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Free Information Session 8th May 2013: Endometriosis and Infertility

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Dr Louise Hull presented the facts about Endometriosis and its impact on fertility.

Dr Louise Hull has worked in fertility services since she graduated as a doctor 15 years ago. She became Obstetrician and Gynaecologist (FRANZCOG) after gaining clinical experience in New Zealand and Cambridge and Somerset in the UK. Louise has a strong interest in reproductive medicine and has worked in IVF units in New Zealand, England and Australia, including Bourn Hall, the fertility centre where the first IVF baby was born. For more information about Dr Hull, please follow this link:

Publicado en: Salud y medicina
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Free Information Session 8th May 2013: Endometriosis and Infertility

  1. 1. Endometriosisand InfertilityPresented byDr Louise Hull
  2. 2. • What is endometriosis?• How many women suffer from endometriosis?• How do you know if you have endometriosis?• How do you know if it will affect your fertility?• What causes endometriosis?• What causes fertility problems in endometriosis?Questions about endometriosis?
  3. 3. The lining of the wombgrows outside theuterine cavityWhat is endometriosis?
  4. 4. What causes endometriosis?Sampson’s theory90% of women have retrograde menstruation but only 10%develop endometriosisAlso genetic, immune, environmental and hormonal factors
  5. 5. What are the costs of Endometriosis?In one year, on average a women with endometriosis will incur:$2,898 in direct costs $12,330 in indirect costs50% women have >17.6 days absenteeism /yearKiejoff et al, 1987
  6. 6. What are the symptoms of endometriosis?EndometriosisPainfulperiodsDifficultyconceivingPremenstrual spottingPainful sexChronic painHeavyperiods
  7. 7. How do we diagnose endometriosis?
  8. 8. Laparoscopic surgeryDiagnostic laparoscopy• Costly• Requires anesthesia• Is invasive• Carries risks1/3 of women that undertakelaparoscopy – do not haveendometriosis
  9. 9. Promising non- invasive diagnostic testsOur research group at the universityDifferences in microRNA profiles in women withand without endometriosisOther research groups are exploring proteinsand clinical parametersAlso MRI diagnostics
  10. 10. Does stage of endometriosis affect IVF outcomes?Dmowski et al 2002
  11. 11. Can we predict fertility outcomes in women withendometriosis?579 women evaluatedand EFI formulatedTested in an additional222 womenValidated in a Dutchpopulation
  12. 12. Does endometriosis impact on fertility?1. Prevalence is higher in women who have difficulty conceiving-10% in general population vs 38% in women with infertility2. Monthly pregnancy rate is reduced in endometriotic womentreated with donor sperm (12% vs 3.6%)4. Poorer outcomes in IUI-reduced pregnancy rates in FSH/IUI (11%)-laparoscopic excision improved pregnancy rates in COH/IUI
  13. 13. What causes subfertility in endometriosis?
  14. 14. ****Adhesion and wounding****Inflammation•*•* **** •*•* *Remodelling, healing andblood vessel formationEstablished lesion
  15. 15. The environmentThe endometrial environment hasimmune cells and other factorsthat can stress eggs sperm andembryosEndometriotic peritoneal fluidreduced fertility in animal models
  16. 16. Oxidative stressPatient Number0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26CumuluscellREDOX(meanfluorescentpixels)020406080100LOWINTERMEDIATEHIGH
  17. 17. Oocyte qualitySingle embryo cultureOptimal lab handling and environment
  18. 18. Reduced ovarian reserveWomen with endometriosis have:-lower day 3 FSH levels-lower AMH levels-reduced oocytes in cortical ovarian biopsies-diminished response to FSH in IVFRole of surgery- surgically treated women have lower ovarianreserve- Postoperative decline in AMH levels
  19. 19. Preserving Fertility in EndometriosisIn young women undertaking surgeryconsider discussing:Measuring AMH and planningpregnancyCryopreserving oocytesFreezing ovarian tissue at excision ofendometriomaAt this stage little research re outcomes
  20. 20. Donor Studies: Egg versus EndometriumEndometriosis recipients(n=25)Control recipients(n=33)LBR =28% LBR =27.2%Diaz et al 2000Fertity Sterility, 74,1: 31-34
  21. 21. Pregnancy outcomes for women with endometriosisSwedish Cohort (Stephansson et al 2009)8,922 women with endometriosis had13090 singleton birthsIn a registry of >1.4 million singletonsWomen with endometriosis had:-increased risk of preterm birth-increased rate of caesarean section
  22. 22. Consulting Clinic345 Carrington StreetAdelaide SA 5000Phone 8100 2900e