Authors
Tsypurdeyeva A.A.1, 2, 3, Yarmolinskaya M.I.1, 4, Protasova A.E.2, 3, 4, 5, Molotkov A.S.1, 2, 4
1 The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott, Saint-Petersburg
2 Saint-Petersburg State University, Saint-Petersburg
3 OOO «AVA-PETER», Saint-Petersburg
4 North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg
5 Almazov National Medical Research Centre, St. Petersburg
Abstract
Within current clinical guidelines there is a clear trend towards a decrease in surgical activity in endometriosis due to the possible adverse effect that surgery on the ovaries has on the ovarian reserve and the achievement of pregnancy. In the absence of contraindications preference is given to long-term hormone therapy or the use of assisted reproductive technologies.
The aim of the study was to analyse and compare existing scientific studies and clinical guidelines for the treatment of endometriosis and overcoming female infertility in order to develop the most rational approach to surgical interventions for external genital endometriosis (EGE).
Methods: The study analysed Russian and international scientific articles on endometriosis and female infertility, clinical guidelines and treatment protocols published in 2013-2020. In the studied sources, special attention was paid to the verification of the diagnosis of EGE, indications for surgical treatment, and currently accepted patient management regimens.
Results: The study showed that the main indications for surgery remain the presence of large endometriomas, as well as genital endometriosis associated with pelvic pain or infertility with ineffective hormonal therapy or ART programs. In the presence of infertility and endometriosis, the patient should be informed about the possible decrease in the ovarian reserve associated with surgical treatment; consultation with a reproductologist is required.
Conclusion: Treatment of endometriosis should remain as personalised as possible, with particular attention paid to defining clear indications for surgical treatment. An absence of specific reproductive plans allows for empirical hormone therapy to treat the patient and postpone surgery. The surgical stage of the treatment should be single-stage, optimal in intervention volume, radical in regard to the foci of endometriosis, and performed in the most appropriate period.
Keywords: еndometriosis, ovarian reserve, surgical treatment.
References
1. Korsak VS, editor. Vspomogatel’nye reproduktivnye tekhnologii i iskusstvennaya inseminaciya. Сlinical recommendations (treatment protocol). Moscow; 2018. (In Russ).
2. Busacca M, Candiani M, Chiàntera V, et al. Guidelines for diagnosis and treatment of endometriosis. Italian Journal of Gynaecology and Obstetrics. 2018; 30: 7-21. doi: 10.14660/2385-0868-85.
3. Chaichian S, Kabir A, Mehdizadehkashi A, et al. Comparing the efficacy of surgery and medical therapy for pain management in endometriosis: A Systematic Review and Meta-analysis. Pain Physician. 2017; 20(3): 185-195.
4. Chapron C, Pietin-Vialle C, Borghese B, et al. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril. 2009; 92(2): 453-457. doi:10.1016/j.fertnstert.2008.06.003.
5. Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016; 48(3): 318-332. doi:10.1002/uog.15955.
6. Timmerman D, Valentin L, Bourne TH, et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000; 16(5): 500-505. doi:10.1046/j.1469-0705.2000.00287.x.
7. Glanc P, Benacerraf B, Bourne T, et al. First International Consensus Report on Adnexal Masses: Management Recommendations. J Ultrasound Med. 2017; 36(5): 849-863. doi:10.1002/jum.14197.
8. Karimi-Zarchi M, Dehshiri-Zadeh N, Sekhavat L, Nosouhi F. Correlation of CA-125 serum level and clinico-pathological characteristic of patients with endometriosis. Int J Reprod Biomed. 2016; 14(11): 713-718.
9. Carrillo L, Seidman DS, Cittadini E, Meirow D. The role of fertility preservation in patients with endometriosis. J Assist Reprod Genet. 2016; 33(3): 317-323. doi:10.1007/s10815-016-0646-z.
10. Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod. 2013; 28(6): 1552-1568. doi:10.1093/humrep/det050.
11. Molotkov AS, Popov EN, Ivanova AO, Kazantseva EV. Experience of the use of anti-adhesive barrier based on sodium hyaluronate and carboxymethylcellulose in gynecological surgery. Meditsinskiy sovet. 2019; 13: 149-153. (In Russ). doi: 10.21518/2079-701X-2019-13-149-153.
12. Lockyer EK, Schreurs A, Lier M, et al. Treatment of ovarian endometriomas using plasma energy in endometriosis surgery: effect on pelvic pain, return to work, pregnancy and cyst recurrence. Facts Views Vis Obgyn. 2019; 11(1): 49-55.
13. Working group of ESGE, ESHRE, and WES, Saridogan E, Becker CM, et al. Recommendations for the surgical treatment of endometriosis-part 1: ovarian endometrioma. Hum Reprod Open. 2017; 4: hox016. doi:10.1093/hropen/hox016.
14. Adamyan LV, editor. Endometrioz: diagnostika, lechenie i reabilitaciya. Сlinical recommendations. Moscow; 2013. (In Russ).
15. Cohen A, Almog B, Tulandi T. Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis. Fertil Steril. 2017; 108(1): 117-124. e5. doi:10.1016/j.fertnstert.2017.05.015.
16. Chiofalo B, Baiocco E, Mancini E, et al. Practical recommendations for gynecologic surgery during the COVID-19 pandemic. Int J Gynaecol Obstet. 2020; 150(2): 146-150. doi:10.1002/ijgo.13248.
17. Leonardi M, Horne AW, Armour M, et al. Endometriosis and the Coronavirus (COVID-19) Pandemic: Clinical Advice and Future Consideration. Front. Reprod. Health. 2020; 2. doi:10.3389/frph.2020.00005.
