Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome

Stephansson, Olof; Kieler, Helle; Granath, Fredrik; Falconer, Henrik

doi:10.1093/humrep/dep186

Cited by 204 publications

(219 citation statements)

References 30 publications

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“…We observed an increased prevalence of endometriosis amongst our patients, 26% as compared to 15% in the population (40). An association between endometriosis and neuromuscular disease of the gastrointestinal tract has been described previously (31).…”

Section: Discussionsupporting

confidence: 74%

Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility

Hammar

Ohlsson

Veress

et al. 2012

Scandinavian Journal of Gastroenterology

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Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility.Hammar, Oskar; Ohlsson, Bodil; Veress, Bela; Alm, Ragnar; Nordin Fredrikson, Gunilla; Montgomery, Agneta . (2012). Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility. Scandinavian Journal of Gastroenterology, 47(10), 1165Gastroenterology, 47(10), -1173Gastroenterology, 47(10), . https://doi.org/10.3109/00365521.2012 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. GnRH and dysmotility AbstractObjective: Many patients, especially women, suffer from severe gastrointestinal pain and dysmotility for several years without being diagnosed. Depletion of gonadotropin-releasing hormone (GnRH) in the enteric nervous system (ENS) has been described in some patients.The aim of this study was to examine the expression of GnRH in ENS and antibodies against GnRH in serum, in a dysmotility patient cohort of southern Sweden. Materials and Methods:All consecutive patients (n=35) referred for laparoscopic fullthickness biopsy because of symptoms or signs of severe dysmotility between 1998 and 2009, or patients with a severe dysmotility disorder having had a bowel resection within the timeframe, were considered for inclusion. In 22 cases, representative biopsy material containing ganglia was available, and these patients were included. Medical records were scrutinized.The expression of GnRH was determined by immunohistochemistry in bowel biopsies from these patients and in patients with carcinoma or diverticulosis without ENS histopathology.Antibodies against GnRH in serum were determined by ELISA in patients and controls.Results: Fourteen patients were diagnosed with enteric dysmotility and 8 with chronic intestinal pseudo-obstruction due to varying etiology. Immunostained biopsies showed expression of GnRH in the ENS. A reduced expression of GnRH-containing neurons was found in 5 patients, as well as antibodies against GnRH in serum. Three of these patients had a history of in vitro fertilization (IVF) using GnRH analogs. Conclusions:A subgroup of patients with severe dysmotility had a reduced expression of GnRH-containing neurons in the ENS and expressed antibodies against GnRH in serum.

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Section: Discussionsupporting

confidence: 74%

Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility

Hammar

Ohlsson

Veress

et al. 2012

Scandinavian Journal of Gastroenterology

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“…Furthermore, TAI may coexist with other (autoimmune) syndromes and a higher prevalence of TAI has been found in women with endometriosis or polycystic ovarian syndrome (PCOS) conditions, which themselves can hamper fertility and pregnancy outcome (5,6,7). Moreover, women seeking treatment for sub-or infertility tend to be older, and this per se influences fertility (8,9,10). Importantly, Krassas et al (11) have recently highlighted in their excellent review that despite the vast study data, an interpretation of findings on TAI and reproduction is still hampered by weaknesses in study design and sample bias, such as focussing on women seeking help for sub-or infertility in fertility clinics rather than assessing the 'natural' effect of TAI on reproduction in the normal population.…”

Section: Introductionmentioning

confidence: 99%

Thyroid autoantibodies per se do not impair intracytoplasmic sperm injection outcome in euthyroid healthy women

