Document Detail


Combination medical and surgical therapy for infertile patients with endometriosis.
MedLine Citation:
PMID:  2664616     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Endometriosis is a difficult problem for practicing gynecologists and is commonly associated with infertility. The diagnosis of endometriosis should only be made at the time of laparoscopy or laparotomy and should be confirmed with biopsy if possible. Once the diagnosis is made, it should be classified according to the revised AFS system. The treatment of infertility associated with endometriosis is controversial and usually consists of either medical therapy with hormonal manipulation designed to suppress the disease, surgical therapy designed to debulk the disease and repair anatomic distortion, or a combination of both. Despite an abundance of research on the treatment of endometriosis, the pregnancy rate for patients with endometriosis remains lower than that of the normal population. The reasons for this are obscure. Endometriosis does not respond to hormonal changes the same way that normal endometrium does and has been shown to persist despite extensive medical therapy. The recurrence rate of the disease is impressively high after either medical or surgical therapy. Interestingly, expectant management of minimal or mild disease is associated with pregnancy rates equal to those of any other type of therapy. Only when the disease is more extensive does aggressive treatment appear to show improvement in pregnancy rates. Whether combination therapy of endometriosis is better than single agent therapy remains open to debate. Some of the best-designed studies using combination therapy have shown no difference in pregnancy rates. Yet, when taken as a whole, it would appear that if combination medical and surgical therapy is chosen, the medical therapy should be given preoperatively. The literature abounds with a wide variety of classification systems, methods of calculating pregnancy rates, and inclusion of control groups. Because of this disparity between studies, reliable conclusions cannot be drawn.
Authors:
L M Kettel; A A Murphy
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Obstetrics and gynecology clinics of North America     Volume:  16     ISSN:  0889-8545     ISO Abbreviation:  Obstet. Gynecol. Clin. North Am.     Publication Date:  1989 Mar 
Date Detail:
Created Date:  1989-08-16     Completed Date:  1989-08-16     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8709551     Medline TA:  Obstet Gynecol Clin North Am     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  167-77     Citation Subset:  IM    
Affiliation:
Department of Reproductive Medicine, University of California, San Diego, La Jolla.
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MeSH Terms
Descriptor/Qualifier:
Combined Modality Therapy
Endometriosis / surgery,  therapy*
Female
Humans
Infertility, Female / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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