Бесплодие, ассоциированное с эндометриозом яичников: современный взгляд на проблему
Бесплодие, ассоциированное с эндометриозом яичников: современный взгляд на проблему
Оразов М.Р., Хамошина М.Б., Абитова М.З. и др. Бесплодие, ассоциированное с эндометриозом яичников: современный взгляд на проблему.
Гинекология. 2020; 22 (5): 44–49. DOI: 10.26442/20795696.2020.5.200405
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Orazov M.R., Khamoshina M.B., Abitova M.Z. et al. Ovarian endometriosis associated infertility: a modern view to the problem. Gynecology. 2020; 22 (5): 44–49. DOI: 10.26442/20795696.2020.5. 200405
Бесплодие, ассоциированное с эндометриозом яичников: современный взгляд на проблему
Оразов М.Р., Хамошина М.Б., Абитова М.З. и др. Бесплодие, ассоциированное с эндометриозом яичников: современный взгляд на проблему.
Гинекология. 2020; 22 (5): 44–49. DOI: 10.26442/20795696.2020.5.200405
________________________________________________
Orazov M.R., Khamoshina M.B., Abitova M.Z. et al. Ovarian endometriosis associated infertility: a modern view to the problem. Gynecology. 2020; 22 (5): 44–49. DOI: 10.26442/20795696.2020.5. 200405
В настоящем обзоре обобщены современные представления о патогенезе одной из самых распространенных форм наружного генитального эндометриоза – эндометриоидных кист яичников (ЭКЯ). Ввиду их частой встречаемости у молодых женщин репродуктивного возраста и крайне негативного влияния на морфофизиологическое состояние яичников данное заболевание вносит весомый вклад в структуру эндометриозассоциированного бесплодия. Основной детерминантой негативного влияния ЭКЯ на репродуктивную функцию является снижение овариального резерва, которое может происходить как из-за непосредственного гонадотоксического действия самой эндометриодной кисты, так и за счет непреднамеренного удаления здоровой овариальной ткани во время хирургического вмешательства или использования агрессивных методов электрохирургии. Отсюда дискутабельным является вопрос о методах достижения гемостаза во время операции с точки зрения ятрогенного влияния на здоровую овариальную ткань. Стратегия ведения пациенток с бесплодием, ассоциированным с эндометриозом яичников, складывается из двух составляющих: оперативное лечение и/или применение вспомогательных репродуктивных технологий. Лапароскопическая
цистэктомия показана при размере кист более 3 см. Повторные оперативные вмешательcтва по поводу эндометриоза не улучшают исходы фертильности. Методы вспомогательных репродуктивных технологий следует рассматривать в качестве первоочередной тактики у пациенток старшего репродуктивного возраста с низкими показателями овариального резерва или длительностью бесплодия более 2 лет, а также при рецидивах ЭКЯ. Ведение таких пациенток обязательно должно быть персонализированным и учитывать возраст, состояние овариального резерва, длительность бесплодия, стадию и количество оперативных вмешательств по поводу данного заболевания.
This review summarizes current understanding of the pathogenesis of one of the most common forms of external genital endometriosis – ovarian endometrioma’s. Due to their frequent occurrence in young women of reproductive age and extremely negative impact on the morphophysiological state of the ovaries, this disease makes a significant contribution to the structure of endometriosis-associated infertility. The main determinant of the negative effect of ovarian endometrioma’s on reproductive function is a decrease in ovarian reserve, which can occur either due to the direct gonadotoxic effect of the endometriod cyst itself, or due to the unintentional removal of healthy ovarian tissue during surgery or the use of aggressive methods of electrosurgery. Hence, the question of methods for achieving hemostasis during surgery in terms of iatrogenic effects on healthy ovarian tissue is debatable. The management strategy for patients with infertility associated with ovarian endometriosis consists of two components: surgical treatment and/or the use of assisted reproductive technologies. Laparoscopic cystectomy is indicated for cysts larger than 3 cm. Repeated surgical interventions in case of endometriosis do not improve fertility outcomes. Assisted reproductive technologies methods should be considered as a priority tactic in patients of older reproductive age with low ovarian reserve indicators or infertility duration of more than 2 years, as well as in cases of recurrent ovarian endometrioma’s. Management of such patients must be personalized and take into account the age, state of the ovarian reserve, duration of infertility, stage and number of surgical interventions for this disease.
