SlideShare a Scribd company logo
The Newer Concepts
for
Reduced Surgery to
preserve fertility in
Endometriosis Dr. Sharda Jain
ENDOMETRIOSIS IS ENIGMA
• DIAGNOSTIC DILEMMA
• DEBILITATING DISEASE QOL
• PROGRESSIVE DISEASE
• RECURRENCE IS BIG PROBLEM
• NO FINAL VERDICT ON CAUSE
• NO PERMANENT CURE
• The exact prevalence of endometriosis is unknown, but estimates 10% in the
general female population in India but up to 50% in infertile women
AFS, American Fertility Society.
1. Yovich. Med J Obstet Gynecol 2020;8:1130; 2. Tran et al. Gynecolog Surgery 2012;9:369‒373.
John A. Sampson
provided implantation
hypothesis of
endometriosis1
AFS endometriosis
staging2
Guidelines from
international societies
Histologic
confirmation
of endometriosis
is NOT
mandatory
Progression of Endometriosis Diagnosis Standards
2022
ESHRE, European Society of Human Reproduction and Embryology.
ESHRE: Endometriosis Guideline of European Society of Human Reproduction and Embryology. 2022.
ESHRE 2022 Guidelines
“Laparoscopy is no longer the
diagnostic gold standard and it is
now only recommended in patients
with negative imaging results and/or
where empirical treatment was
unsuccessful or inappropriate.”
Laparoscopy is no longer the diagnostic gold standard
Proprietary and confidential — do not distribute
It is a Significant Shift to more Traditional
Approaches Instead of LAPAROSCOPY
• Now focus on Non-Invasive Diagnostic Methods
• Does not require Laparoscopy for diagnosis.
• Good Gynaecologist should plan Medical
Management for Life
& follow Dictum for SURGERY once in life time / Bet
Caution against Repeated Surgeries .
Proprietary and confidential — do not distribute
MANTRA : Maximizing Medical treatment
optimized and individualized
Whether You & Your patient like it or not
 long-term medical management is
needed until seeking pregnancy
or, sometimes, menopause .
Endometriosis
Life Long Plan
Although many drugs are available for
endometriosis treatment, there is an unmet
need for a therapy that can preserve fertility
while mitigating the endometriosis
progression & associated pain.
Women with
endometriosis are
at risk of decreased
ovarian reserve and
ovarian tissue
damage which can
lead to:
Infertility
Premature ovarian
failure
Reduced response to
ovarian stimulation
Fertility Preservation should be the focus of
Endometriosis therapy in women of 18-40 yrs
Treatment option for Endometriosis
Surgical Medical
To destroy or prevent
the recurrence of
lesions
Adhesiolysis
DIE
Treatment
option for
Endometriosis
Features on Hysterolaparoscopy
• Number, location, and size of the endometriotic plaques, implants, lesions, and cysts are
determined and confirmed by histology although negative histology does not entirely
rule out the disease
Ovarian endometrioma is confirmed by histology or by presence of following features:
• Adhesions to pelvic side wall and/or broad ligament
• Endometriotic spots on ovarian surface
• Thick, tarry, and chocolate colored fluid inside the cyst
Features on Hysterolaparoscopy
Morphology of peritoneal and ovarian implants are characterized as
follows:
• Red (red, red-pink, and clear lesions)
• White (white, yellow-brown, and peritoneal defects)
• Black (black and blue lesions)
Need for Reduced Surgery to
preserve fertility
Infertility & Surgery : ONE & BEST
ESHRE, European Society of Human Reproduction and Embryology.
Becker CM, et al. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009.
The decision to perform surgery should be guided by
the presence or absence of pain symptoms, patient
age and preferences, history of previous surgery,
presence of other infertility factors, ovarian reserve,
and estimated Endometriosis Fertility Index (EFI).
ESHRE
2022
1. SOGC: Leyland et al. J Obstet Gynaecol Can 2010;37:S1–S32; 2. Busacca et al. Ital J Gynaecol Obstet 2018;30:7–21.
● Surgical management encompasses conservative and definitive procedures1
● Surgical management is indicated in the following groups:1,2
►Patients with pelvic pain who have not responded to medical therapy
►Patients who have declined medical therapy or have contraindications to
medical therapy
►Symptomatic patients with confirmed/suspected ovarian endometrioma of
>3 cm diameter or increasing volume
►Patients with functional organ damage (e.g. bowel sub-occlusion/occlusion,
urinary tract impairment with renal function involvement)
Surgery can be indicated for some women but decisions should consider
individual patient needs
1. Duffy et al. Cochrane Database Syst Rev 2014.CD011031; 2. Guo. Hum Reprod Update 2009;15:441–461; 3.
Singh et al. J Obstet Gynaecol Can 2020;42:881–888;
● Systematic reviews of the literature
estimated the recurrence rate of
endometriosis to be 21.5% at 2 years and
40%–50% at 5 years,2 and
● Post-operative pain and pain recurrence
estimated to occur in 25%–34% and 16%–
29% of patients, respectively3
However…
Surgical excision of lesions shown to both improve pain and enhance fertility1
1. 4. Busacca et al. Am J Obstet Gynecol 1999;180:519–523;
5. Koga et al. Hum Reprod 2006;21:2171–2174.
• Recurrence rates of endometrioma after
surgical excision are quite variable, ranging
from 7%‒30%4,5 depending on the duration
of follow-up, criteria for definition of
recurrence and prognostic profile of
patients
However…
Surgical excision of lesions shown to both improve pain and enhance fertility1
1. Ouchi et al. J Obstet Gynaecol Res 2014;40:230–236; 2. SOGC: Leyland et al. J Obstet Gynaecol Can 2010;37:S1–S3; 3. World
Endometriosis Society: Johnson et al. Hum Reprod 2013;28:1552–1568;
4. ESHRE: Endometriosis Guideline of European Society of Human Reproduction and Embryology. 2022
International guidelines recognise the
