Oocyte quality in women with infertility associated endometriosis

The mechanisms of endometriosis-related infertility remain still unknown. Endometriosis and clinical markers of oocyte quality are a very important problem of reproduction. The purpose of the study is to assess the quality of oocytes in women with infertility associated with endometriosis. The study included infertile reproductive aged women, between 29 and 40 years who underwent IVF and ICSI procedures. The patients were divided into three groups: group I involved 50 (n = 50) patients with recurrent unilateral endometriomas, group II included 50 patients (n = 50) unilateral endometriomas after surgical treatment and control group with 30 (n = 30) patients with tubal factor infertility. Clinical and morphological assessment of oocyte quality was performed in all IVF/ICSI cycles. The results of the study demonstrate a statistically significant increase in the number of immature oocytes of metaphase MI and immature oocytes at the GV germinal vesicle stage in patients with infertility associated with endometriosis, compared with the control group (p<.005). There is deterioration in the quality of the obtained oocytes in patients with the presence of endometrioma more than 3 cm in diameter. The results of this study allow to conclude that endometriomas negatively affect quality of oocyte and ovarian reserve, whereas endometriomas after cystectomy, have a deleterious and sustained effect on ovarian reserve. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group

Chronic endometritis in women with endometriosis-associated infertility

The article highlights modern ideas about the role of the endometrium in the genesis of reproductive failures. A crucial place of chronic endometritis in the structure of the endometrial infertility factor in endometriosis is noted. Given the frequent association of chronic endometritis and endometriosis, common features of these diseases have been identified. The characteristic of endometrial microbiota in infertility, chronic endometritis and endometriosis is given. An extremely important area of scientific research is precisely the interaction between the microbiota of the endometrium and its immunity, and not just the confirmation of the presence of microorganisms in the endometrium. The modern aspects of the etiology and pathogenesis of chronic endometritis and endometriosis are described. The main pathogenetic determinants of chronic endometritis are the failure of adaptation mechanisms to the constant effects of microbes and, as a consequence, the decrease and inferiority of the immune response and the development of autoimmune reactions. The modern paradigm for the development and progression of endometriosis involves the presence of bacterial contamination of the endometrium and the abdominal cavity, which in turn becomes a trigger for genetically-epigenetic modifications of cells, launching different cascades that underlie reproductive function disorders. The pathogenetically significant relationship between chronic endometritis and endometriosis is highlighted. It was revealed that chronic endometritis can be both a cause and a consequence of endometriosis. Disorders of the endometrial receptivity in chronic endometritis associated with endometriosis, their importance in the implementation of endometrial infertility are described. The important role of the microbiome in the formation of reproductive disorders is noted. © 2020 Gynecology. All rights reserved

Эффективность лечения бесплодия, обусловленного рецидивирующим наружным генитальным эндометриозом

Relevance. Despite lots of studies, issues on a choice of the most effective treatment method for patients with recurrent external genital endometriosis (EGE) as well as a role and features of assisted reproductive technology programs and ways to improve their performance are still unresolved. Aim. To provide a current understanding on etiopathogenesis and management strategy for patients with recurrent EGE and infertility according to Russian and foreign literature date. Materials and methods. In order to write this review, domestic and foreign publications were searched in Russian and international search systems (PubMed, eLIBRARY, etc.) for the last 2-15 years. The review includes articles from peer-reviewed literature. Results. The article provides risk factors for EGE development, disease pathogenesis and clinical manifestation as well as drug and surgical methods for a treatment of endometriosis. Conclusion. Endometriosis remains still to be a mysterious disease for modern science. An individual approach given an age, ovarian reserve and a history of surgical treatment (numbers of surgical interventions for EGE) will allow you to elaborate a personal approach for each woman with subfertility.Актуальность. Несмотря на многочисленные исследования, вопросы о выборе наиболее эффективного метода лечения для пациенток с рецидивирующим наружным генитальным эндометриозом (НГЭ), роли и особенностях программ вспомогательных репродуктивных технологий и способах повышения их результативности до сих пор являются не решенными. Цель. Отразить современные представления об этиопатогенезе и тактике ведения пациенток с рецидивирующим НГЭ и бесплодием по данным отечественной и зарубежной литературы. Материалы и методы. Для написания данного обзора был осуществлен поиск отечественных и зарубежных публикаций в российских и международных системах поиска (PubMed, eLIBRARY и пр.) за последние 1-18 лет. В обзор были включены статьи из рецензируемой литературы. Результаты. Представлены факторы риска развития НГЭ, патогенез и клиническая картина заболевания, рассмотрены медикаментозные и оперативные методы терапии эндометриоза. Заключение. Эндометриоз продолжает оставаться загадочным заболеванием для современной науки. Индивидуальный подход с учетом возраста, состояния овариального резерва, хирургического лечения в анамнезе (количество оперативных вмешательств по поводу НГЭ) позволит выработать персональный подход для каждой субфертильной женщины

