Seven ways to preserve female fertility in patients with endometriosis

Figures & data

Figure 1. Seven ways to reduce infertility in patients with endometriosis.

COH: Controlled ovarian hyperstimulation; FSH: Follicle-stimulating hormone; GnRH: Gonadotropin-releasing hormone.

Reprinted with permission from the Cleveland Clinic Center for Medical Art & Photography © 2011–2012. All Rights Reserved.

Table 1. Laparoscopic endometrioma cystectomy and ovarian reserve.

Study (year)	Surgery technique	Methods used to assess OR	Effect of surgery on OR measurement	Ref.
Donnez et al. (2001)	Laparoscopic cystectomy	Stimulation parameters, fertilization, implantation and pregnancy rates	No change	[27]
Suganuma et al. (2002)	Laparoscopic removal of endometrioma	Number of retrieved oocytes	Decrease	[12]
Marconi et al. (2002)	Laparoscopic cystectomy	Estradiol levels, number of follicles, oocytes retrieved and clinical pregnancy rate	No change	[13]
Marconi et al. (2002)	Laparoscopic cystectomy	Number of gonadotrophin ampoules used for IVF–ET cycle	Increase	[13]
Exacoustos et al. (2003)	Laparoscopic removal of endometrioma	Transvaginal sonographic evaluation of residual ovarian volume	Decrease	[14]
Loo et al. (2005)	CO2 laser vaporization	Number of oocytes available for retrieval	Decrease	[31]
Esinler et al. (2006)	Laparoscopic cystectomy	Number of oocytes retrieved	Decrease (compared with nonoperated side)	[25]
Horikawa et al. (2008)	Laparoscopic cystectomy	Ovulation rate	Decrease	[23]
Iwase et al. (2010)	Bilateral cystectomy	AMH levels	Decrease	[32]
Almog et al. (2010)	Laparoscopic cystectomy	AFC, number of dominant follicles and number of oocytes collected	Decrease	[15]
Tsolakidis et al. (2010)	Three-stage procedure	AMH levels	Less diminished in three-step procedure group	[16]
Chang et al. (2010)	Laparoscopic ovarian cystectomy	AMH levels	Decrease	[17]
Pados et al. (2010)	Three-stage procedure	AFC	Increase in patients who underwent three-stage procedure	[18]
Hirokawa et al. (2011)	Laparoscopic cystectomy	AMH levels	Decrease (in both groups, but more in bilateral group)	[19]

AFC: Antral follicle count; AMH: Anti-Müllerian hormone; IVF–ET: IVF and embryo transfer; OR: Ovarian reserve.

Table 2. Summary of the manuscripts included in this review.

Study (year)	Method/condition	Results	Ref.
Choose the best endometria/endometriosis surgical techniques
Alborzi et al. (2007)	Cystectomy vs fenestration/coagulation	No difference	[26]
Donnez et al. (2001)	Endometria surgery by internal wall vaporization	Does not impair IVF outcome	[27]
Nakagawa et al. (2007)	Laparoscopic surgery	Establishes good pelvic condition for ART	[24]
Pados et al. (2010)	Laparoscopic cystectomy vs three-stage procedure	Functional ovarian tissues higher after three-stage procedure	[18]
Shimizu et al. (2010)	Laparoscopic ablation surgery	75.6% pregnancy rate	[28]
Avoid unnecessary surgery
Benaglia et al. (2010)	Endometrioma surgery	Ovarian damage	[20]
Horikawa et al. (2008)	Laparoscopic cystectomy	Reduces frequency of ovulation	[23]
Iwase et al. (2010)	Laparoscopic cystectomy	Postoperative decrease of serum AMH level	[32]
Var et al. (2011)	Coagulation/cystectomy	Decrease in AFC/ovarian volume	[22]
Loo et al. (2005)	Ovarian cystectomy for endometriomas	Fewer oocytes harvested during IVF	[31]
Measure ovarian reserve before surgery (AMH, AFC)
Iwase et al. (2010)	Serum AMH	Useful marker of ovarian reserve after cystectomy	[32]
Hwu et al. (2011)	Serum AMH	Used to mark ovarian reserve after surgery	[11]
Emergency IVF before surgery
de Ziegler et al. (2010)	Emergency IVF before surgery	Prevents ovarian damage before IVF	[30]
Using GnRH in endometriosis patients
Olive (2008)	GnRH agonist	Treatment of pain	[40]
Ruhland et al. (2011)	GnRH agonist	Pain reduction	[38]
Surrey et al. (2002)	GnRH agonist before IVF–ET	Higher pregnancy rates	[39]
Role of lifestyle in endometriosis
Tavmergen et al. (2007)	GnRH agonist before IVF	Higher pregnancy rates	[41]
Cramer et al. (1986)	Smoking and exercise	Decreases risk of endometriosis	[65]
Cramer et al. (2002)	Smoking and exercise	Decreases risk of endometriosis	[61]
	Caffeine and alcohol	Increases risk of endometriosis
Missmer et al. (2004)	High body mass and alcohol	Increases risk of endometriosis	[63]
Vitonis et al. (2010)	High body mass	Increases risk of endometriosis	[62]
Nagle et al. (2009)	Late childhood obesity	Increases risk of endometriosis	[64]
Missmer et al. (2010)	Specific dietary fat (trans-fat)	Increases risk of endometriosis	[69]
Egg donation and cryopreservation
Elizur et al. (2009)	Fertility preservation	Good preoperative counseling for women with severe endometriosis	[46]
Oktay et al. (2001)	Ovarian tissue and oocyte cryopreservation	Sustains reproductive function in a select group of women	[51]
Katayama et al. (2003)	Oocyte vitrification	Preserves fertility	[52]
Garrido et al. (2002)	Egg donation from nonendometriosis patient	Overcomes hostile uterus environment	[47]
Donnez et al. (2006)	Embryo cryopreservation	Most effective fertility preservation	[55]
	Oocyte cryopreservation	Effective fertility preservation for single women
	Ovarian tissue cryopreservation	Only fertility preservation option for prepubertal girls
Practice Committee (2004)	Ovarian tissue and oocyte cryopreservation	Promise for future female fertility preservation	[48]
Wennerholm et al. (2009)	Vitrification and slow freezing of embryos	Fewer developmental problems during pregnancy and infancy	[57]
Kim and Hong (2011)	Cryopreservation after vitrification	Developmental competence of oocytes	[58]

AFC: Antral follicle count; AMH: Anti-Müllerian hormone; ART: Assisted reproductive technique; GnRH: Gonadotropin-releasing hormone; IVF–ET: IVF and embryo transfer.

Activity Evaluation: Where 1 is strongly disagree and 5 is strongly agree

	1	2	3	4	5
1. The activity supported the learning objectives.
2. The material was organized clearly for learning to occur.
3. The content learned from this activity will impact my practice.
4. The activity was presented objectively and free of commercial bias.

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