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Infertility: HELP
Articles by Émile Daraï
Based on 27 articles published since 2009
(Why 27 articles?)
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Between 2009 and 2019, E. Daraï wrote the following 27 articles about Infertility.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline [Fertility preservation, contraception and menopause hormone therapy in women treated for rare ovarian tumors: Guidelines from the French national network dedicated to rare gynaecological cancer]. 2018

Rousset-Jablonski, Christine / Selle, Fréderic / Adda-Herzog, Elodie / Planchamp, François / Selleret, Lise / Pomel, Christophe / Chabbert-Buffet, Nathalie / Daraï, Emile / Pautier, Patricia / Trémollières, Florence / Guyon, Frederic / Rouzier, Roman / Laurence, Valérie / Chopin, Nicolas / Faure-Conter, Cécile / Bentivegna, Enrica / Vacher-Lavenu, Marie-Cécile / Lhomme, Catherine / Floquet, Anne / Treilleux, Isabelle / Lecuru, Fabrice / Gouy, Sébastien / Kalbacher, Elsa / Genestie, Catherine / de la Motte Rouge, Thibault / Ferron, Gwenael / Devouassoux-Shisheboran, Mojgan / Kurtz, Jean-Emmanuel / Namer, Moise / Joly, Florence / Pujade-Lauraine, Eric / Grynberg, Michael / Querleu, Denis / Morice, Philippe / Gompel, Anne / Ray-Coquard, Isabelle. ·Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France; Hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du grand-Revoyet, 69495 Pierre-Bénite cedex, France. Electronic address: christine.rousset-jablonski@lyon.unicancer.fr. · Groupe hospitalier Diaconesses Croix-Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France. · Hôpital Foch, service de gynécologie-obstétrique, 40, rue Worth, 92151 Suresnes, France. · Institut Bergonié, 229, Cours-de-l'Argonne, 33000 Bordeaux, France. · Hôpital Tenon, service de gynécologie-obstétrique et médecine de la reproduction, 4, rue de la Chine, 75020 Paris, France. · Centre Jean-Perrin, 58, rue Montalembert BP, 392, 63011 Clermont-Ferrand cedex 1, France. · Institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France. · Hôpital Paule-de-Viguier, centre de ménopause et de dépistage de l'ostéoporose, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France. · Institut Curie, 26, rue d'Ulm, 75005 Paris, France. · Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France. · Hôpital Cochin-Port Royal, 53, avenue de l'Observatoire, 75014 Paris, France. · Hôpital Européen Geroges-Pompidou, 20, rue Leblanc, 75015 Paris, France. · CHU Besançon-Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France. · Centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France. · CLCC, institut Claudius-Regaud, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France. · Hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du grand-Revoyet, 69495 Pierre-Bénite cedex, France. · CHU de Strasbourg, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France. · Recommandations pour la pratique clinique, Nice-Saint-Paul, 06000 Nice, France. · Centre François-Baclesse, 3, avenue du Général-Harris, 14076 Caen cedex 5, France. · CHU Paris Centre, hôpital Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75004 Paris, France. · Hôpital Jean-Verdier, avenue du 14 juillet, 93140 Bondy, France. ·Bull Cancer · Pubmed #29397916.

ABSTRACT: INTRODUCTION: Rare ovarian tumors include complex borderline ovarian tumors, sex-cord tumors, germ cell tumors, and rare epithelial tumors. Indications and modalities of fertility preservation, infertility management and contraindications for hormonal contraception or menopause hormone therapy are frequent issues in clinical practice. A panel of experts from the French national network dedicated to rare gynaecological cancers, and of experts in reproductive medicine and gynaecology have worked on guidelines about fertility preservation, contraception and menopause hormone therapy in women treated for ovarian rare tumors. METHODS: A panel of 39 experts from different specialties contributed to the preparation of the guidelines, following the DELPHI method (formal consensus method). Statements were drafted after a systematic literature review, and then rated through two successive rounds. RESULTS: Thirty-five recommendations were selected, and concerned indications for fertility preservation, contraindications for ovarian stimulation (in the context of fertility preservation or for infertility management), contraceptive options (especially hormonal ones), and menopause hormone therapy for each tumor type. Overall, prudence has been recommended in the case of potentially hormone-sensitive tumors such as sex cord tumors, serous and endometrioid low-grade adenocarcinomas, as well as for high-risk serous borderline ovarian tumors. DISCUSSION: In the context of a scarce literature, a formal consensus method allowed the elaboration of guidelines, which will help clinicians in the management of these patients.

2 Editorial [How to improve endometriosis management]. 2017

Daraï, Emile / Chabbert-Buffet, Nathalie. ·AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 4, rue de la Chine, 75020 Paris, France; Centre expert en endométriose (C3E), Groupe de recherche clinique (GRC-6 UPMC), inserm UMRS-938, France. ·Presse Med · Pubmed #29224704.

ABSTRACT: -- No abstract --

3 Review Colorectal endometriosis and fertility. 2017

Daraï, Emile / Cohen, Jonathan / Ballester, Marcos. ·Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, UMRS-938, Université Pierre et Marie Curie Paris 6, Groupe de Recherche Clinique (GRC 6-UPMC), Centre Expert en Endométriose (C3E), France. Electronic address: emile.darai@aphp.fr. · Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, UMRS-938, Université Pierre et Marie Curie Paris 6, Groupe de Recherche Clinique (GRC 6-UPMC), Centre Expert en Endométriose (C3E), France. ·Eur J Obstet Gynecol Reprod Biol · Pubmed #27342685.