importance of post-surgical medical
therapy to minimise recurrence of disease2–4
No post-surgical medical therapy
3 years: 23% recurrence1
5 years: 50% recurrence1
Post-surgical medical therapy for endometriosis can minimize the recurrence of disease
ART, assisted reproductive technology; COC, combined oral contraceptive; GnRH, gonadotropin-releasing hormone analogue.
Capezzuoli et al. Reprod Biomed Online. 2021;42:451‒456.
Objective: To identify the role of medical treatment both before and after surgery, with the aim of preventing
endometriosis recurrence and reducing repetitive surgery for recurrence
No hormonal treatment
and after first surgery
N=185 Hormonal treatment after first surgery
n=34
n=75
≥2 years follow-up after surgery
n=76
First
surgery
Hormonal treatment before
(Minimum of 12 months)
Inclusion criteria
● Fertile age (25–45 years)
● Previous surgery for endometriosis
● No desire for pregnancy
● Nulliparity
Exclusion criteria
● Women wishing to become pregnant when the survey was conducted
or those who had previously tried to conceive, both naturally or
through ART
Hormonal treatment:
● Progestins (40%), GnRHa
(30%) or COC (30%)
● Minimum of 12 months before
surgery
● Prolonged for 2 years or more
after surgery
Observational study to determine the effect of long-term hormonal
treatment on the need for repetitive surgery for recurrence of disease
ART, assisted reproductive technology; COC, combined oral contraceptive; GnRH, gonadotropin-releasing hormone analogue.
Capezzuoli et al. Reprod Biomed Online. 2021;42:451‒456.
Compared with women who received hormonal
treatment only after surgery, those receiving
hormonal treatment before and after the first
surgery had:
• Lower incidence of endometriosis recurrence
requiring reoperation (P=0.011)
● Lower rate of current dysmenorrhea (P=0.006)
Key message
“Hormonal treatment is useful as an alternative to surgery,
before surgery to plan better, and after surgery to reduce the
risk of recurrence. These data have several implications in
individualized endometriosis surgery.”
Hormonal treatment before and after surgery reduced the need for
repetitive surgery for disease recurrence
AMH, anti-Mullerian hormone.
Raffi et al. J Clin Endocrinol Metab 2012;97:3146–3154.
Meta-analysis of weighted mean difference in serum AMH
post-surgery for endometrioma
“The results of this study suggest a negative impact of excision of endometriomas on
ovarian reserve as evidenced by a significant postoperative fall in circulating AMH”
How should the impact of excision of endometriomas on ovarian
reserve be minimized?
Surgical Treatment of associated infertility
ESHRE, European Society of Human Reproduction and Embryology; GDG, Guideline Development Group; MRI, magnetic resonance imaging; US, ultrasonography
Becker CM, et al. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009.
Recommendations Strength
Laparoscopy could be offered as a treatment option (in rASRM stage I/II
endometriosis) as it improves the rate of ongoing pregnancy.
Weak
Laparoscopy may be an option in symptomatic patients wishing to conceive in stage
3 & 4 endometriosis. Golden time for ART is 1st 6 months
Weak
ESHRE
2022
Few Tips on Medical
Therapies for
Endometriosis with
Pain & Infertility
Endometriosis Tt : Pain and Ovulation ESHRE
2022
Pain • Ovulation inhibition is not required and is not
necessary for endometriosis-associated pain
treatment.
• NSAIDS are good enough
• There is also some limited evidence that
NSAIDs might inhibit ovulation if taken
continuously during the cycle (making
conception less likely)
Women with endometriosis have a lower
monthly fecundity of about 0.02–0.1 per
month.
Endometriosis is associated with a lower
live birth rate.
Infertile women are 6 to 8 times more likely to
have endometriosis than fertile women.
Endometriosis and Infertility
Bulletti C, et al. J Assist Reprod Genet. 2010;27(8):441–447.
Proprietary and confidential — do not distribute
Doctors dilemma in endometriosis pt coming
for ART- pain and infertility
Pain Infertilityb
Combined oral
contraceptives1
GnRH
analogues4
Surgery1,3 Laparoscopic
surgery5,6 c
Ovulation induction7
ART5
Surgery1,3
Analgesics2 a
Progestogens1
Endometriosis & A R T
ESHRE, European Society of Human Reproduction and Embryology.
Becker CM, et al. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009.
ESHRE
2022
• for endometriosis-associated infertility,
medical therapies that suppress
ovulation in general are ineffective and
should not be used.TIP 1
• Medical Therapy after surgery in
infertile women with endometriosis
clinicians should not prescribe ovarian
suppression treatment to improve
fertility. TIP 2
Infertility
TAKE HOME TIPS :infertility & Endom
ESHRE, European Society of Human Reproduction and Embryology; GDG, Guideline Development Group; MRI, magnetic resonance imaging; US, ultrasonography
Becker CM, et al. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009.
Recommendations Strength
Clinicians should not prescribe ovarian suppression treatment to improve fertility. Strong
Women seeking pregnancy should not be prescribed postoperative hormone suppression
with the sole purpose to enhance future pregnancy rates.
Strong
Women who cannot attempt to conceive immediately after surgery may be offered
hormone therapy (it doesn’t negatively impact fertility and improves the outcome of
surgery for pain).
Weak
Clinicians should not prescribe pentoxifylline, other anti-inflammatory drugs or letrozole
outside ovulation-induction to improve natural pregnancy rates.
Strong
ESHRE
2022
© 2023 Abbott
Proprietary and confidential — do not distribute GLO1167549-2 I July 2023
NEW WAY FOR MORE EFFECTIVE , LESS INVASIVE TT &
IMPROVING QUALITY OF LIFE

