ABSTRACT
Increasing evidence suggests that female infertility is associated with endometriosis. Indeed, 40% of women with this disease are infertile. However, a causal relationship has not yet been established, and the possible pathophysiology of infertility in this disease also has not been completely elucidated. In this article, we analyze the mechanisms necessary to achieve a successful live birth in patients with this disease as well as the important steps of fertility, pregnancy and birth that can be impaired in these women. Specifically, we will review new advances in research on folliculogenesis, oocyte quality and sperm quality, egg fertilization, embryo quality, transport through fallopian tube and utero-tubal transport sperm, implantation defects, risk of miscarriage, risk during pregnancy and pre-term delivery. The physiopathology of these alterations and the clinical results of the studies are still very controversial. For these reasons, we can conclude that more research is needed to study the biological pathways of the fertility impairment caused by this disease.
Subject(s)
Endometriosis/physiopathology , Fertilization , Genital Diseases, Female/physiopathology , Parturition , Abortion, Spontaneous/etiology , Embryo Implantation , Embryo, Mammalian/physiopathology , Female , Hemoperitoneum/etiology , Humans , Ovarian Follicle/physiopathology , Ovum Transport , Pregnancy , Premature Birth/physiopathology , Risk FactorsSubject(s)
Humans , Female , Pregnancy , Infant, Newborn , Pregnancy Complications , Fetal Membranes, Premature Rupture , Gestational AgeABSTRACT
Context and objetive:the incidence of scar endometrioma ranges from 0,03 to 3,5%. Certain factors relating to knowledge of the clinical history of the disease make correct diagnossi and treatment difficult. The aim here was to identify the clinical pattern of the disease and show surgicxal results. The literature on this topic was reviewed. Design and setting: retrospective study at hospital municipal municipal maternidade-escola dr. mário de moraes altenfelder silva. Methods: data from the medical records of patients with preoperative diagnoses of scar endometrioma who underwent operations between 2001 and 2007 were surveyed and reviewed. The postoperative diagnosis came from histopathological analysis. The main information surveyed was age, obstetric antecedents, symptoms, tumor location, size and palpation, duration of complaint, diagnosis and treatment. All patients underwent tumor excision with a safety margin. Results: there were 33 patients, of mean age 30,1+/- 5,0 years (range: 18-41 years). The total incidence was 0,11%: 0,29% in cesarean sections and 0,01% in vaginal deliveries. Twenty -nine tumors (87,9%) were located in cesarean scars, two (6,0%) in episiotomy scars and two (6,0%) in the umbilical region. the main symptom was localized cyclical pain (66,7%), of mean duration 30,5 months (+/-23). surgical treatment was successful in all cases. conclusion: this is an uncommon disease. the most important diagnostic characteristic is coincidence of painful syntoms with menstruation. patients undergoing cesarean section are at greatest risk: relative risk of 27,37 (p < 0,01). The surgical treatment of choice is excision of the endometrioma with a safety margin(au) - en