ABSTRACT: OBJECTIVE: The goal of this review was to assess the impact of colorectal endometriosis on spontaneous fertility and the potential benefit of Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) and surgery on fertility outcomes. STUDY DESIGN: MEDLINE search for articles on fertility in women with DIE published between 1990 and December 2015 using the following terms: "deep endometriosis", "deep infiltrating endometriosis", "bowel endometriosis", "colorectal endometriosis", "fertility", "infertility", "IVF-ICSI", "Assisted Reproductive Techniques (ART)", and "MAR". RESULTS: Spontaneous pregnancy rate (PR) in patients undergoing resection of DIE but leaving in situ colorectal endometriosis was 26.5% (95% CI=14-39). PR after MAR was 27.4% (95% CI=19-35) and the overall PR was 37.9% (95% CI=29-37). After colorectal surgery, among the 855 patients with and without proved infertility, the spontaneous PR was 31.4% (95% CI=28-34) without difference between the groups. PR after MAR was 19.8% (95% CI=17-22). PR after MAR in patients with and without proved infertility was 21.4% (95% CI=18-25) and 15.5% (95% CI=11-20), respectively. The overall PR after colorectal surgery was 51.1% (95% CI=48-54). CONCLUSION: Our review supports a potential benefit of surgery on fertility outcomes for women with colorectal endometriosis. Further studies are required to determine whether surgical management should be first-intention or restricted to failure of MAR.

4 Review Finding the balance between surgery and medically-assisted reproduction in women with deep infiltrating endometriosis. 2016

Cohen, Jonathan / Ballester, Marcos / Selleret, Lise / Mathieu D'Argent, Emmanuelle / Antoine, Jean M / Chabbert-Buffet, Nathalie / Darai, Emile. ·Department of Gynecology, Obstetrics and Reproductive Medicine, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Pierre et Marie Curie Paris 6 University, GRC6-UPMC - Specialized Center for Endometriosis (C3E), Paris, France - drcohenjonathan@gmail.com. ·Minerva Ginecol · Pubmed #27098393.

ABSTRACT: Deep infiltrating endometriosis (DIE) affects several anatomical locations including the bladder, torus uterinum, uterosacral ligament, rectovaginal septum and bowel. It is the most debilitating form of endometriosis and causes severe pain, digestive and urinary symptoms as well as infertility. Faced with an infertile woman suffering from DIE, the dilemma is whether to opt for first-line IVF treatment or for surgery. In the absence of high-level of evidence from randomized studies, several factors should be taken into account in the decision-making process. The main criterion is whether the patient wants in-vitro fertilization (IVF) treatment or not. Secondly, while previous reports have demonstrated the positive impact of surgery on pregnancy, they also underline the risk of severe complications requiring management in expert centers. Despite the availability of predictive models or scoring systems, the decision mainly boils down to the couple's characteristics. It seems logical to propose first-line IVF when spontaneous fertility is not possible due to associated male infertility or tubal obstruction; for women aged ≥35 years; or in women with diminished ovarian reserve. Conversely, first-line surgery could be the best option for women without these characteristics. However, this strategy is mainly based on low-level of evidence underlining the requiring of randomized trials.

5 Review Fertility before and after surgery for deep infiltrating endometriosis with and without bowel involvement: a literature review. 2014

Cohen, J / Thomin, A / Mathieu D'Argent, E / Laas, E / Canlorbe, G / Zilberman, S / Belghiti, J / Thomassin-Naggara, I / Bazot, M / Ballester, M / Daraï, E. ·Department of Gynecology and Obstetrics Hôpital Tenon, Assistance Publique des Hôpitaux de Paris Université Pierre et Marie Curie Paris 6 GRC 6-UPMC Centre Expert en Endométriose (C3E), Paris, France - drcohenjonathan@gmail.com. ·Minerva Ginecol · Pubmed #25373015.

ABSTRACT: AIM: Endometriosis affects from 10% to 15% of women of childbearing age and 20% of these women have deep infiltrating endometriosis (DIE). The goal of this review was to assess the impact of various locations of DIE on spontaneous fertility and the benefit of surgery and Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) on fertility outcomes. METHODS: MEDLINE search for articles on fertility in women with DIE published between 1990 and April 2013 using the following terms: "deep infiltrative endometriosis", "colorectal", "bowel", "rectovaginal", "uterosacral", "vaginal", "bladder" and "fertility" or "infertility". Twenty-nine articles reporting fertility outcomes in 2730 women with DIE were analysed. RESULTS: Among the women with DIE and no bowel involvement (N.=1295), no preoperative data on spontaneous pregnancy rate (PR) were available. The postoperative spontaneous PR rate in these women was 50.5% (95% Confidence Interval [CI] =46.8-54.1) and overall PR (spontaneous pregnancies and after MAR) was 68.3% (95% CI=64.9-71.7). No evaluation of fertility outcome according to locations of DIE was feasible. For women with DIE with bowel involvement without surgical management (N.=115), PR after MAR was 29%; 95% CI=20.7-37.4). For those with bowel involvement who were surgically managed (N.=1320), postoperative spontaneous PR was 28.6% (95% CI=25-32.3) and overall postoperative PR was 46.9% (95% CI=42.9-50.9). CONCLUSION: For women with DIE without bowel involvement, surgery alone offers a high spontaneous PR. For those with bowel involvement, the low spontaneous and relatively high overall PR suggests the potential benefit of combining surgery and MAR.

6 Review [Role of GnRH agonists in preserving female fertility]. 2014

Thomin, A / Torre, A / Daraï, É / Chabbert-Buffet, N. ·Service de gynécologie obstétrique, médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: anne.thomin@tnn.aphp.fr. · Service de gynécologie obstétrique, médecine de la reproduction, centre hospitalier intercommunal Poissy, 78300 Saint-Germain-en-Laye, France. · Service de gynécologie obstétrique, médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #24321862.

ABSTRACT: The impact of cancer treatment on ovarian function and fertility has been known since the 70s. Preservation of fertility is now an important focus of care for patients of reproductive age with cancer. The beneficial role of GnRH agonists in fertility preservation is controversial since the early 2000s. Recent randomized studies come to overturn this role. The POEMS multicenter randomized trial with long-term follow-up is ongoing and will provide results that could help clarify the current uncertain indication of these compounds in this context.

7 Review [Postoperative abdominal adhesions and their prevention in gynaecological surgery: I. What should you know?]. 2012

Audebert, A / Darai, E / Bénifla, J-L / Yazbeck, C / Déchaud, H / Wattiez, A / Crowe, A / Pouly, J-L. ·Service d'endoscopie gynécologique, polyclinique de Bordeaux, 145, rue du Tondu, 33000 Bordeaux, France. audebert@alienor.fr ·Gynecol Obstet Fertil · Pubmed #22129851.