More Related Content

Similar to The Newer Concepts for Reduced Surgery to preserve fertility in Endometriosis : Dr Sharda Jain

PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
Lifecare Centre
 
CUNLU_-Recurrent-Endometriosis.ppt
CUNLU_-Recurrent-Endometriosis.pptCUNLU_-Recurrent-Endometriosis.ppt
CUNLU_-Recurrent-Endometriosis.ppt
NazmiMehmeti1
 
Fertility management in ovarian endometrioma
Fertility management in ovarian endometrioma Fertility management in ovarian endometrioma
Fertility management in ovarian endometrioma
Sujoy Dasgupta
 
Recurrent endometriosis
Recurrent endometriosisRecurrent endometriosis
Recurrent endometriosis
Niranjan Chavan
 
Management of endometriosis
Management of endometriosisManagement of endometriosis
Management of endometriosis
obsgynhsnz
 
New frontiers in endometriosis.Prof Salah.Roshdy
New frontiers in endometriosis.Prof Salah.RoshdyNew frontiers in endometriosis.Prof Salah.Roshdy
New frontiers in endometriosis.Prof Salah.Roshdy
Salah Roshdy AHMED
 
Laparoscopy in recurrent endometriosis
Laparoscopy in recurrent endometriosisLaparoscopy in recurrent endometriosis
Laparoscopy in recurrent endometriosis
Niranjan Chavan
 
Current Role of Surgery in Endometriosis; Indications and Progress
Current Role of Surgery in Endometriosis; Indications and ProgressCurrent Role of Surgery in Endometriosis; Indications and Progress
Current Role of Surgery in Endometriosis; Indications and Progress
Crimsonpublisherssmoaj
 
Future Directions in Endometriosis Management 11.04.2021.pptx
Future Directions in Endometriosis Management 11.04.2021.pptxFuture Directions in Endometriosis Management 11.04.2021.pptx
Future Directions in Endometriosis Management 11.04.2021.pptx
Kawita Bapat
 
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...
Sujoy Dasgupta
 
endometriosis - a 21st century enigma
endometriosis - a 21st century enigmaendometriosis - a 21st century enigma
endometriosis - a 21st century enigma
parul sehgal
 
SAVE THE UTERUS
SAVE THE UTERUSSAVE THE UTERUS
Fertility Preserving Hysteroscopic Surgery
Fertility Preserving Hysteroscopic SurgeryFertility Preserving Hysteroscopic Surgery
Fertility Preserving Hysteroscopic Surgery
Sujoy Dasgupta
 
Adenomyosis and Infertility
Adenomyosis and InfertilityAdenomyosis and Infertility
Adenomyosis and Infertility
Anusch Yazdani
 
Endometriosis: A changing paradigm from surgical to medical therapy
Endometriosis: A changing paradigm from surgical to medical therapyEndometriosis: A changing paradigm from surgical to medical therapy
Endometriosis: A changing paradigm from surgical to medical therapy
Mahmoud Abdel-Aleem
 
Fertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsFertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility Specialists
Sujoy Dasgupta
 
Endometriosis and fertility how and when to treat
Endometriosis and fertility how and when to treatEndometriosis and fertility how and when to treat
Endometriosis and fertility how and when to treat
Dr Aditya Keya
 
Management Of Endometriosis Related Infertility By Dr. Abayomi Ajayi
Management Of Endometriosis Related Infertility By Dr. Abayomi AjayiManagement Of Endometriosis Related Infertility By Dr. Abayomi Ajayi
Management Of Endometriosis Related Infertility By Dr. Abayomi Ajayi
abayomi ajayi
 
Endometriosis and Subfertility, Primium non nocere
Endometriosis and Subfertility, Primium non nocereEndometriosis and Subfertility, Primium non nocere
Endometriosis and Subfertility, Primium non nocere
Sujoy Dasgupta
 
Ls,infertility 2007
Ls,infertility 2007Ls,infertility 2007
Ls,infertility 2007
Adnan Dizboyu
 

Similar to The Newer Concepts for Reduced Surgery to preserve fertility in Endometriosis : Dr Sharda Jain (20)

PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
 
CUNLU_-Recurrent-Endometriosis.ppt
CUNLU_-Recurrent-Endometriosis.pptCUNLU_-Recurrent-Endometriosis.ppt
CUNLU_-Recurrent-Endometriosis.ppt
 
Fertility management in ovarian endometrioma
Fertility management in ovarian endometrioma Fertility management in ovarian endometrioma
Fertility management in ovarian endometrioma
 
Recurrent endometriosis
Recurrent endometriosisRecurrent endometriosis
Recurrent endometriosis
 
Management of endometriosis
Management of endometriosisManagement of endometriosis
Management of endometriosis
 
New frontiers in endometriosis.Prof Salah.Roshdy
New frontiers in endometriosis.Prof Salah.RoshdyNew frontiers in endometriosis.Prof Salah.Roshdy
New frontiers in endometriosis.Prof Salah.Roshdy
 
Laparoscopy in recurrent endometriosis
Laparoscopy in recurrent endometriosisLaparoscopy in recurrent endometriosis
Laparoscopy in recurrent endometriosis
 
Current Role of Surgery in Endometriosis; Indications and Progress
Current Role of Surgery in Endometriosis; Indications and ProgressCurrent Role of Surgery in Endometriosis; Indications and Progress
Current Role of Surgery in Endometriosis; Indications and Progress
 
Future Directions in Endometriosis Management 11.04.2021.pptx
Future Directions in Endometriosis Management 11.04.2021.pptxFuture Directions in Endometriosis Management 11.04.2021.pptx
Future Directions in Endometriosis Management 11.04.2021.pptx
 
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...
 
endometriosis - a 21st century enigma
endometriosis - a 21st century enigmaendometriosis - a 21st century enigma
endometriosis - a 21st century enigma
 
SAVE THE UTERUS
SAVE THE UTERUSSAVE THE UTERUS
SAVE THE UTERUS
 
Fertility Preserving Hysteroscopic Surgery
Fertility Preserving Hysteroscopic SurgeryFertility Preserving Hysteroscopic Surgery
Fertility Preserving Hysteroscopic Surgery
 
Adenomyosis and Infertility
Adenomyosis and InfertilityAdenomyosis and Infertility
Adenomyosis and Infertility
 
Endometriosis: A changing paradigm from surgical to medical therapy
Endometriosis: A changing paradigm from surgical to medical therapyEndometriosis: A changing paradigm from surgical to medical therapy
Endometriosis: A changing paradigm from surgical to medical therapy
 
Fertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsFertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility Specialists
 
Endometriosis and fertility how and when to treat
Endometriosis and fertility how and when to treatEndometriosis and fertility how and when to treat
Endometriosis and fertility how and when to treat
 
Management Of Endometriosis Related Infertility By Dr. Abayomi Ajayi
Management Of Endometriosis Related Infertility By Dr. Abayomi AjayiManagement Of Endometriosis Related Infertility By Dr. Abayomi Ajayi
Management Of Endometriosis Related Infertility By Dr. Abayomi Ajayi
 
Endometriosis and Subfertility, Primium non nocere
Endometriosis and Subfertility, Primium non nocereEndometriosis and Subfertility, Primium non nocere
Endometriosis and Subfertility, Primium non nocere
 
