A study of prevalence, severity, stages, conception rate and associated problems in patients with endometriosis

Endometriosis should be suspected in women with sub-infertility, dysmenorrhea, dyspareunia or chronic pelvic pain. However, these symptoms can also be associated with other diseases. Endometriosis may be asymptomatic even in some women with more advanced disease. The objective of this study was to prevalence, severity, stages, conception rate and associated problems in patients with endometriosis

Present study was retrospective and prospective study from January 2007 to September 2012 which included 200 infertile patients who underwent laparoscopy and were diagnosed with endometriosis in the Department of Obstetrics and Gynecology at Owaisi Hospital and Research Centre, Hyderabad, Telangana, India.

Majority of the patients belonged to the age group of 18-25 years i.e. 45.5%. The most common symptom with which the women presented to the hospital was abnormal uterine bleeding seen in 26% of the cases. Out of total cases, 64% had primary infertility and remaining i.e. 36% had secondary infertility. Ovarian endometrioma was seen in 22% of the cases. Majority of the patients had dysmenorrheal in 62% of the cases. Majority were found out to be present in the stage one or minimal endometriosis i.e. they constituted 78 women which amounted at 39% of the total cases. As the severity of the endometriosis increased, the symptomatic relief rate after laparoscopy decreased. As the severity of the endometriosis increased, the conception rate following laparoscopic laser fulguration decreased. As the severity of the endometriosis increased, the requirement for ART increased.

Laparoscopy is considered to be better than laparotomy since there is less morbidity and less adhesions and tissue trauma. Metrics

Sanfilippo JS, Williams RS, Yussman MA, Cook CL, Bissonnette F. Substance P in peritoneal fluid. Am J Obstet Gynecol. 1992;166(1):155-9. Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertile Steril. 1991;55(4):759-65. Moen MH. Endometriosis in women at interval sterilization. Acta Obstet Gynecol Scand. 1987;66:451-4. Waller KG, Lindsay P, Curtis P, Shaw RW.. The prevalence of endometriosis in women with infertile partners. Eur J Obstet Gynecol Reprod Biol. 1993;48(2):135-9. Haney AF, Muscato JJ, Weinberg JB. Peritoneal fluid cell populations in infertility patients. Fertile Steril. 1981;35(6):696. Oliver DI, Weinberg JB, Haney AF. Peritoneal macrophages and infertility the association between cell number and pelvic pathology. Fertile Steril. 1985;44(6):772. Lebovic DI, Mueller MD, Taylor RN. Immunobiology of endometriosis. Fertile Steril. 2001;75(1):1. Ozkan S, Murk W, Arici A. Endometriosis and infertility: epidemiology and evidence based treatment. Ann New York Acad Sci. 2008;1127(1):92-100. Wheeler JM. Epidemiology of endometriosis associated infertility. J Reprod Med. 1989;34(1):34-6. Bellelis P, Dias Jr JA, Podgaec S, Gonzales M, Baracat EC, Abrão MS Epidemiology and clinical aspects of endometriosis. Rev Assoc Med Bras. 2010;56(4):461-71. Haider G, Rani S, Talpur S, Zehra N, Munir A. Laparoscopic evaluation of female infertility. J Ayub Med Coll Abbottabad. 2010;22(1):136-8. Canis M, Donnez JG, Guzick DS, Halme JK, Rock JA, Schenken RS, et al. American Society for Reproductive Medicine. Revised american society for reproductive medicine classification of endometriosis. Fertility and Sterility. 1997;67(5):817-21. Koninckx PR, Anastasia USSIA. Epidemiology of endometriosis. Available at: http://www.gynsurgery.org/ols/pdf/030101_Epidemiology%20of%20endometriosis.pdf. Accessed 12-10-2012. Bussacca M, Vignali M. Ovarian endometriosis from pathogenesis to surgical treatment. Curr Obstet Gynecol. 2003;15(4):321-6. Das P, Ahuja A, Gupta SD. Incidence, etiopathogenesis and pathological aspects of genitourinary tuberculosis in India. A journey revisited. Indian J Urol. 2008;24(3):356-61. Kyama CM, Overbergh L, Debrock S, Valckx D, Vander Perre S, Meuleman C et al. Increased peritoneal and endometrial gene expression of biologically relevant cytokines and growth factors during the menstrual phase in women with endometriosis. Fertile Steril. 2006;85(6):1667-75. Jefout MA. Laparoscopy for diagnosis and treatment of endometriosis. Advanced Gynecologic Endoscopy. Available at: https://www.intechopen.com/books/advanced-gynecologic-endoscopy/laparoscopy-for-diagnosis-and-treatment-of-endometriosis Accessed 12-10-2012. Paulson JD, Habli M, Alizad A, Borromeo R. The treatment of mild endometriosis with laparoscopy a two-step treatment analysis of patients whose primary therapy was successful. J Soc Laparoendoscopic Surgeons. 2006;10(1):30-6 Ziegler D, Borghese B, Chapron C. Endometriosis and infertility: pathophysiology and management. The Lancet. 2010;376(9742):730-8.