Luiza Helena Abbamonte

Fertility after bowel resection for endometriosis.

OBJECTIVE To determine the pregnancy rate after bowel resection for rectosigmoid endometriosis. DESIGN Prospective cohort study. SETTING University hospital. PATIENT(S) Forty-six symptomatic women with bowel endometriosis requiring colorectal resection. INTERVENTION(S) Bowel resection by either laparoscopy or laparotomy. MAIN OUTCOME MEASURE(S) Pregnancy rate after surgery. RESULT(S) The pregnancy rate was higher in women who underwent bowel resection by laparoscopy (57.6%) than in those who underwent laparotomy (23.1%). No significant difference was observed in pregnancy rate and mode of conception between women with different fertility status before bowel resection. Women who conceived were significantly younger than those who did not conceive; only 26.7% of women aged > or =35 years conceived after bowel resection. Uterine adenomyosis was more frequently present in women who did not conceive than in those who conceived. Infertile women who conceived had a shorter length of infertility before surgery than those who did not conceive. CONCLUSION(S) Laparoscopic colorectal resection is less likely to impact negatively on fertility than the laparotomy approach. Previous laparotomies, age > or =35 years, uterine adenomyosis, and longer duration of infertility before surgery are associated with decreased pregnancy rate.

Does transvaginal ultrasonography combined with water-contrast in the rectum aid in the diagnosis of rectovaginal endometriosis infiltrating the bowel?

BACKGROUND The aim of this study was to determine whether adding water-contrast in the rectum during transvaginal ultrasonography (RWC-TVS) improves the diagnosis of rectal infiltration in women with rectovaginal endometriosis. METHODS This prospective study included 90 women, with suspect rectovaginal endometriosis, who underwent operative laparoscopy. TVS and RWC-TVS were independently performed by different investigators. RWC-TVS was performed by injecting saline solution into the rectal lumen under ultrasonographic control through a 6-mm catheter. Presence of rectovaginal nodules, presence and degree of rectal infiltration, and the largest diameter of the bowel nodules were evaluated. Ultrasonographic results were compared to surgical and histological findings. RESULTS Although RWC-TVS had higher accuracy than TVS in diagnosing rectovaginal endometriosis, the difference between the two techniques was not statistically significant. RWC-TVS was significantly more accurate than TVS in determining the presence of endometriotic infiltration reaching at least the muscular layer of the rectal wall. The sensitivity of RWC-TVS in identifying rectal lesions was 97%, the specificity 100%, the positive predictive value 100% and the negative predictive value 91.3%. RWC-TVS caused a higher intensity of pain than TVS. CONCLUSIONS RWC-TVS determines the presence of rectovaginal nodules infiltrating the rectal muscularis propria more accurately than TVS; RWC-TVS could be used when TVS cannot exclude the presence of rectal infiltration.

Letrozole and desogestrel‐only contraceptive pill for the treatment of stage IV endometriosis

Background:  It has recently been suggested that aromatase inhibitors may effectively reduce pain symptoms related to the presence of endometriosis both in postmenopausal women and in subjects of reproductive age.

Future perspectives in the medical treatment of endometriosis.

In the last few years, our understanding of the pathogenesis of endometriosis at the cellular and molecular levels has improved significantly. This may give us the opportunity to use new, specific agents for the treatment of this disorder. Despite the effectiveness of the available treatments, novel therapeutic strategies may improve our ability to eliminate endometriotic lesions when present and to prevent the recurrence of endometriosis after surgical treatment. This review focuses on the new, experimental approaches to the medical treatment of endometriosis and its symptoms. The blockage of aromatase activity in endometriotic lesions with an aromatase inhibitor may represent a new step in the medical treatment of endometriosis. Preliminary clinical studies have demonstrated the efficacy of third-generation nonsteroidal aromatase inhibitors (ie, anastrozole and letrozole) in reducing the intensity of pain symptoms associated with the presence of endometriosis. The new selective progesterone receptor modulators may represent a valid hormonal treatment option. Therapeutic manipulation of the immune system through TNFα inhibitors may be beneficial in women with endometriosis. New pharmaceutical agents affecting inflammation, angiogenesis, and matrix metalloproteinase activity may prevent or inhibit the development of endometriosis. Further clinical trials may determine if these new therapies are superior to current medical treatment strategies for endometriosis. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to describe the new experimental medical treatments of endometriosis, state that the clinical use of nonsteroidal aromatase inhibitors for endometriosis appears to be efficacious but is based on preliminary clinical data, and recall that the drugs used for endometriosis in the future may include manipulation of the immune system.

Irritable bowel syndrome and endometriosis

In clinical practice, gynaecological and gastroenterological symptoms often coexist. Considering that the aim of the study was ‘to ascertain whether there were any symptoms additional to those of IBS that might be useful in helping physicians to avoid missing coexistent symptomatic gynaecological pathology’, the authors excluded all gynaecological patients with symptoms suggestive of IBS. Although this methodological approach gave the authors the opportunity to present interesting findings, it may lead to misleading conclusions.

Constitutional change of Italian legislation on assisted reproduction technology improves pregnancy rate especially in older patients

production and expression of cytochrome P450 aromatase enzyme mRNA in long-term serum-free cultures of pig granulosa cells. J Reprod Fertil 1999b;115:67–77. Shores EM, Picton HM, Hunter MG. Differential regulation of pig theca cell steroidogenesis by LH, insulin-like growth factor I and granulosa cells in serum-free culture. J Reprod Fertil 2000;118:211–219. Soleimani R, De Vos W, Van Oostveldt P, Lierman S, Van Den Broecke R, De Sutter P, Dhont M, Van Der Elst J. Two novel techniques to detect follicles in human ovarian cortical tissue. Hum Reprod 2006; 21:1720–1724. Soleimani R, Heytens E, Van den Broecke R, Rottiers I, Dhont M, Cuvelier CA, De Sutter P. Xenotransplantation of cryopreserved human ovarian tissue into murine back muscle. Hum Reprod 2010; 25:1458–1470. Zuang V The neutral red release assay: A review. Altern Lab Anim 2001; 29:575–599.

Images of children born following infertility treatment.

ObjectiveThis cross-sectional survey investigates patients’ attitudes towards the use of photos of children born following infertility treatment.Materials and methodsEach partner of 270 infertile couples independently completed a standardized questionnaire investigating patients’ attitudes towards the presence of photos of children born following infertility treatment in fertility clinics, Internet websites, brochure, and videos.ResultsSubjects (77.4%) were pleased to provide a photo of their child to hang on the walls of the fertility centre, a lower percentage of subjects desired to exhibit the photo in the fertility centre website, brochure, and video. Among subjects wishing to hang the photo of their child in the infertility centre, 60.3% wanted the name of the child on the photo and 15.3% wanted both the name and surname of the child on the photo. If a photo is explicitly requested by a member of the fertility team, 30.9% of the subjects feel to have the duty to give it. No significant difference was observed in the desire to provide a photo of the child to hang on the walls of the fertility centre according to sex of the patient.ConclusionThe majority of infertile patients are pleased to exhibit a photo of their babies in the fertility centre. Members of the fertility team should avoid asking explicitly the photo because parents may feel to have the duty to give it.