Endoscopia - Aplicação na Infertilidade

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Aula Endoscopia - Aplicação na Infertilidade Gramado 2008

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Endoscopia - Aplicação na Infertilidade

  1. 1. <ul><li>ENDOSCOPIA </li></ul><ul><li>Aplicação na Infertilidade </li></ul><ul><li>Jean Louis Maillard </li></ul><ul><li>Florianópolis - SC </li></ul>
  2. 2. <ul><li>LAPAROSCOPIA </li></ul><ul><li>Histórico </li></ul><ul><li>Palmer , R. final dos anos 50 </li></ul><ul><li>Maillard, J. Caxias do Sul – 1962 </li></ul><ul><li>Varios centros a partir da década de 70 </li></ul><ul><li>Grande “ boom “ após os anos 90 com a video </li></ul>jlm
  3. 3. <ul><li>Infértil: pessoa com atividade sexual sem Método Anticoncepcional que não engravida após um ano de tentativas </li></ul><ul><li>American Reproductive Society, Speroff 1995. </li></ul><ul><li>Fatores principais de ação laparoscópica: </li></ul><ul><li> ovulatório </li></ul><ul><li> tubo-peritoneal </li></ul><ul><li> canalicular </li></ul>ENDOSCOPIA jlm
  4. 4. Utilidade da endoscopia no diagnóstico e tratamento da infertilidade 88 laparoscopia e histeroscopia Infertilidade 1ª Pelve normal Tubas pérvias SOP e Endometriose Infertilidade 2ª Aderências Lesões tubárias 476 laparoscopia Infertilidade 1ª Mal-formações uterinas Infertilidade 2ª Miomas Aderências intra-uterinas 72 histeroscopia 636 pacientes entre 20 a 41 anos Kaminski et al. Neuro Endocrinol Lett; 27(6): 813-17, 2006 Dec
  5. 5. FATOR OVARIANO S O P
  6. 6. FATOR OVARIANO S O P
  7. 7. Efficacy of laparoscopic ovarian drilling for polycystic ovary syndrome resistant to clomiphene citrate <ul><li>Thirty-two women with PCOS resistant to CC who underwent LOD were evaluated . </li></ul><ul><li>After LOD, spontaneous ovulation occurred in 16/19 (84.2%) and 9/13 (69.2%) patients in Groups H and N testosterone, respectively. </li></ul><ul><li>Kato M; Kikuchi I; Shimaniki H; Kobori H; Aida T; Kitade M; Kumakiri J; Takeuchi H </li></ul><ul><li>J Obstet Gynaecol Res ;33(2):174-80, 2007 Apr </li></ul>LAPAROSCOPIA
  8. 8. FATOR PERITONEAL endometriose
  9. 9. Laparoscopic surgery for subfertility associated with endometriosis <ul><li>Meta-analysis of the two randomised trials show improvement in infertility associated with endometriosis with laparoscopic surgery. The largest trial (Marcoux 1997) clearly supports this outcome with an increased chance of pregnancy (OR 2.03, 95% CI 1.28 to 3.24) and ongoing pregnancy rate after 20 weeks (OR 1.95, 95% CI 1.18 to 3.22) </li></ul><ul><li>Reviewers' conclusions </li></ul><ul><li>The use of laparoscopic surgery in the treatment of minimal and mild endometriosis may improve success rates. </li></ul><ul><li>Jacobson TZ, Barlow DH, Koninckx PR, Olive D, Farquhar C. </li></ul><ul><li>Laparoscopic surgery for subfertility associated with endometriosis (Cochrane Review). In: The Cochrane Library, Issue 2, 2007. </li></ul>LAPAROSCOPIA
  10. 10. ENDOMETRIOSE OVARIANA
  11. 11. Fertility after laparoscopic surgery for endometriomas <ul><li>There are a number of published studies documenting pregnancy rates after endoscopic surgery in patients with endometriomas. These reports present similar pregnancy rates regardless of the surgical technique used to treat the cyst. This finding indicates that it does not matter whether the endometrioma is excised or ablated. </li></ul><ul><li>Jones KD; Sutton C </li></ul><ul><li>Hum Fertil (Camb);5(3):117-22, 2002 Aug. </li></ul>LAPAROSCOPIA
