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Infertility: HELP
Articles by Horace Roman
Based on 15 articles published since 2009
(Why 15 articles?)
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Between 2009 and 2019, H. Roman wrote the following 15 articles about Infertility.
 
+ Citations + Abstracts
1 Guideline [Management of endometriosis: CNGOF-HAS practice guidelines (short version)]. 2018

Collinet, P / Fritel, X / Revel-Delhom, C / Ballester, M / Bolze, P A / Borghese, B / Bornsztein, N / Boujenah, J / Bourdel, N / Brillac, T / Chabbert-Buffet, N / Chauffour, C / Clary, N / Cohen, J / Decanter, C / Denouël, A / Dubernard, G / Fauconnier, A / Fernandez, H / Gauthier, T / Golfier, F / Huchon, C / Legendre, G / Loriau, J / Mathieu-d'Argent, E / Merlot, B / Niro, J / Panel, P / Paparel, P / Philip, C A / Ploteau, S / Poncelet, C / Rabischong, B / Roman, H / Rubod, C / Santulli, P / Sauvan, M / Thomassin-Naggara, I / Torre, A / Wattier, J M / Yazbeck, C / Canis, M. ·Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. Electronic address: pierre.collinet@chru-lille.fr. · Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France. · Haute Autorité de santé, 5, avenue du Stade-de-France, 93218 La Plaine-Saint-Denis cedex, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard-Lyon 1, 69000 Lyon, France. · Service de chirurgie gynécologie-obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France. · 29, rue de l'Essonne, 91000 Evry, France. · Service de gynécologie-obstétrique, CHU Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France. · 98, route de Blagnac, 31200 Toulouse, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 centre expert en endométriose (C3E), Sorbonne université, Paris, France; UMR-S938 Inserm Sorbonne université, Paris, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. · 3, rue Pablo-Picasso, 92160 Antony, France. · Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4308 gamétogenèse et qualité du gamète, CHRU de Lille, 59037 Lille cedex, France. · EndoFrance, BP 50053, 01124 Montluel cedex, France. · Université Claude-Bernard-Lyon 1, 69000 Lyon, France; Clinique gynécologique et obstétricale, hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France. · Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France. · Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, équipe épidémiologie et évaluation des stratégies de prise en charge, VIH, reproduction, pédiatrie, université Paris-Sud, Paris, France. · Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87042 Limoges, France. · Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. · Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France. · Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris-Sud, 94276 Le Kremlin-Bicêtre cedex, France. · Service de chirurgie digestive, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, Paris, France; GRC6-UPMC, centre expert en endométriose (C3E), hôpital Tenon, Paris, France. · Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France. · Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France. · Service d'urologie, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 60495 Pierre-Bénite, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France. · Service de gynécologie-obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93022 Bobigny, France. · Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. · Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France. · Service d'imagerie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, Paris, France; Institut universitaire de cancérologie, Assistance publique, Paris, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France. · Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France. · Service de gynécologie-obstétrique, hôpital Foch, AP-HP, 40, rue Worth, 92151 Suresnes, France; Centre d'assistance médicale à la procréation, clinique Pierre-Cherest, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France. ·Gynecol Obstet Fertil Senol · Pubmed #29550339.

ABSTRACT: First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.

2 Guideline [Minimal and mild endometriosis: Impact of the laparoscopic surgery on pelvic pain and fertility. CNGOF-HAS Endometriosis Guidelines]. 2018

Ploteau, S / Merlot, B / Roman, H / Canis, M / Collinet, P / Fritel, X. ·Service de gynécologie-obstétrique et médecine de la reproduction, hôpital mère-enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France. Electronic address: stephane.ploteau@chu-nantes.fr. · Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 39000 Bordeaux, France. · Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charle-Nicolle, 1, rue de Germont, 76031 Rouen, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France. · Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France. ·Gynecol Obstet Fertil Senol · Pubmed #29510965.

