and infertility
Nama: Nia Apryanti
Nim : 03011213
Pembimbing
: dr. Komang Arianto
Sp.OG
Introduction
The presence of endometrial-like tissue
outside the uterus
Induces a chronic inflammatory reaction,
scar tissue, and adhesions
Primarily found in young women
Not related to ethnic and social group
distinctions
Mainly
complain
:
pelvic
pain,
dysmenorrhea, dyspareunia.
Epidemiology
25% - 50% of infertile woman have
endometriosis
30%
50%
of
women
with
endometriosis are infertile
6080%
4050%
Deep dyspareunia
4050%
Infertility
3050%
1020%
1-2%
1-2%
Endometriosis and
infertility
Infertile women are 6 to 8 more likely to
have endometriosis than fertile women
Mechanisms : distorted pelvic anatomy,
endocrine and ovulatory abnormalities,
altered peritoneal function, and altered
hormonal and cell-mediated functions in
endometrium.
Impair
oocyte
release
from the
ovary
Inhibit
ovum
pickup /
impede
ovum
transport
receptivity
and
embryo
Treatment of endometriosis-associated
confirmed disease
infertility
in
Medical treatment
Relieving pain associated with endometriosis
There is no evidence that medical therapy improves
fecundity
Comparing medical treatment to no treatment or
placebo, the common odd ratio for pregnancy was 0.85%
In minimal-mild endometriosis : suppression of ovarian
function to improve infertility is not effective
In severe disease : there is no evidence of its
effectiveness
Surgical treatment
In minimal-mild endometriosis : ablation of endometriotic
lesions plus adhesiolysis to improve fertility
In moderate-severe endometriosis : no explanations
available to answer the question whether surgical
excision enhances pregnancy rate
By normalizing pelvic anatomy distortion and by
adhesiolysis, may enhance fertility
After surgery : negative correlation between the stage of
endometriosis
and
the
spontaneous
cumulative
pregnancy rate
Laparoscopic cystectomy for ovarian endometriomas
>4cm diameter improves fertility compared to drainage
and coagulation
Coagulation or laser vaporization of endometriomas
without excision of the pseudocapsule is associated with
a significantly increased risk of cyst reccurrence
Favours surgery
Favours
expectant
management
Previous intervention of
endometriosis
None
Ovarian reserve
Intact
Damaged
Pain symptoms
Present
Absent
Bilaterality
Monolateral
disease
Bilateral
disease
Sonographic feature of
malignancy
Present
Absent
Growth
Rapid growth
Stable