Ovarian endometriosis associated infertility: a modern view to the problem

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 44-49
Author(s):  
Mekan R. Orazov ◽  
Marina B. Khamoshina ◽  
Marianna Z. Abitova ◽  
Lyudmila M. Mikhaleva ◽  
Snezhana V. Volkova ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Assisted Reproductive Technologies ◽  
Negative Impact ◽  
Ovarian Tissue ◽  
Reproductive Function ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Ovarian Endometriosis ◽  
Surgical Interventions ◽  
Ovarian Endometriomas

This review summarizes current understanding of the pathogenesis of one of the most common forms of external genital endometriosis ovarian endometriomas. Due to their frequent occurrence in young women of reproductive age and extremely negative impact on the morphophysiological state of the ovaries, this disease makes a significant contribution to the structure of endometriosis-associated infertility. The main determinant of the negative effect of ovarian endometriomas on reproductive function is a decrease in ovarian reserve, which can occur either due to the direct gonadotoxic effect of the endometriod cyst itself, or due to the unintentional removal of healthy ovarian tissue during surgery or the use of aggressive methods of electrosurgery. Hence, the question of methods for achieving hemostasis during surgery in terms of iatrogenic effects on healthy ovarian tissue is debatable. The management strategy for patients with infertility associated with ovarian endometriosis consists of two components: surgical treatment and/or the use of assisted reproductive technologies. Laparoscopic cystectomy is indicated for cysts larger than 3 cm. Repeated surgical interventions in case of endometriosis do not improve fertility outcomes. Assisted reproductive technologies methods should be considered as a priority tactic in patients of older reproductive age with low ovarian reserve indicators or infertility duration of more than 2 years, as well as in cases of recurrent ovarian endometriomas. Management of such patients must be personalized and take into account the age, state of the ovarian reserve, duration of infertility, stage and number of surgical interventions for this disease.

CLINICAL CASE OF SUCCESSFUL TREATMENT OF INFERTILITY IN A PATIENT WITH FAILURE IVF RESULTS IN ANAMNESIS

2020 ◽  
pp. 61-67
Author(s):  
Kalinkina O.B. ◽  
Tezikov Yu.V. ◽  
Lipatov I.S. ◽  
Aravina O.R.
Keyword(s):  
Assisted Reproductive Technologies ◽  
Transvaginal Ultrasound ◽  
Clinical Manifestations ◽  
Reproductive Function ◽  
Abnormal Uterine Bleeding ◽  
Clinical Situation ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Deficiency Anemia ◽  
Number Of Publications

Genital endometriosis is a disease of women of reproductive age, accompanied by infertility in 50% [1]. Adenomyosis can be considered as an endometriosis of the uterus. Histologically, this process is represented by ectopic, non-tumor endometrial glands, and stroma surrounded by hypertrophic and hyperplastic myometrium [2]. Adenomyosis is accompanied by pelvic pain of varying intensity as well as menstrual disorders [1]. The disease is accompanied by significant violations of reproductive function (infertility, unsuccessful attempts at pregnancy and miscarriage, abnormal uterine bleeding). Adenomyosis can be accompanied by a violation of the function of adjacent organs (such as the bladder, rectum). Often, one of the clinical manifestations of adenomyosis is the development of sideropenic syndrome, which is also caused by the development of chronic post-hemorrhagic iron deficiency anemia. This is accompanied by a deterioration in the general condition of patients, a decrease in their ability to work. Despite a large number of publications in Russian and foreign scientific sources devoted to this problem, reproductive doctors and obstetricians-gynecologists often underestimate the role of adenomyosis in pregnancy planning using assisted reproductive technologies. Without interpreting the anamnesis data obtained through an active survey, doctors do not prescribe additional methods for diagnosing this pathology, which is not complex and expensive. To confirm the diagnosis, a transvaginal ultrasound examination of the pelvic organs during the premenstrual period is sufficient. In cases that are difficult to diagnose, the MRI method of the corresponding anatomical area can be used. Underestimation of the clinical picture and under-examination of the patient did not allow prescribing timely correction of the pathology and led to unsuccessful attempts to implement the generative function using assisted reproductive technologies. The conducted examination with clarification of the cause of IVF failures and the prescribed reasonable treatment made it possible to achieve regression of endometriosis foci in this clinical situation, followed by the patient's ability to realize generative function.

