scholarly journals Fertility Preservation Counselling for Women With Endometriosis: A European Online Survey

Author(s):  
Nicole Sänger ◽  
Marco Menabrito ◽  
Atillio Di Spiezo Di Spiezo Sardo ◽  
Josep Estadella ◽  
Jasper Verguts

Abstract Background: Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital are strategies to preserve fecundity. Methods: An online survey was sent to reproductive specialists and gynaecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients. Results: Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis. Conclusions: To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.

2012 ◽  
Vol 27 (8) ◽  
pp. 2413-2419 ◽  
Author(s):  
U. Balthazar ◽  
A. M. Deal ◽  
M. A. Fritz ◽  
L. A. Kondapalli ◽  
J. Y. Kim ◽  
...  

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044986
Author(s):  
Chris Skedgel ◽  
Eleanor Ralphs ◽  
Elaine Finn ◽  
Jennifer A Whitty ◽  
Marie Markert ◽  
...  

ObjectivesTo understand attitudes towards infertility and willingness to pay (WTP) towards a publicly funded national assistive reproductive therapies (ART) programme.DesignAttitudes survey with dichotomous and open-ended WTP questions.SettingOnline survey administered in the USA, UK, Spain, Norway, Sweden, Finland, Denmark and China.Participants7945 respondents, analysed by country. Nordic respondents were pooled into a regionally representative sample.Primary and secondary outcome measuresPrimary outcome measures were proportion of sample agreeing with different infertility-related and ART-related value statements and supporting a monthly contribution to fund a national ART programme, expressed in local currency. Secondary outcome measure was maximum WTP.ResultsAcross the nationally representative samples, 75.5% of all respondents agreed with infertility as a medical condition and 82.3% and 83.7% with ART eligibility for anyone who has difficulty having a baby or a medical problem preventing them from having a baby, respectively. 56.4% of respondents supported a defined monthly contribution and 73.9% supported at least some additional contribution to fund a national ART programme. Overall, converting to euros, median maximum WTP was €3.00 and mean was €15.47 (95% CI 14.23 to 16.72) per month. Maximum WTP was highest in China and the USA and lowest in the European samples.ConclusionsThis large, multicountry survey extends our understanding of public attitudes towards infertility and fertility treatment beyond Europe. It finds evidence that a majority of the public in all sampled countries/regions views infertility as a treatable medical condition and supports the idea that all infertile individuals should have access to treatments that improve the chance of conception. There was also strong agreement with the idea that the desire for children is a basic human need. WTP questions showed that a majority of respondents supported a monthly contribution to fund a national ART programme, although there is some evidence of an acquiescence bias that may overstate support among specific samples.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Nisolle

Abstract text "The ovarian endometriotic cyst” Ovarian endometriomas affect 17 to 44% of women with endometriosis, and are often associated with pelvic pain and infertility. Patients suffering from endometriosis frequently present an already reduced ovarian reserve, assessed by AMH dosage or by antral follicular count during TVS. Pain and infertility are the main indications for endometrioma surgery which is a complex procedure as endometriosis leads to inflammation around the lesions, causing fibrosis. Three main surgical procedures have been described: the ovarian cystectomy, the endometrioma ablation or the combined technique. During the cystectomy, after ovarian mobilization and adhesions lifting, an incision of the cortex is realized to find a cleavage plane between the cyst wall and the ovarian cortex. Traction and countertraction movements are performed to carefuly dissociate the cyst from the ovarian cortex. It is crucial to handle the ovarian tissue as atraumatically as possible. With this technique, the cyst wall as well as the surrounding fibrosis are excised with the risk of oocytes removal responsible for decreased ovarian reserve. The ablative surgery is defined by the fenestration and vaporization of the endometrioma cyst. The ablation is carried out using a laser or plasma energy or electrocoagulation. Once the endometrial cyst has been emptied of its contents, the entire internal surface of the endometrioma must be sprayed or evaporated using the different chosen techniques. Where feasible, the cyst may be turned inside out to facilitate further treatment. The combined technique associates partial cystectomy (80-90%) and ablation of the 10-20% remaining endometrioma. This method is especially useful while operating large endometriomas. It prevents excessive bleeding or damage to the ovarian tissue. In cases of large ovarian endometrioma, the three-step approach has been proposed, consisting on an opening and drainage of the cyst followed by a 3 months’ administration of Gn-RH agonists in order to reduce its diameter and vascularization. A second surgical procedure is then scheduled to ablate the remaining cyst wall. In conclusion, it is crucial to keep in mind that endometriosis and especially the presence of endometrioma reduce fertility whereas in the majority of cases, the ovarian reserve is already diminished in relation to the patient's age. Ovarian preservation must be one of our priorities in young patients of childbearing age and it is therefore really important to carry out surgeries that are as atraumatic as possible. Trial registration number: Study funding: Funding source:


