Thursday, 16 February 2017

Free Article Series: Fertility and Endometriosis

There are lots of articles being published on endometriosis all the time, (for example there were over a thousand articles either directly or indirectly related to endometriosis published last year) the main reason this blog exists is because the vast majority of these studies never get read by people actually affected by the disease. Mostly this is because these studies are published in scientific journals and/or hidden behind online paywalls only accessible to people in academic institutions, and even then the studies are written in very dry, scientific terms. 

Sometimes research in endometriosis makes it to the news, but often this is conveyed by journalists who, as well meaning as they can be, often misinterpret or exaggerate scientific information. I aim to write about the latest endometriosis research in a way anyone can read and understand, but there is so much being published all the time it difficult to cover it all here. Fortunately some research is made available for free for anyone to read, so I’m starting a series providing free articles on a certain theme each time. This time I’m going to be listing some of the most relevant, free articles concerning one of the major facets of endometriosis; fertility, how it affects women, how surgery affects pregnancy rate, how fertility therapy can help women with endometriosis and several other areas. Just click on the title of each article to be taken to the full text.

As mentioned though some of the articles are written in a rather dry prose and include a lot of detail about scientific methods and analysis that may not be relevant to the lay reader, so I would say the most important parts of some articles are the introductions/background and the discussion/conclusions, so feel free to skip to those parts to get the most interesting information. I’ve included the summary for each article so you can see which ones are of most interest to you.

Authors: González-Comadran M, Schwarze JE, Zegers-Hochschild F, Souza MD, Carreras R, Checa MÁ.
Published In: Reproductive Biology and Endocrinology. 2017 Jan 24;15(1):8. doi: 10.1186/s12958-016-0217-2.
Summary: Reproductive outcomes among women undergoing IVF and diagnosed with endometriosis-associated infertility do not differ significantly from women without the disease. Although women with endometriosis generate fewer oocytes, fertilization rate is not impaired and the likelihood of achieving a live birth is also not affected.

Authors: Nezhat C, Li A, Abed S, Balassiano E, Soliemannjad R, Nezhat A, Nezhat CH, Nezhat F.
Published In: Journal of the Society of Laproendoscopic Surgeons. 2016 Jul-Sep;20(3). pii: e2016.00053. doi: 10.4293/JSLS.2016.00053
Summary: In our patient population, 87.1% of patients with a chief concern of symptomatic fibroids also had a diagnosis of histology-proven endometriosis, which affirms the need for concomitant diagnosis and intraoperative treatment of both conditions. Overlooking the coexistence of endometriosis in women with symptomatic leiomyoma may lead to suboptimal treatment of fertility and persistent pelvic pain. It is important for physicians to be aware of the possibility of this association and to thoroughly evaluate the abdomen and pelvis for endometriosis at the time of myomectomy or hysterectomy in an effort to avoid the need for reoperation.

Authors: Ke X, Qian H, Kang L, Wang J, Xie Y, Cheng Z.
Published In: International Journal of Clinical and Experimental Medicine. 2015 Nov 15;8(11):21703-6. eCollection 2015
Summary: Surgery can improve the symptom remission rate and fertility of patients. Postoperative drug therapy does not improve the chance of pregnancy

Authors: Nesbitt-Hawes EM, Campbell N, Maley PE, Won H, Hooshmand D, Henry A, Ledger W, Abbott JA.
Published In: Biomed Research International. 2015;2015:438790. doi: 10.1155/2015/438790. Epub 2015 Jul 12.
Summary: These data provide information to women with suspected severe disease preoperatively concerning their likely postoperative fertility outcomes. Ours is a population with severe endometriosis, rather than an infertile population with endometriosis, so caution needs to be applied when applying these data to women with fertility issues alone.