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J Ovar Res 2019; 12 (1): 104.
4. Benagiano G, Guo SW, Puttemans P et al. Progress in the diagnosis and management of adolescent endometriosis: an opinion. Reprod Bio Med Online 2018; 36: 102–14.
5. Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin N Am 2012; 39 (4): 535–49.
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[Orazov M.R., Radzinskiy V.E., Khamoshina M.B. et al. Treatment efficacy of infertility due to recurrent external genital endometriosis. Gynecology. 2019; 21 (1): 38–43 (in Russian).]
7. Radzinskiy VE, Orazov MR, Ivanov II et al. Implantation failures in women with infertility associated endometriosis. Gynecological Endocrinology 2019; 35 (1): 27–30.
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35. Kitajima M, Dolmans MM, Donnez O et al. Enhanced follicular recruitment and atresia in cortex derived from ovaries with endometriomas. Fertil Steril 2014; 101: 1031–37.
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40. Da Broi MG, Navarro PA. Oxidative stress and oocyte quality: ethiopathogenic mechanisms of minimal/mild endometriosis-related infertility. Cell Tissue Res 2016; 364: 1–7.
41. Giacomini E, Sanchez AM, Sarais V et al. Characteristics of follicular fluid in ovaries with endometriomas. Eur J Obstet Gynecol Reprod Biol 2017; 209: 34–8.
42. Scutiero G, Iannone P, Bernardi G et al. Oxidative stress and endometriosis: a systematic review of the literature. Oxid Med Cell Longev 2017; 2017: 7265238.
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________________________________________________
1. Adamyan L.V., Andreeva E.N., Apolikhina I.A. et al. Endometrioz: federal'nye klinicheskie rekomendatsii po vedeniyu bol'nykh. Мoscow, 2016 (in Russian).
2. Adamson GD, Kennedy S, Hummelshoj L. Creating solutions in endometriosis: global collaboration through the World Endometriosis Research Foundation. J Endometrios 2010; 2 (1): 3–6.
3. Gałczyński K, Jóźwik M, Lewkowicz D et al. Ovarian endometrioma – a possible finding in adolescent girls and young women: a mini-review.
J Ovar Res 2019; 12 (1): 104.
4. Benagiano G, Guo SW, Puttemans P et al. Progress in the diagnosis and management of adolescent endometriosis: an opinion. Reprod Bio Med Online 2018; 36: 102–14.
5. Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin N Am 2012; 39 (4): 535–49.
6. Orazov M.R., Radzinskiy V.E., Khamoshina M.B. et al. Treatment efficacy of infertility due to recurrent external genital endometriosis. Gynecology. 2019; 21 (1): 38–43 (in Russian).
7. Radzinskiy VE, Orazov MR, Ivanov II et al. Implantation failures in women with infertility associated endometriosis. Gynecological Endocrinology 2019; 35 (1): 27–30.
8. Evans MB, Decherney AH. Fertility and endometriosis. Clin Obstet Gynecol 2017; 60: 497–502.
9. Cranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand 2017; 96 (6): 633–43.
10. When more is not better: 10 don’ts in endometriosis management. An ETIC position statement. Hum Reprod Open 2019; 3: hoz009.
11. Donnez J, Nisolle M, Gillet N et al. Large ovarian endometriomas. Hum Reprod 1996; 11 (3): 641–46.
12. Vercellini P, Somigliana E, Vigano P et al. ‘Blood On The Tracks’ from corpora lutea to endometriomas. BJOG 2009; 116 (3): 366–71.
