The effect of sclerotherapy and pre-pregnancy training with inositol and vitamin D3 on the size and number of cysts in women with infertility on the background of endometriosis

I. I. Kulik, S. V. Khmil
In: Reports of Vinnytsia National Medical University · 2020 · vol. 24(3) , pp. 444–448 · doi:10.31393/reports-vnmedical-2020-24(3)-12 · W3134639954
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Sclerotherapy combined with inositol and vitamin D3 supplementation significantly reduced ovarian cyst diameter in women with endometriosis-associated infertility compared to baseline and cystectomy.

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The study evaluated women aged 22–40 with endometriosis-associated infertility (n=105) by measuring ultrasound-confirmed endometrioid ovarian cyst diameters before and after transvaginal sclerotherapy, with some participants also receiving pre-pregnancy training using an inositol/vitamin D3 preparation (FT 500 plus and vitamin D3 dosed as prophylactic or therapeutic depending on vitamin D hypovitaminosis). Sclerotherapy involved transvaginal puncture and aspiration followed by intracapsular injection of 76% ethanol under transvaginal ultrasound guidance without disrupting cyst integrity. After sclerotherapy plus inositol/vitamin D3, cyst diameters in the right and left ovaries were reported to probably decrease relative to pre-sclerotherapy values, and the paper also compared outcomes with groups undergoing different surgery histories (sclerotherapy vs cystectomy). This paper is centrally about endometriosis — it specifically investigates how sclerotherapy combined with inositol and vitamin D3 affects ovarian endometrioid cyst size in women with endometriosis-associated infertility.

