Features of reproductive potential in patients with extensive endometriosis forms

Aim: to determine the optimal tactics for managing patients with deep infiltrating endometriosis.

Materials and Methods. A prospective cohort clinical trial was conducted with 69 patients examined following surgical treatment for extensive infiltrating endometriosis and 3-month-long anti-relapse therapy with gonadotropin-releasing hormone agonists. Reproductive potential was assessed based on quantitating anti-Müllerian hormone (AMH) before and 6 months post-surgery, recording cases with/without onset of spontaneous pregnancy within 1 year.

Results. While comparatively analyzing AMH level in preand postoperative period revealed its decline in 51.8 % by average 0.152 ng/ml; the smallest reduction was found in women aged 28.5 to 33.5 years, regardless of the extent of surgical treatment. Pregnancy occurred in 10 of 43 planning women (average age 36,0 [32,0–42,5] years): 7 patients underwent ovarian interventions, 3 – surgical treatment for endometriosis of other localizations.

Conclusion. The data obtained evidence that subject’s age plays a decisive role in maintaining reproductive potential and a need for a differentiated approach in developing individual tactics for management and treatment of patients with deep infiltrating endometriosis, taking into account age, localization of endometriosis and reproductive plans.

1. Politova A.K., Kira E.F., Vershinina Yu.A., Aleksandrova A.D. Surgical treatment of deep retrocervical endometriosis. [Khirurgicheskoe lechenie glubokogo retrotservikalnogo endometrioza]. Vestnik nacional'nogo mediko-hirurgicheskogo centra imeni N.I. Pirogova. 2021;16(1):177–80. (In Russ.). https://doi.org/10.25881/20728255_2021_16_2_149.

2. Alieva P.M., Dumanovskaya M.R., Solopova A.E. et al. The features of the course of retrocervical endometriosis. [Osobennosti techeniya retrotservikalnogo endometrioza]. Akusherstvo i ginekologiya. 2024;(2):157–64. (In Russ.). https://doi.org/10.18565/aig.2023.222.

3. Almova I.K., Khilkevich E.G., Chuprynin V.D. et al. Comparative analysis of techniques for diagnosing retrocervical endometriosis. [Sravnitelnyy analiz metodov diagnostiki retrotservikalnogo endometrioza]. Akusherstvo i ginekologiya. 2019;(10):129–39. (In Russ.). https://doi.org/10.18565/aig.2019.10.129-139.

4. Adamyan L.V., Andreeva E.N., Apolikhina I.A. et al. Endometriosis: diagnostics, treatment and rehabilitation. Federal clinical guidelines for patient management. [Endometrioz: diagnostika, lechenie i reabilitaciya. Federal'nye klinicheskie rekomendacii po vedeniyu bol'nyh]. Мoscow, 2013. 65 p. (In Russ.).

5. Ponomareva T.A., Altukhova O.B., Ponomarenko I.V., Churnosov M.I. The role of genetic factors in developing endometrioid lesions. [Rol' geneticheskih faktorov v formirovanii endometrioidnyh porazhenij]. Obstetrics, Gynecology and Reproduction. 2023;17(4):443–54. (In Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2023.434.

6. Carfagna P., De Cicco Nardone C., De Cicco Nardone A. et al. Role of transvaginal ultrasound in evaluation of ureteral involvement in deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2018;51(4):550–5. https://doi.org/10.1002/uog.17524.

7. Rusina E.I., Yarmolinskaya M.I., Piankova E.O. Deep infiltrative endometriosis. Contentious issues: pros and cons. [Glubokij infil'trativnyj endometrioz. Spornye voprosy: za i protiv]. Ginekologiya. 2020;22(5):50–6. (In Russ.). https://doi.org/10.26442/20795696.2020.5.200274.

8. Bezhenar V.F., Kruglov S.Yu., Kuzmina N.S. et al. Functional outcomes of nerve-sparing sirgery for retrocervical endometriosis. [Funktsionalnye rezultaty nervsberegayushchikh operatsiy pri retrotservikalnom endometrioze]. Rossijskij vestnik akushera-ginekologa. 2022;5(2):80–1. (In Russ.). https://doi.org/10.24884/0042-4625-2022-181-3-62-68.

9. Trishkin A.G., Zotova O.A., Yushchenko M.A. Reproductive outcomes of infiltrative endometriosis after surgical treatment with assisted reproductive technologies (a clinical case). [Reproduktivnye iskhody infiltrativnogo endometrioza posle khirurgicheskogo lecheniya s primeneniem vspomogatelnykh reproduktivnykh tekhnologiy (klinicheskiy sluchay)]. Opuholi zhenskoj reproduktivnoj sistemy. 2024;20(1):139–42. (In Russ.). https://doi.org/10.17650/1994-4098-2024-20-1-139-142.

10. Abesadze E., Chiantera V., Sehouli J., Mechsner S. Post-operative management and follow-up of surgical treatment in the case of rectovaginal and retrocervical endometriosis. Arch Gynecol Obstet. 2020;302(4):957–67. https://doi.org/10.1007/s00404-020-05686-0.

11. Ovsyannikova M.R., Popov A.A., Chantieva T.M., Shidlovskaya N.V. Fatal complications during pregnancy and delivery in women with profound endometriosis infiltrates: what is new in general clinical practice. [Fatalnye oslozhneniya v period beremennosti i rodov u zhenshchin s glubokim infiltrativnym endometriozom: chto novogo v obshcheklinicheskoy praktike]. Rossijskij vestnik akushera-ginekologa. 2023;23(4):9–19. (In Russ.). https://doi.org/10.17116/rosakush2023230419.