ABSTRACT: Adhesions are the most frequent complications of abdominopelvic surgery, causing important short- and long-term problems, including infertility, chronic pelvic pain and a lifetime risk of small bowel obstruction. They also complicate future surgery with increased morbidity and mortality risk. They pose serious quality of life issues for many patients with associated social and healthcare costs. Despite advances in surgical techniques, including laparoscopy, the healthcare burden of adhesion-related complications has not changed in recent years. Adhesiolysis remains the main treatment although adhesions reform in many patients. The extent of the problem of adhesions has been underestimated by surgeons and the health authorities. There is rising evidence however that surgeons can take important steps to reduce the impact of adhesions. As well as improvements in surgical technique, developments in adhesion-reduction strategies and new agents offer a realistic possibility of reducing adhesion formation and improving outcomes for patients. This paper is the first of a two-part publication providing a comprehensive overview of the evidence on adhesions to allow gynaecological surgeons to be best informed on adhesions, their development, impact on patients, health systems and surgical outcomes. In the second paper we review the various strategies to reduce the impact of adhesions and improve surgical outcomes to assist fellow surgeons in France to consider the adoption of adhesion reduction strategies in their own practice.

8 Article Nomogram predicting the likelihood of live-birth rate after surgery for deep infiltrating endometriosis without bowel involvement in women who wish to conceive: A retrospective study. 2019

Arfi, Alexandra / Bendifallah, Sofiane / Mathieu D'argent, Emmanuelle / Poupon, Clothilde / Ballester, Marcos / Cohen, Jonathan / Darai, Emile. ·Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France. Electronic address: alexandra.arfi@gmail.com. · Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; INSERM UMR_S_707, Epidemiology, Information Systems, Modeling, University Pierre and Marie Curie, Paris 6, France. · Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France. · Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Groupe de Recherche Clinique 6 (GRC6-UPMC), Centre Expert En Endométriose (C3E), France; UMR_S938 Université Pierre et Marie Curie Paris 6, France. ·Eur J Obstet Gynecol Reprod Biol · Pubmed #30831447.

ABSTRACT: OBJECTIVE: To study the fertility and live birth (LB) rate in women after surgery for deep infiltrating endometriosis (DIE) without bowel involvement and to evaluate the predictive factors of LB after DIE surgery without bowel involvement. STUDY DESIGN: Retrospective cohort study. A total of 118 women who wished to conceive and who underwent surgery for DIE without bowel involvement were analyzed between January 2006 and December 2014. A multivariate logistic regression analysis of selected factors and a nomogram to predict the subsequent LB rate was constructed. RESULTS: Thirty-six woman had a LB (30.5%). In multivariate analysis, factors associated with a LB were: age ≤30 years (p = 0.0024), BMI ≤ 25 kg/m CONCLUSIONS: This work presents the originality of describing the fertility and the LB rate after surgery for DIE without bowel involvement with a predictive model. Such tools can help clinicians to support the patient in making an informed decision about fertility treatment options, contributing to the decision-making process by defining simple risk factors of poor LB probability that can help identify good candidates for MAR.

9 Article Fertility outcomes in women experiencing severe complications after surgery for colorectal endometriosis. 2018

Ferrier, C / Roman, H / Alzahrani, Y / d'Argent, E Mathieu / Bendifallah, S / Marty, N / Perez, M / Rubod, C / Collinet, P / Daraï, E / Ballester, M. ·Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, 75006 Paris, France. · Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France. · Groupe de Recherche Clinique GRC6-UPMC, Centre Expert En Endométriose (C3E), University Pierre and Marie Curie, 75006 Paris, France. · Department of Gynaecology and Obstetrics, Jeanne de Flandre University Hospital, Université Lille Nord-de-France, CHRU de Lille, 59000 Lille, France. · UMR_S938, Université Pierre et Marie Curie, 75006 Paris, France. ·Hum Reprod · Pubmed #29315418.

ABSTRACT: STUDY QUESTION: What are the fertility outcomes in women wishing to conceive after experiencing a severe complication from surgical removal of colorectal endometriosis? SUMMARY ANSWER: The pregnancy rate (PR) among women who wished to conceive after a severe complication of surgery for colorectal endometriosis was 41.2% (spontaneously for 80%, after ART procedure for 20%). WHAT IS KNOWN ALREADY: While the long-term benefit of surgery on pain and quality of life is well documented for women with colorectal endometriosis, it exposes women to the risk of severe complications. However, little is known about fertility outcomes in women experiencing such severe postoperative complications. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study included women who experienced a severe complication after surgery for colorectal endometriosis between January 2004 and June 2014, and who wished to conceive. A total of 53 patients met the inclusion criteria. The fertility outcome was available for 48 women, who were therefore included in the analysis. The median follow-up was 5 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: All the women underwent complete removal of colorectal endometriosis. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification. Fertility outcomes, PR and cumulative pregnancy rate (CPR), were estimated. MAIN RESULTS AND THE ROLE OF CHANCE: Most women experienced a grade IIIb complication (83.3%). Of 48 women, 20 became pregnant (overall PR: 41.2%); spontaneously for 16 (80%) and after ART procedure for 4 (20%). The median interval between surgery and first pregnancy was 3 years. The live birth rate was 14/48 (29.2%). The 5-year CPR was 46%. A lower CPR was found for women who experienced anastomotic leakage (with or without rectovaginal fistula) (P = 0.02) or deep pelvic abscess (with or without anastomotic leakage) (P = 0.04). LIMITATIONS REASONS FOR CAUTION: Due to a lack of information, no sub-analysis was done to investigate other parameters potentially impacting fertility outcomes. WIDER IMPLICATIONS OF THE FINDINGS: The PR for our population was slightly lower to that observed in the literature for women who experience such surgery without consideration for the occurrence of complications. However, 'severe complications' covers a range of conditions which are likely to have a very different impacts on fertility. Even if the PR and CPR appear satisfactory, septic complications can negatively impact fertility outcomes. Rapid ART may be a good option for these patients. STUDY FUNDING/COMPETING INTEREST(S): No funding was required for the current study. Pr H. Roman reported personal fees from Plasma Surgical Inc. (Roswell, GA, USA) for participating in a symposium and a masterclass, in which he presented his experience in the use of PlasmaJet®. None of the other authors declared any conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