scholarly journals Negative impact of high doses of follicle-stimulating hormone during superovulation on the ovulatory follicle function in small ovarian reserve dairy heifers†

2020 ◽  
Author(s):  
Kaitlin R Karl ◽  
Fermin Jimenez-Krassel ◽  
Emily Gibbings ◽  
Janet L H Ireland ◽  
Zaramasina L Clark ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Assisted Reproductive Technologies ◽  
Negative Impact ◽  
Follicle Stimulating Hormone ◽  
Prostaglandin F2α ◽  
Reproductive Technologies ◽  
Corpora Lutea ◽  
Ovulatory Follicle ◽  
High Doses ◽  
Stimulating Hormone

Abstract When women with small ovarian reserves are subjected to assisted reproductive technologies, high doses of gonadotropins are linked to high oocyte and embryo wastage and low live birth rates. We hypothesized that excessive follicle-stimulating hormone (FSH) doses during superovulation are detrimental to ovulatory follicle function in individuals with a small ovarian reserve. To test this hypothesis, heifers with small ovarian reserves were injected twice daily for 4 days, beginning on Day 1 of the estrous cycle with 35, 70, 140, or 210 IU doses of Folltropin-V (FSH). Each heifer (n = 8) was superovulated using a Williams Latin Square Design. During each superovulation regimen, three prostaglandin F2α injections were given at 12-h interval, starting at the seventh FSH injection to regress the newly formed corpus luteum (CL). Human chorionic gonadotropin was injected 12 h after the last (8th) FSH injection to induce ovulation. Daily ultrasonography and blood sampling were used to determine the number and size of follicles and corpora lutea, uterine thickness, and circulating concentrations of estradiol, progesterone, and anti-Müllerian hormone (AMH). The highest doses of FSH did not increase AMH, progesterone, number of ovulatory-size follicles, uterine thickness, or number of CL. However, estradiol production and ovulation rate were lower for heifers given high FSH doses compared to lower doses, indicating detrimental effects on ovulatory follicle function.

scholarly journals The Correlation of Basal Serum FSH, Antral Follicle Count with Ovarian Response in Women with Advanced Reproductive Age

2016 ◽  
Vol 30 (1) ◽  
pp. 20-24
Author(s):  
Tanzeem S Chowdhury ◽  
Shirin Akhter Begum ◽  
TA Chowdhury
Keyword(s):  
Ovarian Reserve ◽  
Assisted Reproductive Technologies ◽  
Antral Follicle ◽  
Reproductive Technologies ◽  
Antral Follicle Count ◽  
Female Partner ◽  
Reproductive Age ◽  
Mature Follicle ◽  
Basal Serum ◽  
Tertiary Center

Objective (s): The aim of this study was to find out the correlation between basal serum Follicle Stimulating Hormone (FSH) level, antral follicle count and number of oocytes retrieved during IVF cycle in women with advanced reproductive age.Method: It was a cross sectional observational study which was done between January 2015 and December 2015 in Infertility Management Center, a tertiary center in Dhaka where assisted reproductive technologies are being offered. Eighty nine (89) infertile patients who were between 35 to 45 years of age and have come for IVF treatment for the first time were included in this study. The selected patients had undergone estimation of basal serum FSH by automated immuno assay analyzer and counting of the antral follicles by transvaginal sonography on day two or three. In total sixty nine (69) patients started IVF treatment according to GnRH long agonist protocol. Controlled ovarian stimulation started with 225 IU rFSH. Follicle monitoring was done on day 5 and day 9 and the dosage was kept same or changed according to the patient’s response. After day nine of stimulation, ten women were excluded as they had no mature follicle of 18 mm or more and cycle was cancelled. So in fifty nine (59) cases ovulation was triggered with hCG 5000 IU on the day when at least one mature follicle measuring 18mm was observed. The ovum pickup was done 32 hours after the trigger and the number of collected oocytes was counted under microscope. Outcome measures of this study was to compare basal FSH and antral follicle count as predictors of ovarian reserve by correlating with the number of oocytes retrieved and to correlate the age of the female partner with the number of oocytes retrieved.Results: Most couples in this study (68.33%) have been suffering from primary infertility and majority of them had six to ten years of infertility. Higher proportion of the female partners (75%) was between 35 to 37 years. The majority of infertile couples have male factor infertility (32%). The second commonest cause found was tubal factor in female partner (20%).Stepwise multiple regression analysis was done. Significant positive correlation was noticed between AFC and number of oocytes (b = 0.2413).There was negative correlation between the basal FSH level and the number of oocytes (b= -0.5083). Age of female partner had weak correlation with ovarian reserve.Conclusion: Measurement of antral follicle number in the follicular phase is a better predictor of ovarian reserve in comparison to basal FSH and age of the women.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 20-24