Treatment efficacy of infertility due to recurrent external genital endometriosis [Эффективность лечения бесплодия, обусловленного рецидивирующим наружным генитальным эндометриозом]

Relevance. Despite lots of studies, issues on a choice of the most effective treatment method for patients with recurrent external genital endometriosis (EGE) as well as a role and features of assisted reproductive technology programs and ways to improve their performance are still unresolved. Aim. To provide a current understanding on etiopathogenesis and management strategy for patients with recurrent EGE and infertility according to Russian and foreign literature date. Materials and methods. In order to write this review, domestic and foreign publications were searched in Russian and international search systems (PubMed, eLIBRARY, etc.) for the last 2–15 years. The review includes articles from peer-reviewed literature. Results. The article provides risk factors for EGE development, disease pathogenesis and clinical manifestation as well as drug and surgical methods for a treatment of endometriosis. Conclusion. Endometriosis remains still to be a mysterious disease for modern science. An individual approach given an age, ovarian reserve and a history of surgical treatment (numbers of surgical interventions for EGE) will allow you to elaborate a personal approach for each woman with subfertility. © 2018 Consilium Medikum. All right reserved

Ovarian endometriosis associated infertility: A modern view to the problem

This review summarizes current understanding of the pathogenesis of one of the most common forms of external genital endometriosis - ovarian endometrioma's. Due to their frequent occurrence in young women of reproductive age and extremely negative impact on the morphophysiological state of the ovaries, this disease makes a significant contribution to the structure of endometriosis-associated infertility. The main determinant of the negative effect of ovarian endometrioma's on reproductive function is a decrease in ovarian reserve, which can occur either due to the direct gonadotoxic effect of the endometriod cyst itself, or due to the unintentional removal of healthy ovarian tissue during surgery or the use of aggressive methods of electrosurgery. Hence, the question of methods for achieving hemostasis during surgery in terms of iatrogenic effects on healthy ovarian tissue is debatable. The management strategy for patients with infertility associated with ovarian endometriosis consists of two components: Surgical treatment and/or the use of assisted reproductive technologies. Laparoscopic cystectomy is indicated for cysts larger than 3 cm. Repeated surgical interventions in case of endometriosis do not improve fertility outcomes. Assisted reproductive technologies methods should be considered as a priority tactic in patients of older reproductive age with low ovarian reserve indicators or infertility duration of more than 2 years, as well as in cases of recurrent ovarian endometrioma's. Management of such patients must be personalized and take into account the age, state of the ovarian reserve, duration of infertility, stage and number of surgical interventions for this disease. © 2020 Gynecology. All rights reserved

Бесплодие, ассоциированное с эндометриозом: от легенды к суровой реальности

Endometriosis, being a widespread disease, still remains an urgent problem of modern medicine which has not been completely studied yet. The problem is even more significant due to the functional and structural changes in the reproductive system of women with endometriosis, whose infertility frequency reaches 55-75%. To date, none of the proposed strategies for the treatment of endometriosis has led to its complete cure. The article discusses the modern ideas about the etiopathogenesis and tactics of management of patients with endometriosis-associated infertility, according to the data of domestic and foreign literature.Эндометриоз все еще остается широко распространенным и в то же время до конца неизученным заболеванием, являясь одной из актуальных проблем современной медицины. Проблема приобретает еще большую значимость в связи с функциональными и структурными изменениями в репродуктивной системе женщин с эндометриозом, у которых частота бесплодия достигает 55-75%. До настоящего времени ни одна из предложенных стратегий лечения эндометриоза не привела к его полному излечению. В статье отражены современные представления об этиопатогенезе и тактике ведения пациенток с эндометриоз-ассоциированным бесплодием по данным отечественной и зарубежной литературы

