Objectives

Endometriosis is defined as the presence of endometrial glands and stroma outside uterine the endometrial cavity and musculature. The most common site of endometriosis is pelvis, but endometrotic implants may occur nearly anywhere in the body. Endometriosis is a common and serious gynecologic problem in reproductive age women, who have pelvic pain, dyspareunia, or infertility. The goal of this research, using immediate medical treatment after surgical procedure to improve the fertility rate in ovarian endometriomas.

ResuLt of fenestration and coagulation of endometriomal cyst

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What is your approach in the treatment of ovarian endometrioma?

Dr.Rasekh Jahromi (MD,Obstetrician & Gynecologist) Jahrom university of medical sciences,Jahrom,Iran. [email protected]

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Methods

200 this clinical trial research evaluates 189 patients with primary infertility during 5 years were operated due to unresponsive to medical therapy. Women aged were 21-35 years. 17 (8.9%) patients who had ovarian endometriom greater than 3cm, which underwent surgical Laparoscopy.

Ovarian endometriomas was diagnosed by vaginal ultrasonography. Ovarian cysts are specified with a view of round and relative thick-wall that is filled with echogenic fluid.

These cysts were persisted despite several menstrual cycles.

The patients were treated medical therapy with endometrioma in size 3-5 cm for three months by combination of contraceptive HD and Danazole(400mg per day). But, they didn’t response. Hormonal assay (AMH, FSH) was done previous operation that was in normal range. Therefore, it was applied the technique of ovarian laparoscopic fenestration and bipolar coagulation of the inner wall of the endometriotic ovarian cyst in 9 to 10 points at 70 watt cutting power and a 40 watt coagulating power setting and pushed into the capsule, as the probe is electricity is activated for 3-4 seconds . At the end of ovarian drilling was cooled down by irrigation using saline normal solution (500-1000cc).

Then treatment was performed with GnRH Agonist for three months.when

menstruation was started , induction of ovulation was begun with clomiphene citrate, and other drugs if need then followed monitoring by ultrasonography, when follicular size were 18-20mm ,HCG was prescribed. The data were analyzed by SPSS.

endometrioma

Results

The patients were followed up about 8 years.13 (76.4 %) patients from 17(8.95%) patients with ovarian endometriomas who had clinical pregnancies rates after 18 months of operation and immediate medical therapy. 10 (58.8%) patients from 13 patients had term pregnancy. 3(30%) of 10 patients had stillbirth initially and their second pregnancy was term. 3(30%) patients had 2 abortions without term pregnancy. 4(23.5%) patients have not conception yet. One (5.8%) of them have had recurrent endometriomal cys t .

Three laparoscopic techniques are present fo treatment of ovarian endometriomas greater than 3 cm diameter: 1-Donnez and Brosens and colleagues, were suggested three stages; 1- drainage of ovarian endometriomas by laparoscopy 2-treatment with GnRH Agonist for three months 3- second laparoscopy for remnant implants by laser vaporization. 2- Sutton and colleagues suggested Laser vaporization of the cyst wall without any medical treatment before surgery in ovarian endometriomas fewer than 10 cm in 1997.3-Canis and Wattiez proposed Laparoscopic ovarian endometriomal cystectomy using the stripping techniques. There is a new debate about determination of AMH levels before and after surgery of endometriotic ovarian cyst and choosing the best method to compare theAMH levels before and after surgery. This method has several research centers including the Center of professor Dannez. It seems to be the lowest rate AMH in the three stages of laparoscopic technique of professor Dannez.

In our study , following to stop the menstrual cycle after surgery for 3 months because the suppressor remnants of endometriotic lesions immediately after laparoscopic surgery, response rates will be better and further in healthy tissues. The fenestration and bipolar coagulation is carried out on the basis of hormone levels; so the rate of follicle damage is reduced. Preservation of ovarian blood supply is an important role in maintaining of follicular reserve .

the fertility outcome is much faster.

Therefore

Conclusions

The application of ovarian laparoscopic fenestration and coagulation of the inner wall of the endometriotic ovarian cyst and immediate medical therapy is suggested. Because Conception occurred more quickly in this technique than ovarian cystectomy in literature (6% versus 22%). Recurrent pain was minimal in this research. But broader research will be needed in this field.

8,95% 76,40% 59% 30% 23,50% 5,80%

150 100 50 0 Ряд1 patients 189 mean age 28 year 5

References

fig: Endometrioma in TVS (Dr.Athar Rasekh)

management method of endometrioma 1000 17 3 10 70 40

Dr Rasekh during laparoscopic Endomtrioic patient procedure in Jahrom Pymanyh Hospital.

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