10 Article Fertility outcomes after laparoscopic partial bladder resection for deep endometriosis: Retrospective analysis from two expert centres and review of the literature. 2018

Nyangoh Timoh, Krystel / Ballester, Marcos / Bendifallah, Sofiane / Fauconnier, Arnaud / Darai, Emile. ·Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, University Pierre et Marie Curie, Paris 6, France. Electronic address: k.nyangoh@gmail.com. · Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, University Pierre et Marie Curie, Paris 6, France; GRC6-UPMC, Centre expert en Endométriose (C3E), France; UMR_S938 University Pierre et Marie Curie Paris, France. · Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, University Pierre et Marie Curie, Paris 6, France; GRC6-UPMC, Centre expert en Endométriose (C3E), France. · Department of Obstetrics and Gynecology, Poissy Hospital, University of Saint Quentin en Yvelines, Paris, Saclay, France. ·Eur J Obstet Gynecol Reprod Biol · Pubmed #29126089.

ABSTRACT: OBJECTIVE: To evaluate fertility outcomes after laparoscopic partial bladder resection in women with bladder endometriosis and to review the literature. STUDY DESIGN: A retrospective study conducted at two tertiary referral centres -Tenon University Hospital and Poissy University Hospital (Canadian Task Force Classification Level II-2)-from July 2006 to November 2015. Patients with bladder endometriosis who underwent either laparoscopic partial bladder resection (PBR) alone for those without posterior endometriotic lesions (PBR group) or both laparoscopic PBR and associated posterior deep infiltrating endometriosis (DIE) resection (PBR-PDIE group) were included. Pregnancy and live birth rates according to prior infertility, and associated posterior DIE resection were analysed. RESULTS: Thirty-four patients were included; 15 in the PBR group and 19 in the PBR-PDIE group. The median age (range) was 31 years (25-37), Seventeen patients (50%) had prior infertility. The median follow-up after bladder resection was 60.6 months (12-116). Overall, of the 25 (73.5%) patients who wished to conceive, 17 (68%) achieved pregnancies resulting in a live birth rate of 76.4%. Among the 17 patients with prior infertility, nine (52.9%) conceived. Overall, eight patients (53.3%) in the PBR group conceived and nine (47.3%) in the PBR-PDIE group (difference not significant). CONCLUSION: The present study demonstrates that laparoscopic PBR results in a high pregnancy rate in patients with prior infertility as well as in those with associated posterior DIE suggesting that surgery could be an acceptable alternative to first-line assisted reproductive technology.

11 Article [Fertility and deep infiltrating endometriosis]. 2017

Cohen, Jonathan / Mathieu d'Argent, Emmanuelle / Selleret, Lise / Antoine, Jean-Marie / Chabbert-Buffet, Nathalie / Bendifallah, Sofiane / Ballester, Marcos / Darai, Emile. ·Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, GRC6-UPMC : centre expert en endométriose (C3E), service de gynécologie-obstétrique et médecine de la reproduction, 75020 Paris, France. Electronic address: drcohenjonathan@gmail.com. · Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, GRC6-UPMC : centre expert en endométriose (C3E), service de gynécologie-obstétrique et médecine de la reproduction, 75020 Paris, France. · Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, GRC6-UPMC : centre expert en endométriose (C3E), service de gynécologie-obstétrique et médecine de la reproduction, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, Inserm, UMR_S938, 75012 Paris, France. ·Presse Med · Pubmed #29129409.

ABSTRACT: Deep infiltrating endometriosis is the most severe form of the disease, defined by infiltration beneath the peritoneum greater than 5mm. It affects several anatomical locations including the bladder, the vesico-uterine cul-de-sac, the torus uterinum, the uterosacral ligament, rectovaginal septum and the colon-rectum. Deep infiltrating endometriosis is associated with infertility. Surgery performed for deep infiltrating endometriosis in the context of pain offers good pregnancy rates either spontaneously or after assisted reproductive technologies. The results are less favorable when digestive tract is involved. IVF performed in the context of deep infiltrating endometriosis allows very satisfactory results and does not entail risks of aggravation of the pathology. There is currently no clear evidence to support either IVF or surgery to manage infertility associated with deep infiltrating endometriosis, but patients should be informed, although a risk of severe complication exists, that surgery is the only way to increase the chances of spontaneous fertility.

12 Article Pregnancy outcomes after controlled ovarian hyperstimulation in women with endometriosis-associated infertility: GnRH-agonist versus GnRH-antagonist. 2017

Kolanska, K / Cohen, J / Bendifallah, S / Selleret, L / Antoine, J-M / Chabbert-Buffet, N / Darai, E / d'Argent, E-M. ·Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; UMRS-938, Pierre-et-Marie-Curie University-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France. · Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; UMRS-938, Pierre-et-Marie-Curie University-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France. Electronic address: drcohenjonathan@gmail.com. · Department of Gynecology and Obstetrics, Tenon Hospital, Assistance publique-Hôpitaux de Paris, Pierre-et-Marie-Curie University (UMPC)-Paris 6, 75020 Paris, France; Clinical Research Group (GRC-6 UPMC): Centre expert en endométriose (C3E), Tenon Hospital, Pierre-et Marie-Curie-University (UMPC)-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France. ·J Gynecol Obstet Hum Reprod · Pubmed #28970135.

