Stage Of Endometriosis Research Articles

Application of serum markers in diagnosis and staging of ovarian endometriosis

Laparoscopic surgery is widely used for diagnosing ovarian endometriosis but it has medical risks. This study explored the application of blood indicators in diagnosis and staging of ovarian endometriosis, aiming to develop a noninvasive diagnostic method. A total of 190 ovarian endometriosis patients were included in observation group, among these participants, 77 patients among them were stages I-II, and the rest 113 patients were stages III-IV, and a total of 103 healthy women as control group. Serum biochemical indexes, tumor markers, and cytokines levels in two groups were used for the diagnosis and staging of the disease. Area under the receiver operating characteristic (ROC) curve (AUC) predicted the value of individual and joint tests for indicators. Biochemical indexes, namely, alkaline phosphatase (ALP), total protein (TP), and glucose (Glu) could distinguish patients from normal women; and that ALP and Glu could indicate disease staging. In tumor markers, alpha fetoprotein (AFP), carcinoembryonic antigen (CA) 125, CA199 and human epididymis protein 4 (HE4) helped to diagnose endometriosis; CA125, HE4, and cytokeratin 19 fragment (CYFRA21-1) could differentiate stages. In cytokines, vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF)-α, interleukin (IL)-6, soluble fms-like tyrosine kinase receptor 1 (sflt-1), monocyte chemoattractant protein (MCP)-1 therefore, have values to diagnose endometriosis; VEGF, TNF-α, IL-6, and sflt-1 helped to differentiate disease staging. Serological indicators in ovarian endometriosis patients were different from healthy women, which were of certain differential values in diagnosis and disease staging. The current study provided a novel strategy for endometriosis diagnosis.

Endometriosis-associated infertility: surgery or IVF?

Endometriosis is a chronic disease frequently associated with female infertility. The choice of treatment in case of endometriosis is one of the most discussed topics in Reproductive Medicine. The approach to the patient with endometriosis and infertility should be tailored based on different parameters. The localization of the disease, the severity of symptoms and the age of the patient are just some of them. Management options include surgery, in-vitro fertilization (IVF), or a combination of both. Data, mostly uncontrolled, would favor surgery at any stage of endometriosis, increasing the chances of natural conception compared to expectant management. Laparoscopic excision of the ovarian endometrioma should be the treatment of choice when there is associated pain. Surgery should be performed following appropriate techniques to reduce the possible damage to the ovarian reserve. Pregnancy rates around 50% have been consistently reported after surgery, which compare favorably with those obtained with IVF. IVF, on the other hand, may be preferred in case of associated male or tubal factor, in case of a reduced ovarian reserve, or if previous surgery has failed, particularly if there is no associated pain, and when the ultrasonographic features of the ovarian cyst are reassuring. Sometimes IVF may be preceded by surgery, when a difficult access to follicles at pick-up, due to the size and location of the ovarian cyst, or to severe adhesions, is anticipated. Due to the lack of solid evidence in the scenario of endometriosis-associated infertility, robust data from randomized clinical trials (RCTs) are strongly needed.

Effectiveness of ultra-long protocol on in vitro fertilization/intracytoplasmic sperm injection-embryo transfer outcome in infertile women with endometriosis: A systematic review and meta-analysis of randomized controlled trials.

To evaluate the effectiveness of ultra-long protocol on reproductive and controlled ovarian hyperstimulation outcome in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) in infertile women with endometriosis versus long protocol. We retrieved articles without language restrictions in the Elsevier ScienceDirect, Embase, Medline, PubMed, Web of Science, China National Knowledge Infrastructure, Wan Fang Data Knowledge Service Platform and China Science and Technology Journal Database from inception to August 2020. RCTs including the comparison of reproductive outcome of infertile patients with endometriosis who underwent ultra-long protocol and long protocol were selected. Data extraction was conducted using RevMan 5.3. A total of nine RCTs in compliance with the standard literature were included. This meta-analysis suggested that ultra-long protocol with a 3-month downregulation could increase clinical pregnancy rate of infertile women with endometriosis (RR=1.31, 95% CI:1.11 ~ 1.55, P = 0.002) versus long protocol. However, subgroup analysis found the different protocol provided no significant difference in improving clinical outcomes in patients with different disease stage of endometriosis. The ultra-long protocol could improve the clinical pregnancy rate of infertile women with endometriosis compared with long protocol with a 3-month downregulation. And ultra-long protocol could be effective to increase the ongoing pregnancy rate compared to long-protocol. But, the efficacy of ultra-long protocol is not different between early and advanced stage of endometriosis.

