19:30-21:00 Endometriosis NZ Symposium

Transcription

1 Ms Miriama Kamo Dr Guy Gudex Director Repromed Professor Neil Johnson Gynaecologist and REI Subspecialist Auckland Gynaecology Group and Repromed Auckland Dr Fiona Connell Gynaecologist North Shore and Auckland City Hospitals Auckland Ms Deborah Bush Co-founder and Chief Executive Endometriosis New Zealand Auckland 19:30-21:00 Endometriosis NZ Symposium

2 Options for Your Patients with Subfertility Neil Johnson Repromed Auckland

3 Disclosures Affiliations: Shareholding with Repromed Auckland & Auckland Gynaecology Group, NZ Collaboration/association with Fertility SA, Adelaide, Australia Universities of Adelaide, Australia & Auckland, NZ ENZ and WES board member, including current WES president Potential conflict of interest: In the last 3 years, I have received funding to international meetings from the following companies: MSD Bayer Pharma Merck-Serono Guerbet and research funding from: Abb-Vie Myovant Sciences Guerbet Consultant for: Vifor Pharma, Guerbet and Myovant Sciences Invitation to this conference from:

4 Endometriosis Causes Infertility Anatomical distortion Blocked fallopian tubes Disrupts tubo-ovarian relationship Adhesions ovarian reserve Impacts intraperitoneal environment Poorer egg quality Endometrium less receptive

5 Endometriosis Affects 1 in 10 women Some estimate 60-70% women attending fertility clinic Reduces chance of success through IVF

6 Treatment Options Laparoscopic surgical removal of endometriosis Stimulated IUI IVF

7 Treatment Options Lipiodol Laparoscopic surgical removal of endometriosis Stimulated IUI IVF

8 Laparoscopic surgery Laparoscopic surgical removal of endometriosis LBR/OPR OR 1.9 (95%CI 1.2 to 3.2)» Duffy et al (2014) Laparoscopic ov cystectomy for endometriomas improves fertility more than ablation OR 5.2 (95%CI 2.0 to 13.3)» Hart et al (2008) Surgery to remove endometriomas ov reserve Should consider ov reserve and discuss egg freezing

9 IVF Indicated for infertility related to endometriosis But success rate GnRH analog (Zoladex) pretreatment for 3 months prior endometrial expression of integrins OR 4.2 (95%CI 2.0 to 9.2)» Sallam et al (2006) New RCT no sigt differences (preg 39% vs 40%), n=120» Decleer et al (2016) Atosiban bolus prior to thawed ET Sigtly CPR (58% vs 38%), n=240» He et al (2016)

10 Lipiodol Ethyl esters of iodised fatty acids of poppy seed oil

11 Tubal flushing for subfertility. Mohiyiddeen L, Hardiman A, Fitzgerald C, Hughes E, Mol BWJ, Johnson N, Watson A. Cochrane Database Syst Rev 2015;5:CD Watson et al (1994); Vandekerchove et al (2000) OSCM v No intervention OSCM v WSCM

12 RCT The FLUSH Trial Flushing with Lipiodol for Unexplained Subfertility by Hysterosalpigography n=158 (96 unexplained; 62 endometriosis) Lipiodol v No intervention Significant benefit

13 Population: Findings: Observational Study 296 consecutive women undergoing lipiodol procedure Feb 2000 to Oct 2006 (incl women on FLUSH Trial ) Follow up at 6 months, then extended follow up for pregnancy Similar demographics; mean age 35.8 (range years), 56 women >40 years; 295/296 procedures completed Pregnancy overall 119/296 (40.2%) v 8/17 (47.1%) unflushed Intravasation 6/296 (2%) In last decade ~1,000 Lipiodol procedures One lipogranuloma

14 Population: Findings: Observational Study 296 consecutive women undergoing lipiodol procedure Feb 2000 to Oct 2006 (incl women on FLUSH Trial ) Follow up at 6 months, then extended follow up for pregnancy Similar demographics; mean age 35.8 (range years), 56 women >40 years; 295/296 procedures completed Pregnancy overall 119/296 (40.2%) v 8/17 (47.1%) unflushed Intravasation 6/296 (2%) In last decade ~1,000 Lipiodol procedures One lipogranuloma

15 Summary of Options for Women with Endometriosis Related Subfertility Lipiodol Stimulated IUI Often alternating with natural cycle attempts to become pregnanct following Lipiodol Laparoscopic surgical removal of endometriosis IVF Consider ovarian reserve esp with endometrioma surgery Ultra-long with GnRH analogue for 6 months prior Atosiban with embryo transfer