ABSTRACT: BACKGROUND OR OBJECTIVE: Endometriosis is common in women referred for infertility. In vitro fertilization provides good results but the choice of the best-controlled ovarian hyperstimulation protocol remains a subject of debate. The objective of this retrospective study was to compare pregnancy outcomes in women with endometriosis-associated infertility after COH with a long agonist protocol or a six-week oral contraception-antagonist protocol. MATERIAL AND METHODS: Retrospective analysis of a prospective database identified 284 COH cycles - 165 with GnRH-agonist protocol (GnRH-agonist group) and 119 with GnRH-antagonist protocol (GnRH-antagonist group) - in 218 women, with endometriosis from January 2013 to October 2015. RESULTS: No difference in the epidemiological characteristics was found between the groups. Per started cycle, pregnancy and live-birth rates after fresh embryo transfer were higher with the GnRH-agonist protocol (25% vs. 13%, P=0.02 and 18% vs. 8%, P=0.04, respectively). Considering analysis per cycle with embryo transfer, the pregnancy rate was similar in both groups while the live-birth rate was higher in the GnRH-agonist group (29% vs. 17%, P=0.053 and 22% vs. 10%, P=0.02, respectively). No difference was observed between the groups with freeze-thaw embryo transfer. Subgroup analysis (endometrioma alone, deep infiltrating endometriosis with and without endometrioma, endometriosis with and without adenomyosis) revealed no difference between the groups for either pregnancy or live-birth rates. CONCLUSION: A GnRH-agonist protocol appears to result in higher pregnancy and live-birth rates after fresh embryo transfer in women with endometriosis-associated infertility, suggesting that a GnRH-antagonist protocol might negatively impact endometrial receptivity.

13 Article Colorectal endometriosis-associated infertility: should surgery precede ART? 2017

Bendifallah, Sofiane / Roman, Horace / Mathieu d'Argent, Emmanuelle / Touleimat, Salma / Cohen, Jonathan / Darai, Emile / Ballester, Marcos. ·Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Institut Universitaire de Cancérologie, Paris, France; INSERM UMRS 707, Epidemiology, Information Systems, Modeling, University Pierre and Marie Curie, Paris, France. Electronic address: sofiane.bendifallah@aphp.fr. · Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France. · Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Institut Universitaire de Cancérologie, Paris, France. · Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Institut Universitaire de Cancérologie, Paris, France; UMRS 938 Université Pierre et Marie Curie, Paris, France; Groupe de Recherche Clinique GRC6-UPMC, Centre Expert En Endométriose, Paris, France. ·Fertil Steril · Pubmed #28807397.

ABSTRACT: OBJECTIVE: To compare the impact of first-line assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI]-IVF) and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility. DESIGN: Retrospective matched cohort study using propensity score (PS) matching (PSM) analysis. SETTING: University referral centers. PATIENT(S): A total of 110 women were analyzed from January 2005 to June 2014. A PSM was generated using a logistic regression model based on the age, antimüllerian hormone (AMH) serum level, and presence of adenomyosis to compare the treatment strategy. INTERVENTION(S): First-line surgery group followed by ART versus exclusive ART with in situ colorectal endometriosis. MAIN OUTCOME MEASURE(S): After PSM, pregnancy rates (PRs), live-birth rates (LBRs), and cumulative rates (CRs) were estimated. RESULT(S): After PSM, in the whole population, the total LBR and PR were 35.4% (39/110) and 49% (54/110), respectively. The specific cumulative LBR at the first ICSI-IVF cycle in the first-line surgery group compared with the first-line ART was, respectively, 32.7% versus 13.0%; at the second cycle, 58.9% versus 24.8%; and at the third cycle, 70.6% versus 54.9%. The cumulative LBRs were significantly higher for women who underwent first-line surgery followed by ART compared with first-line ART in the subset of women with good prognosis (age ≤ 35 years and AMH ≥ 2 ng/mL and no adenomyosis) and women with AMH serum level < 2 ng/mL. CONCLUSION(S): First-line surgery may be a good option for women with colorectal endometriosis-associated infertility.

14 Article [Deep infiltrative endometriosis without digestive involvement, what is the impact of surgery on in vitro fertilization outcomes? A retrospective study]. 2017

Mounsambote, L / Cohen, J / Bendifallah, S / d'Argent, E Mathieu / Selleret, L / Chabbert-Buffet, N / Ballester, M / Antoine, J M / Daraï, E. ·Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France. · Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France; Inserm UMRS 938, université Pierre-et-Marie-Curie, 75012 Paris, France. Electronic address: drcohenjonathan@gmail.com. · Department of Obstetrics, Gynecology and Reproductive Medicine, hôpital Tenon, GRC 6-UPMC centre expert en endométriose (C3E), université Pierre-et-Marie-Curie-Paris 6, Assistance publique-Hôpitaux de Paris, 75020 Paris, France; Inserm UMRS 938, université Pierre-et-Marie-Curie, 75012 Paris, France. ·Gynecol Obstet Fertil Senol · Pubmed #28238309.

ABSTRACT: OBJECTIVES: To evaluate the impact of complete removal of endometriosis in case of deep infiltrative endometriosis without digestive involvement, on in vitro fertilization outcomes. METHODS: Retrospective monocentric study. We included infertile women with deep infiltrative endometriosis without colorectal involvement that underwent IVF. Women were divided in two groups, following their history: "surgery" when they underwent complete endometriosis resection before IVF and "without surgery" when they underwent IVF without endometriosis removal. We analysed IVF outcomes considering pregnancy rates per cycle and cumulative pregnancy rates per patient. RESULTS: We included 72 patients: 35 in the "surgery" group and 37 in the "without surgery" group. Women in the two groups were comparable in terms of baseline characteristics (age, body mass index, anti-Müllerian hormone, antral follicular count), endometriosis localizations and in vitro fertilization parameters. Cumulative pregnancy rates per patient were similar in both groups (40 % in the "surgery" group and 41 % in the "without surgery" group; P=1). Clinical pregnancy rate per cycle were also comparable groups (24 % in the "surgery" group and 28 % in the "without surgery" group; P=0.67). Surgery performed was comparable in women that became pregnant and in women that did not. Age was lower in women that became pregnant (P=0.01) and there were more pregnancy obtained in women under 35 years. CONCLUSION: In women with deep infiltrative endometriosis without digestive involvement, in vitro fertilization outcomes were not impacted by surgery. Therapeutic choice between IVF or surgery as first-line treatment remains thus questionable and shall be guided by other influencing factors, such as pain symptomatology, age, tubal permeability, ovarian reserve, partner's sperm characteristics and woman's choice.

