Management of Infertility for DIE Patients: Surgery First Abstract ID

Management of Infertility for DIE Patients: Surgery First
Abstract ID : 1645
Soumis par : Mauricio Abrao Le 2016-03-14 03:52:38
Nom de la catégorie : SEUD CONGRESS
Typologie : Communication orale / Oral communication
Statut : En attente de validation
Autorisation de diffusion : Yes/Oui
------------------------------------Endometriosis compromises 10% to 15% of women in reproductive ages and is one of the main
causes of female infertility. One of the most relevant classifications of the disease consider
endometriosis as three diferent entities: peritoneal, ovarian and deep disease. Recent studues shows
that in addiction to the complexity of the deep disease treatment, this kind of endometriosis is more
associated with severe pain and with infertility.
Recently studies show that ovarian and deep endometriosis can be diagnosed before the surgery with
a good clinical exam associated with an ultrasound, preformed by sonographists trained for this kind of
diagnosis.
A big chalenge for the therapeutic decision for infertile patients with endometriosis is to define if, after
a well done pre operative diagnosis, surgery or in vitro fertilization come first.
In our experience, we start performing an accurate clinical exam associated to an ultrasound with
bowel preparation one hour before the exame (a simple enema) and an evaluation by ultrasound and
by the measurement of the anti mullerian hormone levels. If the patient doesn’t have relevant pain
(less than seven according to the visual analogic scale) and with normal tubal patency (after a
hysterosalpingogram) we consider a conservative treatment with ovulation induction or even in vitro
fertilization in cases of lower ovarian reserve. In cases of pain higher than seven according to the
visual analogic scale and / or signs of bowel or ureteral obstrucion or two in vitro fertilization failures,
surgery must be consider.
Many studies show the benefits of the surgical treatment for infertile patients with advanced
endometriosis. Most of them are non randomized, due to the difficulties to randomize patients with this
objectives. With this lack of evidences, we indicate surgery according to multiple factors, from the level
of pain to the ovarian reserve. In most cases, cryopreservation before surgery should be considered.
Future randomized studies may be helpful to help us to define the best strategy to treat infertile
patients with this relevant disease.
------------------------------------Mots clefs : Endometriosis, Infertility, Surgical Treatment
Auteurs :
Références : , , ,
Auteurs
Mauricio Abrao 1,
1. Ob/Gyn, Endometriosis Division, Sao Paulo University, Sao Paulo, BRAZIL
Auteurs (raw format)
Abrao Mauricio - email : [email protected] Etablissement : Sao Paulo University Service : Ob/Gyn,
Endometriosis Division Ville : Sao Paulo Pays : BRAZIL Présentateur : Oui