Control-matched surgical evaluation of endometriosis progression after IVF: a retrospective cohort study.

BACKGROUND: The aim of this study was to examine the surgical findings at repeated surgeries for endometriosis and to compare disease progression in patients after IVF to those without interval fertility treatments. METHODS: A retrospective case-control study set at the referral center for gynecologic endoscopy at Stanford University. Women who had two surgeries for treatment of symptomatic endometriosis since 1997 were searched in the database. Twenty-one women were identified who underwent IVF treatment between the two procedures (IVF group), and compared to 36 women who did not receive any fertility treatment (controls). The main outcomes were time to recurrence and surgical findings including rASRM score. The presence and size of endometrioma, rectovaginal and para-rectal spaces location of endometriosis were also compared between the two surgical procedures. RESULTS: Demographics in the two groups were similar. The change in rASRM score between surgeries was not significantly different (P=0.80) between the two groups. There was no difference between the two groups in the size and number of pathology proven endometriomas as well as no difference in the presence of rectovaginal and pararectal endometriosis. CONCLUSIONS: No significant difference was found in the two groups, suggesting that IVF treatment does not lead to an accelerated progression of endometriosis in patients with recurrence.

Use of ultrasonographic cut point for diagnosing endometrial pathology in postmenopausal women with multiple risk factors for endometrial cancer.

OBJECTIVE: To determine if the established endometrial thickness cut point (5 mm) for abnormal endometrial pathology shifts to higher thickness in the presence of selected risk factors/comorbidities. STUDY DESIGN: A sample of 112 postmenopausal women was identified. The outcome was abnormal endometrial pathology, be it endometrial cancer or hyperplasia with atypia. Logistic regression was used to calculate prevalence odds ratios (ORs) of abnormal results for women with thick or thin endometria and 0 or > or = 1 of the following comorbidities/cofactors: obesity, diabetes, hypertension and use of hormone replacement therapy. RESULTS: Approximately half the sample was hypertensive; 56.3% were obese. A large proportion (84.8%) of the patients had > or = 1 of the comorbidities/cofactors of interest. Women with endometria > or = 12 mm and > or = 1 comorbidities appeared to have 5 times the odds of having an abnormal result compared to women with thin endometria (<12 mm) who had 0 comorbidities; this result was not statistically significant (adjusted OR = 5.08, p = 0.07). A dose-response curve (regression spline) showed that the prevalence of an abnormal outcome increased sharply between 5 and 9 mm. CONCLUSION: Clinicians should continue to use the 5-mm cut point when deciding whether patients should have endometrial sampling.