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Chapter-34 Fertility Preservation in Women with Endometriosis

BOOK TITLE: Endometriosis: Current Management and Future Trends

Author
1. Donnez Jacques
2. Jadoul Pascale
3. Dolmans Marie-Madeleine
4. Squifflet Jean
ISBN
9788184488081
DOI
10.5005/jp/books/11032_34
Edition
1/e
Publishing Year
2010
Pages
9
Author Affiliations
1. Université Catholique de Louvain, Cliniques Universitaires, St Luc, Brussels, Belgium
2. Université Catholique de Louvain Brussels, Belgium
3. Université Catholique de Louvain Brussels, Belgium
4. Université Catholique de Louvain Brussels, Belgium
Chapter keywords

Abstract

The most important surgery in endometriosis-associated infertility is ovarian surgery. Because surgery has to be effective (decrease the risk of recurrence) and protective (avoid normal ovarian tissue destruction), we propose a new surgical procedure that combines the best results of the stripping technique in terms of recurrence outcomes, since most of the cyst wall is excised, and the ablation technique, since the hilus area of the ovary is spared from surgical damage. In case of severe endometriosis and/or recurrent endometriomas, normal residual ovarian tissue and/or ovarian vascularization may be compromised. In case of radical treatment (oophorectomy) in particular, but also conservative treatment as there is a risk of recurrence, preservation of ovarian tissue should be considered with a view to future autotransplantation. Orthotopic autotransplantation of fresh ovarian cortex is one option, as our results provide proof of the survival of primordial follicles and the presence of a neovascular network. Cryopreservation and autotransplantation of frozen-thawed ovarian tissue is another valuable technique, as demonstrated by the live births obtained in cancer patients.

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