Association between dietary inflammatory index and endometriosis risk in a case-control study

Background: Endometriosis is defined as the presence of functioning endometrial tissue in extra uterine structures that causes pain, infertility and reduced quality of life. Diet plays an important role in the modulation of endometriosis. Aim: This study aimed to evaluate the association between the dietary inflammatory index (DII) score and the endometriosis compared to healthy people in a case-control study in Iran. Methods: This study included 78 women with laparoscopically confirmed endometriosis and 78 women with normal pelvis. The DII was calculated from dietary intake assessed using a validated food frequency questionnaire. The association between DII scores (divided in tertiles) and endometriosis risk was investigated using logistic regression analysis and reported as odds ratios (ORs) and 95% confidence intervals (CI) adjusted for age, energy, BMI, education, para, smoking, pelvic pain, menorrhagia, stage of endometriosis, physical activity, and income. Results: In the age-adjusted models, subjects who consumed more pro-inflammatory diets (the upper tertile of DII) had an OR of 2.24 (95% CI = 2.03, 3.91) as compared to subjects in the lowest tertile. Also after multivariable adjustment, women in the highest tertile of DII (versus lowest tertile) were more likely to have endometriosis (OR 2.63; 95% CI 1.88–2.91, p = 0.004). Conclusion: Our results suggest that women with more consumption of pro-inflammatory diet were at increased endometriosis risk.

Detection of Endometrial Nerve Fibres in the Diagnosis of Endometriosis: A Case-control Study

Introduction: Due to non-availability of a good non-invasive or semi-invasive test for diagnosing endometriosis, there is a substantial time delay between the onset of symptoms and surgically confirmed endometriosis. Development of a simple non-invasive or semi-invasive diagnostic method can greatly help to reduce this delay and prevent severe morbidity in minimal to mild endometriosis which cannot be diagnosed clinically or by ultrasonography. Aim: To evaluate the role of nerve fibre detection in endometrial biopsy for diagnosing endometriosis Materials and Methods: In this observational study, detection of endometrial nerve fibres in endometrial biopsy in women undergoing laparoscopy/laparotomy for pelvic pain or infertility was done using polyclonal rabbit anti-protein gene product 9.5 (Dako, Australia). The results were compared between women who has laparoscopic/laparotomy visualisation of endometriotic lesions with those who don't have endometriotic lesions. Women with visual evidence of endometriosis in laparoscopy/laparotomy were taken as cases (n=32). Women without evidence of endometriosis in laparoscopy/laparotomy were taken as controls (n=29). Presence of endometrial nerve fibre was compared between women with and without evidence of endometriosis. Presence of endometrial nerve fibres and its association with painful symptoms, history of hormonal therapy, endometrial histopathology and stages of endometriosis was analysed. Results: Endometrial nerve fibres were detected in the functional layer in 21.8% of the endometriosis patients and no nerve fibres were detected in the control group. There was no significant association between endometrial nerve fibres in endometriosis and presentation of painful symptoms, history of hormonal therapy, endometrial histopathology and stages of endometriosis. Sensitivity of detecting endometriosis by the presence of nerve fibres in endometrial nerve biopsy specimen was 21.8% and specificity was 100%. Conclusion: Endometrial nerve fibre assessment for identifying endometriosis in women undergoing laparoscopy/laparotomy using routine endometrial sampling and immunohistochemical analysis was found not to be sensitive for the diagnosis of endometriosis.

Elevated Levels of CA-125, Estradiol and Cortisol as Prominent Markers to Diagnose Various Stages of Endometriosis

Elevated Levels of CA-125, Estradiol and Cortisol as Prominent Markers to Diagnose Various Stages of Endometriosis

Role of Epithelial-to-Mesenchymal Transition Markers in Different Stages of Endometriosis: Expression of the Snail, Slug, ZEB1, and Twist Genes.

