Laparoscopic surgery for subfertility related to endometriosis: A meta-analysis

Jin, Xingzhong; Beguerie, Julieta Ruíz

doi:10.1016/j.tjog.2013.02.004

Cited by 33 publications

(38 citation statements)

References 24 publications

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“…It should be noted that the relatively small sample of the study is purely attributed to the strict inclusion and exclusion criteria. The increase in clinical pregnancy rate, following endometriosis correction, is supported by standing literature 18,19 . Similar clinical pregnancy rate improvements have been observed with respect to natural conception following corrective laparoscopy in patients with more than 3 failed IVF attempts and unexplained infertility 16,20 .…”

Section: Discussionmentioning

confidence: 82%

Couples with mild male factor infertility and at least 3 failed previous IVF attempts may benefit from laparoscopic investigation regarding assisted reproduction outcome

Pantou¹,

Sfakianoudis²,

Maziotis

et al. 2020

Sci Rep

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the aim of this study is to assess the value of laparoscopy for couples diagnosed with mild male factor infertility and at least three previous failed In-Vitro Fertilization (IVF) attempts. A total of 169 couples were included in this prospective cohort study. patients were presented with the option of being subjected to laparoscopic investigation for correction of previously unidentified endometriosis or pelvic adhesions. The outcome measures were Live Birth/Ongoing Pregnancy, clinical pregnancy and positive hCG rate. One-hundred and one of them opted for, whereas 68 opted against laparoscopic investigation. All patients proceeded with a single ICSI cycle. Following laparoscopic investigation, 43 patients were diagnosed with endometriosis, 22 with adhesions, while for 36 patients laparoscopic investigation provided no further diagnosis. No statistically significant differences were observed regarding baseline hormonal levels and other characteristics between the two groups and the three subgroups. When compared to the no-laparoscopy group, women subjected to laparoscopy presented with a higher clinical pregnancy and ongoing pregnancy/live birth rate. following endometriosis correction, a marginally non-statistically significant trend was observed regarding a decrease in poorquality blastocysts (p = 0.056). A statistically significant higher clinical pregnancy (p = 0.03) and ongoing pregnancy/live birth rate was observed in the endometriosis group when compared to male factor infertility only (p = 0.04). Laparoscopic identification and correction of undiagnosed endometriosis in couples initially diagnosed with male infertility and at least 3 failed previous IVF attempts, appears to be a promising approach efficiently addressing infertility for these patients while avoiding IVF overuse.Male factor infertility stands as a common infertility etiology, identified in up to 50% of infertile couples 1 , as the sole etiology or coupled with female factor infertility. Studies on male factor infertility, provide robust data that this may be successfully managed through in vitro fertilization (IVF) treatment, ensuring high implantation and pregnancy rates 2 . In fact, even severe and challenging cases of male factor infertility could be effectively managed, through the employment of a wide pallet of techniques improving standard employment of Intracytoplasmic Sperm Injection (ICSI) along with fertilization rates 3 . Male infertility has been categorized as mild, moderate or severe 4 . Mild male factor infertility does not present with a strict definition, including a range of different

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Section: Discussionmentioning

confidence: 82%

Couples with mild male factor infertility and at least 3 failed previous IVF attempts may benefit from laparoscopic investigation regarding assisted reproduction outcome

Pantou¹,

Sfakianoudis²,

Maziotis

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Definitive diagnosis is made through direct operative visualization by laparoscopy (Figure 1) or laparotomy and histological confirmation [9]. On laparoscopy, endometriosis can appear as yellow-brown discolorations, raised flame-like patches, whitish opacifications or reddish irregularly shaped spots [1,2].…”

Section: Diagnosis and Evolutionmentioning

confidence: 99%

“…Endometriosis has four stages or types: stage I, minimal, with small lesions and shallow endometrial implants on the ovary; stage 2, mild, with light lesions and shallow implants on the ovary and the pelvic lining; stage 3, moderate, with deep and more implants on the ovary and pelvic lining; and stage 4, severe, with deep implants on the pelvic lining and ovaries [1][2][3][4][5][6][7][8][9][10][11].…”