ABSTRACT: Minimal and mild endometriosis (stage 1 and 2 AFSR) can lead to chronic pelvic pain and infertility but can also exist in asymptomatic patients. The prevalence of asymptomatic patients with minimal and mild endometriosis is not clear but typical endometriosis lesions are found in about 5 to 10% of asymptomatic women and more than 50% of painful and/or infertile women. Laparoscopic treatment of minimal and mild endometriotic lesions is justified in case of pelvic pain because their destruction decrease significatively the pain compared with diagnostic laparoscopy alone. In this context, ablation and excision give identical results in terms of pain reduction. Moreover, literature shows no interest in uterine nerve ablation in case of dysmenorrhea due to minimal and mild endometriosis. Then, it is recommended to treat these lesions during a laparoscopy realised as part of pelvic pain. On the other hand, it is not recommended to treat asymptomatic patients. With regard to treatment of minimal and mild endometriosis in infertile patients, only two studies can be selected and both show that laparoscopy with excision or ablation and ablation of adhesions is superior to diagnostic laparoscopy alone in terms of pregnancy rate. However, it is not recommended to treat these lesions when they are asymptomatic because there is no evidence that they can progress with symptomatic disease. There is no study assessing the interest to treat these lesions when they are found fortuitously. Adhesion barrier utilisation permits to reduce post-operative adhesions, however literature failed to demonstrate the clinical profit in terms of reduction of the risk of pain or infertility.

3 Editorial [The policy of systematic first line IVF in patients with severe deep endometriosis and pregnancy intention: A thin scientific support with severe collateral damages]. 2016

Roman, H. ·Clinique gynécologique et obstétricale, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France; Groupe de recherche, EA 4308 « Gamétogénése et qualité des gamètes », CHU de Rouen, 76031 Rouen, France; Centre expert « Rouendométriose », 76031 Rouen, France. Electronic address: horace.roman@gmail.com. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #26900140.

ABSTRACT: -- No abstract --

4 Review Endometriosis surgery and preservation of fertility, what surgeons should know. 2018

Roman, H. ·Clinique gynécologique et obstétricale, centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France. Electronic address: horace.roman@gmail.com. ·J Visc Surg · Pubmed #29709485.

ABSTRACT: Colorectal surgeons often participate in the multidisciplinary management of young females with endometriosis. Complications of endometriosis as well as its management often result in infertility since they can involve all pelvic organs including the procreative organs: uterus, ovaries and fallopian tubes. Complete excision of all endometriotic lesions should not be performed at the expense of irreversible destruction of the procreative organs; definitive infertility should not be the price to pay in order to obtain an improvement of the painful symptoms caused by endometriosis. Surgery for ovarian endometriomas should be specifically adapted to the patient's desire for future conception and to her preoperative ovarian reserve. Two main techniques are used to treat ovarian endometriomas: ovarian cystectomy excises the wall of the cyst while ablation consists of destruction of the internal surface of the cyst. The use of mono polar or biolar coagulation for cyst ablation is strongly contra-indicated. Ablation using laser or plasma energy has resulted in comparable rates of post-operative pregnancy to those obtained by ovarian cystectomy. Patients who wish to delay their attempt to conceive for some period of time, should be placed on long-term oral contraception with prevention of menstruation to reduce the risk of recurrent endometriosis. When surgery for colorectal endometriosis is necessary, the laparoscopic approach increases the chances of spontaneous conception compared to laparotomy. Surgery for deep-seated endometriosis has been accompanied by a high rate of spontaneous conception and successful pregnancy and does not seem to decrease the chances for conception by in vitro fertilization.

5 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.

6 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.

7 Article Does preoperative antimüllerian hormone level influence postoperative pregnancy rate in women undergoing surgery for severe endometriosis? 2017

Stochino-Loi, Emanuela / Darwish, Basma / Mircea, Oana / Touleimat, Salma / Millochau, Jenny-Claude / Abo, Carole / Angioni, Stefano / Roman, Horace. ·Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy. · Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France. · Department of Gynecology and Obstetrics, University of Medicine and Pharmacy, Targu Mures, Romania. · Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy. · Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group EA 4308 "Spermatogenesis and Male Gamete Quality," Institut Hospitalier Universitaire Rouen Normandy, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com. ·Fertil Steril · Pubmed #28089574.

