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Infertility: HELP
Articles by Lucian Puscasiu
Based on 2 articles published since 2008

Between 2008 and 2019, L. Puscasiu wrote the following 2 articles about Infertility.
+ Citations + Abstracts
1 Article Fertility Outcomes After Ablation Using Plasma Energy Versus Cystectomy in Infertile Women With Ovarian Endometrioma: A Multicentric Comparative Study. 2016

Mircea, Oana / Puscasiu, Lucian / Resch, Benoit / Lucas, Jerome / Collinet, Pierre / von Theobald, Peter / Merviel, Philippe / Roman, Horace. ·Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; University of Medicine and Pharmacy, "Carol Davila" Bucharest, Romania. · Department of Gynecology and Obstetrics, University of Medicine and Pharmacy, Târgu Mureş, Romania. · Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Department of Gynecologic Surgery, Mathilde Clinic, Rouen, France. · Department of Gynecologic Surgery, Europe Clinic, Rouen, France. · Department of Gynecologic Surgery, "Jeanne de Flandre" University Hospital, Lille, France. · Department of Gynecologic Surgery, Caen University Hospital, Caen, France. · Department of Gynecologic Surgery, Amiens University Hospital, Amiens, France. · Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group 4308 "Spermatogenesis and Gamete Quality", IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com. ·J Minim Invasive Gynecol · Pubmed #27553184.

ABSTRACT: STUDY OBJECTIVE: To compare the probability of postoperative pregnancy in infertile women with ovarian endometrioma larger than 3 cm in diameter, managed by either ablation using plasma energy or cystectomy. DESIGN: A multicentric case-control study (Canadian Task Force classification II-2). SETTING: Six surgical departments, affiliated with 4 university hospitals and 2 private facilities. PATIENTS: One hundred four infertile patients with ovarian endometrioma larger than 3 cm. INTERVENTIONS: Endometrioma ablation using plasma energy was performed in 64 patients (61.5%) and cystectomy in 40 patients (38.5%). MEASUREMENTS AND MAIN RESULTS: Patients were enrolled in the CIRENDO prospective cohort database (NCT02294825) from June 2009 to June 2014 and managed in 6 different facilities. The minimum length of follow-up was 1 year. Postoperative probabilities of pregnancy in patietns and control subjects were estimated using the Kaplan-Meier method with 95% confidence intervals (CIs) and compared using the log-rank test. The Cox model was used to assess independent predictive factors for pregnancy. Patients managed by plasma energy were significantly older than patients managed by cystectomy, had significantly higher overall revised American Fertility Society (rAFS) score, and had higher rate of Douglas pouch obliteration, deep endometriosis, and colorectal localizations. After a mean follow-up of 35.3 ± 17.5 months (range, 12-60), fertility outcomes were comparable between the groups. The probability of pregnancy at 24 and 36 months after surgery in plasma energy and cystectomy groups was, respectively, 61.3% (95% CI, 48.2%-74.4%) versus 69.3% (95% CI, 54.5%-83%) and 84.4% (95% CI, 72%-93.4%) versus 78.3% (95% CI, 63.8%-90%). The Cox's model revealed that the type of surgical procedure on ovarian endometrioma had no statistically significant impact on the probability of pregnancy, after adjustment for women's age, bilateral cysts larger than 3 cm, colorectal endometriosis, and rAFS stage of endometriosis. CONCLUSION: Postoperative pregnancy rates were comparable after management of ovarian endometrioma by either ablation using plasma energy or cystectomy despite an overall higher rate of unfavorable fertility predictive factors in women managed by ablation.

2 Article [Management of menometrorrhagia in women with and without pregnancy intention: hierarchy of therapies]. 2008

Roman, H / Loisel, C / Puscasiu, L / Sentilhes, L / Marpeau, L. ·CHU de Rouen, clinique gynécologique et obstétricale, 1, rue de Germont, 76031 Rouen, cedex, France. horace.roman@gmail.com ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #19268219.

ABSTRACT: The first line of treatment recommended for women with idiopathic menorrhagia is pharmaceutical agents, i.e. levonorgestrel intra-uterine device, tranexamic acid, estroprogestatif pills, oral progestin and non-sterodial anti-inflammatory drugs. The second line of treatment is surgical, using endometrial curettage for women who desire pregnancy in the future. On the other hand, in women who no longer intend to get pregnant either endometrial ablation or hysterectomy can be used. The menorrhagia associated with endometrial polyps is treated through the hysteroscopic polypectomy, which result can be improved by the use of the levonorgestrel intra-uterine device or the endometrial ablation. The menorrhagia related to submucosal myomas is managed by hysteroscopic myomectomy, either as a first line of treatment or following the failure of the pharmaceutical management. The first line of treatment of interstitial myomas is represented by the medical management, followed by laparoscopic or abdominal myomectomy for women who still want to be pregnant, and by myomectomy or uterine arteries embolization for women who no longer desire pregnancy. Hysterectomy is the most efficient treatment of menorrhagia due to interstitial myomas, and may be proposed either as a third line of treatment for the myomectomy and embolization failures or as a second line of treatment for women who do not wish to conserve their uterus. Finally, the treatment for women with clinically or radiologically suspected adenomyosis is medical, followed by hysterectomy for women who desire no pregnancy.