Tan

Dieterle

Pechlavanis

et al. 2014

European Journal of Endocrinology

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Objective: Autoimmune thyroid disease (AITD) has been associated with adverse pregnancy outcomes in subfertile women with spontaneous and assisted reproductive technology-induced pregnancies. The underlying pathophysiology is still elusive and an association with thyroid dysfunction or other infertility causes is discussed. However, whether thyroid autoimmunity (TAI) per se has a negative impact on female fertility has not yet been clarified. In this study, we investigated whether TAI in healthy women undergoing intracytoplasmic sperm injection (ICSI) for male infertility may affect pregnancy outcome. Design: A retrospective, single-centre study. Methods: The ICSI outcome data obtained from 835 euthyroid women (age: 31.4G4.3 years, BMI: 23.7G4.2 kg/m 2 ) were correlated with pre-ICSI TAI status. The known causes of female subfertility were excluded. Outcome parameters included rates of pregnancy, birth, miscarriage and preterm delivery. Blood analysis was carried out retrospectively using blood samples drawn before ICSI. TAI was defined by elevation of anti-thyroperoxidase-or anti-thyroglobulin-antibodies O100 U/l. Results: TAI-positive and -negative groups did not differ in age, BMI or TSH levels. TAI status did not influence any ICSI outcome parameters. In contrast, increasing maternal age was significantly correlated with lower pregnancy rate (odds ratio (OR): 0.94 (95% CI: 0.91-0.97); PZ0.0003) and birth rate (OR: 0.93 (95% CI: 0.09-0.97); P!0.0001). Conclusions: Our study suggests that TAI per se does not influence ICSI outcome. A strict definition of AITD and TAI and consideration of TAI-associated and -independent confounders are important to further elucidate the interplay between TAI and reproduction.

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“…In a study including more than 1.4 million singleton births, Stephansson et al [30] observed that endometriosis was associated with preterm birth, preeclampsia, and placental complications.…”

Section: Discussionmentioning

confidence: 99%

Delivery and pregnancy outcome in women with bowel resection for deep endometriosis: a retrospective cohort study

et al. 2015

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Endometriosis affects women in reproductive age and can involve bowel in 6-12 % of the patients. In case of bowel occlusion or deep pain, radical laparoscopic endometriosic surgery associated with bowel resection is recommended. The purpose of this study was to analyze the conception rate, the obstetric complications, and the pregnancy outcome. This is a retrospective study; we investigated 51 patients with deep endometriosis who underwent surgical treatment with bowel resection during the period between 2000 and 2007. Among the 30 patients who gave birth to at least one live child after surgery, we considered only the first pregnancy following bowel resection and we investigated the incidence of pregnancy disorders, the gestational age at delivery, the baby birth weight, and the complications related to the different ways of delivery. We compared the results with a control group of 93 patients with no previous abdominal surgery. The whole group of 51 patients tried to conceive after surgery, and 30 women had at least one pregnancy with the birth of an alive baby. Considering only the first pregnancies after surgery, 6 (20 %) experienced gestational hypertensive disorders, 3 (10 %) had placenta previa, 6 (20 %) had preterm birth (<37 weeks), and 1 patient (3.3 %) gestational diabetes. In this group, the average newborn weight was 3000±545 g. Compared with the control group, women with previous bowel resection for deep endometriosis had a higher risk of hypertensive disorders (p<0.05), placenta previa (p<0.05), and lower newborn weight (p<0.05), while the association with preterm birth and gestational diabetes was not statistically significant. These patients experience 12 vaginal deliveries (40 %) and 18 caesarean sections (60 %). Comparing with the caesarean rate in the control group (29.03 %), the incidence of caesarean section in the study population was substantially higher (p<0.01) with 33.3 % of the sections performed because of previous bowel surgery. No differences in severe complication rates were observed between vaginal and caesarean deliveries (ns). Complete removal of endometriosis with bowel segmental resection seems to improve the pregnancy rate, but in this group, there is an increased incidence of hypertensive disorders, placenta previa, and lower newborn weight. Despite the small number of patients, we do not observe more complications in the vaginal group than in the caesarean group, so we hypothesize the previous radical surgery should not influence the way of delivery.

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Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome

Abstract: Endometriosis appears to be a risk factor for preterm birth, irrespective of ART. Women with endometriosis may be more likely to be delivered by Caesarean section and to suffer from antepartal haemorrhage/placental complications and pre-eclampsia.

Cited by 204 publications

References 30 publications

Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility

Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility

Thyroid autoantibodies per se do not impair intracytoplasmic sperm injection outcome in euthyroid healthy women

Delivery and pregnancy outcome in women with bowel resection for deep endometriosis: a retrospective cohort study

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