Among various epithelial-to-mesenchymal transition (EMT)-related transcription factors (TFs), altered expression levels of Snail-1, Snail-2/Slug, Twist, and ZEB1 have shown a significant association in different cancers having a higher risk of metastasis. However, their role in the circulation of endometriosis patients is not well understood. Hence, the present study was designed to evaluate the crucial role of these TFs in defining the molecular pathogenesis for endometriosis progression and differentiation from control subjects. The qualitative and quantitative expression analysis of Snail-1, Snail-2/Slug, Twist, and ZEB1 were analyzed in peripheral blood samples of 75 different stages of endometriosis patients and compared with 50 control subjects. Total RNA was extracted and converted into complementary DNA (cDNA) for relative quantification of each gene transcript using SYBRGreen-based reverse transcriptase quantitative polymerase chain reaction (RT-qPCR). The Livak method of relative quantification was used for calculating the fold change in each TF compared with endogenous control. All four selected TFs showed significantly upregulated expression levels in endometriosis patients compared with control subjects. A three-fold increase was observed for Snail-1 (p = 0.0001), and a two-fold increase was observed for Snail-2 (p = 0.01), Twist (p = 0.0002), and ZEB1 (p = 0.001) in stage III and IV compared with stage I and II of endometriosis patients. The present study revealed that EMT-related TFs play a crucial role in the pathogenesis and differentiating different stages of endometriosis patients through expression analysis of specific molecular cascades using non-invasive tools.

КЛИНИЧЕСКАЯ ХАРАКТЕРИСТИКА ПАЦИЕНТОК С НАРУЖНЫМ ГЕНИТАЛЬНЫМ ЭНДОМЕТРИОЗОМ

A pairwise comparison of the clinical characteristics of patients with external genital endometriosis (EGE) stages I–III was carried out using Fisher's exact test. Patients with the most common (and newly diagnosed) stage II showed the greatest number of statistically significant correlations between clinical signs: dysmenorrheas with primary infertility (p = 0,0201), with localization of endometrioid heterotopias in the pouch of Douglas (p = 0,0214) and sacro-uterine ligaments (p = 0,0259); in addition, a relationship was found between the symptom of chronic pelvic pain and the presence of endometrioid heterotopias in the uterovesical space (p = 0,0071) and on the sacro-uterine ligaments (p = 0,0228). Along with this, they have a combination of foci of adenomyosis with multiple myoma of the uterine body was noted (p = 0,0000). In patients with stage III EGE, only one statistically significant (p = 0,0139) contingency of clinical signs was revealed — dyspareunia and heterotopias on the sacro-uterine ligaments.

The Clinical Outcome of Laparoscopic Surgery for Endometriosis on Pain, Ovarian Reserve, and Cancer Antigen 125 (CA-125): A Cohort Study.

Background:Endometriosis is an important cause of chronic pain and infertility. Surgery is considered the gold standard for diagnosis and treatment. In this study, we aim to describe the clinical outcomes of women who undergo laparoscopic surgery for endometriosis.Materials and Methods:In this cohort study, a total of 174 women who referred to Farmaniyeh Hospital, Tehran, Iran from August 2015 to December 2017 with surgical diagnoses of endometriosis stages III and IV enrolled. The participants’ demographic, gynaecological, and clinical characteristics were recorded and they were asked to use a numeric rating scale (NRS) to record their severity of pain before and three months after surgery. Blood samples were also taken from the patients before and three months after surgery for measurement of serum levels of anti-Müllerian hormone (AMH) and cancer antigen 125 (CA-125). Data were analysed using SPSS version 21.Results:The patients had a mean age of 34.86 ± 6.47 years, 60.9% were married, and 49.4% were housewives. The primary indication for surgery was pain (68.4%), followed by both pain and infertility in the remainder of patients. Types of endometriotic lesions included endometrioma (19%), deep infiltrating endometriosis (DIE, 3.4%), and both endometrioma and DIE (77.6%). There was a reduction in pain from 6.79 ± 2.19 before surgery to 1.48 ± 1.68 after surgery; serum AMH levels reduced from 2.80 ± 1.86 ng/mL to 1.76 ± 1.40 ng/mL and CA- 125 reduced from 257.06 ± 220.25 U/mL to 23.27 ± 23.25 U/mL (all P<0.001). Of the 21.2% who experienced recurrence, 13.5% underwent additional surgery. The total additional surgery rate was 2.8%. Of the 55 patients with infertility, 78.1% became pregnant after surgery, 54.5% of which was spontaneous.Conclusion:Surgical treatment of endometriosis had a favourable effect on the patients’ pain and inflammation and resolved the patients’ infertility with a minimal need for additional surgery.

