Endométriose et stérilité : nouvelle approche diagnostique et thérapeutique par laparoscopie

H Frangenheim, Th. Frangenheim, N. Schroer, Margit Schröer
In: Acta Endoscopica · 1985 · vol. 15(1) , pp. 51–58 · doi:10.1007/bf02966114 · W2242186542
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A 10-year study of 914 infertile patients found endometriosis in 32%, with 29% achieving pregnancy after treatment, and suggested pregnancy outcomes depend on other tubal lesions' extent.

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This paper reports a 10-year analysis (1968–1977) of 914 cases of infertility established by laparoscopy, assessing the incidence of endometriosis and related pregnancy outcomes after surgical or hormonal therapy, including antigonadotropic treatment such as Danazol. Endometriosis was present in 32% of patients, and 29% of those with endometriosis achieved pregnancy following treatment. The authors conclude that endometriosis by itself does not influence the outcome of infertility treatment, and this finding also held when endometriosis co-occurred with other tubal disorders. They propose staging into incipient, moderate, and advanced disease, and report that conception chances in cases with additional tubal lesions were mainly determined by the extent and localization of adhesions. This paper is centrally about endometriosis — it evaluates laparoscopy-detected endometriosis in infertile patients and links pregnancy outcomes to disease stage and adhesion extent/location.

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Abstract

Les nouvelles possiblités de traitement de l’endométriose sont devenues possibles depuis l’introduction des hormones antigona-dotrophiques (Danazol). Une étude sur 10 ans (1968–1977) de 914 cas de stérilité établie par laparoscopie, montre une incidence de l’endométriose chez 32 % des patientes. Parmi ces cas, 29% présentent une grossesse après thérapeutique chirurgicale ou hormonale. L’endométriose par elle-même, comparée à d’autres causes de stérilité féminine, n’influence pas l’issue du traitement de la stérilité. Cette absence se retrouve si l’endométriose est associée a d’autres anomalies tubaires. Un classement de l’endométriose en 3 stades a été proposé : endométriose au début (stade I), modérée (stade II) et avancée (stadeIII). Les chances de grossesse en cas d’endométriose associée à d’autres lésions tubaires sont avant tout déterminées par l’extension et la localisation des adhérences.
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RéSUMé Les nouvelles possiblités de traitement de l’endométriose sont devenues possibles depuis l’introduction des hormones antigona-dotrophiques (Danazol). Une étude sur 10 ans (1968–1977) de 914 cas de stérilité établie par laparoscopie, montre une incidence de l’endométriose chez 32 % des patientes. Parmi ces cas, 29% présentent une grossesse après thérapeutique chirurgicale ou hormonale. L’endométriose par elle-même, comparée à d’autres causes de stérilité féminine, n’influence pas l’issue du traitement de la stérilité. Cette absence se retrouve si l’endométriose est associée a d’autres anomalies tubaires. Un classement de l’endométriose en 3 stades a été proposé : endométriose au début (stade I), modérée (stade II) et avancée (stadeIII). Les chances de grossesse en cas d’endométriose associée à d’autres lésions tubaires sont avant tout déterminées par l’extension et la localisation des adhérences. Summary New aspects in the treatment of infertility due to endometriosis have arisen from the introduction of antigonadotropic hormones ( = Danazol). A 10 year study (1968–1977 of 914 cases of laparoscopically established infertility has shown the presence of endometriosis in 32 % of the patients. Of these, 29 % became pregnant following surgical or hormonal therapy. This is evidence for the fact that endometriosis per se - as compared with other causes of female infertility - does not influence the outcome of infertility treatment. The same is true if endometriosis is found in the presence of other tubal disorders. To classify endometriosis, we recommend three stages, incipient (stage I), moderate (stage II) and advanced (stageIII). The chances of conception in endometriosis associated with other tubal disorders are predominantly determined by the extent and localization of adhesions. Références -ACOSTA A., BUTTRAM V.C. Jr., MALINAK L.R., BESCH P.G., FRANKLIN R.R.- The use of synthetic luteinizing hormone-releasing hormone in induction of ovulation.Fertil. and Steril., 1975,26, 1173–1177. -AUDEBERT A.J.M., EMPERAIRE J.C., LARUE- CHARLUS S. -Endometriosis and sterility: review of 50 cases treated with Danazol. Vortr. E.S.C.O., Venedig, 1978. -BUTTRAM V.C. - Conservative surgery for endometriosis in the infertile female: a study of 206 patients with implications for both medical and surgical therapy.Fertil and Steril., 1979,31, 117–123. -DMOWSKI W.P., COHEN, M.R. - Treatment of endometriosis with an antigonadotropin, Danazol. A laparoscopic and histologic evaluation.Obstet. and Gynec, 1975,46, 147–154. -FRANGENHEIM H. -Die Laparoskopie bei der Diagnostik und Therapie des Tubensterilität.In: Fortschritte der Sterilitätsforschung, Band 2, S. 19–25, Grosse, Berlin, 1971. -FRANGENHEIM H. -Möglichkeiten und Grenzen der laparoskopischen Diagnostik des Ovarialfaktors bei der Sterilitätsuntersuchung.In: Fortschritte der Fertilitätsforschung, S. 208–215, Grosse, Berlin, 1975. -HUSSLEIN H. - Die medikamentöse Behandlung der Endometriose.Arch. Gynäk., 1969,207, 265–271. -KISTNER R.W. - Management of endometriosis in the infertile patient.Fertil. and Steril., 1975,26, 1151–1166. -MITCHELL G.W., FARBER, M. -Medical versus surgical management of endometriosis. In: Reid D., Christian C., Controversy in obstetrics and gynecology. Vol. 2, Saunders, Philadelphia, 1974. -SchrÖer N. -Neue Erkenntnisse über die Therapie der weiblichen Sterilität. Ergebnisse einer retrospektiven Computeranalyse. Inaug. Diss., Freiburg, 1982. -SWOLIN K. - Electromicrosurgery and salpingostomy: long-term results.Amer. J. Obstet. Gynec., 1975,121, 418–419. -GLATTHAAR E. -Klinik und Therapie der Endometriose.In: Gynäkolog, u. Geburtsh. Band III, spezielle Gynäkologie, S. 762, Thieme-Verlag, Stuttgart, 1972. -JAVERT CT. - Observations on the pathology and spread of endometriosis based on the theory of benign metastasis.Amer. J. Obstet. Gynec, 1951,62, 477. -SCOTT R.B., TELINDE R.W. - External endometriosis - the scourge of the private patient.Ann. Aurg., 1950,131, 697. -MEIGS J.V. - Endometriosis. Etiologic role of marriage age and parity ; conservative treatment.Obstet, and Gynec, 1953,2, 46. Author information Authors and Affiliations About this article Cite this article Frangenheim, H., Frangenheim, T., Schroer, N. et al. Endométriose et stérilité : nouvelle approche diagnostique et thérapeutique par laparoscopie. Acta Endosc 15, 51–58 (1985). https://doi.org/10.1007/BF02966114 Issue date: DOI: https://doi.org/10.1007/BF02966114

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