not only pain and infertility but also economical, societal, and physiological burdens. Studies of reproductive events in women are difficult to conduct due to a host of confounding personal and environmental factors and ethically limited due to the very nature of working with reproductive tissues and cells, especially embryos. Animal models are a viable adjunct to study mechanisms causing human reproductive anomalies and infertility in endometriosis. This chapter discusses reproductive anomalies causing infertility in endometriosis and well-established animal models which help decipher the problems and lead to heretofore unknown nonsurgical, nonhormonal methods to manage endometriosis in women. In addition, studies of effects of developmental exposure to endometriosis are revealing for the first time, in both female and male offspring, transgenerational subfertility in a rat model providing insights into the familial nature of endometriosis and possible epigenetic involvement.

Placental Genetic Variants in the Upstream Region of the FLT1 Gene in Pre-eclampsia.

Background:Inflammatory responses within the peritoneal cavity may result in endometrial dysfunction in women with endometriosis. The true causes of this disease remain poorly understood. It is hypothesized that downstream toll-like receptors (TLRs) inflammatory cytokines in response to pathogens may be associated with endometriosis. So, this study was aimed at evaluating the expression of TLRs signaling and endometriosis-associated inflammatory responses.Methods:Totally, 20 infertile endometriosis patients and 20 normal women undergoing controlled ovarian stimulation were enrolled. The cellular pellet and supernatant were obtained by centrifugation of follicular fluid (FF). Evaluation of TLRs and their signaling pathway gene expression was performed on cellular pellets using quantitative-PCR. The supernatant was used for determination of cytokine protein expression by ELISA. The results are expressed as mean±SEM and a p<0.05 was considered statistically significant.Results:Quantitative-PCR analysis suggested that TLR1, 5, 6, 7, 8, 10, MYD88, NF-ĸB, IL-10 and TGF-β genes expression significantly increased in patients compared to the control group (p<0.05). TLR3, 9, INF-β genes expression was significantly lower in endometriosis than control group (p<0.05). There was no significant difference in the expression of TLR2, TLR4, TIRAP, TRIF, TRAM, and IRF3 between two groups. Also, significant increase in the levels of IL-6, IL-8 and MIF protein in FF of endometriosis group was detected in comparison with normal women (p<0.05).Conclusion:The expression of TLR downstream signaling in the follicular cells can initiate inflammatory responses and changes in the FF cytokine profile which in turn may induce endometriosis and infertility disorder.

Dose-Dependent Decreased Fertility in Response to the Burden of Endometriosis in a Murine Model.

Endometriosis is a gynecological disease caused by the growth of endometrial cells outside the uterus leading to inflammation, pelvic pain, and infertility. The relationship between the amount of ectopic uterine tissue growth and the severity of symptoms is still unclear. The presence or degree of pain and infertility does not correlate with the stage of disease as currently defined. Here, we report a clear dose-response relationship between the amount of ectopic tissue transplanted and the reproductive outcomes in a murine model of endometriosis. Endometriosis was induced in mice using various amounts of transplanted uterine tissue. Four groups of mice consisted of a sham surgery control or those transplanted with 1, 2, or 4 endometrial segments of 5 mm each. Pregnancy rates were significantly lower in those transplanted with 2 or 4 segments compared to sham or the 1 segment groups. We demonstrate that infertility does correlate with the extent of active disease. Current clinical staging systems do not account for disease activity and may inappropriately weight sequela of disease. Early recognition and treatment in women may help to minimize the effect of endometriosis on fertility. Here, we describe a mouse model of endometriosis and infertility that may be useful to elucidate the mechanisms of infertility in endometriosis.

Predicting the likelihood of a live birth for women with endometriosis-related infertility

ObjectiveEndometriosis affects 10% of women in reproductive age and alters fertility. Its management is still debated notably the timing of surgery and ART in infertility. Several tools have been created to guide the practitioner and the couple yet many limitations persist. The objective is to create a nomogram to predict the likelihood of a live birth after surgery followed by assisted reproductive technology (ART) for patients with endometriosis-related infertility. Study designAll women in a public university hospital who attempted to conceive by ART after surgery for endometriosis-related infertility from 2004 to 2016 were included. We created a model using multivariable linear regression based on a retrospective database. ResultOf the 297 women included, 171 (57.6%) obtained a live birth. Age, duration of infertility, number of ICSI-IVF cycles, ovarian reserve and the revised American Fertility Society (rAFS) score were included in the nomogram. The predictive model had an area under the curve (AUC) of 0.77 (95% CI, 0.75–0.79) and was well calibrated. The external validation of the model was achieved with an AUC of 0.71 (95% CI, 0.69–0.73) and calibration was good. The staging accuracy according to AUC criteria for the nomogram compared to the currently used Endometriosis Infertility Index to predict live births were 0.77 (95% CI, 0.75–0.79) and 0.60 (95% CI: 0.57–0.63), respectively. ConclusionThis simple tool appears to accurately predict the likelihood of a live birth for a patient undergoing ART after surgery for endometriosis-related infertility. It could be used to counsel patients in their choice between spontaneous versus ART conception, or oocyte donation.