ASSESSMENT THE HEALTH- RELATED QUALITY OF LIFE AMONG ENDOMETRIOSIS WOMEN IN MATERNAL AND CHILD HEALTH CENTERS IN DAMIETTA

Background:Endometriosis is a disease affect Women' health and Quality of life especially in child bearing age. Aim: Assess the Health- Related Quality of life among Endometriosis Women in Maternal and Child Health Centers in Damietta. Design: A descriptive study was used. Setting: Gynecology and Obstetrics out patient at three Maternal and Child Health centers; New Damietta MCH center, Shata MCH center and KaferShehata MCH center in Damietta city. Subjects: A total of 100 women with surgically diagnosed endometriosis were purposively selected. Tools: Include; structured interviewing questionnaire and the Endometriosis Health Profile (EHP-30+5). Results: shows that 83.0% of women had infertility. There was a delay in seeking treatment that ranged between 2-10 years. Endometriosis had a negative impact on woman's quality of life and there is statistically significant relation between stages of endometriosis and the negative aspect of women’s quality of life in terms of physical, psychological, sexual, educational and working life. Recommendations: there is a need for teaching patients to avoid the delay in seeking treatment. As well as how to cope with chronic pelvic pain and to teach patients how to strengthen relationships with their partner and friends, so they will be supportive in coping with the disease instead of drifting apart due to potentialmisunderstandings.Conclusion: There was a delay in seeking treatment for endometriosis despite its negative impact on woman's quality of life in terms of physical, psychological, sexual, educational and working life.

Estimation of the Endometriosis Fertility Index prior to operative laparoscopy.

Can the Endometriosis Fertility Index (EFI) be estimated accurately before surgery? The EFI can be estimated accurately based on mere clinical/ultrasound information, with some improvement after adding data from diagnostic laparoscopy. The EFI is a validated clinical instrument predicting the probability of pregnancy after endometriosis surgery without the use of ART. Being an end-of-surgery-score, it implies the decision for operative laparoscopy to be made in advance-hence, its role in the pre-surgical decision-making process remains to be established. Single-cohort prospective observational study in 82 patients undergoing complete endometriosis excision (between June and December 2016). Two methods were used to estimate the final EFI: type A based on non-surgical clinical/ultrasound findings only, and type B based on the combination of non-surgical clinical/ultrasound findings and diagnostic laparoscopy data. To calculate EFI type A, an algorithm was created to translate non-surgical clinical/imaging information into rASRM (revised American Society of Reproductive Medicine)-and EFI points. EFI type A and type B estimates were assessed for their clinical and numerical agreement with the final EFI score. Agreement was defined as clinical if EFI scores were within the same range (0-4, 5-6, 7-10), and numerical if their difference was ≤1. All 82 patients underwent complete laparoscopic CO2-laser excision of any rASRM stage of endometriosis in the Leuven University Fertility Centre (LUFC) of University Hospitals Leuven, a tertiary referral centre for both endometriosis and infertility. An anonymized clinical research file was created. For each patient, three different data sets were created, in order to allow the estimation of the (surgical part) EFI and of the rASRM scores, defined as follows: 'Estimated type A' contained only non-surgical clinical/imaging data, 'Estimated type B' included type A information plus the information of the diagnostic laparoscopy and 'Final EFI' included information of type A, type B and all intra-operative information required to calculate the final EFI. To calculate EFI type A without surgical information, a set of rules was used to translate pre-surgical clinical/imaging information into (rASRM and EFI points). Scoring was done by one person (C.T.), with a time interval of 4 weeks between sessions for each EFI type. Next to the EFI, also rASRM score and stage were calculated. Agreement rate between estimated EFI type A and final EFI was high for both the clinical (0.915; 95% CI 0.832-0.965) and numerical definition (0.878; 95% CI 0.787-0.940). Agreement rates between estimated EFI type B and final EFI were even higher (clinical (0.988; 95% CI 0.934-1.000), numerical (0.963; 95% CI 0.897-0.992)). Type A estimation is dependent on high-level gynaecological ultrasound expertise, which may not be available in all clinics. A small number of patients had no prior clinical, ultrasound (hard markers) or surgical confirmation of the diagnosis of endometriosis. When applying the estimated EFI type A in clinical practice, a priori assumptions of the presence or absence of endometriosis will need to be made in adjunct to the estimation of the estimated type A EFI when counselling patients on the potential benefit of an (at least diagnostic) laparoscopy. The level of agreement for type A or B should also be taken into account when counselling patients on the type of efforts undertaken to attempt to diagnose or rule out endometriosis. As this study reports, the EFI can be estimated accurately based on clinical/ultrasound data only without the need for any surgical data. This means that the EFI could be used as an instrument to guide joint physician-patient decision-making between surgery, ART or other fertility management options for the individualized treatment of women with endometriosis-related infertility. During this study period, C.T. was supported by FWO (Research Fund Flanders, Grant number 1700816N) and UZ Leuven KOF (University Hospitals Leuven, Klinisch Onderzoeksfonds).The LUFC received unrestricted research grants from Ferring Pharmaceuticals and Merck SA. Gedeon Richter and MSD sponsored travel to and attendance at scientific meetings. C.M. received consultancy fees from Lumenis (paid to KU Leuven, no private revenue). T.D. has been vice-president and head of global medical affairs infertility for the multinational pharmaceutical company Merck (Darmstadt, Germany) since 1 October 2015. He continues his academic appointment on a part-time basis as Professor of Reproductive Medicine at the University of Leuven (KU Leuven). T.D. has been vice-president and head of global medical affairs infertility for the multinational pharmaceutical company Merck (Darmstadt, Germany) since October 2015. He is also a Guest Professor in Reproductive Medicine and Biology at the Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium, and an Adjunct Professor at the Department of Obstetrics and Gynecology in the University of Yale, New Haven, USA. This work was initiated before he joined Merck KGaA in October 2015, and completed during the subsequent years. study registration number at UZ Leuven Clinical Trial Centre: S59221.