ABSTRACT: OBJECTIVE: To compare postoperative pregnancy rates as they relate to presurgery antimüllerian hormone (AMH) level in patients with stage 3 and 4 endometriosis. DESIGN: Retrospective comparative study using data prospectively recorded in the North-West Inter-Regional Female Cohort for Patients with Endometriosis (CIRENDO) database. SETTING: University tertiary referral center. PATIENT(S): One hundred eighty patients with stage 3 and 4 endometriosis and pregnancy intention, managed from June 2010 to March 2015, were divided into two groups according to their preoperative AMH levels: group A (AMH ≥2 ng/mL) and group B (AMH <2 ng/mL). INTERVENTION(S): Surgical procedure involved ovarian endometrioma ablation by plasma energy along with resection of various localizations of the disease. Postoperative conception was either spontaneous or used assisted reproductive technology, depending on patient characteristics. MAIN OUTCOME MEASURE(S): Patient characteristics, preoperative symptoms, infertility history, intraoperative findings, and probability of pregnancy were recorded and compared between the two groups. RESULT(S): Among 180 women enrolled in the study, 134 (74.4%) were assigned to group A and 46 (25.6%) to group B. The women's ages were, respectively, 30 ± 3.8 and 32 ± 4.6 years. Pregnancy was achieved by 134 (74.4%) patients, and conception was spontaneous in 74 of them (55.2%). Pregnancy rates in groups A and B were, respectively, 74.6% (100 women) and 73.9% (34 women), while spontaneous conception represented 54% (54 women) and 58.8% (20 women). The probability of pregnancy at 12, 24, and 36 months after surgery in groups A and B was comparable, respectively, 65% (95% confidence interval [CI], 55%-75%), 77% (95% CI, 86%-68%), and 83% (95% CI, 90%-75%) versus 50% (95% CI, 69%-34%), 77% (95% CI, 90%-61%), and 83% (95% CI, 94%-68%). Supplementary analysis in women with normal (≥2 ng/mL), low (1-1.99 ng/mL), and very low (<1 ng/mL) AMH level showed an inverse relationship between AMH level, age, and antecedents of miscarriage; however, postoperative pregnancy rates were comparable among the three groups at 12 and 24 months, respectively, 59.5% (95% CI, 49.3%-70%) and 77.4% (95% CI, 68%-85.4%); 57.1% (95% CI, 34%-83%) and 78.6% (95% CI, 55.2%-94.8%); and 46.7% (95% CI, 25.6%-73.7%) and 73.3% (95% CI, 50.4%-91.7%). CONCLUSION(S): The probability of postoperative pregnancy was comparable between women with low and normal AMH level who were managed for stage 3 and 4 endometriosis and who were a mean age of 30 years. However, the small sample size might have been unable to detect differences in pregnancy and live-birth rates between the two groups. As the majority of pregnancies were spontaneous, our results suggest that surgical management may be offered to young patients with severe endometriosis and reduced ovarian reserve with good fertility outcomes.

8 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.

9 Article In vitro fertilization outcomes after ablation of endometriomas using plasma energy: A retrospective case-control study. 2016

Motte, I / Roman, H / Clavier, B / Jumeau, F / Chanavaz-Lacheray, I / Letailleur, M / Darwish, B / Rives, N. ·Department of gynecology and obstetrics, Rouen university hospital, 76031 Rouen, France; Expert Center in the Diagnostic and Multidisciplinar Management of Endometriosis "Rouendometriose", 76031 Rouen, France. · Department of gynecology and obstetrics, Rouen university hospital, 76031 Rouen, France; Expert Center in the Diagnostic and Multidisciplinar Management of Endometriosis "Rouendometriose", 76031 Rouen, France; Research Group 4308 "Spermatogenesis and Gamete Quality", IHU Rouen Normandy, IFRMP23, reproductive biology laboratory, Rouen university hospital, 76031 Rouen, France. Electronic address: horace.roman@gmail.com. · Department of reproductive biology, Rouen university hospital, 76031 Rouen, France. · Expert Center in the Diagnostic and Multidisciplinar Management of Endometriosis "Rouendometriose", 76031 Rouen, France; Research Group 4308 "Spermatogenesis and Gamete Quality", IHU Rouen Normandy, IFRMP23, reproductive biology laboratory, Rouen university hospital, 76031 Rouen, France; Department of reproductive biology, Rouen university hospital, 76031 Rouen, France. ·Gynecol Obstet Fertil · Pubmed #27665252.

