National survey of the current management of endometriomas in women undergoing assisted reproductive treatment

Abstract

what is known already: The ideal management of endometriomas in women undergoing ART remains controversial and presents a dilemma to reproductive specialists. study design, size and duration: This was a national cross-sectional survey. A total of 388 gynaecologists completed the questionnaire.participants, settings and methods: All clinicians fully registered with the Royal College of Obstetricians and Gynaecologists were contacted. An 11-item survey was administered electronically using Survey Monkey software. Quantitative data were analysed using descriptive and comparative statistics.main results and the role of chance: The majority of responders were consultants (65%), 25% practiced ART and 65% performed laparoscopic surgery. Overall, 95% of responders would offer surgery for endometriomas in women undergoing ART, either on the basis of the size (.3-5 cm) of the endometrioma (52%), the presence of symptoms (16%), the presence of multiple/bilateral endometriomas (2%), regardless of the size and symptoms (19%) or only to women undergoing IVF (6%). The remaining 5% of responders would not offer surgery before ART. Excision was the most common surgical modality (68%), followed by ablation (25%). Laparoscopic surgeons were almost twice as likely to 'offer surgery to all patients with endometriomas prior to ART' compared with clinicians performing laparotomy (22 versus 12%, P , 0.001).limitations, reasons for caution: Our overall response rate, with answers to the questionnaire, was low (15%). However, the response rate amongst reproductive specialists was estimated at 60%. It is possible that there might have been an element of bias towards over-representation of responders who are more concerned about 'normalization' of the pelvic anatomy. Furthermore, our survey relied on self-reporting of practice and it is possible that being presented with a list of 'ideal' options may have resulted in respondent bias.wider implications of the findings: Despite the available evidence that surgery for endometriomas does not improve the outcome of ART and may damage ovarian reserve, it seems that the majority of gynaecologists in the UK offer ovarian cystectomy to their patients.

Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability

“…Still, because confounding factors like age, gender and clinical settings (hospital versus community) did not affect the results, a selection bias for respondent answers appears to be unlikely. Further, our sampling rate is higher than the 7% of Israeli physicians sampled in a recent national survey (Asher, Greenberg-Dotan, Halevy, Glick, & Reuveni, 2012) and comparable with those of other surveys of the membership of large medical associations (Raffi, Shaw, & Amer, 2012;Ghaderi, Madani, de Gara, & Schlachta, 2013). Thirdly, the study was conducted in Israel, and cultural factors may limit its generalizability.…”

Effect of Hemostatic Method on Ovarian Reserve Following Laparoscopic Endometrioma Excision; Comparison of Suture, Hemostatic Sealant, and Bipolar Dessication. A Systematic Review and Meta-Analysis

“…Although surgical treatment is frequently undertaken for removal/ablation of an endometrioma, indications for surgery and possible adverse effects are under debate (9,10).…”

Sonographer Skill Teaching Practices Survey: Development and initial validation of a survey instrument

“…The second involved contacting participants via email and then inviting them to forward the email invitation and hyperlink to other sonographer tutors or health educators who performed an academic or instruction role (snowball sampling) . Initially, nine emails were sent to participants in each cohort (as per well‐established recommendations) and follow‐up email invitations were distributed to each professional cohort.…”