Endometriosis shows no impact on the euploid blastocyst rate per cohort of inseminated metaphase-II oocytes: A case-control study

ObjectiveTo evaluate the true impact of endometriosis on oocytes’ competence defined as blastulation, euploidy and implantation rates. DesignRetrospective multicenter case-control study involving infertile couples undergoing ICSI with qPCR and trophectoderm biopsy-based PGT-A. Patients affected from endometriosis (n = 210) were diagnosed through transvaginal sonography or surgical history with histological confirmation. Each case was matched to two controls (n = 420) according to IVF clinic, maternal age at retrieval (38.6 ± 2.7 yr), number of previous failed IVF treatments (0.5 ± 0.8) and number of metaphase-II oocytes retrieved (6.1 ± 3.7 per patient). The primary outcome was the mean euploid blastocyst rate per cohort of inseminated metaphase-II oocytes. Other embryological, clinical, obstetric and neonatal outcomes were also evaluated. ResultsThe mean euploid blastocyst rate per cohort of inseminated metaphase-II oocytes was identical in the two groups (18 %±22 %) independently of maternal age. No difference was shown for all embryological outcomes investigated. The live birth rates per vitrified-warmed single euploid blastocyst transfer were also similar (67/158, 42 % in patients affected from endometriosis versus 132/327, 40 % in matched-controls). No difference was reported in the gestational and neonatal outcomes. The cumulative live birth delivery rates among completed cycles were also identical (61/201, 30 % versus 117/391, 30 % in endometriosis and matched-control groups, respectively) independently of maternal age. ConclusionsEndometriosis might not impair oocyte developmental and reproductive competence, although its potential impact on the number of metaphase-II oocytes retrieved cannot be ignored. This information is critical for clinicians during counseling to outline an effective strategy to treat infertile patients affected from this condition. Future prospective studies are needed to evaluate the impact of endometriosis stage on euploidy rates.