ABSTRACT: OBJECTIVE: Ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy, because it could spare underlying ovarian parenchyma resulting in high spontaneous and overall pregnancy rates. After initial postoperative decrease, anti-mullerian hormone (AMH) level progressively increases several months after ablation. The aim of our study was to assess the outcomes of in vitro fertilization (IVF) in women managed for ovarian endometriomas by ablation using plasma energy, when compared to those in women free of endometriosis. METHODS: Retrospective preliminary case-control study, enrolling women undergoing IVF or IntraCytoplasmic Sperm Injection (ICSI), from July 2009 to December 2014. Cases were infertile women with previous ovarian endometrioma ablation using plasma energy and were matched by age, AMH level and assisted reproductive technique with controls presumed free of endometriosis. IVF/ICSI response (type of protocol, dose of gonadotrophin, number of oocytes, fertilization rate) and outcomes were compared between the two groups. RESULTS: In all, 37 cases were compared to 74 controls. Age (30.9±4.4 years vs. 31.7±4.2 years), AMH level (2.8±2ng/mL vs. 2.8±1.7ng/mL) and ART procedures (ICSI in 24.3% vs. 27%) were comparable between the two groups. Of the 37 cases, previous surgical procedures on right and left ovaries were performed in 27% and 21.6% of patients respectively, 81% of patients were nullipara. AFSr score was 73±41, while deep endometriosis infiltrated the rectum and the sigmoid colon in respectively 40.5% and 27% of patients. Despite a lower number of oocytes retrieved, cases presented better implantation rate, pregnancy and delivery rates per cycle, oocyte retrieval, transfer, and embryo, as well as superior cumulative birth rate per transfer. CONCLUSION: Ovarian endometrioma ablation using plasma energy is followed by good IVF/ICSI outcomes, suggesting that surgical procedure spares underlying ovarian parenchyma. These results consolidate those of previous studies reporting high spontaneous conception rate. Hence, ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy in patients presenting with endometriosis and pregnancy intention.

10 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.

11 Article Adhesions and endometriosis: challenges in subfertility management : (An expert opinion of the ANGEL-The ANti-Adhesions in Gynaecology Expert PaneL-group). 2016

De Wilde, R L / Alvarez, J / Brölmann, H / Campo, R / Cheong, Y / Lundorff, P / Pawelczyk, L / Roman, H / di Spiezio Sardo, A / Wallwiener, M. ·Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany. rudy-leon.dewilde@pius-hospital.de. · Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28702, San Sebastián de Los Reyes, Spain. · Department of Obstetrics and Gynecology, VU University, 1081, Amsterdam, The Netherlands. · Leuven Institute for Fertility and Embryology (LIFE), Tiensevest 168, 3000, Louvain, Belgium. · Human Development and Health Unit, University of Southampton and Complete Fertility Centre, Southampton, UK. · Department of Obstetrics and Gynecology, Privathospitalet Mølholm, 7100, Vejle, Denmark. · Division of Infertility and Reproductive Endocrinology, Poznan University of Medical Sciences, Poznan, Poland. · Hopitaux De Rouen, Clinique Gynecologique et Obstetricale, 1 Rue Germont, 76031, Rouen Cedex, France. · Studio medico, via San Giacomo dei Capri 63, Naples, Italy. · Department of Obstetrics and Gynecology, University Clinic Heidelberg, 69120, Heidelberg, Germany. ·Arch Gynecol Obstet · Pubmed #26894304.

ABSTRACT: There is molecular evidence that endometriosis has a negative impact on the ovaries, although the exact pathophysiology concerning endometriosis-associated subfertility is not known. The negative impact on the tubo-ovarian unit can be directly by distorting the anatomy, indirectly by invoking inflammation or by oxidative damage with poorer-quality oocytes. Endometriosis even seems to have a negative effect on pregnancy outcome after in vitro fertilization.

12 Article Recurrent Hemoperitoneum During Pregnancy in Large Deep Endometriosis Infiltrating the Parametrium. 2016

Stochino Loi, Emanuela / Darwish, Basma / Abo, Carole / Millischer-Bellaiche, Anne-Elodie / Angioni, Stefano / Roman, Horace. ·Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France. · Imaging Medical Center, Paris, France. · Department of Surgical Sciences, Cagliari University Hospital, Cagliari, Italy. · 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 #26826678.

