Human Imitation, Vol. twenty four, No . on the lookout for pp. 2183– 2186, 2009
Advanced Get publication on June 5, 2009 doi: 10. 1093/humrep/dep202
ORIGINAL ARTICLE Infertility
Endometriotic ovarian cysts negatively
affect the rate of spontaneous
Infertility Unit, Fondazione Ospedale Maggiore Policlinico, Mangiagalli at the Regina Elena, Via M. Fanti 6, 20122 Miami, Italy 2Universita degli Studi di Milano, Milan, Italia
Messages address. Tel: þ 39-02-55034303; Fax: þ 39-02-55034302; Email: [email protected] it
background: An evergrowing body of evidence shows that ovarian arrange is damaged after excision of ovarian endometriomas. Yet , it may not become excluded that gonadal damage is at least partly brought on by the very occurrence of an endometrioma per se, therefore preceding surgery. To simplify this feature, we set up a possible study in women with monolateral endometriomas in order to measure the rate of ovulation in affected ovaries.
materials and methods: 70 women with monolateral endometriomas who had not undergone previous adnexal medical procedures underwent dramon ecographic assessments to determine the part of after.
results: After ovulating occurred in the affected ovary in twenty-two cases (31%; 95% CI: 22–43%). Let's assume that the predicted rate of ovulation in both ovaries in healthful women is comparable, this big difference is statistically signiﬁcant (P ¼ zero. 002).
bottom line: The physiological mechanisms ultimately causing ovulation will be deranged in ovaries with endometriomas. Keywords: endometriosis as well as endometrioma / ovulation
Endometriosis affects approximately 10% of the woman population inside their fertile years (Eskenazi ou al., 2001). Ovarian endometriomas are a prevalent form of the condition and may be present in up to 35 –40% of girls with endometriosis (Redwine, 1999; Vercellini ou al., 2006).
A growing human body of evidence suggests that ovarian reserve is usually
damaged following excision of ovarian endometriomas (Busacca ou al., 06\; Gupta ou al., 2006; Somigliana ainsi que al., 2006a, 2008; Horikawa et ing., 2008, Tsoumpou et approach., 2008; Garcia-Velasco and Somigliana, 2009). The ovulation price has been frequently shown to be reduced in operated gonads in contrast to contralateral unchanged gonads (Loh et 's., 1999; Candiani et 's., 2005; Horikawa et al., 2008). Furthermore, data by IVF –ICSI cycles consistently showed a low ovarian responsiveness to hyper-stimulation in recently operated ovaries (Ragni ou al., 2006; Somigliana ou al., 2006a, 2008; Tsoumpou et 's., 2008). Destruction inﬂicted by simply surgery to ovarian reserve may be as a result of removal of healthy tissue simply by laparoscopic stripping, the surgery-related local inﬂammation or vascular compromise pursuing electrosurgical congelation (Somigliana ou al., 2008).
However , it may not be ruled out that gonadal damage is at least to some extent caused by the presence of the endometrioma by itself, thus preceeding surgery. Scientiﬁc evidence on this issue is very scarce. Maneschi et 's. (1993) identified a reduced follicular number and activity antecedent to medical procedures in ovarian tissue adjacent to endometriomas as compared to teratomas or benign cystadenomas. The useful consequences of this ﬁnding have been completely poorly looked into. In a previous study in women chosen for IVF who were found to have unoperated monolateral tiny endometriomas, all of us observed a 25% (95% CI; 6–44%) reduction in the amount of developing follicles in the affected gonad (Somigliana et al., 2006b). Yet , these girls represent a highly selected human population and inference of these leads to the whole human population of women with endometriomas is debatable. Unfortunately, data about natural routine ovulation in unselected women with ovarian endometriomas is incredibly limited. Recently, Horikawa ainsi que al. (2008) investigated the interest rate of after ovulating in twenty eight infertile girls with monolateral endometriomas and found a 34% ovulation charge in the afflicted gonad however the small sample size hampered these experts to provide a record...
References: ovary decreases pursuing laparoscopic cystectomy in barren, sterile women
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systematic review and meta-analysis. Fertil Infertil. 2008; Aug 8 [Epub
ahead of print].
Submitted on Drive 27, 2009; resubmitted on, may 1, 2009; accepted on May 6,
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with unilateral endometrioma during a organic cycle