Determination of treatment policy for infertility in patients with ovarian endometrioid cysts

Lavrukhina M.A.

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
There are three methods to overcome infertility in ovarian endometrioid cysts: assisted reproductive technologies through in vitro fertilization, surgical or medical treatment followed by expectant management, and surgical treatment followed by the use of assisted reproductive technologies. In vitro fertilization with cycle segmentation also increases fertility: surgical and medical treatment in a cryoprotocol is performed before embryo transfer. Minimally invasive treatment, such as ultrasound-guided transvaginal puncture and aspiration of a cyst with or without sclerosis, is used as an alternative to laparoscopic cystectomy. The rate of relapses can be reduced, by using 96% ethanol that acts as a sclerosing agent for the cyst bed for 15 minutes, which causes its obliteration. Cryopreservation of oocytes, embryos, or ovarian tissue may be offered to a number of patients in terms of a higher risk for infection of the pelvic organs during material sampling. Repeat surgical treatment is not recommended due to diminished ovarian reserve: it is advisable to use assisted reproductive technologies in case of recurrence.
Conclusion: The choice of a fertility-preserving treatment for ovarian endometriosis depends on the patient’s age, her ovarian reserve, medical history, and desire for the time of pregnancy onset.

Keywords

ovarian endometrioid cysts
infertility
laparoscopic cystectomy
transvaginal aspiration
sclerosing
assisted reproductive technologies for ovarian endometriosis

