Endometriosis: Coccia ME

Bianconi L, Hummelshoj L, Coccia ME, Vigano P, Vittori G, Veit J, Music R, Tomassini A, D'Hooghe T. · XII Committee on Hygiene and Health in the XIV Parliament of the Italian Senate, Rome, Italy. · Fertil Steril. · Pubmed #17991515 No free full text.

Abstract: Started at the grassroot level, increased awareness and investment in research has resulted in unprecedented recognition of endometriosis by the European Parliament, taken up by the Italian Senate in a 5-year action plan. This offers welcome assurance to the scientific community.

Scarselli G, Rizzello F, Cammilli F, Ginocchini L, Coccia ME. · Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy. · Minerva Ginecol. · Pubmed #15758866 No free full text.

Abstract: The correct approach for endometriosis management is still unclear. This review explores recent data concerning diagnosis and treatment of endometriosis, trying to define guidelines for the most appropriate diagnostic approach and therapeutic regimen. At present, laparoscopy is still considered the gold standard in endometriosis diagnosis. The risks and the diagnostic limitations of laparoscopy and the inaccuracy of clinical examination justify the considerable efforts made to improve the diagnosis with imaging techniques. The therapeutic approach is still far from being defined as causal and focuses on management of clinical symptoms of the disease rather than on the disease itself. A first-line medical therapy should be tried in patients with pelvic pain not asking for a pregnancy. Surgical treatment is considered the best treatment for women with pain and or pelvic mass who wish to become pregnant in a short time. For infertile patients, medical therapy has a limited role. The 2 treatment options include surgery or in vitro fertilization (IVF). According to our results, it seems that correct management of infertile women with endometriosis is a combination of surgery and IVF in women who did not obtain post-surgery pregnancy spontaneously.

Coccia ME, Rizzello F, Cammilli F, Bracco GL, Scarselli G. · Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy. · Eur J Obstet Gynecol Reprod Biol. · Pubmed #18243485 No free full text.

Abstract: OBJECTIVES: Laparoscopy is considered the gold standard for treatment of endometriosis. In vitro fertilization and embryo transfer (IVF-ET) is often used to treat women with infertility associated with endometriosis. The objective of the study was to evaluate the pregnancy rate after surgical treatment and to assess whether a combined approach with laparoscopic surgery followed by IVF-ET can improve the "overall" pregnancy rate. STUDY DESIGN: A retrospective observational study was carried out on 107 infertile patients who underwent laparoscopic surgery for endometriosis and came at follow-up for a period of time between 1 and 11 years. Sixty-seven patients who did not become pregnant after surgery subsequently underwent IVF-ET. RESULTS: The pregnancy rate achieved after the integrated laparoscopy-IVF approach was 56.1%. The pregnancy rate after surgery, was significantly lower (37.4%). The fecundity rate for spontaneous conceptions within 6 months of laparoscopy (23.2%) was significantly higher (P<0.05) than for the following intervals. The cumulative fecundity in women older than 35 years was significantly lower than in younger women. CONCLUSIONS: In patients with endometriosis-associated infertility, surgery followed by IVF-ET is more effective than surgery alone. When patients fail to conceive spontaneously, after a maximum of 1 year from laparoscopic surgery, IVF should be suggested.