Ls,infertility 2007
Ls,infertility 2007Ls,infertility 2007
Ls,infertility 2007
 

More from Lifecare Centre

The Newer Concepts In Endometriosis Management : Dr Sharda Jain
The Newer Concepts In Endometriosis  Management : Dr Sharda JainThe Newer Concepts In Endometriosis  Management : Dr Sharda Jain
The Newer Concepts In Endometriosis Management : Dr Sharda Jain
Lifecare Centre
 
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...
Anemia Free India Gynaecologist  to focuss on *12gm Haemoglobin at Delivery I...Anemia Free India Gynaecologist  to focuss on *12gm Haemoglobin at Delivery I...
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...
Lifecare Centre
 
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
Lifecare Centre
 
Liver Dialogue for Gynaecologists : Dr Sharda Jain
Liver Dialogue for Gynaecologists : Dr Sharda JainLiver Dialogue for Gynaecologists : Dr Sharda Jain
Liver Dialogue for Gynaecologists : Dr Sharda Jain
Lifecare Centre
 
National Tuberculosis elimination programme (NIKSHAY) Big Challenge to GOI : ...
National Tuberculosis elimination programme (NIKSHAY)Big Challenge to GOI : ...National Tuberculosis elimination programme (NIKSHAY)Big Challenge to GOI : ...
National Tuberculosis elimination programme (NIKSHAY) Big Challenge to GOI : ...
Lifecare Centre
 
Innovations & Breakthrough in IVF PART 3
Innovations & Breakthrough in IVF PART 3Innovations & Breakthrough in IVF PART 3
Innovations & Breakthrough in IVF PART 3
Lifecare Centre
 
Strategies for Improving Success Rates in ART PART
Strategies for Improving Success Rates in ART PARTStrategies for Improving Success Rates in ART PART
Strategies for Improving Success Rates in ART PART
Lifecare Centre
 
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
Lifecare Centre
 
Vaccination during Pregnancy & its Importance : Dr Sharda Jain
Vaccination during Pregnancy & its Importance : Dr Sharda JainVaccination during Pregnancy & its Importance : Dr Sharda Jain
Vaccination during Pregnancy & its Importance : Dr Sharda Jain
Lifecare Centre
 
How to optimize success rates in ART? : Dr Sharda Jain
How to optimize success rates in ART? : Dr Sharda JainHow to optimize success rates in ART? : Dr Sharda Jain
How to optimize success rates in ART? : Dr Sharda Jain
Lifecare Centre
 
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
SOCIALEGG FREEZING : Dr Poorva Bhargav  and Dr Sharda JainSOCIALEGG FREEZING : Dr Poorva Bhargav  and Dr Sharda Jain
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Lifecare Centre
 
White Coat Hypertension During Pregnancy : Dr Sharda Jain
White Coat Hypertension During Pregnancy : Dr Sharda JainWhite Coat Hypertension During Pregnancy : Dr Sharda Jain
White Coat Hypertension During Pregnancy : Dr Sharda Jain
Lifecare Centre
 
White Coat hypertension Why it is Important? : Dr Sharda Jain
White Coat hypertension Why it is  Important? : Dr Sharda JainWhite Coat hypertension Why it is  Important? : Dr Sharda Jain
White Coat hypertension Why it is Important? : Dr Sharda Jain
Lifecare Centre
 
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda JainUnderstanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
Lifecare Centre
 
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda JainKnow Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
Lifecare Centre
 
Still Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda JainStill Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda Jain
Lifecare Centre
 
IRON DEFICIENCY ANEMIA OVERVIEW WITH FOCUS ON PARENTRAL IRON THERAPY : Dr ...
IRON DEFICIENCY ANEMIA  OVERVIEW  WITH FOCUS ON PARENTRAL IRON THERAPY  : Dr ...IRON DEFICIENCY ANEMIA  OVERVIEW  WITH FOCUS ON PARENTRAL IRON THERAPY  : Dr ...
IRON DEFICIENCY ANEMIA OVERVIEW WITH FOCUS ON PARENTRAL IRON THERAPY : Dr ...
Lifecare Centre
 
Iron Deficiency Anemia in Pregnancy Role of IV Ferric Carboxymaltose and its ...
Iron Deficiency Anemia in PregnancyRole of IV Ferric Carboxymaltose andits ...Iron Deficiency Anemia in PregnancyRole of IV Ferric Carboxymaltose andits ...
Iron Deficiency Anemia in Pregnancy Role of IV Ferric Carboxymaltose and its ...
Lifecare Centre
 
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
Lifecare Centre
 
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...
Lifecare Centre
 

More from Lifecare Centre (20)

The Newer Concepts In Endometriosis Management : Dr Sharda Jain
The Newer Concepts In Endometriosis  Management : Dr Sharda JainThe Newer Concepts In Endometriosis  Management : Dr Sharda Jain
The Newer Concepts In Endometriosis Management : Dr Sharda Jain
 
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...
Anemia Free India Gynaecologist  to focuss on *12gm Haemoglobin at Delivery I...Anemia Free India Gynaecologist  to focuss on *12gm Haemoglobin at Delivery I...
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...
 
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
 
Liver Dialogue for Gynaecologists : Dr Sharda Jain
Liver Dialogue for Gynaecologists : Dr Sharda JainLiver Dialogue for Gynaecologists : Dr Sharda Jain
Liver Dialogue for Gynaecologists : Dr Sharda Jain
 
National Tuberculosis elimination programme (NIKSHAY) Big Challenge to GOI : ...
National Tuberculosis elimination programme (NIKSHAY)Big Challenge to GOI : ...National Tuberculosis elimination programme (NIKSHAY)Big Challenge to GOI : ...
National Tuberculosis elimination programme (NIKSHAY) Big Challenge to GOI : ...
 
