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Fertility preservation counselling for women with endometriosis: a European online survey

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital is a strategy to preserve fecundity.

Methods

An online survey was sent to reproductive specialists and gynecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients.

Results

Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis.

Conclusions

To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.

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Data availability

This was not an interventional study and no new patient data were created or analyzed. Data sharing is not applicable to this article.

Abbreviations

ACOG:

American college of obstetricians and gynecologists

AFC:

Antral follicular count

AMH:

Anti-müllerian hormone

ART:

Assisted reproductive techniques

ASRM:

American society for reproductive medicine

AWMF:

Arbeitsgemeinschaft der wissenschaftlichen medizinischen fachgesellschaften

CNGOF:

Collège national des gynécologues et obstétricien français

DGGG:

Deutsche gesellschaft für gynäkologie und geburtshilfe

ESHRE:

European society of human reproduction and embryology

FertiPROTEKT:

Network of fertility preservation centres in German-speaking countries

FIGO:

International federation of gynecology and obstetrics

FP:

fertility preservation

FSH:

Follicle-stimulating hormone

GnRH:

Gonadotropin-releasing hormone

IVF:

In vitro fertilization

NICE:

National institute for health and care

SEF:

Sociedad española de fertilidad

SIGO:

Italian society of gynecology and obstetrics

SOGC:

Society of obstetricians and gynaecologists of Canada

WES:

World endometriosis society

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Acknowledgements

Editorial support and assistance in the preparation of figures was provided by Joanne Fitz-Gerald and Jonathan A C Lee at FourWave Medical Communications, the funding for which was provided by PregLem S.A./Gedeon Richter.

Funding

The survey platform was funded by PregLem (PregLem SA, Route de Frontenex 41A, 1207 Geneva, Switzerland) [a member of the Gedeon Richter group, Budapest, Hungary] and dispersed through the ORBIS-network across Europe.

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Authors and Affiliations

  1. Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany

    Nicole Sänger

  2. Gedeon Richter Plc/PregLem S.A., 41A Route de Frontenex, 1207, Geneva, Switzerland

    Marco Menabrito

  3. Department of Public Health, University Federico II of Naples, Corso Umberto I, 80131, Naples, Italy

    Attilio Di Spiezo Sardo

  4. Department of Obstetrics and Gynecology, Hospital de La Santa Creu I Sant Pau-Universitat Autònoma de Barcelona, Carrer de Sant Quintí 89, 08025, Barcelona, Spain

    Josep Estadella

  5. Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium

    Jasper Verguts

  6. University Hasselt, Martelarenlaan 42, 3500, Hasselt, Belgium

    Jasper Verguts

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Contributions

NS and JV conceived of the presented idea, developed the survey and performed the computations. NS and MM verified the analytical methods. All authors helped to shape the research, disseminate the survey and contributed to the analysis and interpretation of the results. NS took the lead in writing the manuscript and all authors provided critical feedback and contributed to the final manuscript. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Jasper Verguts.

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MM is employed by the funder of this survey, PregLem S.A., and contributed to the design of the survey and reviewed the manuscript. The other authors declare no conflicts of interest.

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Sänger, N., Menabrito, M., Di Spiezo Sardo, A. et al. Fertility preservation counselling for women with endometriosis: a European online survey. Arch Gynecol Obstet 307, 73–85 (2023). https://doi.org/10.1007/s00404-022-06616-y

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