scholarly journals THE USE OF THE PRP THERAPY TO ACTIVATE FOLLICULOGENESIS IN WOMEN OF THE LATE REPRODUCTIVE AGE IN PROGRAMS OF ASSISTED REPRODUCTIVE TECHNOLOGIES

World Science ◽  
2021 ◽  
Author(s):  
Uliana Dorofeieva ◽  
Oleksandra Boichuk
Keyword(s):  
Embryo Quality ◽  
Assisted Reproductive Technologies ◽  
Negative Impact ◽  
Platelet Rich Plasma ◽  
Married Couples ◽  
Treatment Method ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Medical Problems ◽  
Fertilization Program

The rate of infertility in married couples of reproductive age in this country makes up from 10 to 15%, in some regions this value is close to 20% - acritical level that has a negative impact on demographic figures. The rate of pregnancy depends directly on the women’s age and decreases by 3.3times starting from the age of 19 and by the age of 48. The decrease in the ability to conceive is accounted for by subtle mechanisms related to thedeterioration of the quality of oocytes. The patients who are prepared for an extracorporeal fertilization program (ECF) and do not respond tocontrolled ovarian hyperstimulation protocols are considered to be poor respondents. Many studies focused on the development of an optimaltreatment method. However, none of the approaches seems to be effective enough to guarantee a successful use. Platelet-rich plasma is a new andpromising method that is successfully used in the reproductive science to solve a number of medical problems. All the patients whose commonfeatures were low oocyte output and poor embryo quality as well as failed ECF attempts were offered a treatment method of autologous PRP therapyafter their written consent. Three months later, one obtained astonishing results, which by the markers of biochemical infertility alone could beclassified as a complete biological phenomenon and are also characterized by improved embryo quality. The results of hormonal homeostasis show adecrease in the level of the follicle-stimulating hormone by 67.33% while the level of the anti-muellerian hormone is 75.18% higher.Thus, the use of the PRP therapy in poor respondents helps them to overcome their problematic reproductive barrier.

scholarly journals ENDOMETRIOSIS AND INFERTILITY. OPERATION OR ASSISTED REPRODUCTIVE TECHNOLOGIES?

2018 ◽  
Vol 5 (1) ◽  
pp. 31-36
Author(s):  
Natalya S. Kuzmina ◽  
V. F Bezhenar ◽  
A. S Kalugina
Keyword(s):  
Surgical Treatment ◽  
Ovarian Reserve ◽  
Assisted Reproductive Technologies ◽  
Transvaginal Ultrasound ◽  
Statistical Significance ◽  
Reproductive Function ◽  
Ovarian Response ◽  
Reproductive Technologies ◽  
Ovarian Endometrioma ◽  
Infertility Patients

The aim of the study was to study the influence of the ovarian endometrioma on the ovarian reserve, the ovarian response in ovarian hyperstimulation, and outcomes of assisted reproductive technologies (ART). Material and methods. The study included 43 infertility patients underwent the surgical treatment of an ovarian endometrioma in the history. During the study, the follicles were counted separately (according to transvaginal ultrasound), eggs and embryos were obtained from the operated and intact ovaries. Results. The number of follicles in the ovary, operated due to endometriosis, is significantly lower than in the contralateral ovary (p = 0.005). The number of ovules punctured from the ovary, operated for endometriosis, is less than the number of ovules obtained from the intact ovary, but the difference does not reach statistical significance (p = 0.07). The number of high-quality embryos obtained from the ovary, operated for endometrioma, is statistically significantly lower than the number of similar embryos obtained from the intact ovary (p = 0.013). Conclusion. According to the conducted study, it can be concluded that the surgical treatment of endometrioma in infertility patients with the need for the implementation of the reproductive function reduces the number of follicles in the operated ovary and, accordingly, does not lead to an improvement in indices of the infertility treatment using ART. At the same time, the very presence of endometrioma is also known to negatively impact on outcomes of ART. Therefore, in infertility patients with the reduced ovarian reserve, individualization of approaches to treatment is extremely important.

