Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis complicated by endometrioma

Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage

endometriosis complicated by endometrioma

Objawy kliniczne i narzędzia diagnostyczne w niepłodności i wodniaku jajowodu u kobiet z zaawansowanym stadium endometriozy powikłanym torbielą endometrialną

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1 Department of Obstetrics and Gynecology, Düzce University Faculty of Medicine, Düzce, Turkey

2 Department of Obstetrics and Gynecology, International Medicana Hospital, İstanbul, Turkey

Abstract

Objectives: The study included patients suffering from stage III-IV endometriosis complicated by an endometrioma (OMA). We investigated the association between age, presence of dysmenorrhea/dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility, as well as the risk of intraoperative detection of hydrosalpinx that was not suspected on pre-operative assessment.

Materials and Methods: The study included patients with stage III-IV endometriosis complicated by OMA who underwent a laparoscopic or open surgery due to pre-diagnosis of infertility or adnexal mass.

Results: Dysmenorrhea had statistically significant association with infertility (p=0.031). There was no statistically significant relation between age, dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility (p=0. 203, p=0.561, p=0.561 and p=0.668, respectively). No statistically significant relation was found between age, CA 125 level, dysmenorrhea, dyspareunia and detection of an unilateral/bilateral hydrosalpinx, that was not suspected on pre-operative assessment (p=0.179, p=0.295, p=0.895, p=0.424, respectively). There was an association between OMA size (p=0.023) and detection of unilateral/bilateral hydrosalpinx.

Conclusions: Patients who desire to have children but suffer from severe dysmenorrhea must be preoperatively informed about the possibility of having stage III-IV endometriosis. Infertile patients who are about to undergo an operation, especially due to a large OMA, may turn out to have hydrosalpinx. These patients should be informed preoperatively about the possibility of having salpingectomy or the proximal tubal surgery for improving fertility.

Key words: endometriosis / endometrioma / hydrosalpinx / infertility /

Otrzymano: 06.05.2013

Zaakceptowano do druku: 30.07.2013 Corresponding author:

Ali Yavuzcan

Department of Obstetrics and Gynecology, Duzce University School of Medicine, 81000, Konuralp,Duzce,-TURKEY

Mobile: +90 (532) 634 54 31 e-mail: draliyavuzcan@yahoo.com

P R A C E O R Y G I N A L N E

ginekologia +MRIOSP4SP

Ali Yavuzcan et al. Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis...

List of abbreviations:

endometrioma, OMA; revised endometriosis scoring of the American Fertility Society, R-AFS; in vitro fertilization, IVF; ultrasonography, USG;

deep infiltrating endometriosis, DIE; peritoneal superficial endometriosis, SUP; nerve growth factor, NGF; protein gene product 9.5, PGP9.5.

Introduction

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Streszczenie

Cel: Do badania włączono pacjentki cierpiące na endometriozę w stopniu III-IV powikłaną torbielą endometrialną (OMA). Zbadano powiązania między wiekiem, obecnością bolesnego miesiączkowania/dyspareunii, przedoperacyjnym poziomem CA125, rozmiarem OMA w USG a niepłodnością. Oceniono również ryzyko śródoperacyjnego rozpoznania wodniaka jajowodu, którego nie podejrzewano przed operacją.

Materiał i metoda: Do badania włączono pacjentki z III-IV stopniem endometriozy powikłanym OMA, które przeszły laparoskopię lub operację metodą otwartą z powodu niepłodności lub guza jajnika.

Wyniki: Bolesne miesiączkowanie miało istotny związek z niepłodością (p=0,031). Nie znaleziono istotnego związku pomiędzy wiekiem, dyspareunia, przedoperacyjnym poziomem CA125, rozmiarem OMA w USG a niepłodnością (p=0,203; p=0,561; p=0,561 i p=0,424, odpowiednio). Rozmiar OMA miał istotny związek z rozpoznaniem jedno/

obustronnego wodniaka jajowodu (p=0,023).

Wnioski: Kobiety, które chcą zajść w ciążę ale cierpią z powodu bolesnych miesiączek powinny być poinformowane przed operacją o możliwej endometriozie III-IV stopnia. Niepłodne pacjentki, które mają się poddać leczeniu operacyjnemu, zwłaszcza z powodu dużych torbieli endometrialnych, mogą w rzeczywistości mieć wodniaka jajowodu. Te pacjentki powinno się informować przed operacją o konieczności wykonania usunięcia jajowodu lub chirurgii proksymalnego odcinka jajowodu celem poprawy płodności.

Słowa kluczowe: endometrioza / endometrioma / wodniak jajowodu / niepáodnoĞü /

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P R A C E O R Y G I N A L N E

ginekologia +MRIOSP4SP

Ali Yavuzcan et al. Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis...

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