Innovations & Breakthrough in IVF PART 3
Innovations & Breakthrough in IVF PART 3Innovations & Breakthrough in IVF PART 3
Innovations & Breakthrough in IVF PART 3
 
Strategies for Improving Success Rates in ART PART
Strategies for Improving Success Rates in ART PARTStrategies for Improving Success Rates in ART PART
Strategies for Improving Success Rates in ART PART
 
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
 
Vaccination during Pregnancy & its Importance : Dr Sharda Jain
Vaccination during Pregnancy & its Importance : Dr Sharda JainVaccination during Pregnancy & its Importance : Dr Sharda Jain
Vaccination during Pregnancy & its Importance : Dr Sharda Jain
 
How to optimize success rates in ART? : Dr Sharda Jain
How to optimize success rates in ART? : Dr Sharda JainHow to optimize success rates in ART? : Dr Sharda Jain
How to optimize success rates in ART? : Dr Sharda Jain
 
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
SOCIALEGG FREEZING : Dr Poorva Bhargav  and Dr Sharda JainSOCIALEGG FREEZING : Dr Poorva Bhargav  and Dr Sharda Jain
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
 
White Coat Hypertension During Pregnancy : Dr Sharda Jain
White Coat Hypertension During Pregnancy : Dr Sharda JainWhite Coat Hypertension During Pregnancy : Dr Sharda Jain
White Coat Hypertension During Pregnancy : Dr Sharda Jain
 
White Coat hypertension Why it is Important? : Dr Sharda Jain
White Coat hypertension Why it is  Important? : Dr Sharda JainWhite Coat hypertension Why it is  Important? : Dr Sharda Jain
White Coat hypertension Why it is Important? : Dr Sharda Jain
 
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda JainUnderstanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
 
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda JainKnow Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
 
Still Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda JainStill Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda Jain
 
IRON DEFICIENCY ANEMIA OVERVIEW WITH FOCUS ON PARENTRAL IRON THERAPY : Dr ...
IRON DEFICIENCY ANEMIA  OVERVIEW  WITH FOCUS ON PARENTRAL IRON THERAPY  : Dr ...IRON DEFICIENCY ANEMIA  OVERVIEW  WITH FOCUS ON PARENTRAL IRON THERAPY  : Dr ...
IRON DEFICIENCY ANEMIA OVERVIEW WITH FOCUS ON PARENTRAL IRON THERAPY : Dr ...
 
Iron Deficiency Anemia in Pregnancy Role of IV Ferric Carboxymaltose and its ...
Iron Deficiency Anemia in PregnancyRole of IV Ferric Carboxymaltose andits ...Iron Deficiency Anemia in PregnancyRole of IV Ferric Carboxymaltose andits ...
Iron Deficiency Anemia in Pregnancy Role of IV Ferric Carboxymaltose and its ...
 
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
 
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...
 

Recently uploaded

Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa AjmanFriendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
FACIAL NERVE
FACIAL NERVEFACIAL NERVE
FACIAL NERVE
aditigupta1117
 
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTNURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
blessyjannu21
 
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
DrDevTaneja1
 
nurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdfnurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdf
Carolyn Harker
 
Hypotension and role of physiotherapy in it
Hypotension and role of physiotherapy in itHypotension and role of physiotherapy in it
Hypotension and role of physiotherapy in it
Vishal kr Thakur
 
Management of Post Operative Pain: to make doctors conscious about the benefi...
Management of Post Operative Pain: to make doctors conscious about the benefi...Management of Post Operative Pain: to make doctors conscious about the benefi...
Management of Post Operative Pain: to make doctors conscious about the benefi...
Nilima65
 
Pneumothorax and role of Physiotherapy in it.
Pneumothorax and role of Physiotherapy in it.Pneumothorax and role of Physiotherapy in it.
Pneumothorax and role of Physiotherapy in it.
Vishal kr Thakur
 
Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -
Gokul Rangarajan
 
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
Media Logic
 
3. User Guide Activity Budget Tracking App Steps to apply.pptx
3. User Guide Activity Budget Tracking App Steps to apply.pptx3. User Guide Activity Budget Tracking App Steps to apply.pptx
3. User Guide Activity Budget Tracking App Steps to apply.pptx
habtegirma
 
Research, Monitoring and Evaluation, in Public Health
Research, Monitoring and Evaluation, in Public HealthResearch, Monitoring and Evaluation, in Public Health
Research, Monitoring and Evaluation, in Public Health
aghedogodday
 
Innovative Minds France's Most Impactful Healthcare Leaders.pdf
Innovative Minds France's Most Impactful Healthcare Leaders.pdfInnovative Minds France's Most Impactful Healthcare Leaders.pdf
Innovative Minds France's Most Impactful Healthcare Leaders.pdf
eurohealthleaders
 
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...
Pristyn Care Reviews
 
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
5sj7jxf7
 
India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...
India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...
India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...
Kumar Satyam
 
Hypertension and it's role of physiotherapy in it.
Hypertension and it's role of physiotherapy in it.Hypertension and it's role of physiotherapy in it.
Hypertension and it's role of physiotherapy in it.
Vishal kr Thakur
 
nhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdf
nhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdfnhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdf
nhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdf
Carolyn Harker
 
Data-Driven Dispensing- Rise of AI in Pharmacies.pdf
Data-Driven Dispensing- Rise of AI in Pharmacies.pdfData-Driven Dispensing- Rise of AI in Pharmacies.pdf
Data-Driven Dispensing- Rise of AI in Pharmacies.pdf
Jasper Colin
 
The Importance of Black Women Understanding the Chemicals in Their Personal C...
The Importance of Black Women Understanding the Chemicals in Their Personal C...The Importance of Black Women Understanding the Chemicals in Their Personal C...
The Importance of Black Women Understanding the Chemicals in Their Personal C...
bkling
 

Recently uploaded (20)

Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa AjmanFriendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
 
FACIAL NERVE
FACIAL NERVEFACIAL NERVE
FACIAL NERVE
 
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTNURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
 
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
 
nurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdfnurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdf
 
Hypotension and role of physiotherapy in it
Hypotension and role of physiotherapy in itHypotension and role of physiotherapy in it
Hypotension and role of physiotherapy in it
 
Management of Post Operative Pain: to make doctors conscious about the benefi...
Management of Post Operative Pain: to make doctors conscious about the benefi...Management of Post Operative Pain: to make doctors conscious about the benefi...
Management of Post Operative Pain: to make doctors conscious about the benefi...
 
Pneumothorax and role of Physiotherapy in it.
Pneumothorax and role of Physiotherapy in it.Pneumothorax and role of Physiotherapy in it.
Pneumothorax and role of Physiotherapy in it.
 
Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -
 
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
 
3. User Guide Activity Budget Tracking App Steps to apply.pptx
3. User Guide Activity Budget Tracking App Steps to apply.pptx3. User Guide Activity Budget Tracking App Steps to apply.pptx
3. User Guide Activity Budget Tracking App Steps to apply.pptx
 
Research, Monitoring and Evaluation, in Public Health
Research, Monitoring and Evaluation, in Public HealthResearch, Monitoring and Evaluation, in Public Health
Research, Monitoring and Evaluation, in Public Health
 
Innovative Minds France's Most Impactful Healthcare Leaders.pdf
Innovative Minds France's Most Impactful Healthcare Leaders.pdfInnovative Minds France's Most Impactful Healthcare Leaders.pdf
Innovative Minds France's Most Impactful Healthcare Leaders.pdf
 
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...
 
