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Endometriosis and Infertility: Insights into the Causal Link and Management...
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Endometriosis and Infertility: Insights into the Causal Link and Management Strategies

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Reproductive Medicine & Andrology".

Deadline for manuscript submissions: closed (25 June 2022) | Viewed by 19056

Special Issue Editor

Prof. Dr. Michelle Nisolle

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Guest Editor
CHU of Liege – Liege University, Liège, Belgium
Interests: endometriosis; adenomyosis; Mullerian anomalies; fibroids; ovarian cyst; endoscopic surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Endometriosis is highly prevalent among women of reproductive age and is frequently associated to infertility. Even three different entities of endometriosis have been described, their exact mechanisms involved in infertility are still not completely understood. Several studies have demonstrated that anatomical changes may impair gametes and embryo transport along the fallopian tubes; per se, endometriosis could affect the ovarian reserve, peritoneal endometriosis may lead to a pro-oxidant peritoneal microenvironment and the peritoneal fluid may alter sperm function. The reduced endometrial receptivity could also play a role in infertility of women affected by endometriosis.

Regarding the management strategies, different treatment options of endometriosis-related infertility include minimal invasive surgery (MIS) as well as assisted reproductive technologies (ART).

Even the presence of ovarian endometrioma is related to infertility in the majority of cases, the impact of deep endometriosis on infertility is less clear and the place of conservative versus radical rectal surgery has to be defined. Moreover, due to the effect of endometriosis on ovarian reserve as well as the impact of surgery of large endometriomas on the ovarian reserve, the ovocytes cryopreservation could be considered as a new option to preserve future fertility.

Prof. Dr. Michelle Nisolle
Guest Editor

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Keywords

  • peritoneal endometriosis
  • ovarian endometrioma
  • deep endometrioisis
  • infertility
  • etiopathogenesis
  • minimal invasive surgery
  • IVF
  • ovarian cystectomy
  • ablative surgical techniques
  • ovocytes cryopreservation

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Published Papers (4 papers)

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Research

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12 pages, 701 KiB  
Article
Endometriosis and Isthmocele: Common or Rare?
by Marietta Gulz, Sara Imboden, Konstantinos Nirgianakis, Franziska Siegenthaler, Tilman T. Rau and Michael D. Mueller
J. Clin. Med. 2022, 11(5), 1158; https://doi.org/10.3390/jcm11051158 - 22 Feb 2022
Cited by 8 | Viewed by 3994
Abstract
Higher cesarean section rates and better ultrasound diagnostics have led to a more frequent diagnosis of isthmocele, a cesarean scar defect. Sometimes, endometriosis is found in the isthmocele, but simultaneous extrauterine endometriosis and endometriosis in the isthmocele have not yet been reported. Additionally, [...] Read more.
Higher cesarean section rates and better ultrasound diagnostics have led to a more frequent diagnosis of isthmocele, a cesarean scar defect. Sometimes, endometriosis is found in the isthmocele, but simultaneous extrauterine endometriosis and endometriosis in the isthmocele have not yet been reported. Additionally, the surgical technique to repair the isthmocele is the subject of ongoing controversy. The aim of this study is to analyze a possible correlation between uterine scar (isthmocele) endometriosis and extrauterine endometriosis and to investigate the outcome of laparoscopic isthmocele resection in the rendezvous technique. In this single-center retrospective study, we included 83 women of reproductive age with symptomatic isthmocele undergoing laparoscopic isthmocele repair in rendezvous technique from 2004 to 2020 at the University of Bern. We collected data on patient and surgical characteristics as well as on postoperative outcomes (symptoms, further pregnancy, and pregnancy outcomes) retrospectively. We analyzed and compared these data for patients with and without endometriosis. Endometriosis was diagnosed during surgery in 22 out of 83 operated patients (26.5%). Diagnosis of isthmocele endometriosis (n = 9, 11%) was significantly higher in patients with extrauterine endometriosis (n = 6, p = 0.004). While the duration of surgery was significantly longer for patients with endometriosis (p = 0.006), the groups did not differ with regard to blood loss or complications. In addition, both groups showed similar indications for isthmocele repair (infertility, abnormal uterine bleeding, or dysmenorrhea). Surgery significantly improved abnormal uterine bleeding (χ2 p < 0.001), dysmenorrhea (χ2, p = 0.03), and infertility (χ2, p < 0.001). Regardless of the presence of endometriosis, 25 of 40 (63%) infertile patients became pregnant after surgery. In one out of eight pregnancies, however, we observed scar complications during pregnancy such as uterine scar pregnancy (n = 3), uterine scar dehiscence (n = 3), and placenta previa (n = 1). Endometriosis is a non-negligible intraoperative finding in patients with symptomatic isthmocele. The laparoscopic approach in the rendezvous technique is safe and effective. Therefore, this method should be recommended, especially in women with secondary infertility, and preoperatively simultaneous endometriosis resection should be discussed with the patient. In follow-up, postoperative pregnancies have to be monitored with care. Full article
(This article belongs to the Special Issue Endometriosis and Infertility: Insights into the Causal Link and Management Strategies)
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12 pages, 705 KiB  
Article
Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section
by Stavros Karampelas, Georges Salem Wehbe, Laurent de Landsheere, Dominique A. Badr, Linda Tebache and Michelle Nisolle
J. Clin. Med. 2021, 10(24), 5785; https://doi.org/10.3390/jcm10245785 - 10 Dec 2021
Cited by 16 | Viewed by 5700
Abstract
Objective: To evaluate the effect of laparoscopic isthmocele repair on isthmocele-related symptoms and/or fertility-related problems. The residual myometrial thickness before and after subsequent cesarean section was also evaluated. Design: Retrospective, case series. Setting: Public university hospital. Population: Women with isthmocele (residual myometrium < [...] Read more.
Objective: To evaluate the effect of laparoscopic isthmocele repair on isthmocele-related symptoms and/or fertility-related problems. The residual myometrial thickness before and after subsequent cesarean section was also evaluated. Design: Retrospective, case series. Setting: Public university hospital. Population: Women with isthmocele (residual myometrium < 5 mm) complaining of abnormal uterine bleeding, chronic pelvic pain or secondary infertility not otherwise specified. Methods: Women’s complaints and the residual myometrium were assessed pre-operatively and at three to six months post-operatively. In patients who conceived after surgery, the latter was measured at least six months after delivery by cesarean section. Main Outcome Measures: Resolution of the main symptom three to six months after surgery and persistence of laparoscopic repair benefits after subsequent cesarean section were considered as primary outcome measures. Results: Overall, 31 women underwent laparoscopic isthmocele repair. The success rates of the surgery as improvement of abnormal uterine bleeding, chronic pelvic pain and secondary infertility were 71.4% (10 of 14), 83.3% (10 of 12) and 83.3% (10 of 12), respectively. Mean residual myometrial thickness increased significantly from 1.77 mm pre-operatively to 6.67 mm, three to six months post-operatively. Mean myometrial thickness in patients who underwent subsequent cesarean section (N = 7) was 4.49 mm. In this sub-group, there was no significant difference between the mean myometrial thickness measured after the laparoscopic isthmocele repair and that measured after the subsequent cesarean section. None of these patients reported recurrence of their symptoms after delivery. Conclusion: Our findings suggest that the laparoscopic isthmocele excision and repair is an appropriate approach for the treatment of isthmocele-related symptoms when done by skilled laparoscopic surgeons. The benefit of this new surgical approach seems to persist even after a subsequent cesarean section. Further investigations and prospective studies are required to confirm this finding. Full article
(This article belongs to the Special Issue Endometriosis and Infertility: Insights into the Causal Link and Management Strategies)
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Review