Authors: Xu B, Guo N, Zhang XM, Shi W, Tong XH, Iqbal F, Liu YS.
Published In: Scientific Reports. 2015 May 29;5:10779. doi: 10.1038/srep10779
Summary: Endometriosis, a pathological condition in which the endometrium grows outside the uterus, is one of the most common causes of female infertility; it is diagnosed in 25-40% of infertile women. The mechanism by which endometriosis affects the fertility of females remains largely unknown. We examined the ultrastructure of oocytes from patients with minimal or mild endometriosis and control females undergoing in vitro fertilization (IVF) treatment. Our results suggest that decreased oocyte quality because of impaired mitochondrial structure and functions probably an important factor affecting the fertility of endometriosis patients.

Authors: Mavrelos D, Saridogan E.
Published In: Journal of Obstetrics and Gynaecology of India. 2015 Feb;65(1):11-6. doi: 10.1007/s13224-014-0652-y.
Summary: Endometriosis is a common condition affecting a significant proportion of women in their reproductive age. Apart from the impact of endometriosis on the quality of life of these patients, it also can have an impact on the potential of these women to have a family. The options for treating women with endometriosis desiring a family include surgery or assisted reproduction techniques. The choice of treatment will depend on the stage of disease and the characteristics of the couple seeking help. We review here the latest evidence on the management of endometriosis in women desiring fertility and describe our current practice.

Authors: Borghese B, Sibiude J, Santulli P, Lafay Pillet MC, Marcellin L, Brosens I, Chapron C.
Published In: PLoS One. 2015 Feb 13;10(2):e0117387. doi: 10.1371/journal.pone.0117387.
Summary: The influence of intrauterine environment on the risk of endometriosis is still controversial. Whether birth weight modifies the risk of endometriosis in adulthood remains an open question. For this purpose, we designed a case-control study involving 743 women operated on for benign gynecological indications from January 2004 to December 2011. Among patients with LBW, the risk is almost two-times higher to develop DIE. This association could reflect common signalling pathways between endometriosis and fetal growth regulation. There is also the possibility of a role played by placental insufficiency on the development of the neonate's pelvis and the occurrence of neonatal uterine bleeding that could have consequences on the risk of severe endometriosis.

Authors: Fadhlaoui A, Bouquet de la Jolinière J, Feki A.
Published In: Frontiers of Surgery. 2014 Jul 2;1:24. doi: 10.3389/fsurg.2014.00024.
Summary: Endometriosis is defined as the presence of endometrial-like tissue (glands or stroma) outside the uterus, which induces a chronic inflammatory reaction. Although endometriosis impairs fertility, it does not usually completely prevent conception. The question of evidence based-medicine guidelines in endometriosis-associated infertility is weak in many situations. Therefore, we will highlight in this issue where the challenges are.

(endometriosis covered in chapter 10)
Authors: Various
Summary: This guideline offers best practice advice on assisting people of reproductive age who have problems conceiving. It is estimated that infertility affects about one in seven heterosexual couples in the UK. Since the original NICE guideline on fertility was published in 2004 there has been a small increase in the prevalence of fertility problems and a greater proportion of people now seeking help for such problems. The main causes of infertility in the UK are (percentage figures indicate approximate prevalence): ovulatory disorders (25%); tubal damage (20%); factors in the male causing infertility (30%); uterine or peritoneal disorders (10%). In about 25% of cases infertility is unexplained, with no identified male or female cause. In about 40% of cases disorders are found in both the man and the woman. Uterine or endometrial factors, gamete or embryo defects, and pelvic conditions such as endometriosis may also play a role. Given the range of causes of fertility problems, the provision of appropriate investigations is critical. These investigations include semen analysis; assessment of ovulation, tubal damage and uterine abnormalities; and screening for infections such as Chlamydia trachomatis and susceptibility to rubella. Once a diagnosis has been established, treatment falls into three main types: medical treatment to restore fertility (for example the use of drugs for ovulation induction); surgical treatment to restore fertility (for example laparoscopy for ablation of endometriosis); assisted reproduction technology (ART) – any treatment that deals with means of conception other than vaginal coitus; frequently involving the handling of gametes or embryos.

