[Frontiers in Bioscience E4, 1654-1662, January 1, 2012]

Fertility preservation in women with ovarian endometriosis

Jacques Donnez1, Jean Squifflet1, Pascale Jadoul1, Jean-Christophe Lousse1, Marie-Madeleine Dolmans1, Olivier Donnez1

1Universite Catholique de Louvain, Cliniques Universitaires St. Luc, Department of Gynecology, Institut de Recherche Experimentale et Clinique, Avenue Hippocrate 10, B-1200 Brussels, Belgium

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. How to preserve fertility in endometriosis
3.1. Laparoscopic management of endometriomas using a combined technique of excisional and ablative surgery
3.2 .Autotransplantation of fresh human ovarian tissue in endometriosis patients
3.3. How to preserve fertility in women at risk of premature ovarian failure
3.3.1. Cryopreservation of ovarian tissue and transplantation
3.3.2. Orthotopic transplantation techniques
3.4. Isolation of primordial follicles from cryopreserved ovarian tissue
4. Conclusion and perspectives
5. Acknowledgements
6. References

1. ABSTRACT

Endometriosis is one of the most frequently encountered benign diseases in gynecology. Complete resolution of endometriosis is not yet possible, but therapy has essentially three main objectives: (1) to preserve and improve fertility, (2) to reduce pain, and (3) to delay recurrence for as long as possible. The aim of this paper is to focus on fertility preservation in women with severe endometriosis. In moderate and severe endometriosis, a medico-surgical approach remains the gold standard, but more and more papers are reporting a low ovarian reserve after laparoscopic cystectomy for endometriomas. Indeed, very frequently, normal ovarian tissue is excised together with the endometrioma wall. Ovarian surgery in endometriosis patients should therefore be performed by experienced surgeons in order to both preserve and improve fertility. Preservation of ovarian tissue should be considered in all patients at serious risk of future fertility impairment, particularly before any treatment likely to result in ovarian endometriosis recurrence and/or premature ovarian failure.