  12. 12. ESHRE GUIDELINE FOR THE DIAGNOSIS AND TREATMENT OF ENDOMETRIOSIS LAPAROSCOPIA Laparoscopic cystectomy for ovarian endometriomas >4 cm diameter improves fertility compared to drainage and coagulation (Beretta et al. , 1998; Chapron et al. , 2002) Coagulation or laser vaporization of endometriomas without excision of the pseudo-capsule is associated with a significantly increased risk of cyst recurrence (Vercellini et al. , 2003b). Human Reproduction 2005 20(10):2698-2704 Stephen Kennedy1,10, Agneta Bergqvist2, Charles Chapron3, et al
  13. 13. ESHRE guideline for the diagnosis and treatment of endometriosis <ul><li>Prolonged treatment with a GnRH agonist before IVF in moderate–severe endometriosis should be considered and discussed with patients because improved pregnancy rates have been reported (Rickes et al. , 2002; Surrey et al. , 2002). </li></ul><ul><li>Evidence level 1b </li></ul><ul><li>Human Reproduction 2005 20(10):2698-2704 </li></ul>LAPAROSCOPIA
  14. 14. FATOR PERITONEAL seqüela DIP
  15. 15. FATOR TUBO-PERITONEAL Hidrosalpinge
  16. 16. Adhesions and adhesiolysis: the role of laparoscopy. <ul><li>The majority of studies indicate that laparoscopy may reduce postoperative adhesion formation relative to laparotomy. However, laparoscopy by itself does not appear to eliminate adhesions completely </li></ul><ul><li>Kavic SM; Kavic SM </li></ul><ul><li>JSLS;6(2):99-109, 2002 Apr-Jun. </li></ul><ul><li>Lysis of pelvic adhesions as well as treatment of endometrial implants and endometriomas are now routine laparoscopic procedures with improvement in pregnancy rates comparable to microsurgery. </li></ul><ul><li>The role of laparoscopy in the management of the infertility patient. </li></ul><ul><li>Hawaii Med J ;58(1):10-1, 1999 Jan. </li></ul>LAPAROSCOPIA
  17. 17. FATOR TUBÁRIO avaliação
  18. 18. FATOR TUBÁRIO resolução
  19. 19. Role of laparoscopic salpingostomy in the treatment of hydrosalpinx. <ul><li>Operative laparoscopy may be effective for the correction of hydrosalpinges in selected patients. The probability of achieving an intrauterine or an ectopic pregnancy can be predicted based on combinations of significant variables. </li></ul><ul><li>The overall IUP and EP rates were 24.5% and 16.5%, respectively. </li></ul><ul><li>Taylor RC; Berkowitz J; McComb PF </li></ul><ul><li>Fertil Steril ;75(3):594-600, 2001 Mar. </li></ul>LAPAROSCOPIA
  20. 20. FATOR TUBÁRIO resolução
  21. 21. FATOR TUBÁRIO resolução
  22. 22. FATOR CANALICULAR mioma
  23. 23. <ul><li>HISTEROSCOPIA </li></ul><ul><li>Histórico </li></ul><ul><li>Hinselmann, anos 70 </li></ul><ul><li>Hamou. J, ambulatorial 1979 </li></ul><ul><li>Varios centros, cirúrgica partir da década de 90 </li></ul>jlm
  24. 24. <ul><li>Ação histeroscópica: </li></ul><ul><li> alteração canalicular </li></ul><ul><li>congênita </li></ul><ul><li>adquirida </li></ul>jlm ENDOSCOPIA
  25. 25. <ul><li>SINÉQUIAS </li></ul>jlm
  26. 26. <ul><li>SEPTO </li></ul>jlm
  27. 27. <ul><li>SEPTO </li></ul>jlm jlm
  28. 28. <ul><li>MIOMA </li></ul>jlm
  29. 29. <ul><li>CONCLUSÃO </li></ul><ul><li>Não se concebe nos dias de hoje a atividade de um esterileuta </li></ul><ul><li>sem o uso da ginecoscopia no processo de investigação e do </li></ul><ul><li>tratamento do casal infértil. </li></ul>jlm
  30. 31. jlm Muito Obrigado

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