Authors: Jin X, Ruiz Beguerie J.
Published in: Taiwan Journal of Obstetrics and Gynecology. 2014 Sep;53(3):303-8. doi: 10.1016/j.tjog.2013.02.004.
Summary: The use of laparoscopic surgery in the treatment of subfertility related to minimal endometriosis may increase the chances of future pregnancy and live birth

Authors: Dong X, Liao X, Wang R, Zhang H.
Published in: International Journal of Clinical and Experimental Pathology. 2013 Aug 15;6(9):1911-8.
Summary: Except reduced implantation rate in stage III-IV endometriosis group, no differences were found in other pregnancy parameters. This study suggests that IVF/ICSI yielded similar pregnancy outcomes in patients with different stages ofendometriosis and patients with tubal infertility. Therefore, IVF/ICSI can be considered as an effective approach for managingendometriosis-associated infertility.

Authors: Macer ML, Taylor HS.
Published in: Obstet Gynecol Clin North Am. 2012 Dec;39(4):535-49. doi:10.1016/j.ogc.2012.10.002.
Summary: Endometriosis has been associated with infertility; however, the mechanisms by which it affects fertility are still not fully understood. This article reviews the proposed mechanisms of endometriosis pathogenesis, its effects on fertility, and treatments of endometriosis-associated infertility. Theories on the cause of the disease include retrograde menstruation, coelomic metaplasia, altered immunity, stem cells, and genetics. Endometriosis affects gametes and embryos, the fallopian tubes and embryo transport, and the eutopic endometrium; these abnormalities likely all impact fertility. Current treatment options of endometriosis-associated infertility include surgery, superovulation with intrauterine insemination, and in vitro fertilization. We also discuss potential future treatments for endometriosis-related infertility.

Authors: Carvalho LF, Below A, Abrão MS, Agarwal A.
Published in: Revista de Associacao Medica Brasileira (1992). 2012 Sep-Oct;58(5):607-14.
Summary: Endometriosis, a highly prevalent gynecological disease, can lead to infertility in moderate to severe cases. Whether minimal stages are associated with infertility is still unclear. The purpose of this systematic review is to present studies regarding the association between pregnancy rates and the presence of early stages of endometriosis.

Authors: Lerchbaum E, Obermayer-Pietsch B.
Published In: European Journal of Endocrinology. 2012 May;166(5):765-78. doi: 10.1530/EJE-11-0984.
Summary: Vitamin D has been well-known for its function in maintaining calcium and phosphorus homeostasis and promoting bone mineralization. There is some evidence that in addition to sex steroid hormones, the classic regulators of human reproduction, vitamin D also modulates reproductive processes in women and men

Authors: Bulletti C, Coccia ME, Battistoni S, Borini A.
Published in: Journal of Assisted Reproduction and Genetics. 2010 Aug;27(8):441-7. doi: 10.1007/s10815-010-9436-1.
Summary: Endometriosis is a debilitating condition characterized by high recurrence rates. The aetiology and pathogenesis remain unclear. Typically, endometriosis causes pain and infertility, although 20-25% of patients are asymptomatic. The principal aims of therapy include relief of symptoms, resolution of existing endometriotic implants, and prevention of new foci of ectopic endometrial tissue. Current therapeutic approaches are far from being curative; they focus on managing the clinical symptoms of the disease rather than fighting the disease. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. The benefits of these treatments have not been entirely demonstrated, particularly in terms of expectations that women hold for their own lives. Although theoretically advantageous, there is no evidence that a combination medical-surgical treatment significantly enhances fertility, and it may unnecessarily delay further fertility therapy. Randomized controlled trials are required to demonstrate the efficacy of different treatments.

Access to articles is provided by US National Library of Medicine and National Institutes of Health as well as individual publishers

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