Effect on ovulation of surgically induced endometriosis in rabbits

To study the effect of endometriosis on follicular rupture, endometrial tissue was autografted to New Zealand White rabbits. Endometrium was surgically implanted into the peritoneal cavity or into the rectus muscle. Human chorionic gonadotropin was administered to induce ovulation. During three subsequent laparotomies, the number of corpora lutea and stigmata were counted. The viability of the implants was demonstrated histologically. Ovaries were removed during the last laparotomy and ovarian serial sections were examined. In rabbits with peritoneal induced endometriosis, the percentage of stigmata/corpora lutea was significantly decreased. Macroscopic study was confirmed by histological examination. Indeed, a high incidence of entrapped oocytes was found in rabbits with peritoneal endometriosis. Extraperitoneal endometriosis had no effect on ovulation. Our data demonstrated that endometriosis induced a failure of follicular rupture. After endometriumectomy, no failure to ovulate was observed, suggesting that the effect of endometriosis on the ovulation disappeared with excision of endometrial implants.     

子宫内膜异位症对卵巢功能的影响

子宫内膜异位症(EMs)是育龄妇女常见的疾病,近年来其发病率明显增高,子宫内膜异位症和卵巢功能的关系正日益受到关注,子宫内膜异位症可引起盆腔粘连,破坏卵巢正常解剖结构,影响卵巢排卵,并通过改变盆腔环境,释放大量过氧化物和一氧化氮影响卵子发育.子宫内膜异位症使盆腔积液中巨噬细胞增多.产生多种炎症介质和细胞因子损伤卵巢功能.针对卵巢子宫内膜异位囊肿的手术治疗也会对卵巢功能造成损伤,从子宫内膜异位症疾病本身及卵巢子宫内膜异位囊肿剥除术两方面对卵巢功能的影响加以综述.     

卵巢子宫内膜异位囊肿手术方式探讨

目的　通过对开腹和腹腔镜下卵巢子宫内膜异位囊肿剥除术的比较 ,探讨腹腔镜在临床应用中的价值。方法　回顾性分析了 1 994年 1月～ 2 0 0 1年 8月于我院妇科施行的开腹和腹腔镜下卵巢子宫内膜异位囊肿剥除术的手术经验。两组病人术后随访 1 2～ 36个月。并对两组患者围手术期情况 ,术后症状缓解 ,复发率及妊娠率进行比较。结果　 92例腹腔镜手术患者术中出血量 (1 1 0 5± 82 8)ml明显小于开腹组 (1 89 5± 96 8)ml,P <0 0 5。手术时间腹腔镜组 (1 36 5± 80 4 )min与开腹组 (1 4 8 5± 86 8)min相近 ,P >0 0 5。术后病率腹腔镜组 (4 92 ,4 3% )明显低于开腹组 (1 2 96 ,1 2 5 % ) ,P <0 0 5。术后下床活动及肛门排气时间腹腔镜组比开腹组明显缩短 ,P <0 0 5。随访术后妊娠率两组间差异有显著性 (P <0 0 5 )。结论　腹腔镜在子宫内膜异位囊肿诊断及治疗中具有安全、有效、微创的特点 ,适合于广泛开展     

Effect of ovarian involvement on peritoneal fluid cytokine concentrations in endometriosis patients

Peritoneal fluid cytokines are important for initiation and progression of endometriosis. The objective of this study was to compare a group of five cytokines (interleukins IL-1 beta, IL-6, IL-8, IL-13 and tumour necrosis factor alpha; TNFalpha) in peritoneal fluid of endometriosis patients with ovarian involvement (Group I, n = 17) to those in patients without ovarian involvement (Group II, n = 33) and to a reference group without endometriosis (Group III, n = 25). All three groups were comparable regarding age, parity and body mass index. IL-8 concentrations were significantly higher in groups I and II compared with the reference group (P = 0.01 and 0.02, respectively). Similarly, TNFalpha concentrations were significantly higher in groups I and II compared with the reference group (P < 0.0001 and 0.0004, respectively). All other cytokines were comparable in the three groups. No significant differences were found between groups I and II with respect to the cytokines measured. In conclusion, peritoneal fluid IL-8 and TNFalpha concentrations are significantly higher in endometriosis. Ovarian involvement does not alter the pattern of cytokines. It appears that the inflammatory mediators of endometriosis are similar with and without ovarian involvement.     

Effect of ovarian involvement on the frequency of luteinized unruptured follicle in endometriosis.

OBJECTIVE: When we review the current literature on endometriosis and luteinized unruptured follicle (LUF), we see that most of the studies deal with only the association between LUF frequency and the severity of endometriosis. Our purpose was to evaluate the effect of ovarian involvement on LUF frequency in endometriosis and assess the relationship between endometriosis and LUF in infertile women. STUDY DESIGN: This study is a prospective analysis covering a total of 126 infertile women between 22 and 35 years of age who underwent diagnostic laparoscopy from September 1995 to August 1997 in the Department of Obstetrics and Gynecology at Süleyman Demirel University, Isparta, Turkey. Endometriosis was diagnosed in 58 of these patients. All had received a revised American Fertility Society staging score at the time of the laparoscopic diagnosis. Diagnosis of LUF was made when the following criteria were fulfilled: absence of ultrasonic signs of ovulation, and absence of an ovulation ostium on the follicle by laparoscopy, despite increased serum progesterone. Statistical evaluation was performed using chi2 test and Fisher's exact test where appropriate. RESULTS: The prevalence of LUF in mild, moderate and severe endometriosis cases was 13.3, 41.2 and 72.7%, respectively. The LUF frequencies were 45.9% in 37 endometriosis patients with ovarian involvement, 9.5% in 21 cases without ovarian involvement, and 5.9% in 68 cases without endometriosis. A statistically significant difference was observed between the LUF rate in the group with ovarian involvement and that without involvement (chi(2) = 8.06, p < 0.001). CONCLUSION: In summary, in this study we noted a significant increase in LUF frequency in endometriosis patients with ovarian involvement.     