scholarly journals Inhibin as a reproductive biomarker part 2. Clinical significance of inhibins in reproductive medicine

2019 ◽  
Vol 68 (5) ◽  
pp. 91-106
Author(s):  
Zarina K. Abdulkadyrova ◽  
Maria I. Yarmolinskaya ◽  
Alexander M. Gzgzyan ◽  
Lyailya Kh. Dzhemlikhanova ◽  
Elena I. Abashova
Keyword(s):  
Down Syndrome ◽  
Ovarian Reserve ◽  
Reproductive Medicine ◽  
Prenatal Screening ◽  
Assisted Reproductive Technologies ◽  
Diagnostic Marker ◽  
Reproductive Function ◽  
Reproductive Technologies

In the early 2000s, the determination of inhibin levels was used actively for the diagnosis of ovarian tumors, as a diagnostic marker for prenatal screening of Down syndrome, as well as a prognostic marker for ovarian reserve when conducting assisted reproductive technologies. However, to date, inhibin is rarely used as a marker for reproductive function. At the same time, numerous studies of recent years indicate the crucial role of inhibin in folliculogenesis and spermatogenesis, as well as in implantation and placentation. This allows to significantly expand the diagnostic spectrum of inhibin levels in various disorders of the reproductive system of both women and men.

Ovarian endometriosis and fertility preservation problem

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. 110-116
Author(s):  
Galina E. Chernukha ◽  
Madina R. Dumanovskaya ◽  
Lilia M. Ilina
Keyword(s):  
Fertility Preservation ◽  
Ovarian Reserve ◽  
Assisted Reproductive Technologies ◽  
Therapeutic Option ◽  
Reproductive Technologies ◽  
Ovarian Endometriosis ◽  
Urgent Surgery ◽  
Repeated Surgery ◽  
Appropriate Therapy

Aim. To review the most recent literature regarding the modern management of women with ovarian endometriosis and no desire for immediate pregnancy but wanted fertility preservation in future. Materials and methods. The analysis of latest publications on this topic has been carried out. Results. Ovarian endometriosis is associated with infertility due to several factors including potential gonadotoxic effect per se and ovarian reserve decline after surgical treatment. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy in absence indications for the urgent surgery, for prevention disease progression. Postoperative long-term medical therapy has been effective in the prevention of endometrioma recurrence, repeated surgery, additional ovarian reserve decline and preserve fertility in future. Conclusion. Ovarian endometriosis management should be individualized according to the patients intentions and priorities. Long-term progestins most appropriate therapy for fertility preservation in women prior to performing surgery or provide assisted reproductive technologies, if needed.

scholarly journals Uterine myomas in pregnancy, childbirth and puerperium

2014 ◽  
Vol 142 (1-2) ◽  
pp. 118-124 ◽  
Author(s):  
Radmila Sparic
Keyword(s):  
Assisted Reproductive Technologies ◽  
Reproductive Function ◽  
Neonatal Morbidity ◽  
Bed Rest ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Symptomatic Therapy ◽  
Perinatal Complications ◽  
In Pregnancy

Fibroids are the most common benign tumors of the genital organs of women in reproductive age. Achieving reproductive function later in life, with more frequent use of assisted reproductive technologies, leads to an increased number of pregnancies complicated with fibroids. Their size may change during pregnancy, but the changes are mostly individual. Most fibroids stop growing or decline during the puerperium. The effect of fibroids on pregnancy depends on their number, size and location. The mechanisms bringing about perinatal complications are not fully understood. Fibroids during pregnancy can cause many perinatal complications, such as bleeding in pregnancy, miscarriage, pain due to red degeneration, malpresentation, preterm labor, premature rupture of membranes, placental abruption and obstruction of delivery and are associated with higher incidence of cesarean section, operative vaginal delivery, uterine atony and postpartum hemorrhage. Postpartum hysterectomy in these women is also more likely than in general population. Postpartum infections are more common in patients with fibroids, and myomas may also cause retained placenta. The most common cause of neonatal morbidity is prematurity, due to pregnancy ending in an earlier gestational age. Monitoring of pregnancies complicated with fibroids is essentially indistinguishable from monitoring normal pregnancies. Therapy includes only bed rest and observation, symptomatic therapy in case of pain and intensive fetal surveillance, and surgery in the acute situations.

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