ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Methods to Improve the Treatment Outcomes for Infertility Associated with Endometriomas

DOI:10.31550/1727-2378-2020-19-1-30-33
For citation: Annenkova E.I., Radzinskiy V.E. Methods to Improve the Treatment Outcomes for Infertility Associated with Endometriomas. Doctor.Ru. 2020; 19(1): 30–33. (in Russian) DOI: 10.31550/1727-2378-2020-19-1-30-33
4 February 11:34

Study Objective: to improve the treatment outcomes of infertility associated with endometriomas, by developing a diagnostic and treatment algorithm.

Study Design: randomised comparative study in parallel groups.

Materials and Methods. 82 women with infertility and endometriomas were evaluated. An infertility diagnostic and treatment algorithm for patients with endometriomas was developed on the basis of previous therapies and taking into account literature data; and its efficiency was tested. Patients were allocated to one of two groups: group 1 — 38 patients managed with a traditional set of diagnostic and therapeutic tools; group 2 — 44 patients managed with the help of our new algorithm. We compared the rate and characteristics of pregnancies depending on the method used to manage patients with endometriomas.

Study Results. In group 1, 14 (36.8%) patients conceived, whereas in group 2, 30 (68.2%) (p = 0.005) patients were pregnant; pregnancies were spontaneous in 6 (42.9%) out of 14 patients in group 1 and in 21 (70.0%) out of 30 patients in group 2 (p = 0.002). The rate of pregnancies after surgical treatment of infertility and endometriomas was 21.4% and 20.0% in group 1 and group 2, respectively. After a repeated surgery, 5 (35.7%) out of 14 patients in group 1 and 3 (10%) patients in group 2 (p = 0.031) managed to conceive.

Conclusion. The clinical efficiency of the new algorithm was demonstrated; it allows automating the selection of the management strategy for patients with endometriomas, reducing the time required for medical decisions, and forecasting infertility treatment outcomes.

Received: 18.09.2019
Accepted: 30.11.19

E.I. Annenkova (Corresponding author) — People’s Friendship University of Russia; 6 Miklukho-Maklay Str., Moscow, Russian Federation 117198. eLIBRARY.RU SPIN: 1246-5632. E-mail: mdannenkova@mail.ru

V.E. Radzinskiy — People’s Friendship University of Russia; 6 Miklukho-Maklay Str., Moscow, Russian Federation 117198. eLIBRARY.RU SPIN: 4507-7510. ORCID: http://orcid.org/0000-0003-956-0466. E-mail: radzinsky@mail.ru

Доктор.ру

Fig. 1. An infertility diagnostic and treatment algorithm for patients with endometriomas

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Fig. 2. Decision support menu prior to patient’s data input

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Fig. 3. Program interface after patient’s data analysis

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Fig. 4. Rate of pregnancies depending on the method used to manage patients with infertility and endometriomas.
* P = 0.005

ris6_4.jpg

4 February 11:34
LITERATURE
  1. Smirnova T.A., Zhukovich A.S. Modern aspects of treatment of endometriotic ovarian cysts is a small size in women of reproductive age. Med. J. 2019; 2: 108–14. (in Russian)
  2. Li X., Zeng C., Zhou Y.F., Yang H.X., Shang J., Zhu S.N. et al. Endometriosis fertility index for predicting pregnancy after endometriosis surgery. Chin. Med. J. (Engl.). 2017; 130(16): 1932–7. DOI: 10.4103/0366-6999.211892
  3. Evans M.B., Decherney A.H. Fertility and endometriosis. Clin. Obstet. Gynecol. 2017; 60(3): 497–502. DOI: 10.1097/GRF.0000000000000295
  4. Meshkova O.A., Digaeva M.A., Bogdanov D.Yu., Saakova A.L. Secondary infertility: incidence and current methods of treatment. Endoscopic Surgery. 2015; 21(4): 69–75. (in Russian). DOI: 10.17116/endoskop201521469-75
  5. Dubrovina S.O., Berlim Yu.D., Krasilnikova L.V., Areshyan K.A., Myachina Yu.M., Voronova O.V. Prediction of recurrence of endometrioid ovarian cysts. Pharmatheca. 2017; 12(345): 51–5. (in Russian)
  6. Di Nisio V., Rossi G., Di Luigi G., Palumbo P., D'Alfonso A., Iorio R. et al. Increased levels of proapoptotic markers in normal ovarian cortex surrounding small endometriotic cysts. Reprod. Biol. 2019; 19(3): 225–9. DOI: 10.1016/j.repbio.2019.08.002
  7. Han S., Lee H., Kim S., Joo J., Suh D., Kim K. et al. Risk factors related to the recurrence of endometrioma in patients with long-term postoperative medical therapy. Ginekol. Pol. 2018; 89(11): 611–17. DOI: 10.5603/GP.a2018.0105
  8. Dunselman G.A., Vermeulen N., Becker C., Calhaz-Jorge C., D'Hooghe T., De Bie B. et al. ESHRE guideline: management of women with endometriosis. Hum. Reprod. 2014; 29(3): 400–12. DOI: 10.1093/humrep/det457
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