INVITED SESSION, SESSION 28: MITOCHONDRIA AND ART, Tuesday 5 July 2011 08:30 - 09:30

Introduction: A crucial issue in the long-term management of endometriosis is the possibility of preventing recurrences after conservative surgery. This is of particular importance when ovarian endometriotic cysts are excised. In fact, it is well known that the presence of an endometrioma per se as well as its removal may be both detrimental for future fertility. Moreover, reproductive performance seems significantly worse after repetitive compared with primary surgery, as the probability of conception after second-line surgery for endometriosis appears to be around 25% compared with around 40% after primary procedures. Accordingly, avoiding repetitive damage to the gonads of women with endometriosis would be essential in order to preserve the already reduced reproductive potential. The incidence of disease relapse can be influenced by major demographic changes and by the use of long-term adjuvant medical treatment. Decrease in age at menarche, in number of pregnancies, in duration of breast feeding, and increase in age at first birth, all lead to an increase in the overall number of ovulations and menstruations a woman has within a reproductive lifespan. These mutations impact during the decade at highest risk for endometriosis, i.e. between 25 and 35 years of age, and may substantially expand the hiatus between first-line surgical treatment and conception seeking. Several lines of evidence suggest that ovulation inhibition reduces the risk of endometriosis recurrence. Materials and Methods: A comprehensive literature search was conducted to identify all the English language published comparative studies evaluating the efficacy of long-term ( 12 months) oral contraceptive use after laparoscopic excision of ovarian endometrioma. A combination of keywords was used to identify relevant citations in Medline and Embase. Results: Four studies were identified, three cohort and one randomised, controlled trial, all published in the period 2008-2011. The mean number of subjects enrolled was 240. The patients were followed for a mean period of 24 months in two studies, 28 in one, and 35 in one. After pooling the results, a recurrent endometrioma developed in 40/459 regular users (9%; 95% CI, 6% to 12%) compared with 117/341 never users (34%; 95% CI, 29% to 40%), with a common OR of 0.15 (95% CI, 0.07 to 0.32). Conclusions: After first-line surgery for endometriosis, women should be invited to seek conception as soon as possible. Alternatively, oral contraceptive use until pregnancy is desired should be considered.