13. Hughesdon P. The structure of endometrial cysts of the ovary. J Obstet Gynaecol Br Em 1957; 64: 481–7.
14. Brosens IA, Puttemans PJ, Deprest J. The endoscopic localization of endometrial implants in the ovarian chocolate cyst. Fertil Steril 1994; 61: 1034–8.
15. Gogacz M, Gałczyński K, Wojtaś M et al. Fas-related apoptosis of peritoneal fluid macrophages in endometriosis patients: understanding the disease. J Immunol Res 2017; 2017: 3175394.
16. Ria R, Loverro A, Vacca A et al. Angiogenesis extent and expression of matrix metalloproteinase-2 and -9 agree with progression of ovarian endometriomas. Eur J Clin Invest 2002; 32 (3): 199–206.
17. Bulun SE, Yilmaz BD, Sison C et al. Endometriosis. Endocr Rev. 2019; 40 (4): 1048–79.
18. Rizner TL. Estrogen metabolism and action in endometriosis. Mol Cell Endocrinol 2009; 307 (1–2): 8–18.
19. Artymuk N.V., Guljaeva L.F., Zotova O.A. Metabolism peculiaritirs and estrogenes reception in endometrial hyperplasia and endometriosis. Mat' i ditia v Kuzbasse. 2012; 1: 8–12 (in Russian).
20. Hayashi A, Tanabe A, Kawabe S et al. Dienogest increases the progesterone receptor isoform B/A ratio in patients with ovarian endometriosis. J Ovarian Res 2012; 5 (1): 31.
21. Brosens I, Benagiano G. Clinical significance of neonatal menstruation. Eur J Obstet Gynecol Reprod Biol 2016; 196: 57–9.
22. Benagiano G, Bianchi P, Brosens I. Ovarian endometriomas in adolescents often represent active angiogenic disease requiring early diagnosis and careful management. Minerva Ginecol 2017; 69: 100–7.
23. Sanchez AM, Vigano P, Somigliana E et al. The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum Reprod Update 2014; 20 (2): 217–30.
24. Jwabuchi T, Yoshimoto C, Shigetomi H, Kobayashi H. Oxidative stress and antioxidant defense in endometriosis and its malignant transformation. Oxid Med Cell Longev 2015; 2015: 848595.
25. Melkozerova O.A., Bashmakova N.V., Okulova E.O. Genetic and epigenetic mechanisms of infertility associated with genital endometriosis. Obstetrics and gynecology. 2019; 8: 26–32 (in Russian).
26. Ghosh AK, Vaughan DE. PAI-1 in tissue fibrosis. J Cell Physiol 2012; 227 (2): 493–507.
27. Samarakoon R, Overstreet JM, Higgings PJ. TGF-beta signaling in tissue fibro sis: redox controls, target genes and therapeutic opportunities. Cell Signal 2013; 25: 264–8.
28. Rahmioglu N, Nyholt DR, Morris AP et al. Genetic variants underlying risk of endometriosis: insights from meta-analysis of eight genome-wide association and replication datasets. Hum Reprod Update 2014; 20 (5): 702–16.
29. Qiu JJ, Liu YL, Liu MH et al. Ovarian interstitial blood flow changes assessed by transvaginal colour Doppler sonography: predicting ovarian endometrioid cyst-induced injury to ovarian interstitial vessels. Arch Gynecol Obstet 2012; 285 (2): 427–33.
30. Maneschi F, Marasa L, Incandela S et al. Ovarian cortex surrounding benign neoplasms: a histologic study. Am J Obstet Gynecol 1993; 169: 388–93.
31. Cranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand 2017; 96 (6): 633–43.
32. Khine YM, Taniguchi F, Harada T. Clinical management of endometriosis-associated infertility. Reproductive Medicine and Biology 2016; 15 (4): 217–25.