Section: Diagnosis and Evolutionmentioning

confidence: 99%

“…The aim of medical therapy is to achieve a hypoestrogenic status or to induce a pseudopregnancy [9]. Endometriosis implants can be regressively changed by means of suppression of ovarian function [11].…”

Section: Medical Versus Surgical Therapymentioning

confidence: 99%

“…Because endometriosis is a progressive and evolutive disease, which can cause anatomic destruction of the reproductive organs and infertility, surgical therapy has an important role [6][7][8][9][10].…”

Section: Rationale For Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Endometriosis: When and How We Treat

Saceanu¹,

Pătrașcu²,

Pătraşcu³

et al. 2017

Fertility-Oriented Female Reproductive Surgery

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Endometriosis is a chronic, nonmalignant and estrogen-dependent disease in which endometrial glandular epithelium and stroma are outside the uterine cavity (ovaries, peritoneum, or rectovaginal septum). The prevalence is estimated from 2 to 10% in women of childbearing age and it rises up to 50% in women with infertility. Despite maximal efforts, the therapy of first choice in the management of endometriosis is still unclear. The aim of this chapter is to present an update of its management, emphasizing the benefits and disadvantages of surgical methods. We performed a systematic literature search on the PubMed database of English literature (search terms: endometrioma, surgery, ovarian reserve, assisted reproductive technologies) from 2010 to 2014. For endometrioma, operative laparoscopy proved to be the gold standard. Surgical procedures consist of partial excision of the cyst wall and electro-coagulation of the rest. Stripping technique may be a better method for reducing the recurrence of pain symptoms, recurrence, and reoperation rates, but it raises concerns about ovarian reserve. For endometriosis, surgery often includes partial rectum or sacrouterine ligament resection. Hysterectomy is not obligatory and refused by the young patients. The approach should be laparoscopic and if necessary vaginal assisted. Good cooperation between various disciplines (gynecology, surgery, urology) is mandatory.

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Efficacy of ten interventions for endometriosis: A network meta‐analysis

Chen

Wang

et al. 2019

J of Cellular Biochemistry

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Objective: Clinical trials comparing the efficacy of different interventions for endometriosis are limited and controversial. The aim of the present study is to perform a network meta-analysis on the efficacy of various interventions for endometriosis. Methods:We searched PubMed and Ovid EMBASE through 1 June, 2018, for trials reporting the pain score and 1-year pregnancy rate of patients including at least one pair of direct control group. The mean difference of pain score, odds ratio of 1-year pregnancy rate, and their associated 95% credible intervals (CrI) were used to describe efficacy. The surface under the cumulative ranking curve (SUCRA) was calculated to illustrate the rank probability of various treatments for different outcomes, on the basis of network meta-analysis. Results: Our meta-analysis enrolled six studies for the evaluation of reducing pain and 10 studies for the 1-year pregnancy rate. All involved trials were sufficiently powered with a low risk of bias. Expectant management (EM), progesterone (PR), and gonadotropin-releasing hormone (GnRH)-agonist (GN) were significantly effective to reduce pain when compared with the placebo; EM ranked the highest on the SUCRA curve. For the 1-year pregnancy rate, no significant difference between the interventions was evident. Ablation ranked the highest with a SUCRA value of 0.6328. The rank of EM was acceptable with a SUCRA value of 0.4452. Our experimental results need to be verified by more high-quality randomized controlled trial articles. Conclusion: Limited available evidence showed that EM, PR, and GN were significantly effective to reduce pain when compared with the placebo. Due to a lack of convincing evidence favoring surgery or medication, we recommend considering EM. K E Y W O R D Sendometriosis, gonadotropin-releasing hormone, network meta-analysis, pain score, progesterone

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Laparoscopic surgery for subfertility related to endometriosis: A meta-analysis

Abstract: The use of laparoscopic surgery in the treatment of subfertility related to minimal endometriosis may increase the chances of future pregnancy and live birth.

Cited by 33 publications

References 24 publications

Couples with mild male factor infertility and at least 3 failed previous IVF attempts may benefit from laparoscopic investigation regarding assisted reproduction outcome

Couples with mild male factor infertility and at least 3 failed previous IVF attempts may benefit from laparoscopic investigation regarding assisted reproduction outcome

Endometriosis: When and How We Treat

Efficacy of ten interventions for endometriosis: A network meta‐analysis

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