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
 
India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...
India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...
India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...
 
Hypertension and it's role of physiotherapy in it.
Hypertension and it's role of physiotherapy in it.Hypertension and it's role of physiotherapy in it.
Hypertension and it's role of physiotherapy in it.
 
nhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdf
nhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdfnhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdf
nhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdf
 
Data-Driven Dispensing- Rise of AI in Pharmacies.pdf
Data-Driven Dispensing- Rise of AI in Pharmacies.pdfData-Driven Dispensing- Rise of AI in Pharmacies.pdf
Data-Driven Dispensing- Rise of AI in Pharmacies.pdf
 
The Importance of Black Women Understanding the Chemicals in Their Personal C...
The Importance of Black Women Understanding the Chemicals in Their Personal C...The Importance of Black Women Understanding the Chemicals in Their Personal C...
The Importance of Black Women Understanding the Chemicals in Their Personal C...
 

The Newer Concepts for Reduced Surgery to preserve fertility in Endometriosis : Dr Sharda Jain

  • 1. The Newer Concepts for Reduced Surgery to preserve fertility in Endometriosis Dr. Sharda Jain
  • 2. ENDOMETRIOSIS IS ENIGMA • DIAGNOSTIC DILEMMA • DEBILITATING DISEASE QOL • PROGRESSIVE DISEASE • RECURRENCE IS BIG PROBLEM • NO FINAL VERDICT ON CAUSE • NO PERMANENT CURE • The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
  • 3. AFS, American Fertility Society. 1. Yovich. Med J Obstet Gynecol 2020;8:1130; 2. Tran et al. Gynecolog Surgery 2012;9:369‒373. John A. Sampson provided implantation hypothesis of endometriosis1 AFS endometriosis staging2 Guidelines from international societies Histologic confirmation of endometriosis is NOT mandatory Progression of Endometriosis Diagnosis Standards 2022
  • 4. ESHRE, European Society of Human Reproduction and Embryology. ESHRE: Endometriosis Guideline of European Society of Human Reproduction and Embryology. 2022. ESHRE 2022 Guidelines “Laparoscopy is no longer the diagnostic gold standard and it is now only recommended in patients with negative imaging results and/or where empirical treatment was unsuccessful or inappropriate.” Laparoscopy is no longer the diagnostic gold standard
  • 5. Proprietary and confidential — do not distribute It is a Significant Shift to more Traditional Approaches Instead of LAPAROSCOPY • Now focus on Non-Invasive Diagnostic Methods • Does not require Laparoscopy for diagnosis. • Good Gynaecologist should plan Medical Management for Life & follow Dictum for SURGERY once in life time / Bet Caution against Repeated Surgeries .
  • 6. Proprietary and confidential — do not distribute MANTRA : Maximizing Medical treatment optimized and individualized Whether You & Your patient like it or not  long-term medical management is needed until seeking pregnancy or, sometimes, menopause . Endometriosis Life Long Plan
  • 7. Although many drugs are available for endometriosis treatment, there is an unmet need for a therapy that can preserve fertility while mitigating the endometriosis progression & associated pain.
  • 8. Women with endometriosis are at risk of decreased ovarian reserve and ovarian tissue damage which can lead to: Infertility Premature ovarian failure Reduced response to ovarian stimulation Fertility Preservation should be the focus of Endometriosis therapy in women of 18-40 yrs
  • 9. Treatment option for Endometriosis Surgical Medical To destroy or prevent the recurrence of lesions Adhesiolysis DIE Treatment option for Endometriosis
  • 10. Features on Hysterolaparoscopy • Number, location, and size of the endometriotic plaques, implants, lesions, and cysts are determined and confirmed by histology although negative histology does not entirely rule out the disease Ovarian endometrioma is confirmed by histology or by presence of following features: • Adhesions to pelvic side wall and/or broad ligament • Endometriotic spots on ovarian surface • Thick, tarry, and chocolate colored fluid inside the cyst
  • 11. Features on Hysterolaparoscopy Morphology of peritoneal and ovarian implants are characterized as follows: • Red (red, red-pink, and clear lesions) • White (white, yellow-brown, and peritoneal defects) • Black (black and blue lesions)
  • 12. Need for Reduced Surgery to preserve fertility
  • 13. Infertility & Surgery : ONE & BEST ESHRE, European Society of Human Reproduction and Embryology. Becker CM, et al. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. The decision to perform surgery should be guided by the presence or absence of pain symptoms, patient age and preferences, history of previous surgery, presence of other infertility factors, ovarian reserve, and estimated Endometriosis Fertility Index (EFI). ESHRE 2022
  • 14. 1. SOGC: Leyland et al. J Obstet Gynaecol Can 2010;37:S1–S32; 2. Busacca et al. Ital J Gynaecol Obstet 2018;30:7–21. ● Surgical management encompasses conservative and definitive procedures1 ● Surgical management is indicated in the following groups:1,2 ►Patients with pelvic pain who have not responded to medical therapy ►Patients who have declined medical therapy or have contraindications to medical therapy ►Symptomatic patients with confirmed/suspected ovarian endometrioma of >3 cm diameter or increasing volume ►Patients with functional organ damage (e.g. bowel sub-occlusion/occlusion, urinary tract impairment with renal function involvement) Surgery can be indicated for some women but decisions should consider individual patient needs
  • 15. 1. Duffy et al. Cochrane Database Syst Rev 2014.CD011031; 2. Guo. Hum Reprod Update 2009;15:441–461; 3. Singh et al. J Obstet Gynaecol Can 2020;42:881–888; ● Systematic reviews of the literature estimated the recurrence rate of endometriosis to be 21.5% at 2 years and 40%–50% at 5 years,2 and ● Post-operative pain and pain recurrence estimated to occur in 25%–34% and 16%– 29% of patients, respectively3 However… Surgical excision of lesions shown to both improve pain and enhance fertility1