33. Uncu G, Kasapoglu I, Ozerkan K et al. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod 2013; 28 (8): 2140–5.
34. Nieweglowska D, Hajdyla-Banas I, Pitynski K et al. Age-related trends in anti-Mullerian hormone serum level in women with unilateral and bilateral ovarian endometriomas prior to surgery. Reprod Biol Endocrinol 2015; 13: 128.
35. Kitajima M, Dolmans MM, Donnez O et al. Enhanced follicular recruitment and atresia in cortex derived from ovaries with endometriomas. Fertil Steril 2014; 101: 1031–37.
36. Zulumyan TN, Khamoshina MB, Petrova VD. Еstimation of AMH level after surgery for benign non-inflammatory ovarian diseases of young women. Topical Issues in Experimental and Clinical Medicine: Сollection of papers of the Scientific Conference for Students, Post-Graduate Students and Young Scientists of Medical Faculties of Russian State Universities Including Foreign Participants: 2012 Nov 22–23, Surgut, Russia; р. 185–6.
37. Xu B, Guo N, Zhang XM et al. Oocyte quality is decreased in women with minimal or mild endometriosis. Sci Rep 2015; 5: 10779.
38. Llarena N, Flyckt R. Strategies to preserve and optimize fertility for patients with endometriosis. J Endometr Pelvic Pain Dis 2017; 9: 98–104.
39. AlKudmani B, Gat I, Buell D et al. In vitro Fertilization success rates after surgically treated endometriosis and effect of time interval between surgery and in vitro fertilization. J Min Invas Gynecol 2018; 25 (1): 99–104.
40. Da Broi MG, Navarro PA. Oxidative stress and oocyte quality: ethiopathogenic mechanisms of minimal/mild endometriosis-related infertility. Cell Tissue Res 2016; 364: 1–7.
41. Giacomini E, Sanchez AM, Sarais V et al. Characteristics of follicular fluid in ovaries with endometriomas. Eur J Obstet Gynecol Reprod Biol 2017; 209: 34–8.
42. Scutiero G, Iannone P, Bernardi G et al. Oxidative stress and endometriosis: a systematic review of the literature. Oxid Med Cell Longev 2017; 2017: 7265238.
43. Da Broi MG, de Albuquerque FO, de Andrade AZ et al. Increased concentration of 8-hydroxy-2-deoxyguanosine in follicular fluid of infertile women with endometriosis. Cell Tissue Res 2016; 366: 231–42.
44. Sanchez AM, Viganò P, Somigliana E et al. The endometriotic tissue lining the internal surface of endometrioma: hormonal, genetic, epigenetic status, and gene expression profile. Reprod Sci 2015; 22: 391–401.
45. Altun T, Jindal S, Greenseid K et al. Low follicular fluid IL-6 levels in IVF patients are associated with increased likelihood of clinical pregnancy. J Assist Reprod Genet 2011; 28: 245–51.
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1 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
2 ГБНУ «Научно-исследовательский институт морфологии человека», Москва, Россия;
3 ГБУЗ «Государственная клиническая больница №29 им. Н.Э. Баумана», Москва, Россия;
4 ООО «МедИнСервис» – Центр репродукции и генетики «Nova Clinic» («МедИнСервис»), Москва, Россия
*abitovamarianna@yandex.ru
________________________________________________
Mekan R. Orazov1, Marina B. Khamoshina1, Marianna Z. Abitova*1, Lyudmila M. Mikhaleva2, Snezhana V. Volkova1, Dmitry G. Aryutin1,3, Victoria B. Shustova4
1 Peoples' Friendship University of Russia, Moscow, Russia;
2 Research Institute of Human Morphology, Moscow, Russia;
3 Bauman State Clinical Hospital №29, Moscow, Russia;
4 MedInService – Center for Reproduction and Genetics “Nova Clinic” (“MedInService”), Moscow, Russia
*abitovamarianna@yandex.ru