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A Functional Approach to Gynecologic Pain
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
An endometrioma is a collection of ectopic endometrial tissue within the ovary. It contains a thick brown material made of old blood and is also known as a “chocolate cyst.” Endometriomas can also grow quite large and may be adherent to other pelvic structures. The endometrioma itself may be painful due to changes within the ovarian cortex or inflammation in surrounding structures, but its mere presence in the ovary suggests endometriosis elsewhere in the pelvis.
Ultrasound-Guided Intervention in Assisted Reproductive Technology
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
There are a number of possible theories of how endometrioma contributes to infertility. The pelvic adhesions caused by endometriosis can lead to distortion of the tubo-ovarian anatomy. Endometriomas can cause increased oxidative stress to the ovarian tissue leading to fibrosis, loss of cortex specific stroma, vascularization defect, and reduced follicle maturation [28] leading to a significant reduction in the primordial follicle. The presence of endometrioma alters the follicular environment as evident by increased progesterone and interleukin-6 and decreased vascular endothelial growth factor. This can impact on the quality of the oocytes and embryos, leading to lower fertilization and implantation rates, respectively [29].
Ovarian endometriosis
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh
The word ‘endometrioma’ is used to describe an endometriotic cyst of the ovary. Another term in widespread use is chocolate cyst, because of the characteristic dark brown or chocolate-coloured content of the cyst. Many haemorrhagic cysts are functional cysts, particularly corpus luteal cysts (Figure 6.7). The presence of other signs of endometriosis can help to distinguish between functional cysts and endometriosis.
Impact on ovarian reserve and fertility using carbon dioxide laser for endometriosis treatment: a systematic review
Published in Gynecological Endocrinology, 2022
Andrea Giannini, Linda Tebache, Giacomo Noti, Giulia Cosimi, Michelle Nisolle, Tommaso Simoncini
This ablative technique was inspired by consistent data published by Donnez and his group regarding the safety and efficacy of CO2 laser technology for two decades. They proposed a combined therapy for the management of endometriomas: a 12-week therapy with Gonadotropin-Releasing Hormone (GnRH) followed by laser ablation of the endometrioma internal wall [7]. According to the authors’ reports, the vaporization allows destroying the internal surface of the endometrioma wall selectively, preserving the pericystic fibrotic capsule or the adjacent healthy ovarian cortex. Indeed, ablation depth cannot exceed 1.0–1.5 mm [8–10]. Despite this, a 2008 Cochrane review by Hart et al. suggested the excisional technique as the most effective laparoscopic approach for managing endometriomas despite the encouraging results [11]. According to the authors, the excision of the ovarian cyst provided better postoperative outcomes than drainage and electrocoagulation. Indeed, a lower recurrence rate of endometrioma and improved pain symptoms were detected in women who underwent excisional surgery. Those with a previous subfertility diagnosis have also shown a higher rate of spontaneous pregnancy after surgery. However, there is limited data to define the best surgical approach for women who may have access to in vitro fertilization (IVF) treatment.
Dienogest reduces endometrioma volume and endometriosis-related pain symptoms
Published in Journal of Obstetrics and Gynaecology, 2021
Semih Z. Uludag, Elif Demirtas, Yılmaz Sahin, Ercan M. Aygen
Endometriosis is a benign, oestrogen-dependent, chronic gynecolgic condition with a reported prevalence of 2–10% in the general population, up to 50% in the infertile patients and up to 70% of women with chronic pelvic pain refractory to conventional treatment (Giudice and Kao 2004; Ilangavan and Kalu 2010; Bayoglu Tekin et al. 2011). Endometrioma is defined as the presence of an ovarian cyst with ectopic endometriotic tissues. Among those with endometriosis, 17–44% have ovarian endometrioma, which requires surgical management (Ceyhan et al. 2006) and may be associated with pelvic pain and infertility (Chapron et al. 2002). Laparoscopic excisional surgery for endometrioma is currently the most valid approach in the treatment of endometriomas (Hart et al. 2008; Dan and Limin 2013; Muzii et al. 2016). However, there are concerns about the ovarian reserve damage after excisional surgery including the removal of healthy ovarian tissue adjacent to the cyst capsule, local inflammation or vascular compromise following electrosurgical coagulation for hemostasis purposes (Ceyhan et al. 2006; Busacca and Vignali 2009; Raffi et al. 2012). Non-excisional surgical techniques are yet to be proved to be valid alternatives to excisional surgery (Raffi et al. 2012).
Frozen blastocyst transfer improves the chance of live birth in women with endometrioma
Published in Gynecological Endocrinology, 2020
Mehmet Resit Asoglu, Cem Celik, Mustafa Bahceci
Our study has certain limitations. It has a limitation due to its retrospective nature. The diagnosis of endometrioma was made by ultrasound, but as all patients were examined several times. It is not reasonable to perform laparoscopy for the diagnosis of endometrioma in everyday practice. The cumulative chance of live birth was not evaluated in our study. However, this outcome might have caused a bias in exhibiting the actual impact of frozen embryo transfer on outcome measures as women undergoing the first fresh transfer could undergo subsequent frozen embryo transfers using the surplus embryos, which would mask the actual impact of frozen embryo transfer. Our study also has some strengths. First, the study was sufficiently powered for live birth rate. Second, analyzing only blastocyst transfers in our study better reflects current clinical practice as blastocyst transfer and freezing have been on rise. Third, we minimized selection bias in the study design using the strict inclusion and exclusion criteria. Last, an artificial endometrial preparation cycle was used in frozen-BT group, which eliminated bias that might have resulted from endometrial preparation method.