European Gynecology and obstetrics congress

Biography:

Director Emeritus of the Obstetric-Gynecological Department of the Hospital of Clusone (Bergamo - Italy). Since 2014 Head of the medical clinic for the diagnosis and treatment of Endometriosis and since 2017 Referent of the Multidisciplinary Team for Endometriosis care at the Policlinic San Pietro (San Donato Group) in Ponte San Pietro (Bergamo - Italy).

 

 

 

Abstract:

Ovarian endometrioma is a particular anatomopathological entity in the context of endometriotic pathology. The ovary is the organ most frequently affected by endometriosis and in 30% of cases the pathology is bilateral. The effect of endometriosis on fertility is varied; however, women with severe endometriosis and the presence of endometriomas appear to have significantly lower pregnancy rates following IVF treatment when compared with women with severe endometriosis but without endometriomas.The endometrioma transforms the macro- and microenvironment in the ovary to a highly inflammatory one. The endometriotic tissue may secrete several products, including cytokines, chemokines, and growth factors. These substances may activate specific signaling pathways in the follicular cells, leading to premature follicular development and accelerated atresia. Surgical treatment is indicated if the endometrioma becomes symptomatic and increases in size despite medical therapy, and in cases of related infertility.However, endometrioma surgery can reduce the follicular reserve either through stripping that does not take into account the correct cleavage plan and involves an exaggerated “traction-counter traction”, or with an indiscriminate electro-hemostasis or, with a too narrow suture that causes ischemia.In consideration of this important issues we have organized a surgical technique that tries to safeguard as much as possible the follicular reserve of the ovary affected by endometrioma.The highlights of the technique are: a meticulous search for the correct cleavage plan, stripping replacement with cautious detachment and hemostasis of vascular connections performed directly on the cystic wall, use of a hemostatic adhesive and abolition of electroemostasis.The three-month follow-up includes an early follicular transvaginal ultrasound with antral follicle count. Continuous progestin or estroprogestin therapy is prescribed, except for women who wish to become pregnant. If the pregnancy does not begin within 6 months the AMH dosage is requested for a possible sending to a PMA center.