15 Article Prior colorectal surgery for endometriosis-associated infertility improves ICSI-IVF outcomes: results from two expert centres. 2017

Ballester, Marcos / Roman, Horace / Mathieu, Emmanuelle / Touleimat, Salma / Belghiti, Jeremy / Daraï, Emile. ·Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France; Unité INSERM UMR_S 938, Université Pierre et Marie Curie, Paris, France. Electronic address: marcos.ballester@tnn.aphp.fr. · Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France. · Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France. · Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France; Unité INSERM UMR_S 938, Université Pierre et Marie Curie, Paris, France. ·Eur J Obstet Gynecol Reprod Biol · Pubmed #26965272.

ABSTRACT: OBJECTIVE(S): To assess fertility outcomes after ICSI-IVF in infertile women having undergone prior complete surgical removal of colorectal endometriosis. STUDY DESIGN: Prospective longitudinal cohort study in two referral French centres including 60 infertile women who underwent ICSI-IVF after complete surgical removal of colorectal endometriosis, from January 2005 to May 2014. Women underwent either conservative colorectal surgery (i.e., rectal shaving or full thickness disc excision, n=18) or segmental colorectal resection (n=42). Clinical pregnancies were defined by the presence of a gestational sac on vaginal ultrasound examination from the fifth week. The overall pregnancy rate was calculated. The Kaplan-Meier method was used to estimate the cumulative pregnancy rate (CPR). Comparisons of CPR were made using the log-rank test to detect determinant factors. RESULTS: The median number of ICSI-IVF cycles per patient was one (range: 1-4). Of the 60 women, 36 became pregnant (i.e., overall pregnancy rate=60%). The CPR was 41.7% after one ICSI-IVF cycle, 65% after two ICSI-IVF cycles and 78.1% after three ICSI-IVF cycles. A decreased CPR was observed for women who required segmental colorectal resection compared to those who underwent rectal shaving or full thickness disc excision (p=0.04). A trend for a decreased CPR was observed for women who received a first ICSI-IVF cycle more than 18 months following surgery (p=0.07). Among the nine women with prior ICSI-IVF failure, five (55.5%) became pregnant after surgery. CONCLUSION(S): Colorectal surgery for endometriosis completed by ICSI-IVF is a good option for women with proven infertility, even if prior ICSI-IVF had failed.

16 Article [Endometriosis]. 2014

Daraï, Emile / Bazot, Marc / Ballester, Marcos / Belghiti, Jérémie. · ·Rev Prat · Pubmed #24855793.

ABSTRACT: Endometriosis is a benign disorder affecting 10 to 15% of women of reproductive age. It is defined by the presence of endometrium-like tissue outside the uterus. There are three different entities of endometriosis: superficial endometriosis, ovarian endometriotic cyst and deep infiltrating endometriosis. The main clinical features are dysmenorrhea, chronic pelvic pain and dyspareunia. Endometriosis is also responsible for infertility. Transvaginal sonography and magnetic resonance imaging are required to assess mapping of endometriotic lesions. Medical therapies based on progestins or combined oral contraceptives allow to relief symptoms. Despite a relative efficacy of medical treatment or in case of infertility, surgery is necessary preferentially in specialized centers.

17 Article Safety of uterine and/or ovarian preservation in young women with grade 1 intramucous endometrial adenocarcinoma: a comparison of survival according to the extent of surgery. 2012

Koskas, Martin / Bendifallah, Sofiane / Luton, Dominique / Daraï, Emile / Rouzier, Roman. ·Department of Obstetrics and Gynecology, Bichat University Hospital, Paris, France. martin.koskas@wanadoo.fr ·Fertil Steril · Pubmed #22959452.

ABSTRACT: OBJECTIVE: To compare the survival of patients with grade 1 intramucous endometrial adenocarcinoma according to the extent of surgery. DESIGN: Retrospective cohort study. SETTING: Not applicable. PATIENT(S): A cohort of 489 patients who were 40 years of age or younger with grade 1 intramucous endometrial adenocarcinoma. INTERVENTION(S): The patients were divided into the following three groups: 101 patients who underwent uterine preservation, 184 patients who underwent ovarian preservation, and 204 patients who underwent hysterectomy with oophorectomy. MAIN OUTCOME MEASURE(S): The demographics and survival rates were compared. RESULT(S): In the multivariate analysis, no factors were associated with ovarian preservation. In the multivariate analysis, the factors that were associated with uterine preservation were a later year of diagnosis and young age. In a multivariate Cox model, ovarian and uterine preservation had no effect on either cancer-specific or overall survival. CONCLUSION(S): In patients with grade 1 intramucous endometrial adenocarcinoma, uterine and ovarian preservation were not associated with an increase in cancer-related mortality. Longer follow-up is needed to confirm the safety of a conservative approach toward the ovaries and/or the uterus.

18 Article [Comparison of epidemiological factors between serous and mucinous borderline ovarian tumors: therapeutic implications]. 2012

Fauvet, Raffaèle / Demblocque, Élodie / Morice, Philippe / Querleu, Denis / Gondry, Jean / Daraï, Émile. ·CHU d'Amiens, centre de gynécologie obstétrique, 124, rue Camille-Desmoulins, 80054 Amiens, France. fauvet.raffaele@chu-amiens.fr ·Bull Cancer · Pubmed #22510207.