12. Zilberman A., Eisenberg V., Yoeli R. et al. Uterine artery pseudoaneurysm in a pregnant patient with retrocervical endometriosis. J Minim Invasive Gynecol. 2020;27(5):1209–13. https://doi.org/10.1016/j.jmig.2020.03.010.

13. Filip L., Duicа F., Prаdatu A. et al. Endometriosis associated infertility: a critical review and analysis on etiopathogenesis and therapeutic approaches. Medicina (Kaunas). 2020;56(9):460. https://doi.org/10.3390/medicina56090460.

14. Raja M.H.R., Farooqui N., Zuberi N. et al. Endometriosis, infertility and microRNA's: a review. J. Gynecol Obstet Hum Reprod. 2021;50(9):102157. https://doi.org/10.1016/j.jogoh.2021.102157.

15. Spencer S., Lazaridis A., Grammatis A, Hirsch M. The treatment of endometriosis-associated infertility. Curr Opin Obstet Gynecol. 2022;34(5):300–14. https://doi.org/10.1097/GCO.0000000000000806.

16. Prescott J., Farland L.V., Tobias D.K. et al. A prospective cohort study of endometriosis and subsequent risk of infertility. Hum Reprod. 2016;31(7):1475–82. https://doi.org/10.1093/humrep/dew085.

17. Kimber-Trojnar Ż., Pilszyk A., Niebrzydowska M. et al. The potential of non-invasive biomarkers for early diagnosis of asymptomatic patients with endometriosis. J Clin Med. 2021;10(13):2762. https://doi.org/10.3390/jcm10132762.

18. Orazov M.R., Radzinskiy V.E., Khamoshina M.B. et al. Endometriosisassociated infertility: options of combined therapy. [Besplodie, associirovannoe s endometriozom yaichnikov: vozmozhnosti kombinirovannoj terapii]. Voprosy ginekologii, akusherstva i perinatologii. 2020;19(2):27–34. (In Russ.). https://doi.org/10.20953/1726-1678-2020-2-27-34.

19. Gokhberg Ya.A., Timofeeva A.V., Kalinina E.A. Molecular markers for endometrial receptivity in assisted reproductive technology programs. [Molekulyarnye markery receptivnosti endometriya v programmah vspomogatel'nyh reproduktivnyh tekhnologij]. Akusherstvo i ginekologiya. 2021;(11):56–62. (In Russ.). https://doi.org/10.18565/aig.2021.11.56-62.

20. Baigalmaa B., Bitsadze V.O., Solopova A.G. et al. External genital endometriosis post-surgery hemostasis parameters. [Pokazateli gemostaza posle hirurgicheskogo lecheniya naruzhnogo genital'nogo endometrioza]. Obstetrics, Gynecology and Reproduction. 2024;18(5):648–57. (In Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2024.575.

21. Molotkov A.S., Yarmolinskaya M.I. A role of anti-Mullerian hormone in external genital endometriosis. [Znachenie antimyullerova gormona pri naruzhnom genital'nom endometrioze]. Obstetrics, Gynecology and Reproduction. 2021;15(2):182–8. (In Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.164.

22. Shebl O., Ebner T., Sommergruber M. et al. Anti-muellerian hormone serum levels in women with endometriosis: a case-control study. Gynecol Endocrinol. 2009;25(11):713–6. https://doi.org/10.3109/09513590903159615.

23. Goodman L.R., Goldberg J.M., Flyckt R.L. et al. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 2016;215(5):589.e1–589. https://doi.org/10.1016/j.ajog.2016.05.029.

24. Mostaejeran F., Hamoush Z., Rouholamin S. Evaluation of antimullerian hormone levels before and after laparoscopic management of endometriosis. Adv Biomed Res. 2015;4:182. https://doi.org/10.4103/2277-9175.164006.

25. Kitajima M., Matsumoto K., Murakami N. et al. AMH concentrations in peritoneal fluids of women with and without endometriosis. Front Surg. 2020;7:600202. https://doi.org/10.3389/fsurg.2020.600202.

26. Safronova A.S., Buralkina N.A., Chuprynin V.D., Ivanets T.Yu. Hormonal profile of patients with deep infiltrative endometriosis. [Gormonal'nyj profil' pacientok s glubokim infil'trativnym endometriozom]. Medicinskij sovet. 2021;(3):39–43. (In Russ.). https://doi.org/10.21518/2079-701X-2021-3-39-43.

27. Tishchenko E.N., Artymuk N.V., Zotova O.A., Danilova L.N. Maternal and newborn outcomes in patients with endometriosis-associated infertility. [Iskhody beremennostej i rodov u pacientok s endometriozassociirovannym besplodiem]. Fundamental'naya i klinicheskaya medicina. 2024;9(3):66–73. (In Russ.). https://doi.org/10.23946/25000764-2024-9-3-66-73.

28. Fedorov A.A., Popov A.A., Krasnopol’skaya K.V. et al. Effect of surgical treatment on fertility in patients with endometrioid cysts. [ [Vliyanie hirurgicheskogo lecheniya na fertil'nost' u pacientok s endometrioidnymi kistami]. Rossijskij vestnik akushera-ginekologa. 2022;22(5):56–61. (In Russ.). https://doi.org/10.17116/rosakush20222205156.