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13 pages, 288 KiB  
Review
Endometriosis, Oocyte, and Embryo Quality
by Sania Latif and Ertan Saridogan
J. Clin. Med. 2023, 12(13), 4186; https://doi.org/10.3390/jcm12134186 - 21 Jun 2023
Cited by 10 | Viewed by 3146
Abstract
Endometriosis is a common finding among women with infertility, and women who are diagnosed with endometriosis are almost twice as likely to experience infertility. Mechanisms by which endometriosis causes infertility remain poorly understood. In this review, we evaluate the current literature on the [...] Read more.
Endometriosis is a common finding among women with infertility, and women who are diagnosed with endometriosis are almost twice as likely to experience infertility. Mechanisms by which endometriosis causes infertility remain poorly understood. In this review, we evaluate the current literature on the impact of endometriosis on oocyte and embryo quality. The presence of endometriosis evidently reduces ovarian reserve, oocyte quality, and embryo quality; however, this does not appear to translate to a clear clinical impact. Analysis of data from large assisted reproduction technology registries has shown that women with endometriosis have a lower oocyte yield but no reduction in reproductive outcomes. There is a need for future studies in the form of well-designed randomized controlled trials to further evaluate the role of surgical and medical treatment options in women with endometriosis undergoing assisted conception. Full article
(This article belongs to the Special Issue Endometriosis and Infertility: Insights into the Causal Link and Management Strategies)
23 pages, 656 KiB  
Review
Deep Endometriosis and Infertility: What Is the Impact of Surgery?
by Angelos Daniilidis, Stefano Angioni, Stefano Di Michele, Konstantinos Dinas, Fani Gkrozou and Maurizio Nicola D’Alterio
J. Clin. Med. 2022, 11(22), 6727; https://doi.org/10.3390/jcm11226727 - 14 Nov 2022
Cited by 15 | Viewed by 5113
Abstract
In women with deep endometriosis, the spontaneous fertility rate might range from 2 to 10%. The optimal management of these women is still an area of debate. Therefore, this review aims to explore the literature on the impact of deep endometriosis surgery on [...] Read more.
In women with deep endometriosis, the spontaneous fertility rate might range from 2 to 10%. The optimal management of these women is still an area of debate. Therefore, this review aims to explore the literature on the impact of deep endometriosis surgery on reproductive outcomes and pregnancy rates in women with and without prior infertility. A total of 392 articles were identified through database searching. Twenty-three studies were eligible to be included in the review. A total of 1548 women were identified, 814 of whom became pregnant, with a mean pregnancy rate of 52.6% (95% CI 49.7–63%). Our review suggests that surgery may improve fertility outcomes. Due to the variability in the studies, it is impossible to stratify fertility outcomes of surgery by the localization of deep endometriosis. More investigations are needed to determine whether surgical management should be first-intention or limited to the failure of medically assisted reproduction treatment. Full article
(This article belongs to the Special Issue Endometriosis and Infertility: Insights into the Causal Link and Management Strategies)
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