Serum and Peritoneal Fluid Cytokine Profiles in Infertile Women with Endometriosis.

Endometriosis is a chronic inflammatory disease with the growth of endometrial cells out of uterus and in the peritoneal cavity. T cell subsets participate in the establishment and progress of the disease by producing different cytokines. To investigate a group of cytokines related to Th1/Th2/Th17/Treg subsets within both peripheral blood and peritoneal fluid (PF) samples from infertile endometriosis women. Peripheral blood and PF samples were collected from 30 infertile endometriosis and 30 non-endometriosis fertile women during laparoscopy. Concentration of cytokines, including TNF-α, IFN-γ, TGF-β1, IL-4, IL-10, IL-17 and IL-23 were evaluated using ELISA method. Results indicated that the concentration of IFN-γ within serum was significantly reduced in endometriosis group (p=0.001). Regarding PF cytokines, TGF-β1 was increased in endometriosis group (p=0.030). Furthermore, the ratios of IFN-γ/TGF-β1 and IL-17/IL-23 were significantly different between endometriosis and non-endometriosis women in serum samples (p<0.001 and p<0.01 respectively). The ratios of TNF-α/IL-10 and IL-17/IL-10 were also significantly different regarding PF samples between the two studied groups (p<0.04 and p<0.03 respectively). Finally, significant correlations were observed between the levels of IL-17 and IL-23, inflammatory and anti-inflammatory cytokines, in both samples and serum to PF inflammatory cytokines. Based on the results of the present study, in women with endometriosis, the disturbance of cytokines network might gradually activate the inflammatory responses and tissue repair, resulting in endometriosis development after several years.

Endometriotic lesions

Endometriosis is a complex gynaecological condition affecting women of reproductive age. It is characterised by the presence of lesions containing endometrial glands and stroma outside the uterus. The disease is typically associated with pelvic pain (including dysmenorrhoea and dyspareunia), infertility and bowel-related symptoms. Endometriotic lesions have a highly variable presentation and most commonly occur in the abdominal cavity. These lesions are broadly classified into peritoneal, ovarian and deep infiltrating endometriosis. There have been observations of increased density of nerve fibres and neurological molecules in the endometriotic lesions compared to the uninvolved peritoneum of women without endometriosis and the presence of unmyelinated nerve fibres were higher near the glands. The lesion sites are characterised by a range of immunological alterations, and specific immune cell populations have also been known to synthesise and secrete neurogenic factors. Endometriotic lesions are capable of producing prostaglandins which are direct generators of pain and are capable of inducing inflammation. Diagnosing the disease involves direct visualisation of the lesions through a laparoscopic or laparotomy, which is followed by histopathological examination of biopsied or excised lesions. The staging of endometriosis due to its complexity is highly variable as presentation and gaps in knowledge pose a great challenge in the classification of the disease. The medical management of endometriosis aims at providing adequate analgesia and suppression of the activity of the lesion. A better understanding of endometriotic lesion relationships between innervations and specific clinical characteristics may elucidate aspects of pain mechanisms and infertility in endometriosis and facilitate the development of novel therapeutic approaches.

The impact of repetitive oocyte retrieval on the ovarian reserve: a retrospective cohort study

PurposeTo investigate a possible influence of repetitive micro-traumata on the ovaries in the course of oocyte retrieval during IVF/ICSI treatment on serum anti-Müllerian hormone (AMH) levels.MethodsThe study included retrospectively collected data from women who underwent three or more consecutive IVF/ICSI treatments between 2007 and 2017. The primary endpoint of the study was to evaluate changes in serum AMH levels on cycle days 1–3 during the course of repetitive IVF/ICSI treatments.ResultsA total of 125 patients were included in this study. Median AMH levels before the first, second and third IVF/ICSI cycles were 3.8 ng/mL (IQR 1.8–7.1), 3.3 ng/mL (IQR 1.8–6.1) and 3.0 ng/mL (IQR 1.6–5.3), respectively (p = n.s.). In patients who underwent IVF/ICSI due to polycystic ovary syndrome (PCOS), we found a significant decrease in AMH serum levels between the first [AMH 9.7 ng/mL (IQR 7.4–14.4)] and the third [AMH 5.3 ng/mL (IQR 3.3–10.4)] IVF/ICSI cycles (p = 0.026). When performing a generalized linear model, we found PCOS to be an independent predictor for serum AMH decrease during the course of three oocyte retrievals (p < 0.001).ConclusionsWhen comparing the indications for IVF/ICSI, we observed a significant decrease in AMH serum levels after repetitive oocyte retrievals only in women with PCOS, while the decrease in AMH was not significant in patients with tubal factor, endometriosis, male factor and unexplained infertility. This finding leads us to hypothesize that repetitive micro-traumata on the ovarian cortex might diminish/normalize functional ovarian reserve in women with PCOS. Further prospective studies are highly warranted to allow firm conclusions.