Genetic and Biochemical Markers of Ovarian Function and Their Impact on Women Reproductive Status

Endometriosis is a disease very common nowadays affecting 1-2% of the female population, by estrogen-dependent mechanism. The identification of mutations in the gene encoding for the FSH receptor (FSHR) has been reported since 1995. Physiology teaches us that follicle-stimulating hormone (FSH) is a hormone that is vital in the steroidogenesis regulation mechanisms, while FSH receptor (FSHR) activation helps to promote folliculogenesis and estrogensynthesis. Therefore, studies to show if there are any correlations between endometriosis and FSHR are acquired. Genotyping of FSHR gene polymorphisms were performed using PCR - Restriction Fragment Length Polymorphism (PCR-RFLP) analysis. We analysed a total of 78 patients, 44 infertile patients with endometriosis and 34 controls (non-infertile, pregnant patients). The endometriosis group included women with diagnosis of endo-metriosis confirmed by laparoscopy and /or laparotomy and histological evidence of disease with the endometriosis staging according to American Society for Reproductive Medicine (ASRM). Corroborated with the severity of endometriosis, A919G and A2039G tests found that 71.4% of the M (GG) results were associated with primary infertility, not statistically significant (p=0.994) and 42.9% of the total M results had moderate or severe forms of endometriosis (p = 0.185). The genetic involvement in different pathologies such as endometriosis, has yet to be understood, but knowing more about its mechanism, will help physician target the disease at a more profound level.

Clinical characteristics and pregnancy outcomes of infertile patients with endometriosis and endometrial polyps: A retrospective cohort study

ObjectiveThe aim of this study was to discuss the clinical characteristics and the prognosis of surgically diagnosed endometriosis complicated by endometrial polyps and investigate the association between pregnancy outcomes during subsequent pregnancies. Materials and methodsFrom January 2013 to December 2016, 1263 infertile patients were enrolled in the study. We identified 451 patients with endometriosis, and divided them into a polyp group (n = 204) and a non-polyp group (n = 247) based on whether or not they were associated with endometrial polyps. Postoperative clinical pregnant women (n = 82) among the polyp group were then classified into a study group and a control group composed of those undergoing a singleton pregnancy (n = 164) who delivered during the same time period. Clinical statuses and complications during pregnancy and delivery were collected from hospitals and by telephone interviews and surveys through the mail. ResultsThe prevalence rate of endometriosis infertile group was obviously higher than the non-endometriosis infertile group ([45.23%; 204/451] versus [17.12%; 139/812]). Women suffering from stage 1 to 4 endometriosis had a 42.44% (73/172), 40.69% (59/145), 55.89% (38/68) and 51.52% (34/66) occurrence rate of endometrial polyps, respectively. The frequency of endometrial polyps for stage 3 and 4 patients was obviously higher than that of stage 1 and 2 patients ([53.73%; 72/134] versus [41.64%; 132/317]). Moreover, the occurrence rate of deep infiltrating endometriosis (DIE) was 57.81% (37/64), which was obviously higher than that of ovarian endometriosis (42.42%; 98/231) and peritoneal endometriosis (44.23%; 69/156). Of the 204 women diagnosed with posterior endometrial polyps, 89 became pregnant, 7 pregnancies ended in a spontaneous abortion, and 82 successfully delivered a baby. The clinical pregnancy rate of patients in stages 1 and 2 was wholly higher than that of patients in stages 3 and 4 ([48.70%; 56/115] versus [37.71%; 26/82]). The postsurgical pregnancy status of patients suffering from peritoneal endometriosis was slightly better than those with ovarian or DIE, but differences were not statistically significant (P = 0.626). We also found that the pregnancy rate was statistically elevated in patients whose EFI scores range from 7 to 10. When compared to the control group, women with endometriosis and endometrial polyps had a higher risk of their pregnancy being complicated by placenta previa (13.41%) and cesarean delivery (59.76%). ConclusionPatients with endometriosis have a higher frequency of endometrial polyps. We found that a combined hysteroscopy and laparoscopy surgical procedure is an effective way to increase pregnancy rates. Different endometriosis stages and types in patients were associated with clinical pregnancy and spontaneous abortion rates. Women affected by both endometriosis and endometrial polyps have an independently elevated risk of placenta previa and cesarean delivery during pregnancy.