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Abstract

Annotation. Among gynecological diseases, external genital endometriosis leads to disorders of reproductive function and promotes the development of infertility. Currently, the search for less traumatic and more effective treatments for endometriosis continues. The aim of our study was to analyze the diameter of endometrioid cysts in women with infertility on the background of endometriosis before and after sclerotherapy using pre-pregnancy preparation of a complex vitamin preparation with inositol and vitamin D3. The study included 105 women aged 22 to 40 years with endometriosis-associated infertility. The presence of cysts was confirmed by ultrasound and bimanual examination. The drug FT 500 plus was prescribed in a dosage of 1 sachet – once a day from the 2nd or 3rd day of the cycle for 2 menstrual cycles (the cycle in which sclerotherapy was performed and the next cycle). Vitamin D3 “EuTilia D3” was prescribed in prophylactic doses of 2000 IU to women, or therapeutic (depending on the diagnosed or refuted diagnosis of vitamin D hypovitaminosis). The sclerotherapy procedure was performed by transvaginal puncture of the cyst and aspiration of its contents under the control of transvaginal ultrasound, introduction into the capsule of the cyst (without violating its integrity) 76% ethanol solution. It was found that women with endometriosis-associated infertility, who underwent pre-pregnancy preparation with a complex vitamin preparation with inositol and vitamin D3 after sclerotherapy, probably decreased the diameter of cysts in the right (5.85 times) and left (5.57 times) ovaries relative to data before sclerotherapy. When comparing the diameter of cysts in women who underwent pre-pregnancy preparation with a complex vitamin preparation with inositol and vitamin D3, depending on the type of surgery (sclerotherapy or cystectomy) found a probable decrease in the diameter of cysts after sclerotherapy in the right (82.89%) and left (82.05%) ovaries for such data after cystectomy. Therefore, sclerotherapy with pregravidar preparation with a complex vitamin preparation with inositol and vitamin D3 in women with endometriosis-associated infertility probably reduces the diameter of cysts relative to the experimental group without pregravidar preparation, as well as to the group with a history of cystectomy.
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The effect of sclerotherapy and pre-pregnancy training with inositol and vitamin D3 on the size and number of cysts in women with infertility on the background of endometriosis DOI: https://doi.org/10.31393/reports-vnmedical-2020-24(3)-12Keywords: infertility, genital endometriosis, sclerotherapy, inositol, vitamin D3 preparation, efficacy.Abstract Annotation. Among gynecological diseases, external genital endometriosis leads to disorders of reproductive function and promotes the development of infertility. Currently, the search for less traumatic and more effective treatments for endometriosis continues. The aim of our study was to analyze the diameter of endometrioid cysts in women with infertility on the background of endometriosis before and after sclerotherapy using pre-pregnancy preparation of a complex vitamin preparation with inositol and vitamin D3. The study included 105 women aged 22 to 40 years with endometriosis-associated infertility. The presence of cysts was confirmed by ultrasound and bimanual examination. The drug FT 500 plus was prescribed in a dosage of 1 sachet – once a day from the 2nd or 3rd day of the cycle for 2 menstrual cycles (the cycle in which sclerotherapy was performed and the next cycle). Vitamin D3 “EuTilia D3” was prescribed in prophylactic doses of 2000 IU to women, or therapeutic (depending on the diagnosed or refuted diagnosis of vitamin D hypovitaminosis). The sclerotherapy procedure was performed by transvaginal puncture of the cyst and aspiration of its contents under the control of transvaginal ultrasound, introduction into the capsule of the cyst (without violating its integrity) 76% ethanol solution. It was found that women with endometriosis-associated infertility, who underwent pre-pregnancy preparation with a complex vitamin preparation with inositol and vitamin D3 after sclerotherapy, probably decreased the diameter of cysts in the right (5.85 times) and left (5.57 times) ovaries relative to data before sclerotherapy. When comparing the diameter of cysts in women who underwent pre-pregnancy preparation with a complex vitamin preparation with inositol and vitamin D3, depending on the type of surgery (sclerotherapy or cystectomy) found a probable decrease in the diameter of cysts after sclerotherapy in the right (82.89%) and left (82.05%) ovaries for such data after cystectomy. Therefore, sclerotherapy with pregravidar preparation with a complex vitamin preparation with inositol and vitamin D3 in women with endometriosis-associated infertility probably reduces the diameter of cysts relative to the experimental group without pregravidar preparation, as well as to the group with a history of cystectomy. Downloads References 2. Yarmolunskaya, M. I. (2017). Genitalnuy endometryoz. Razlichnuye granyi problemu [Genital endometriosis. Various facets of the problem]. Eco Vector. ISBN: 978-5-906648-47-1 3. Ahmad, G., O’Flynn, H., Duffy, J. M., Phillips, K., Watson, A. (2012). Laparoscopic entry techniques. Cochrane Database Syst. Rev., 2, doi: 10.1002/14651858.CD006583.pub3 4. Albanese, G., & Kondo, K. L. (2010). Pharmacology of sclerotherapy. Semin Intervent Radiol., 27 (4), 391–99. doi: 10.1055/s-0030-1267848 5. Anastasi, E., Fuggetta, E., De Vito, C., Migliara, G., Viggiani, V., Manganaro, L., & Porpora, M. G. (2017). Low levels of 25-OH vitamin D in women with endometriosis and associated pelvic pain. Clin. Chem. Lab. Med., 55 (12), e282–e284. doi: 10.1515/cclm-2017-0016 6. Elhussein, O. G., Ahmed, M. A., Suliman, S. O., Yahya, L. I., & Adam, I. (2019). Epidemiology of infertility and characteristics of infertile couples requesting assisted reproduction in a low-resource setting in Africa, Sudan. Fertil Res. and Pract., 5 (7). DOI: https://doi.org/10.1186/s40738-019-0060-1 7. García-Tejedor, A., Castellarnau, M., Ponce, J., Fernández, M. E., & Burdio, F. (2015). Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results. EJOG., 187, 25–29. doi: 10.1016/j.ejogrb.2015.02.004 8. Giudice, L. C. (2010). Clinical practice. Endometriosis. N. Engl. J. Med., 362 (25), 2389-98. doi: 10.1056/NEJMcp1000274 9. Imanaka, S., Maruyama, S., Kimura, M., Nagayasu, M., & Kobayashi, H. (2020). Towards an understanding of the molecular mechanisms of endometriosis-associated symptoms (Review). World Acad. Sci. J., 2 (12), 2–14. https://doi.org/10.3892/wasj.2020.53 10. Kennedy, S., Bergqvist, A., Chapron, C., D'Hooghe, T., Dunselman, G., Greb, R., … & Saridogan, E. (2005). ESHRE guideline for the diagnosis and treatment of endometriosis. Hum. Repro., 20 (10), 2698–2704. doi: 10.1093/humrep/dei135 11. Khmil M., Khmil, S., & Marushchak, M. (2020). Hormone Imbalance in Women with Infertility Caused by Polycystic Ovary Syndrome: Is There a Connection with Body Mass Index? Open Access Macedonian Journal of Medical Sciences, 8 (B), 731–37. DOI: https://doi.org/10.3889/oamjms.2020.4569 12. Kichang Han, Seok Kyo Seo, & Do Yun Lee. (2018). Catheter-directed Sclerotherapy for Ovarian Endometrioma: Short-term Outcomes. Radiology, 289 (3), 854–859. https://doi.org/10.1148/radiol.2018180606 13. Laganà, A. S., Garzon, S., & Unfer, V. (2020). New clinicaltargets of d-chiro-inositol: rationale and potential applications. Expert Opinion on Drug Metabolism & Toxicology, 16 (8), 703–710. DOI: 10.1080/17425255.2020.1785429 14. Lee, D., Kim, S. K., Lee, J. R., & Jee, B. C. (2020). Management of endometriosis-related infertility: Considerations and treatment options. Clin. Exp. Reprod. Med., 47 (1), 1–11. doi:10.5653/cerm.2019.02971 15. Matsuzaki, S., Houlle, C., & Darcha, C. (2009). Analysis of risk factors for the removal of normal ovarian tissue during laparoscopic cystectomy for ovarian endometriosis. Human Reproduction, 24 (6), 1402–06. doi: 10.1093/humrep/dep043 16. Vitagliano, A., Noventa, M., & Gizzo, S. (2015). Is it time to consider patients suffering from endometriosis-related infertility as “novel candidates” for targeted peri-conceptional D-chiro inositol supplementation? Hypothesis, rationale and some considerations. J. Assist. Reprod. Genet., 32 (3), 407–408. doi:10.1007/s10815-014-0412-z

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