ABSTRACT: The goals of this multicenter French retrospective study were to compare epidemiological factors within borderline ovarian tumors (BOT) according to their serous (SBOT) or mucinous (MBOT) type and according to the presence of pejorative histological criteria. We analysed 224 SBOT and 164 MBOT diagnosed between 1990 and 2009. The patients mean age was not different according to serous or mucinous type (46.9 ± 16.7 years and 44.6 ± 17.6 years). Women with SBOT, had more frequently history of infertility (17.2% versus 3.9%, P < 0.0001) than women with MBOT. SBOT were more often asymptomatic (52.3% versus 33.5%, P < 0.001), bilateral (26.4% versus 4.3%, P = 0.0001), smaller (9.1 cm versus 14.5 cm, P = 0.0001) and diagnosed at advanced stage (81.2% of stage I versus 95.1%, P < 0.0001) than MBOT. The micropapillary pattern found in 10.3% of SBOT was observed at younger age (38 ± 15.4 years versus 47.9 ± 16.6 years, P = 0.007) and was more often associated with peritoneal implants (26.1% versus 6.5%, P = 0.02). The intraepithelial carcinoma found in 6.7% of MBOT, was more often associated with micro-invasion (36.4% versus 4.6%, P = 0.003). The existence of epidemiologic differences between SBOT and MBOT underlines that the BOT series analysis can not be considered without taking into account this parameter.

19 Article Can ovariopexy at the end of surgery for endometriosis be recommended? A case report. 2012

Daraï, Emile / Touboul, Cyril / Ballester, Marcos / Poncelet, Christophe. ·Department of Gynecology-Obstetrics, Hôpital Tenon, Université Pierre et Marie Curie, Paris. emile.darai@tnn.aphp.fr ·J Reprod Med · Pubmed #22324276.

ABSTRACT: BACKGROUND: Endometriosis affects 10-15% of the female population in the reproductive period and is detected in up to 40% of infertile women. Surgery is indicated to improve fertility and symptoms in these women, but some patients experience severe complications and develop postoperative adhesion. We discuss the potential impact on adhesion of systematic ovariopexy at the end of surgery for endometriosis. CASE: We report a case of a 31-year-old woman who underwent initial laparoscopic removal of endometriomas and rectovaginal endometriosis with bilateral transient ovariopexy five years ago. She was referred for recurrence of symptoms and infertility. Preoperative transvaginal sonography and MRI confirmed the recurrence of endometriosis with bilateral uterosacral ligament and rectal involvement. At laparoscopy severe and dense adhesions of the ovaries to the anterior abdominal wall using nonabsorbable suture were observed associated with distortion of tubal anatomy. In addition to the removal of these adhesions, a sigmoid adhesiolysis was performed with uterosacral ligament, rectosigmoid and vaginal resections, followed by a systematic protective colostomy. CONCLUSION: This case illustrates the deleterious impact on adhesions to the abdominal wall of transient ovariopexy at the end of surgery for endometriosis.

20 Article Deep infiltrating endometriosis is a determinant factor of cumulative pregnancy rate after intracytoplasmic sperm injection/in vitro fertilization cycles in patients with endometriomas. 2012

Ballester, Marcos / Oppenheimer, Anne / Mathieu d'Argent, Emmanuelle / Touboul, Cyril / Antoine, Jean-Marie / Nisolle, Michelle / Daraï, Emile. ·Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. ·Fertil Steril · Pubmed #22177465.

ABSTRACT: OBJECTIVE: To evaluate the cumulative pregnancy rate (CPR) per patient after in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles in patients with endometriomas and to evaluate the determinant factors of CPR per patient. DESIGN: Retrospective study from January 2007 to October 2008. SETTING: Tertiary care university hospital. PATIENT(S): 103 patients who had undergone IVF treatment, comprising isolated endometriomas (n = 30) and endometriomas with associated deep infiltrating endometriosis (DIE) (n = 73). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate after IVF-ICSI cycle. RESULT(S): The total number of cycles was 162, and the median number of cycles per patient was 1 (1 to 5). Fifty-eight women (56.3%) became pregnant. The total number of endometriomas and size of the largest endometrioma and bilateral endometriomas had no impact on the CPR per patient. Using multivariable analysis, the associated DIE and antimüllerian hormone serum level (≤ 1 ng/mL) were independent factors associated with a decrease in the pregnancy rate per patient. Overall, the CPR per patient was 73.7%, and it increased until the third cycle with no benefit for additional cycles. The CPR per patient for women with isolated endometriomas and women with endometriomas and associated DIE was 82.5% and 69.4%, respectively. CONCLUSION(S): Associated DIE has a negative impact on assisted reproduction results in patients with endometriomas. Moreover, our data show that after three IVF-ICSI cycles the CPR per patient is not improved and that surgery should be considered.

21 Article Nomogram to predict pregnancy rate after ICSI-IVF cycle in patients with endometriosis. 2012

Ballester, Marcos / Oppenheimer, Anne / d'Argent, Emmanuelle Mathieu / Touboul, Cyril / Antoine, Jean-Marie / Coutant, Charles / Daraï, Emile. ·Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, 4 rue de la Chine, 75020 Paris, France. marcos.ballester@tnn.aphp.fr ·Hum Reprod · Pubmed #22114107.

ABSTRACT: BACKGROUND: Although several scoring systems have been published to evaluate the pregnancy rate after ICSI-IVF in infertile patients, none of them are applicable for patients with deep infiltrating endometriosis (DIE) nor can they evaluate the chances of pregnancy for individual patients. The aim of this study was to develop a nomogram based on an association of patients' characteristics to predict the clinical pregnancy rate in patients with endometriosis. METHODS: This prospective longitudinal study was conducted from January 2007 to June 2010. The nomogram was built from a training cohort of 94 consecutive patients (141 ICSI-IVF cycles) and tested on an independent validation cohort of 48 patients (83 ICSI-IVF cycles). DIE was confirmed in all participants. RESULTS: The pregnancy rate (per patient) in women with and without DIE was 58 and 83%, respectively (P = 0.03). Increased patient age (P = 0.04), serum anti-Mullerian hormone (AMH) level ≤ 1 ng/ml (P = 0.03) and increased number of ICSI-IVF cycles (P = 0.03) were associated with a decreased clinical pregnancy rate. The presence of DIE was the strongest determinant factor of the clinical pregnancy rate in our model [odds ratio = 0.26, 95% confidence interval (CI): 0.07-0.9 (P = 0.006)], which also included patient age, serum AMH level and number of attempts at ICSI-IVF. The nomogram showed an area under the curve (AUC) of 0.76 for the training cohort (95% CI: 0.7-0.8) and was well calibrated. The AUC for the validation cohort was 0.68 (95% CI: 0.6-0.75) and calibration was good. CONCLUSIONS: Our nomogram provides realistic and precise information about ICSI-IVF success and can be used to guide couples and practitioners.

