The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins.

OBJECTIVE: To clarify whether the presence of ovarian endometriomas is associated with a reduced responsiveness to ovarian hyperstimulation. DESIGN: Observational study. SETTING: University teaching hospital. PATIENT(S): Women selected for in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) cycles who were found to have unilateral ovarian endometriomas and who did not undergo previous ovarian surgery. INTERVENTION(S): Ovarian hyperstimulation using gonadotropins. MAIN OUTCOME MEASURE(S): Number of codominant follicles (mean diameter >15 mm) in the affected and in the contralateral intact gonads. RESULT(S): Thirty-six patients were enrolled. They underwent 56 IVF-ICSI cycles. The number of codominant follicles in the intact and affected ovaries were 4.0 +/- 2.2 and 3.0 +/- 1.7, respectively (P=.01). This difference corresponded to a mean reduction (95% confidence interval [CI]) of 25% (6%-44%). This deleterious effect was more evident in women with larger cysts, in those with more than one cyst, and in those who were more responsive to ovarian hyperstimulation. CONCLUSION(S): The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins.

Does laparoscopic removal of nonendometriotic benign ovarian cysts affect ovarian reserve?

BACKGROUND: The objective of this study was to investigate whether laparoscopic excision of nonendometriotic benign ovarian cysts is associated with a significant injury to ovarian reserve. METHODS: Women selected for IVF-ICSI cycles who previously underwent laparoscopic excision of a monolateral nonendometriotic benign ovarian cyst were retrospectively identified. The operated ovary and the contralateral intact gonad of the same patient were compared in term of basal ovarian volume before initiating ovarian stimulation and number of dominant follicles at the time of human chorionic gonadotropin administration. Non-parametric Wilcoxon Rank test was used to investigate differences between the two ovaries. RESULTS: Seventeen cases were recruited. The numbers of dominant follicles were 4.6 +/- 2.5 and 2.7 +/- 2.4 in the control ovary and in the previously operated ovary, respectively (p = 0.01). This drop corresponded to a mean reduction of 42% (95% confidence interval: 10-74%). Basal volumes of the intact and the operated gonads were 5.7 +/- 3.3 and 3.4 +/- 2.3 cm3 respectively (p = 0.01), corresponding to a mean reduction of 39% (95% confidence interval: 12-66%). CONCLUSIONS: Laparoscopic excision of nonendometrioid benign ovarian cysts is associated with a significant injury to ovarian reserve.

Association rate between deep peritoneal endometriosis and other forms of the disease: pathogenetic implications.

BACKGROUND: It has been suggested recently that deep endometriosis and the other forms of the disease do not share a common pathogenetic mechanism. In this study, we hypothesize that, if this is true, deep peritoneal endometriosis and the other forms should not be significantly associated. METHODS: Clinical and surgical records of all women who were referred to the Department of Obstetrics and Gynecology, Clinica 'L.Mangiagalli' between January 1995 and June 2002 and who were diagnosed with deep peritoneal pelvic endometriosis at the time of surgery were retrieved. The concomitant presence of superficial endometriotic implants, endometriomas and pelvic adhesions was evaluated. A binomial probability distribution model was used to calculate the 95% confidence interval (95% CI) of the association rates. RESULTS: Ninety-three women with deep peritoneal endometriosis were identified. The presence of superficial endometriotic implants, endometriomas and pelvic adhesions was documented in 61.3% (95% CI 51.4-71.2%), 50.5% (95% CI 40.3-60.7%) and 74.2% (95% CI 65.3-83.1%) of patients with deep endometriotic nodules, respectively. Overall, deep peritoneal endometriosis was the only form of the disease in only 6.5% (95% CI 2.8-12.3%) of cases. No relevant differences regarding these associations were observed according to the location and the size of the deep endometriotic nodules. CONCLUSIONS: Results from this study do not support the hypothesis that deep endometriosis should be considered as a distinct entity of the disease.

Endometriosis: novel etiopathogenetic concepts and clinical perspectives.

OBJECTIVE: To discuss current ideas about therapy for endometriosis derived from new observations generated by using molecular biology techniques and in vivo animal models of disease. METHOD(S): The MEDLINE database was reviewed for English-language articles on new drugs that affect the endocrine or immunologic system, the possibility that endometriosis has multiple forms, and the association of endometriosis with cancer. Specific attention was given to in vivo studies in animals or humans. CONCLUSION(S): Among the novel potential candidate drugs, aromatase inhibitors and raloxifene should be considered for treatment of postmenopausal women with endometriosis. Notable observations have emerged from studies of immunomodulators and antiinflammatory agents in animal models of disease. These findings must be confirmed in women. The histogenesis of ovarian endometriomas is still unclear, thus limiting new experimental approaches to this form of disease. Given the low but established risk for malignant transformation of endometriosis, efforts should be directed toward identification of susceptibility loci for the disease and its potential transformation into cancer.