Prevalence of endometriosis in ovarian cancer

Endometriosis may be the precursor of clear cell or endometrioid ovarian cancer. In this review, we focus on the prevalence of endometriosis in ovarian cancer and related clinical and epidemiological issues. According to 15 published reports, the rank order of the prevalence of endometriosis in each histologic type was clear cell (39.2%) > endometrioid (21.2%) > serous (3.3%) > mucinous type (3.0%). The high prevalence of endometriosis in clear cell and endometrioid types is a consistent finding in Japan and western countries. However, the incidence of the clear cell type is much higher (15-20% vs. 7-8%), and that of the endometrioid type is lower (7-16% vs. 18-26%), in Japan compared with western countries. This review is also concerned with the relationship between the presence of ovarian endometriosis and clinical features such as age, parity, menopausal status, clinical stage, and survival in ovarian cancer patients.     

Premature ovulation after ovarian ultrasonography

Summary. Whereas follicle rupture never occurred before the 37th hour after an ovulatory stimulus (either the onset of the LH surge or hCG administration) in control patients, ovulation was observed at 26 to 36 h in women submitted to ultrasonography during the late follicular phase. Premature ovulation was observed in 5 out of 23 and 8 out of 19 cycles when ultrasonography occurred during the 3 days preceding or in the 36 h following ovulatory stimulus. This as yet unexplained observation leads us to reconsider the advisability of ovarian scan during the late follicular phase of the menstrual cycle.     

Anatomopathologic aspects of ovarian endometriosis

The Authors reviewed 284 cases of endometriosis; it interested all age ranges with prevalence of four and fifth decades and showed a range of 19-68 years. Favourite sites was ovary with 271 cases, remaining were: tubes, omentum, vagina, vulva and cecum. The histological appearance is similar to normal endometrium but these foci react to hormonal stimulation variably.     

Malignant transformation of ovarian endometriosis

One hundred forty-seven cases of ovarian endometriosis, encountered from 1976 to 1999 at Tsukuba University Hospital, were studied to clarify the incidence of malignant transformation. There were 18 cases (12.2%) of atypical endometriosis, among which we found a case (5.6%) of ovarian cancer arising from endometriosis not diagnosed before surgery. This is accounted for 0.7% of all ovarian endometriosis cases. Because the incidence was equal to that of the previous reports, it is most likely that the malignant change in ovarian endometriosis occurred in 0.7% of this disease.     

Uterine and ovarian function in endometriosis

Although numerous studies have attempted to elucidate the implication of endometriosis for infertility, this matter still remains unexplained. Diverse clinical approaches based on assisted reproduction techniques have produced conflicting results on this issue. Nevertheless, impairment of implantation and pregnancy rates seems to affect women who suffer from endometriosis. Whether this effect is due to alteration of the oocyte/embryo or the endometrium still remains to be elucidated, although actual data allude to deficiencies in both. Infertility due to poor quality embryos derived from impaired oocytes obtained from malfunctioning ovaries have been described by some groups. Endometrial defects have been argued by others. Adding more confusion to this topic, the influence of peritoneal fluid in women with endometriosis and/or mixed causes also needs to be considered. The aim of this review is to describe the current situation in the endometriosis-related infertility literature.     

Conservative surgery of ovarian endometriosis in infertility

53 patients attending the infertility clinic were operated for ovarian endometriosis. The overall pregnancy rate was 53%. The major benefit of the surgery was that 79% of the pregnancies occurred within the year following the operation.     

A case of inguinal endometriosis secondary to homolateral ovarian endometriosis

Following the observation of a case of inguinal endometriosis secondary to homolateral ovarian endometriosi, the paper describes the possibilities of the disease spreading to areas and organs which are unconnected to the pelvis. Published reports by other Authors are cited to support this hypothesis.     

Regression of ovarian enlargement in pharmacological ovulation induction

The aim of the present study was to determine a possible relationship between ovarian functionality and regression of ovarian enlargement according to the different categories and degree of severity of ovarian hyperstimulation syndrome (OHSS). Among a group of sterile woman (n = 111) ,two subgroups were studied: group A (n = 15) ,patients affected by severe syndrome; and group B (n = 96) ,patients with massive ovarian enlargement only. The protocol of ovarian stimulation was conducted in various in vitro fertilization (IVF) centers; ultrasonographic examination and hematological checks were carried out daily; patients with severe OHSS were hospitalized. In women of group A ,severe symptoms disappeared in 7–11 days; in nine patients with regular cycles ovary size returned to normal in about 30–40 days ,whereas in six subjects with anovulatory cycles ,the resolution was recorded in about 50–60 days; serum estradiol returned to physiological levels within 20–30 days. Women of group B showed a spontaneous regression at different times: in 43 subjects that presented regular ovulatory cycles ,the resolution was recorded in about 30–40 days ,whereas in 36 women with anovulatory cycles before pharmacological induction ,resolution occurred in 50–60 days ,and in 17 cases with polycystic ovary syndrome before pharmacological ovulation ,an incomplete resolution was obtained; serum estradiol levels returned to a physiological range within 20–30 days. Our results show that in patients with regular ovulatory cycles ,resolution of symptoms is obtained in a shorter time than in patients with anovulatory cycles before pharmacological induction.