  • 16. 1. 4. Busacca et al. Am J Obstet Gynecol 1999;180:519–523; 5. Koga et al. Hum Reprod 2006;21:2171–2174. • Recurrence rates of endometrioma after surgical excision are quite variable, ranging from 7%‒30%4,5 depending on the duration of follow-up, criteria for definition of recurrence and prognostic profile of patients However… Surgical excision of lesions shown to both improve pain and enhance fertility1
  • 17. 1. Ouchi et al. J Obstet Gynaecol Res 2014;40:230–236; 2. SOGC: Leyland et al. J Obstet Gynaecol Can 2010;37:S1–S3; 3. World Endometriosis Society: Johnson et al. Hum Reprod 2013;28:1552–1568; 4. ESHRE: Endometriosis Guideline of European Society of Human Reproduction and Embryology. 2022 International guidelines recognise the importance of post-surgical medical therapy to minimise recurrence of disease2–4 No post-surgical medical therapy 3 years: 23% recurrence1 5 years: 50% recurrence1 Post-surgical medical therapy for endometriosis can minimize the recurrence of disease
  • 18. ART, assisted reproductive technology; COC, combined oral contraceptive; GnRH, gonadotropin-releasing hormone analogue. Capezzuoli et al. Reprod Biomed Online. 2021;42:451‒456. Objective: To identify the role of medical treatment both before and after surgery, with the aim of preventing endometriosis recurrence and reducing repetitive surgery for recurrence No hormonal treatment and after first surgery N=185 Hormonal treatment after first surgery n=34 n=75 ≥2 years follow-up after surgery n=76 First surgery Hormonal treatment before (Minimum of 12 months) Inclusion criteria ● Fertile age (25–45 years) ● Previous surgery for endometriosis ● No desire for pregnancy ● Nulliparity Exclusion criteria ● Women wishing to become pregnant when the survey was conducted or those who had previously tried to conceive, both naturally or through ART Hormonal treatment: ● Progestins (40%), GnRHa (30%) or COC (30%) ● Minimum of 12 months before surgery ● Prolonged for 2 years or more after surgery Observational study to determine the effect of long-term hormonal treatment on the need for repetitive surgery for recurrence of disease
  • 19. ART, assisted reproductive technology; COC, combined oral contraceptive; GnRH, gonadotropin-releasing hormone analogue. Capezzuoli et al. Reprod Biomed Online. 2021;42:451‒456. Compared with women who received hormonal treatment only after surgery, those receiving hormonal treatment before and after the first surgery had: • Lower incidence of endometriosis recurrence requiring reoperation (P=0.011) ● Lower rate of current dysmenorrhea (P=0.006) Key message “Hormonal treatment is useful as an alternative to surgery, before surgery to plan better, and after surgery to reduce the risk of recurrence. These data have several implications in individualized endometriosis surgery.” Hormonal treatment before and after surgery reduced the need for repetitive surgery for disease recurrence
  • 20. AMH, anti-Mullerian hormone. Raffi et al. J Clin Endocrinol Metab 2012;97:3146–3154. Meta-analysis of weighted mean difference in serum AMH post-surgery for endometrioma “The results of this study suggest a negative impact of excision of endometriomas on ovarian reserve as evidenced by a significant postoperative fall in circulating AMH” How should the impact of excision of endometriomas on ovarian reserve be minimized?
  • 21. Surgical Treatment of associated infertility ESHRE, European Society of Human Reproduction and Embryology; GDG, Guideline Development Group; MRI, magnetic resonance imaging; US, ultrasonography Becker CM, et al. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. Recommendations Strength Laparoscopy could be offered as a treatment option (in rASRM stage I/II endometriosis) as it improves the rate of ongoing pregnancy. Weak Laparoscopy may be an option in symptomatic patients wishing to conceive in stage 3 & 4 endometriosis. Golden time for ART is 1st 6 months Weak ESHRE 2022
  • 22. Few Tips on Medical Therapies for Endometriosis with Pain & Infertility
  • 23. Endometriosis Tt : Pain and Ovulation ESHRE 2022 Pain • Ovulation inhibition is not required and is not necessary for endometriosis-associated pain treatment. • NSAIDS are good enough • There is also some limited evidence that NSAIDs might inhibit ovulation if taken continuously during the cycle (making conception less likely)
  • 24. Women with endometriosis have a lower monthly fecundity of about 0.02–0.1 per month. Endometriosis is associated with a lower live birth rate. Infertile women are 6 to 8 times more likely to have endometriosis than fertile women. Endometriosis and Infertility Bulletti C, et al. J Assist Reprod Genet. 2010;27(8):441–447.
  • 25. Proprietary and confidential — do not distribute Doctors dilemma in endometriosis pt coming for ART- pain and infertility Pain Infertilityb Combined oral contraceptives1 GnRH analogues4 Surgery1,3 Laparoscopic surgery5,6 c Ovulation induction7 ART5 Surgery1,3 Analgesics2 a Progestogens1
  • 26. Endometriosis & A R T ESHRE, European Society of Human Reproduction and Embryology. Becker CM, et al. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. ESHRE 2022 • for endometriosis-associated infertility, medical therapies that suppress ovulation in general are ineffective and should not be used.TIP 1 • Medical Therapy after surgery in infertile women with endometriosis clinicians should not prescribe ovarian suppression treatment to improve fertility. TIP 2 Infertility
  • 27. TAKE HOME TIPS :infertility & Endom ESHRE, European Society of Human Reproduction and Embryology; GDG, Guideline Development Group; MRI, magnetic resonance imaging; US, ultrasonography Becker CM, et al. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. Recommendations Strength Clinicians should not prescribe ovarian suppression treatment to improve fertility. Strong Women seeking pregnancy should not be prescribed postoperative hormone suppression with the sole purpose to enhance future pregnancy rates. Strong Women who cannot attempt to conceive immediately after surgery may be offered hormone therapy (it doesn’t negatively impact fertility and improves the outcome of surgery for pain). Weak Clinicians should not prescribe pentoxifylline, other anti-inflammatory drugs or letrozole outside ovulation-induction to improve natural pregnancy rates. Strong ESHRE 2022
  • 28. © 2023 Abbott Proprietary and confidential — do not distribute GLO1167549-2 I July 2023 NEW WAY FOR MORE EFFECTIVE , LESS INVASIVE TT & IMPROVING QUALITY OF LIFE