ABSTRACT: We present the case of a young woman at 16 weeks' gestation who presented to a peripheral hospital with severe recurrent hemoperitoneum related to severe deep endometriosis infiltrating the left parametrium. She underwent 2 surgical open procedures in emergency, followed by pregnancy loss. Deep endometriosis infiltrated the rectum, the vagina, and the left parametrium, leading to stenosis of the left ureter and advanced destruction of the left kidney. Ovarian reserve was low with an antimullerian hormone level at .6 ng/mL. To improve endometriosis-related symptoms and preserve fertility, a laparoscopic conservative rectal and ureteral management was proposed with an aim to relieve symptoms, avoid further destruction of the left kidney, preserve the right splanchnic nerves and inferior hypogastric plexus, and enhance spontaneous conception. We performed a combined vaginal-laparoscopic approach that consisted of vaginal infiltration resection, adhesiolysis, rectal shaving, ureterolysis, and restoration of the permeability of the fallopian tubes. Seven months after surgery the patient spontaneously conceived and is doing well.

13 Article [Prognosis factors in donor semen insemination: a 10-years follow-up study of 188 patients]. 2013

Mokdad, C / Clavier, B / Perdrix, A / Roman, H / Marpeau, L / Rives, N. ·Clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France. cecile.mokdad@gmail.com ·Gynecol Obstet Fertil · Pubmed #22989519.

ABSTRACT: OBJECTIVES: Improving our practice by a constant evaluation is essential in the field of donor semen insemination (DI). Our center examined the prognosis factors for DI success in order to standardize patient treatment options. PATIENTS AND METHODS: We retrospectively analysed all couples referred for DI from January 2000 till December 2010. RESULTS: We analysed 551 cycles among 188 patients. Pregnancy rate by stimulation cycle was 19,8% with birth rate of 16.7%. The rate of pregnancy was improved till the fourth trial then plateau. On a patient-based analysis, success factors were age (P=0.04), previous successful DSI (P=0.02), and no previous failure of an ICSI-C (P=0.035). On a cycle-based analysis, success factors were the number of follicles greater than 15mm (P=0.04) and than 18mm (P=0.001). The percentage of 68.1 patients obtained a child by IVF-D after a failed DI. CONCLUSION: There are two predictive factors for DI success: the age of the patient and the number of mature follicles. It seems accurate to referred patients to IVF-D after four unsuccessful cycles of DSI. This recommendation may be adapted according to patient's age and hormonal evaluation.

14 Article [Endometriosis and postoperative infertility. A prospective study (Auvergne cohort of endometriosis)]. 2012

Bourdel, N / Dejou-Bouillet, L / Roman, H / Jaffeux, P / Aublet-Cuvelier, B / Mage, G / Pouly, J-L / Canis, M. ·Pôle de gynécologie-obstétrique, CHU Estaing Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France. nicolas.bourdel@gmail.com ·Gynecol Obstet Fertil · Pubmed #22019744.

ABSTRACT: OBJECTIVE: To evaluate in infertile women the benefit of laparoscopic surgical treatment of endometriosis. PATIENTS AND METHODS: All infertile patients aged 18 to 43 years old, operated between February 2004 and March 2008, with a minimal follow-up of 18 months, coming from the Auvergne cohort of endometriosis has been, were included. The primary end point was the achievement of a pregnancy. RESULTS: One hundred and twenty-three patients have been included. Global pregnancy rate was 48%, which 47% was spontaneous with a mean postoperative delay of 6±4.5 months. Sixty-three patients had benefited from Assisted Reproductive Technology (ART) and 25 pregnancies were obtained (pregnancy rate: 39.7% with a mean delay of 10±3.8 months). Eighty-one percent of spontaneous pregnancies were obtained during the first 12 postoperative months. Duration of preoperative infertility and tubal involvement were significantly associated with lower spontaneous pregnancy rate. No significant differences were found between endometriosis stage I and II compared to stage III and IV, and between patient under 34 years old compared to older. DISCUSSION AND CONCLUSION: With this first study on infertility from the Auvergne cohort of endometriosis, we are confirmed that surgery is one of the central issues in the treatment of infertile endometriosis patient. The postoperative delay to obtain a spontaneous pregnancy requires a quick management by ART after 6 to 12 postoperative month and an immediate management by ART in case of tubal involvement or former infertility.

15 Minor Bowel occlusion in an infertile woman with documented deep endometriosis of the sigmoid colon: Why was it not unexpected? 2016

Quicray, M / Darwish, B / Bridoux, V / Roman, H. ·Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France. · Department of Digestive Surgery, Rouen University Hospital, 76031 Rouen, France. · Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France; Research Group EA 4308 'Spermatogenesis and Male Gamete Quality', Rouen University Hospital, 76031 Rouen, France. Electronic address: horace.roman@gmail.com. ·Gynecol Obstet Fertil · Pubmed #27773612.

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