22 Article Fertility after colorectal resection for endometriosis: results of a prospective study comparing laparoscopy with open surgery. 2011

Daraï, Emile / Lesieur, Benedicte / Dubernard, Gil / Rouzier, Roman / Bazot, Marc / Ballester, Marcos. ·Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie, Paris, France. emile.darai@tnn.aphp.fr ·Fertil Steril · Pubmed #21392746.

ABSTRACT: OBJECTIVE: To determine whether the surgical route of colorectal resection for endometriosis is a determinant factor for fertility. DESIGN: Prospective study. SETTING: Tertiary-care university hospital. PATIENT(S): Fifty-two patients with endometriosis were randomly assigned to laparoscopic or open surgery. INTERVENTION(S): Laparoscopically assisted vs. open colorectal resection. MAIN OUTCOME MEASURE(S): Evaluation of fertility outcomes spontaneously and after assisted reproductive therapy. RESULT(S): The mean follow-up was 29 months. Among the 28 patients wishing to conceive, 11 (39.3%) became pregnant. Overall cumulative pregnancy rate at 52 months for these patients was 45.1%. For patients with or without infertility, the cumulative pregnancy rate was 37.6% and 55.6%, respectively, and the cumulative spontaneous pregnancy rate 13.3% and 36.5%, respectively. All the spontaneous pregnancies were observed in the laparoscopy group. CONCLUSION(S): This study demonstrates that spontaneous pregnancy is more frequent after laparoscopy compared with open surgery for colorectal endometriosis.

23 Article Do patients manage to achieve pregnancy after a major complication of deeply infiltrating endometriosis resection? 2011

Kondo, William / Daraï, Emile / Yazbeck, Chadi / Panel, Pierre / Tamburro, Stefano / Dubuisson, Jean / Jardon, Kris / Mage, Gérard / Madelenat, Patrick / Canis, Michel. ·CHU de Clermont-Ferrand, Polyclinique de l'Hôtel Dieu, Clermont-Ferrand, France. williamkondo@yahoo.com ·Eur J Obstet Gynecol Reprod Biol · Pubmed #20970915.

ABSTRACT: OBJECTIVE: To evaluate the fertility status in women suffering from major postoperative complications following deep endometriosis surgery. STUDY DESIGN: A retrospective study in teaching and research hospitals (tertiary centers) including 23 women submitted to the surgical treatment for deep endometriosis and presenting a major postoperative complication. Postoperatively, women desiring pregnancy who conceived were compared to those who did not conceive using Mann-Whitney test and Fisher's exact test. Main outcome measure included the pregnancy rate among these women. RESULTS: The overall intrauterine pregnancy rate was 47.8% and the live birth rate was 30.4%. There were 10 spontaneous conceptions and 3 IVF conceptions among 11 patients. Women who did not conceive were older than those who conceived (33.9 vs. 29.3 years; p = 0.02). The pregnancy rate after intestinal complications was lower than after urinary complications (33.3% vs. 83.3%; p = 0.04). CONCLUSION: Fertility remains preserved among women experiencing a major complication after removal of deep endometriosis with a live birth rate of 30.4%. Women experiencing bowel complications have a reduced probability of conception compared with those who experience a urologic complication.

24 Article Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility. 2010

Daraï, Emile / Dubernard, Gil / Coutant, Charles / Frey, Catherine / Rouzier, Roman / Ballester, Marcos. ·Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie Paris 6, France. emile.darai@tnn.aphp.fr ·Ann Surg · Pubmed #20485146.

ABSTRACT: OBJECTIVE: We report the first randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis focusing on perioperative complications, improvement in symptoms, quality of life, and fertility. SUMMARY OF BACKGROUND DATA: Bowel endometriosis is one of the most severe forms of endometriosis. Although laparoscopically assisted surgery is a validated technique for colorectal cancer, there are serious concerns about its appropriateness for endometriosis in young women wishing to conceive because it is almost invariably a traumatic procedure. METHODS: We conducted a noninferiority trial and randomly assigned 52 patients with colorectal endometriosis to undergo laparoscopically assisted or open colorectal resection. The median follow-up was 19 months. The primary end point was improvement in dyschesia. RESULTS: Overall, a significant improvement in digestive symptoms (dyschesia P < 0.0001, diarrhea P < 0.01, and bowel pain and cramping P < 0.0001), gynecologic symptoms (dysmenorrhea P < 0.0001 and dyspareunia P < 0.0001), and general symptoms (back pain P = 0.001 and asthenia P = 0.0001) was observed. No difference in the symptom delta values and quality of life was noted between the groups. Median blood loss was lower in the laparoscopic group (P < 0.05). Total number of complications was higher in the open surgery group (P = 0.04), especially grade 3 (P = 0.03). Pregnancy rate was higher in the laparoscopic group (P = 0.006), and the cumulative pregnancy rate was 60%. CONCLUSION: Our findings support that laparoscopy is a safe option for women requiring colorectal resection for endometriosis. Moreover, laparoscopy offers a higher pregnancy rate than open surgery with similar improvements in symptoms and in quality of life.

25 Article Results of first in vitro fertilization cycle in women with colorectal endometriosis compared with those with tubal or male factor infertility. 2010

Mathieu d'Argent, Emmanuelle / Coutant, Charles / Ballester, Marcos / Dessolle, Lionel / Bazot, Marc / Antoine, Jean-Marie / Daraï, Emile. ·Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. ·Fertil Steril · Pubmed #20434149.

ABSTRACT: This retrospective study of women undergoing IVF (29 with colorectal endometriosis, 157 with tubal factor infertility, and 340 with male factor infertility) found similar fertility outcomes between the groups.

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