ART and endometrioma: assessing the outcome

Transcription

1 ART and endometrioma: assessing the outcome

2 ART and Endometrioma: assessing the outcome Juan A Garcia Velasco IVI - Madrid Disclosure of Interest: Nothing to Disclose

3 Topics to be discussed

4 Endometrioma

5 Endometrioma Where to look for information?

6

7 Endometrioma Statement #1 Most effective treatment of ovarian endometriomas?

8 Endometrioma

9 Endometrioma Statement #2 Ovarian response to COH?

10 All cysts are not created equal Risks of having a cyst Ovarian surgery diminishes # eggs

11 Endometrioma

12 Endometrioma 60% 53% 55%

13 All cysts Risks are of not having created a cyst equal Severe damage after surgery Absence of response to COH: not a rare event 13% (7-21%) 0%

14 Endometrioma Statement #3 IVF results?

15 Does endometriosis affect outcome? Endometriosis - IVF Barnhart et al, Fertil Steril 2002

16 Does endometriosis affect outcome? Endometriosis - IVF

17 Does endometriosis affect outcome? Endometriosis - IVF

18 Does endometriosis affect outcome? Oocyte donation

19 Does endometriosis affect outcome?

20 Does endometriosis affect outcome? Endometriosis - IVF PARACRINE (-) AUTOCRINE (-) ENDOCRINE (-)

21 Endometrioma Statement #4 Ovarian damage pre or post surgery?

22 Endometrioma

23 All cysts Risks are of not having created a cyst equal Damage due to the presence of cyst Unilateral endometrioma w/o surgery

24 All cysts are not created equal Risks of having a cyst Damage due to the presence of cyst Unilateral endometrioma w/o surgery

25 Ovarian Assesment Risks recovery of having of ovarian after a cyst Ovarian reserve after surgery reserve

26 All Assesment cysts Risks are of not having of created ovarian a cyst equal All cysts are not created reserve equal Well-defined ovarian capsule dermoids serous cystadenomas mucinous cystadenomas Endometriomas (margin of ovarian tissue)

27 All Assesment cysts Risks are of not having of created ovarian a cyst equal All cysts are not created reserve equal Endometrioma cyst wall

28 All cysts Risks are of not having created a cyst equal All cysts are not created equal Risk of serious damage in bilateral endometrioma resection ovarian artery blood flow changes accidental removal of ovarian tissue severe local inflammation BUT - pain symptoms reduced - 66% pregnant in 24 months Postsurgical ovarian failure 2.4%

29 Ovarian damage pre/post surgery? Operated ov Non - operated AFC * # oocytes collected * % zero eggs collected *

30 Ovarian damage pre/post surgery? Serum AMH Overall Unilateral Bilateral Pre Op Post Op

31 Ovarian damage pre/post surgery?

32 Ovarian damage pre/post surgery?

33 Endometrioma Statement #5 Treatment prior to IVF?

34 Is medical therapy pre-ivf useful?

35 Is medical therapy pre-ivf useful?

36 Is medical therapy pre-ivf useful?

37 Is medical therapy pre-ivf useful?

38 Should we operate pre-ivf? 200 Pagidas 1996; Loh 1999; Al-Azemi 2000; Tinkanen 2000 Donnez 2001; Canis 2001; Marconi 2002

39 All cysts are not created equal Risks of having a cyst Should we operate pre-ivf?

40 All cysts are not created equal Risks of having a cyst Should we operate pre-ivf?

41 All cysts are not created equal Risks of having a cyst Does endometrioma affect IVF? Surgery IVF # patients 49 50

42 Endometrioma Statement #6 Risks: better surgery than expectant?

43 Risks of having a cyst Risk of having a cyst

44 Conclusions Ovarian responsiveness to COH is diminished in women operated of endometriomas Results (PR) seem unaffected suggesting quantitative damage Damage is mainly surgery-mediated Cystectomy does not improve cycle outcome Careful surgery in SYMPTOMATIC women may be required INDIVIDUALIZATION IS CRUCIAL

45 Thank you!