ABSTRACT
In order to assess adequately the effectiveness of danazol, Gestrinone, and Buserelin, a prospective nonrandomized study was initiated in 126 patients with laparoscopically confirmed ovarian endometriosis. After hormonal therapy, laparotomy with microsurgical resection of endometriotic cysts was carried out. Regression (greater than 25%) of ovarian endometriosis was noted in 30%, 34%, and 73% of cases after danazol, Gestrinone, and Buserelin, respectively. The pregnancy rate in moderate endometriosis (53%) differed significantly from the rate obtained in severe endometriosis (45%). The highest percentages were found after Buserelin therapy. In conclusion, Buserelin emerged superior to danazol or Gestrinone treatment. Nevertheless, hormonal treatment leads to an incomplete suppression of ovarian endometriotic implants and this suggests the necessity of surgically removing invasive ovarian endometriosis.
Subject(s)
Buserelin/therapeutic use , Danazol/therapeutic use , Endometriosis/drug therapy , Gestrinone/therapeutic use , Infertility, Female/drug therapy , Ovarian Neoplasms/drug therapy , Adult , Combined Modality Therapy , Endometriosis/pathology , Endometriosis/surgery , Female , Humans , Infertility, Female/etiology , Ovarian Neoplasms/pathology , Ovarian Neoplasms/surgery , Pregnancy , Premedication , Prospective StudiesABSTRACT
One hundred infertile patients with laparoscopically confirmed ovarian endometriosis were treated with either intranasal (IN) Buserelin (Hoechst, AG, Frankfurt am Main, West Germany) (300 micrograms three times a day) or subcutaneous (SC) Buserelin implant (6.6 mg Buserelin). Serum estradiol was suppressed in the menopausal range in both groups, but the inhibition of the pituitary ovarian axis appeared more profound and consistent in the SC group than in the IN group. Laparoscopic findings proved that the SC Buserelin emerged superior to the IN Buserelin. Indeed, the score of endometriotic lesions and the ovarian cyst diameter were more reduced in the SC group than in the IN group. Moreover, the histologic study showed a lower incidence of active endometriosis and a lower mitotic index of ovarian endometrial epithelium in the SC group than in the IN group. In conclusion, the release of a gonadotropin-releasing hormone agonist by a biodegradable implant achieved better efficacy in reducing endometriotic lesions than the IN mode of administration.
Subject(s)
Buserelin/administration & dosage , Endometriosis/drug therapy , Ovarian Neoplasms/drug therapy , Administration, Intranasal , Adult , Biopsy , Buserelin/therapeutic use , Drug Implants , Endometriosis/blood , Endometriosis/pathology , Estradiol/blood , Female , Follicle Stimulating Hormone/blood , Humans , Luteinizing Hormone/blood , Ovarian Neoplasms/blood , Ovarian Neoplasms/pathology , Progesterone/blood , Prospective Studies , Random AllocationABSTRACT
To evaluate the persistence of endometriosis and the morphologic changes occurring in endometriotic foci after hormonal therapy, microsurgical resection of ovarian endometriosis was performed in 148 women. After hormonal therapy (n = 116), a high prevalence of active endometriosis without signs of degeneration was found. Mitotic index was similar in the group of untreated women (n = 32) and in the three groups of women treated either with lynestrenol (Organon, Oss, The Netherlands), gestrinone (Roussel UCLAF, Paris, France), or buserelin (Hoechst, Frankfurt, West Germany). In conclusion, hormonal treatment leads to an incomplete suppression of endometriotic foci.
Subject(s)
Endometriosis/pathology , Adult , Buserelin/therapeutic use , Endometriosis/drug therapy , Female , Gestrinone/therapeutic use , Humans , Lynestrenol/therapeutic useABSTRACT
Fifty patients with moderate or severe endometriosis received 5 mg/day lynestrenol for 6 months prior to microsurgery. A significant regression of the ovarian and peritoneal implants was observed in 72% of the cases after progestative treatment, but the presence of residual epithelium in all cases made surgical resection necessary. After preoperative medical treatment and microsurgery, intrauterine (living births) pregnancy rates of 60 and 47% were obtained in cases of moderate and severe endometriosis, respectively. The following prognostic factors were found in this series: the degree of endometriosis, the concomitant male factors, the decrease of endometriotic lesions after treatment, and the unilaterality of ovarian endometriosis.
Subject(s)
Endometriosis/therapy , Infertility, Female/therapy , Adult , Body Weight/drug effects , Combined Modality Therapy , Dyspareunia/drug therapy , Endometriosis/drug therapy , Endometriosis/surgery , Female , Humans , Infertility, Female/drug therapy , Infertility, Female/surgery , Lynestrenol/adverse effects , Lynestrenol/therapeutic use , Microsurgery , Pain/drug therapy , Premedication , Prospective StudiesABSTRACT
The advantages of microsurgical anastomosis for cornual occlusion are evaluated in a series of 82 pure cases of pathologic cornual occlusion. The term pregnancy rate was 44% and the ectopic pregnancy rate was 7%. The following factors were found influencing the pregnancy rate: maximized tubal length; preserved intramural portion; absence of chronic inflammation; absence of tubal inclusions; absence of tubal endometriosis.