Implantation failures in women with infertility associated endometriosis

Endometriosis is currently considered as one of the most common diseases associated with infertility. A controversial issue is whether endometriosis per se exerts a detrimental effect on IVF outcomes. Failure of implantation due to endometriosis-associated infertility is a contradictory and widely discussed burden nowadays. The purpose of the study is to assess the quality of embryos and implantation rate in women with infertility associated with endometriosis. The study included infertile reproductive aged women, between 26 and 40 years who underwent IVF and ICSI procedures. The patients were divided into two groups: group I (n = 70) involved 70 patients with recurrent unilateral endometriomas, II control group (n = 50) with tubal factor infertility. The quality of the retrieved embryos was assessed according to the generally accepted classification of Gardner, indicating the rate of implantation in each group. Embryo transfer was performed in case of high quality embryos. Assessing the ovarian reserve indicators, in the group I patients with recurrent unilateral endometriomas the serum level of AMH was significantly lower (2.1 ± 1.75 vs. 3.2 ± 1.4, p <.005), as well as the number of retrieved oocytes (8.1 ± 3.9 and 10.1 ± 6.8, p <.005). The analysis of the results demonstrated that the duration of stimulation in the group patients with recurrent unilateral endometriomas was significantly higher in comparison with the group II (12.2 ± 1.8 and 10.2 ± 1.6 days, p <.001). Nevertheless, the number of good quality embryos retrieved was comparable in both groups (2.2 ± 1.5 and 2.8 ± 1.8). In the group I patients with recurrent unilateral endometriomas, there was a statistically significant decrease of implantation rate (17.1% vs. 24% p <.005). The results of the study revealed no statistical difference in embryo quality in the study cohort. However, it is important to note that a statistically significant difference in implantation rate in the group of endometriosis-associated infertility compared was obtained 1.5 times lower than in the control group (15.8% vs. 24.0% p <.005). The achieved results demonstrated an adverse IVF outcome in infertile women with recurrent endometrioma compared to the control group. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group

Endometriosis-associated infertility: Options of combined therapy

Objective. To evaluate the effectiveness of using didrogesterone in combined therapy of endometriosis-associated. Patients and methods. The study included patients with infertility and verified diagnosis of ovarian endometriosis. The screening involved 108 women, of them 75 corresponded to the inclusion criteria. They were divided into two statistically comparable groups depending on a therapy option aimed at management of infertility. Group 1 (n = 36) included patients who underwent only surgical treatment, group 2 (n = 39) – women, who received combined therapy (surgical treatment + didrogesterone 10 mg/day from the 14th to the 25th day of the menstrual cycle for 6 months). The effectiveness of treatment was assessed by the incidence of clinical pregnancy within a 12-month follow-up period and, in case of pregnancy occurrence, by its outcomes. Results. As has been found, pregnancy incidence in women who received combined therapy exceeds by 1.6 times the results in the group of patients who underwent only surgical: 69.2 vs. 44.4%, p = 0.03. In combined treatment with the use of didrogesterone in the second phase of the cycle, the percentage of live births from the total number of pregnancies was significantly higher (by 1.3 times) as compared with group 1, and taking into consideration a greater incidence of pregnancy, the chances of successful management of infertility were by 2.4 times higher with inclusion of didrogesterone in therapy: 59.0% (23 of 39) in group 2 and only 25.0% (9 of 36) in group 1 (p = 0.0029). Conclusion. The use of didrogesterone as post-operative therapy and pregravid preparation of patients with endometriosis-associated infertility significantly improves the effectiveness of treatment and reproductive outcomes. © 2020, Dynasty Publishing House. All rights reserved

INFERTILITY ASSOCIATED WITH ENDOMETRIOSIS - IS IT A "DILEMMA" OR ALL ABUNDANTLY CLEAR?

Endometriosis is still a phenomenon that hides its true face and there is nothing surprising in the fact that this pathological condition is a "disease of mysteries and assumptions." "The problem is within the problem" is infertility on the background of endometriosis with radically different ways of its overcoming. The hypothesis that endometriosis causes infertility or reduces fertility remain controversial. The review deals with the pathogenesis, diagnosis and treatment of infertility, associated endometriosis

The efficacy of combined management of endometriosis-associated infertility

Objective:To evaluate the effectiveness of combined therapy of endometriosis-associated infertility. Materials and Methods: 69 (n = 69) patients with infertility and verified diagnosis of genital endometriosis, were included in the study. In dependence of the medication, patients were divided into two groups. I group included patients (n = 34) only with surgical treatment, group II (n = 35) - patients with combined therapy (surgical treatment + hormone therapy). After surgery patients from II group received dydrogesterone 10 mg per day from the 14th to the 25th day of the menstrual cycle, for 6 months, according to the instruction. The effectiveness of treatment was assessed by the frequency of clinical pregnancy within a year. Results: The analysis revealed statistically significant differences in the pregnancy rate. So, with the use of surgical treatment, the pregnancy rate within 6 months reached 23.5%, which is consistent with the literature, while using the combined treatment, the pregnancy rate for 6 months was 37.1% (p = 0.2195), but there were no statistically significant differences. However, after a year of follow-up in women with the combined therapy applied, the pregnancy rate was 1.5 times higher, compared to only surgical approach (N=26-76.5% versus N=15-44.1% p = 0.004 (p<0.005). However, the 12-month pregnancy rate was 1.5 times higher in the group with the complex management compared to mono-surgical treatment. Conclusions: In our opinion, considering all the pathogenetic peculiarities of endometriosis, patients with endometriosis-associated infertility require hormonal support during the second phase of the menstrual cycle, which allows to overcome the possible insufficiency of early implantation and increasing the incidence of pregnancy and improving the prediction of perinatal outcomes. © 2019, Advanced Scientific Research. All rights reserved