Fertility Preservation in Women with Ovarian Endometriomas

In: Fertility Preservation · 2021 · pp. 79–89 · doi:10.1017/9781108784368.009 · W3150365027
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This paper reviews the three forms of endometriosis and their pathogenesis, focusing on ovarian endometriosis and fertility preservation.

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This chapter discusses fertility preservation options for women with ovarian endometriomas, framing how endometriosis affects ovarian reserve and how fertility-preserving approaches such as assisted reproduction and ovarian cryopreservation can be considered in non-cancer contexts. At a high level, it synthesizes evidence on the mechanisms by which intraovarian endometriomas can lead to follicle loss and reduced ovarian reserve, and it also describes relevant surgical and cryobiology principles used to preserve reproductive potential. A major caveat highlighted in the broader discussion is that the impact of ovarian endometrioma surgery on ovarian reserve can vary, and outcomes depend on factors such as disease severity and surgical technique, making results difficult to generalize. This paper is centrally about endometriosis — it focuses specifically on fertility preservation strategies in women with ovarian endometriomas.

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Abstract

Endometriosis is a benign estrogen-dependent gynecological disease, known to occur in 7–10% of women of childbearing age [1, 2]. This percentage may rise to 30–50% if only women presenting with pelvic pain and infertility are taken into account [3]. The condition is histopathologically defined as the presence of endometrial tissue (glands and stroma) in ectopic locations outside the uterine cavity. It is now widely recognized that three different forms of endometriosis can occur in the pelvis, namely peritoneal endometriosis, ovarian endometriosis, and deep endometriotic nodules of the rectovaginal septum, each with its own pathogenesis [4].
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Fertility Preservation Buy print or eBook [Opens in a new window] Principles and Practice - Fertility Preservation - Fertility Preservation - Copyright page - Dedication - Contents - Contributors - Foreword - Foreword - Preface - Section 1 Introduction - Section 2 Reproductive Biology and Cryobiology - Section 3 Fertility Preservation in Cancer and Non-Cancer Patients - Chapter 7 Fertility Preservation in Non-Cancer Patients - Chapter 8 Fertility Preservation in Women with Ovarian Endometriomas - Chapter 9 Pediatric Cancer Therapy and Fertility - Chapter 10 Breast Cancer Therapy and Fertility - Chapter 11 Fertility Preservation in Young Adults with Gastrointestinal and Hematological Malignancies - Section 4 Fertility Preservation Strategies in the Male - Section 5 Fertility Preservation Strategies in the Female: Medical/Surgical - Section 6 Fertility Preservation Strategies in the Female: ART - Section 7 Ovarian Cryopreservation and Transplantation - Section 8 In Vitro Follicle Culture - Section 9 New Research and Technologies - Section 10 Ethical, Legal, and Religious Issues - Index - References From Surgery to Oocyte and Ovarian Tissue Freezing from Section 3 - Fertility Preservation in Cancer and Non-Cancer Patients Published online by Cambridge University Press: 27 March 2021 Book contents - Fertility Preservation - Fertility Preservation - Copyright page - Dedication - Contents - Contributors - Foreword - Foreword - Preface - Section 1 Introduction - Section 2 Reproductive Biology and Cryobiology - Section 3 Fertility Preservation in Cancer and Non-Cancer Patients - Chapter 7 Fertility Preservation in Non-Cancer Patients - Chapter 8 Fertility Preservation in Women with Ovarian Endometriomas - Chapter 9 Pediatric Cancer Therapy and Fertility - Chapter 10 Breast Cancer Therapy and Fertility - Chapter 11 Fertility Preservation in Young Adults with Gastrointestinal and Hematological Malignancies - Section 4 Fertility Preservation Strategies in the Male - Section 5 Fertility Preservation Strategies in the Female: Medical/Surgical - Section 6 Fertility Preservation Strategies in the Female: ART - Section 7 Ovarian Cryopreservation and Transplantation - Section 8 In Vitro Follicle Culture - Section 9 New Research and Technologies - Section 10 Ethical, Legal, and Religious Issues - Index - References Endometriosis is a benign estrogen-dependent gynecological disease, known to occur in 7–10% of women of childbearing age [1, 2]. This percentage may rise to 30–50% if only women presenting with pelvic pain and infertility are taken into account [3]. The condition is histopathologically defined as the presence of endometrial tissue (glands and stroma) in ectopic locations outside the uterine cavity. It is now widely recognized that three different forms of endometriosis can occur in the pelvis, namely peritoneal endometriosis, ovarian endometriosis, and deep endometriotic nodules of the rectovaginal septum, each with its own pathogenesis [4]. Although the clinical presentation of endometriosis includes dysmenorrhea (painful menstruation), dyspareunia (painful sexual intercourse), and chronic pelvic pain, infertility is still regarded as the biggest concern for endometriosis patients [5, 6]. The presence of intraovarian endometriomas in particular can cause follicle loss, diminishing the ovarian reserve and consequently leading to infertility [7, 8]. - Type - Chapter - Information - Fertility PreservationPrinciples and Practice, pp. 79 - 89Publisher: Cambridge University PressPrint publication year: 2021 Wheeler, JM. Epidemiology of endometriosis-associated infertility. J Reprod Med, 1989;34(1):41–46.Google ScholarPubMed Rogers, PA, D’Hooghe, TM, Fazleabas, A et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci, 2009;16(4):335–346.Google Scholar Nisolle, M, Donnez, J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril, 1997;68(4):585–596.Google Scholar Seyhan, A, Ata, B, Uncu, G. The impact of endometriosis and its treatment on ovarian reserve. 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