References

  1. Miquel L., Preaubert L., Gnisci A., Netter A., Courbiere B., Agostini A. et al. Transvaginal ethanol sclerotherapy for an endometrioma in 10 steps. Fertil. Steril. 2021; 115(1): 259-60. https://dx.doi.org/10.1016/j.fertnstert.2020.08.1422.
  2. Габидуллина Р.И., Кошельникова Е.А., Шигабутдинова Т.Н., Мельников Е.А., Калимуллина Г.Н., Купцова А.И. Эндометриоз: влияние на фертильность и исходы беременности. Гинекология. 2021; 23(1): 12-7. [Gabidullina R.I., Purushnikova E.A., Shigabutdinova T.N. et al. Endometriosis: effects on fertility and pregnancy outcomes. Gynecology. 2021; 23(1): 12-7. (In Russian)].
  3. Чернуха Г.Е., Думановская М.Р., Ильина Л.М. Эндометриоз яичников и проблема сохранения фертильности. Гинекология. 2021; 23(2): 110-6. [Chernukha G.E., Dumanovskaya M.R., Ilyina L.M. Ovarian endometriosis and fertility preservation problem. Gynecology. 2021; 23(2): 110-6. (In Russian)].
  4. Hayashi S., Nakamura T., Motooka Y., Ito F., Jiang L., Akatsuka S. et al. Novel ovarian endometriosis model causes infertility via iron-mediated oxidative stress in mice. Redox Biol. 2020; 37: 101726. https://dx.doi.org/10.1016/j.redox.2020.101726.
  5. Иванов И.И., Прочан Е.Н., Тарасова Е.С., Косолапова Н.В., Черипко М.В. Современный подход к лечению эндометриоза у пациенток, планирующих беременность. Таврический медико-биологический вестник. 2017; 20(2): 179-84. [Ivanov I.I., Prochan E.N., Tarasova E.S., Kosolapova N.V., Cheripko M.V. Modern approach to the treatment of endometriosis in patients planning pregnancy. Tauride medico-biological Bulletin. 2017; 20(2): 179-84. (in Russian)].
  6. Оразов М.Р., Хамошина М.Б., Абитова М.З., Михалева Л.М., Волкова С.В., Арютин Д.Г., Шустова В.Б. Бесплодие, ассоциированное с эндометриозом яичников: современный взгляд на проблему. Гинекология. 2020; 22(5): 44-9. [Orazov M.R., Khamoshina M.B., Abitova M.Z. et al. Infertility associated with ovarian endometriosis: a modern view of the problem. Gynecology. 2020; 22(5): 44-9. (in Russian)].
  7. Barnett R., Banks N., Decherney A. Endometriosis and fertility preservation. Clin. Obstet. Gynecol. 2017; 60(3): 517-23. https://dx.doi.org/10.1097/GRF.0000000000000295.
  8. Falcone T., Flyckt R. Clinical management of endometriosis. Obstet. Gynecol. 2018; 131(3): 557-71. https://dx.doi.org/10.1097/AOG.0000000000002469.
  9. Дубровина С.О., Берлим Ю.Д., Вовкочина М.А., Александрина А.Д., Богомолова К.Р. Медикаментозная терапия у пациенток с эндометриоидными кистами яичников в до- и послеоперационном периоде: ретроспективное когортное исследование. Акушерство и гинекология. 2021; 5: 146-52. [Dubrovina S.O., Berlim Yu.D., Vovkochina M.A., Alexandrina A.D., Bogomolova K.R. Drug therapy in patients with endometrioid ovarian cysts in the pre- and postoperative period: a retrospective cohort study. Obstetrics and Gynecology. 2021; 5: 146-52. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.5.146-152.
  10. de Sanctis V., Matalliotakis M., Soliman A.T., Elsefdy H., Di Maio S., Fiscina B. A focus on the distinctions and current evidence of endometriosis in adolescents. Best Pract. Res. Clin. Obstet. Gynaecol. 2018; 51: 138-50. https://dx.doi.org/10.1016/j.bpobgyn.2018.01.023.
  11. Georgiou E.X., Melo P., Baker P.E., Sallam H.N., Arici A., Garcia-Velasco J.A. et al. Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. Cochrane Database Syst. Rev. 2019; (11): CD013240. https://dx.doi.org/10.1002/14651858.CD013240.pub2.
  12. Liang B., Wu L., Xu H., Cheung C.W., Fung W.Y., Wong S.W., Wang C.C. Efficacy, safety and recurrence of new progestins and selective progesterone receptor modulator for the treatment of endometriosis: a comparison study in mice. Reprod. Biol. Endocrinol. 2018; 16(1): 32. https://dx.doi.org/10.1186/s12958-018-0347-9.
  13. Тезиков Ю.В., Стрижаков А.Н., Липатов И.С., Калинкина О.Б., Аравина О.Р., Амосов М.С. Оптимизация тактики ведения пациенток с эндометриозом яичников и бесплодием. Акушерство и гинекология. 2021; 7: 122-32. [Tezikov Yu.V., Strizhakov A.N., Lipatov I.S., Kalinkina O.B., Aravina O.R., Amosov M.S. Optimization of management tactics for patients with ovarian endometriosis and infertility. Obstetrics and Gynecology. 2021; 7: 122-32. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.7.122-132.
  14. Тетелютина Ф.К., Шестакова О.В., Долгова О.Н., Широбокова Л.М. Прегравидарная подготовка и ведение беременности у женщин, страдающих эндометриозом, в программе экстракорпорального оплодотворения: клинический случай. Гинекология. 2020; 22(1): 29-32. [Tetelyutina F.K., Shestakova O.V., Dolgova O.N., Shirobokova L.M. Pregravidary preparation and management of pregnancy in women suffering from endometriosis in the in vitro fertilization program: a clinical case. Gynecology. 2020; 22(1): 29-32. (in Russian)].
  15. Zakhari A., Delpero E., McKeown S., Tomlinson G., Bougie O., Murji A. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum. Reprod. Update. 2021; 27(1): 96-107. https://dx.doi.org/10.1016/j.jmig.2020.09.019.
  16. de Ziegler D., Pirtea P., Carbonnel M., Poulain M., Cicinelli E., Bulletti C. et al. Assisted reproduction in endometriosis. Best Pract. Res. Clin. Endocrinol. Metab. 2019; 33(1): 47-59. https://dx.doi.org/10.1016/j.beem.2018.10.001.
  17. Santulli P., Collinet P., Fritel X., Canis M., d’Argent E.M., Chauffour C. et al. Stratégies de prise en charge de l’infertilité en assistance médicale à la procréation dans un contexte d’endométriose, RPC Endométriose, CNGOF-HAS. Gynécol. Obstét. Fertil. Sénol. 2018; 46(3): 373-5.