Editor's Notes

  1. While medical therapy is effective for relieving pain associated with endometriosis, there is no evidence that medical treatment of endometriosis improves fertility; indeed, fertility is essentially eliminated during treatment because all medical treatments for endometriosis inhibit ovulation3 Age, duration of infertility, pelvic pain, and stage of endometriosis should all be considered when formulating a management plan3 References Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril. 2016 Dec;106(7):1552-1571.e2. doi: 10.1016/j.fertnstert.2016.10.022. Epub 2016 Nov 4. PMID: 27817837. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 Mar;29(3):400-12. doi: 10.1093/humrep/det457. Epub 2014 Jan 15. PMID: 24435778. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012 Sep;98(3):591-8. doi: 10.1016/j.fertnstert.2012.05.031. Epub 2012 Jun 15. PMID: 22704630.
  2. While medical therapy is effective for relieving pain associated with endometriosis, there is no evidence that medical treatment of endometriosis improves fertility; indeed, fertility is essentially eliminated during treatment because all medical treatments for endometriosis inhibit ovulation3 Age, duration of infertility, pelvic pain, and stage of endometriosis should all be considered when formulating a management plan3 References Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril. 2016 Dec;106(7):1552-1571.e2. doi: 10.1016/j.fertnstert.2016.10.022. Epub 2016 Nov 4. PMID: 27817837. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 Mar;29(3):400-12. doi: 10.1093/humrep/det457. Epub 2014 Jan 15. PMID: 24435778. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012 Sep;98(3):591-8. doi: 10.1016/j.fertnstert.2012.05.031. Epub 2012 Jun 15. PMID: 22704630.
  3. Fertility Preservation in women of reproductive age (18–40 years) should be the focus of endometriosis therapy. Women with endometriosis are at risk of decreased ovarian reserve and ovarian tissue damage that can lead to infertility, reduced response to ovarian stimulation, and premature ovarian failure.1,2 Although many drugs are available for endometriosis treatment, there is an unmet need for a therapy that can preserve fertility while mitigating the endometriosis-associated pain. References Carrillo L, Seidman DS, Cittadini E, et al. The role of fertility preservation in patients with endometriosis. J Assist Reprod Genet. 2016;33(3):317–23. Llarena NC, Falcone T, Flyckt RL. Fertility preservation in women with endometriosis. Clin Med Insights Reprod Health. 2019;13:1–8.
  4. Fertility Preservation in women of reproductive age (18–40 years) should be the focus of endometriosis therapy. Women with endometriosis are at risk of decreased ovarian reserve and ovarian tissue damage that can lead to infertility, reduced response to ovarian stimulation, and premature ovarian failure.1,2 Although many drugs are available for endometriosis treatment, there is an unmet need for a therapy that can preserve fertility while mitigating the endometriosis-associated pain. References Carrillo L, Seidman DS, Cittadini E, et al. The role of fertility preservation in patients with endometriosis. J Assist Reprod Genet. 2016;33(3):317–23. Llarena NC, Falcone T, Flyckt RL. Fertility preservation in women with endometriosis. Clin Med Insights Reprod Health. 2019;13:1–8.
  5. References Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N; ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. doi: 10.1093/hropen/hoac009. PMID: 35350465; PMCID: PMC8951218.
  6. References Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N; ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. doi: 10.1093/hropen/hoac009. PMID: 35350465; PMCID: PMC8951218.
  7. References Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N; ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. doi: 10.1093/hropen/hoac009. PMID: 35350465; PMCID: PMC8951218.
  8. Endometriosis is closely linked with infertility. In normal couples, fecundity is in the range of 0.15 to 0.20 per month and decreases with age. Women with endometriosis tend to have a lower monthly fecundity of about 0.02–0.1 per month. Also, endometriosis is associated with a lower live birth rate. Infertile women are six to eight times more likely to have endometriosis than fertile women. Reference Bulletti C, Coccia ME, Battistoni S, et al. Endometriosis and infertility. J Assist Reprod Genet. 2010;27(8):441–447.
  9. The medical management of endometriosis is targeted towards controlling pain and suppression of the hormonally active endometriotic tissue1 Hormonal therapies that rely on suppression of the endometriotic tissue include combined oral contraceptives, progesterone-only contraceptives, gonadotropin-releasing hormone (GnRH) agonists, aromatase inhibitors, and danazol.1 However, they are limited by their side effects and negative impact on fertility1 Management of infertility in women with endometriosis is a complex issue and needs to take into account age, duration of infertility, severity of symptoms, and stage of the disease1 References Rafique S, Decherney AH. Medical Management of Endometriosis. Clin Obstet Gynecol. 2017 Sep;60(3):485-496. doi: 10.1097/GRF.0000000000000292. PMID: 28590310; PMCID: PMC5794019. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 Mar;29(3):400-12. doi: 10.1093/humrep/det457. Epub 2014 Jan 15. PMID: 24435778 Leonardi M, Gibbons T, Armour M, Wang R, Glanville E, Hodgson R, Cave AE, Ong J, Tong YYF, Jacobson TZ, Mol BW, Johnson NP, Condous G. When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2020 Feb;27(2):390-407.e3. doi: 10.1016/j.jmig.2019.10.014. Epub 2019 Oct 31. PMID: 31676397. Rzewuska AM, et al. Gonadotropin-Releasing Hormone Antagonists—A New Hope in Endometriosis Treatment? Journal of Clinical Medicine. 2023; 12(3) Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019 Nov;15(11):666-682. doi: 10.1038/s41574-019-0245-z. Epub 2019 Sep 5. PMID: 31488888. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020 Mar 26;382(13):1244-1256. doi: 10.1056/NEJMra1810764. PMID: 32212520. Deaton JL, Gibson M, Blackmer KM, Nakajima ST, Badger GJ, Brumsted JR. A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 1990;54(6):1083–1088. doi: https://doi.org/10.1016/S0015-0282(16)54009-6 Carrillo L, Seidman DS, Cittadini E, Meirow D. The role of fertility preservation in patients with endometriosis. J Assist Reprod Genet. 2016 Mar;33(3):317-323. doi: 10.1007/s10815-016-0646-z. Epub 2016 Jan 14. PMID: 26768141; PMCID: PMC4785156.
  10. References Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N; ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. doi: 10.1093/hropen/hoac009. PMID: 35350465; PMCID: PMC8951218.
  11. References Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N; ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. doi: 10.1093/hropen/hoac009. PMID: 35350465; PMCID: PMC8951218.