MiR-532-3p: a possible altered miRNA in cumulus cells of infertile women with advanced endometriosis

Research questionIs the profile of microRNA (miRNA) altered in cumulus cells of infertile women with early (EI/II) and advanced (EIII/IV) endometriosis? DesignIn this prospective case–control study, a miRNA profile including 754 targets was evaluated in samples of cumulus cells from infertile women with endometriosis (5 EI/II, 5 EIII/IV) and infertile controls (5, male and/or tubal factor) undergoing ovarian stimulation for intracytoplasmic sperm injection, using TaqMan® Array Human MicroRNA Cards A and B. The groups were compared with Kruskal–Wallis test, followed by Benjamini–Hochberg correction and Dunn's post hoc test. An in silico enrichment analysis was performed to list the possibly altered pathways in which the altered miRNA target genes are involved. ResultsOnly the miRNA miR-532-3p showed significant differences among the analysed groups, being down-regulated in the EIII/IV group compared with the infertile control group, as well as compared with the EI/II group. The enrichment analysis showed that some genes regulated by this miRNA are involved in important pathways for the acquisition of oocyte competence, such as the oxytocin, calcium, Wnt, FoxO, ErbB and Ras signalling pathways, as well as the oocyte meiosis pathway. ConclusionThe present findings bring new perspectives to understanding the follicular microenvironment of infertile women with different stages of endometriosis. It is suggested that the dysregulation of miR-532-3p may be a potential mechanism involved in the aetiopathogenesis of endometriosis-related infertility. Further studies are needed to evaluate these pathways in cumulus cells of infertile women with the disease, as well as their impact on the acquisition of oocyte competence.

Developing Preoperative Nomograms to Predict Any-Stage and Stage III-IV Endometriosis in Infertile Women.

Study objective: To generate and validate nomograms to predict any-stage and stage III-IV endometriosis before surgery in infertile women.Design: A single center retrospective cohort study.Setting: University affiliated hospital.Patients: Infertile patients (n = 1,016) who underwent reproductive surgery between July 1, 2016 and June 30, 2019.Interventions: None.Main outcome measurements: We randomly selected 2/3 of the included patients (667 patients, training sample) to analyze and generate predictive models and validated the models on the remaining patients (339 patients, validation sample). A multivariate logistic regression model was used with the training sample to select variables using a back stepwise procedure. Nomograms to predict any-stage and stage III–IV endometriosis were constructed separately. The discriminations and calibrations of both nomograms were tested on the overall population and a subgroup without endometrioma diagnosed on transvaginal sonography (TVS) of training and validation samples. The impact of different variables in these models was evaluated.Results: There were 377 (55.7%) women in the training sample and 196 (57.8%) in the validation sample who were diagnosed with endometriosis. The nomogram predicting any-stage endometriosis had an area under the curve (AUC) of 0.760 for the training sample and 0.744 for the validation sample, with favorable calibrations in the overall population. However, the performance was significantly decreased in patients without endometrioma on TVS, with an AUC of 0.726 in the training sample and 0.694 in the validation sample. Similarly, the nomogram predicting stage III–IV endometriosis had an AUC of 0.833 and 0.793 for the training and validation samples, respectively, as well as a favorable calibration. However, the performance of the nomogram on patients without endometrioma on TVS was poor. Endometrioma on TVS strongly predicted both any stage and stage III–IV endometriosis on both samples.Conclusion: We developed nomograms to predict any-stage and stage III–IV endometriosis but their performance were significantly decreased in patients without endometrioma on TVS. Endometrioma on TVS strongly predicted any and III–IV stage endometriosis in both sample groups. Therefore, we recommend that this study be used as encouragement to advance the utilization of advanced imaging for endometriosis for better clinical prognosis.

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.

VP62.22: Comparison of transvaginal sonography and surgical staging of deep endometriosis using the Enzian classification

VP62.22: Comparison of transvaginal sonography and surgical staging of deep endometriosis using the Enzian classification

VP62.35: Can we predict the revised American Fertility Society stage using the preoperative transvaginal ultrasound based endometriosis staging system in women with suspected endometriosis? A retrospective observational study

VP62.35: Can we predict the revised American Fertility Society stage using the preoperative transvaginal ultrasound based endometriosis staging system in women with suspected endometriosis? A retrospective observational study

VP59.51: The importance of the ovarian sliding sign for prediction of surgical complexity when using the ultrasound‐based endometriosis staging system

VP59.51: The importance of the ovarian sliding sign for prediction of surgical complexity when using the ultrasound‐based endometriosis staging system