2021 ◽  
Vol 27 (4) ◽  
pp. 56
Author(s):  
I.Yu. Yershova ◽  
K.V. Krasnopolskaya ◽  
A.A. Popov ◽  
I.V. Krasnopolskaya ◽  
A.A. Koval

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Wedner-Ross ◽  
F Vo. Versen-Höynck

Abstract Study question This cross-sectional survey sought the views of women seeking fertility treatment on the impact of the COVID–19 pandemic on their fertility treatment and attitudes. Summary answer Most respondents worried the recommendations to postpone treatment would reduce their chances of pregnancy and were concerned about negative effects of SARS-Cov–2 infections on pregnancy. What is known already In spring 2020, the recommendations of ESHRE and German professional societies to postpone fertility treatments resulted in limited or closed services from mid-March to early May in many clinics. Previous studies reported that postponing fertility clinic appointments causes psychological distress, with most patients saying they would have preferred to continue treatment. While no similar studies are available from Germany, where COVID–19 incidence was relatively low, concerns of the patients about possible consequences of a treatment delay and a SARS-CoV–2 infection on fertility and pregnancy remain unknown. Study design, size, duration This cross-sectional, anonymous, online questionnaire was completed in June-December 2020 by 249 women attending fertility clinics across Germany. The women were recruited using leaflets, directly by study personnel either in person or by telephone, or via online support group forums for fertility patients. Participants/materials, setting, methods All women seeking treatment in fertility clinics were eligible to participate. The online survey covered questions about the patient’s quality of life, their opinions about the professional societies’ recommendations and their effects as well as any concerns about infection with SARS-CoV–2. Statistical analysis was conducted using SPSS Version 27. Main results and the role of chance Three-quarters of participants disagreed with the pausing of fertility treatments. Women who participated from October-December 2020, when the incidence rate was high, were as likely to disagree as participants that participated from June-September 2020 (73% vs 79%, p = 0.3). Nearly all participants (95%) were concerned that treatment delays would reduce their chances of pregnancy. 72 participants (29%) had their appointments cancelled. Nearly all (97%) reported being upset by this, with 40 (56%) reporting that they were extremely or very disappointed about the cancellation. Women coming for follow-up appointments and women who had to wait 10 weeks or longer were more likely to be upset by the postponement or cancellation of their appointment (p = 0.016 and p = 0.012, respectively). Nearly all (97%) of the participants were worried about possible negative effects a SARS-CoV–2 infection might have related to their fertility, pregnancy or unborn child. Sixty-one percent stated they were very or moderately concerned about the negative influence the infection might have on the womańs own health during pregnancy and 60% were very to moderately concerned about potential negative effects for the unborn child. However, only 26% reported they were very or moderately concerned about the potential negative effects of an infection on fertility. Limitations, reasons for caution The main limitations of this study are the possibility of selection bias as people with strong opinions are more likely to have participated and the lack of information on non-responders due to the study design. Also, the Covid–19 pandemic is evolving continuously meaning that participantś opinions may vary over time. Wider implications of the findings: Postponement of treatments increased distress among patients and should be avoided when possible. If unavoidable, follow-up patients should be prioritised for treatment and the length of postponement should be minimised. Fertility clinics must provide information about the current state of knowledge of SARS-Cov–2 infections in pregnancies and options for immunization. Trial registration number Not applicable


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