  18. Chauffour C., Pouly J.-L., Gremeau A.-S. Prise en charge en FIV en cas d’endométriose, RPC Endométriose CNGOF-HAS. Gynécol. Obstét. Fertil. Sénol. 2018; 46(3): 349-56.
  19. Miller C.E. The endometrioma treatment paradigm when fertility is desired: A systematic review. J. Minim. Invasive Gynecol. 2021; 28(3): 575-86. https://dx.doi.org/10.1016/j.jmig.2020.11.020.
  20. Айзикович Б.И., Зотов С.В., Кулешов В.М., Мотырева П.Ю., Филимонов С.Н., Лихачева В.В. Лечение эндометриоидных кист яичника с позиции сохранения фертильности: обзор современных методов. Мать и дитя в Кузбассе. 2021; 2: 32-9. [Aizikovich B.I., Zotov S.V., Kuleshov V.M., Motyreva P.Yu., Filimonov S.N., Likhacheva V.V. Treatment of endometrioid ovarian cysts from the perspective of fertility preservation: a review of modern methods. Mother and Child in Kuzbass. 2021; 2(85): 32-9. (in Russian)].
  21. Acién P., Velasco I., Quesada J.A., Acién M. Long‐term outcomes of transvaginal ultrasound‐guided aspiration versus traditional conservative surgery as treatment for endometriomas: A retrospective study of cohorts. J. Obstet. Gynaecol. Res. 2021; 47(4): 1462-71. https://dx.doi.org/10.1111/jog.14679.
  22. De Cicco Nardone A., Carfagna P., De Cicco Nardone C., Scambia G., Marana R., De Cicco Nardone F. Laparoscopic ethanol sclerotherapy for ovarian endometriomas: preliminary results. J. Minim. Invasive Gynecol. 2020; 27(6): 1331-6. https://dx.doi.org/10.1016/j.jmig.2019.09.792.
  23. Alborzi S., Zahiri Sorouri Z., Askari E., Poordast T., Chamanara K. The success of various endometrioma treatments in infertility: A systematic review and meta-analysis of prospective studies. Reprod. Med. Biol. 2019; 18(4): 312-22. https://dx.doi.org/10.1002/rmb2.12286.
  24. Зотов С.В., Мотырева П.Ю., Кулешов В.М., Айзикович Б.И., Лихачева В.В., Филимонов С.Н. Сравнительная эффективность программ экстракорпорального оплодотворения после лечения эндометриоидных кист яичника путем лапароскопической эксцизии и редукционной терапии. Мать и дитя в Кузбассе. 2021; 2: 78-82. [Zotov S.V., Motyreva P.Yu., Kuleshov V.M., Aizikovich B.I., Likhacheva V.V., Filimonov S.N. Comparative effectiveness of in vitro fertilization programs after treatment of ovarian endometrioid cysts by laparoscopic excision and reduction therapy. Mother and Child in Kuzbass. 2021; 2(85): 78-82. (in Russian)].
  25. Зотов С.В., Мотырева П.Ю., Кулешов В.М., Айзикович Б.И., Лихачева В.В., Филимонов С.Н. Преимущества редукционной терапии эндометри­оидных кист яичников по сравнению с лапароскопической эксцизией при подготовке к программам вспомогательных репродуктивных технологий (ВРТ). Медицина в Кузбассе. 2021;1:26-31. [Zotov S.V., Motyreva P.Yu., Kuleshov V.M., Aizikovich B.I., Likhacheva V.V., Filimonov S.N. Advantages of reduction therapy of endometrioid ovarian cysts in comparison with laparoscopic excision in preparation for assisted reproductive technologies (ART) programs. Medicine in Kuzbass. 2021; 1: 26-31. (in Russian)].
  26. Vassilopoulou L., Matalliotakis M., Zervou M., Matalliotaki C., Spandidos D., Matalliotakis I. et al. Endometriosis and in vitro fertilisation (Review). Exp. Ther. Med. 2018: 16(2): 1043-51.
  27. Huang H., Takai Y., Mikami Y., Samejima K., Gomi Y., Narita T. et al. Safety of transvaginal aspiration of cysts in pregnancies complicated with ovarian endometrioma. J. Gynecol. Obstet. Hum. Reprod. 2021; 50(8): 102146. https://dx.doi.org/10.1016/j.jogoh.2021.102146.
  28. Tanbo T., Fedorcsak P. Endometriosis-associated infertility: aspects of patho-physiological mechanisms and treatment options. Acta Obstet. Gynecol. Scand. 2017; 96(6): 659-67. https://dx.doi.org/10.1111/aogs.13082.
  29. Краснопольская К.В., Попов А.А., Федоров А.А., Ершова И.Ю. Алгоритм преодоления бесплодия при эндометриоидных кистах яичников: взгляд репродуктолога и хирурга. Акушерство и гинекология. 2020; 11: 78-84. [Krasnopolskaya K.V., Popov A.A., Fedorov A.A., Ershova I.Yu. Algorithm for overcoming infertility in endometrioid ovarian cysts: the view of a reproductologist and surgeon. Obstetrics and Gynecology. 2020; 11: 78-84. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.11.78-84.
  30. Kitajima M. Association between ovarian endometrioma and ovarian reserve. Front, Biosci. (Elite Ed). 2018; 10(1): 92-102. https://dx.doi.org/10.2741/e810.
  31. Somigliana E., Viganò P., Benaglia L., Busnelli A., Paffoni A., Vercellini P. Ovarian stimulation and endometriosis progression or recurrence: a systematic review. Reprod. Biomed. Online. 2019; 38(2): 185-94. https://dx.doi.org/10.1016/j.rbmo.2018.11.021.

Received 07.02.2022

Accepted 15.03.2022

About the Authors

Maria A. Lavrukhina, 4th year student, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, +7(977)575-80-18,
maria.alexandrovna05@mail.ru, 117997, Russian Federation, Moscow, Ostrovityanova str., 1.

Conflicts of interest: The author declares that there are no possible conflicts of interest.
Funding: The investigation has not been sponsored.
For citation: Lavrukhina M.A. Determination of treatment policy
for infertility in patients with ovarian endometrioid cysts.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 5: 23-29 (in Russian)
https://dx.doi.org/10.18565/aig.2022.5.23-29

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.