ESHRE2017: Endometriosis highlights

The 33rd Annual Scientific Meeting of ESHRE in Geneva, Switzerland, featured a lot of very well attended sessions on endometriosis – the halls were packed with an audience eager to learn more about the management of the disease.

Whereas there was no groundbreaking news, the overall feeling was that of increased focus on the challenges of endometriosis – paired with an acknowledgment of a necessity for personalised care, and recognition that endometriosis affects those around the women with the disease also.

One presenter spoke of her study of nearly 200 women that confirmed that endometriosis can negatively affect the mental health of women with the condition, but she emphasised that personality (‘greater self-concept’) and being in a stable relationship reduced the impact considerably.

See also: psychological aspects of endometriosis

Another presenter had studied 31 publications on sexual function and endometriosis and told the audience that endometriosis has a negative impact on multiple domains of sexual functioning – something we knew already. This was followed by a presentation of a study that showed that male partners of women with endometriosis are less satisfied with their sexual relationship and that this often leads to relationship difficulties.

Coordinators of the ESHRE Special Interest Group on Endometriosis and Endometrial Disorders, Professor Andrew Horne and Dr Carla Tomassetti

All of these presentations highlighted the need to acknowledge the more wide ranging effects of endometriosis and the need for appropriate counselling.

said ESHRE SIGEED past-coordinator, Professor Andrew Horne.

A session was dedicated to basic science presentations on ‘Markers and mechanisms of endometriosis’.

Interesting novelties that were presented include the identification of possibly oocytotoxic lipids in the peritoneal fluid, new mechanisms acting on the growth (alterations in: apoptosis by steroid hormones, autophagy of natural killer cells by endometrial stromal cells, activation of ectopic cells), and ectopic adhesion of endometrial cells, and identification of genetic markers in the endometrium of women with adenomyosis.

said ESHRE SIGEED coordinator, Dr Carla Tomassetti.

Surgical versus medical therapy for endometriosis

An overview of “future surgical procedures”, eloquently presented by Dr Tin-Chiu Li (Hong Kong), concluded that that

surgery will become more selective, and will increasingly be about the preservation of ovarian function.

He added that surgery for adenomyosis and adenomyoma will more often be performed by hysteroscopy (as opposed to laparoscopy).

Dr Edgardo Somigliana
Head of the Infertility Unit, Fondazione Cà Ganda, Milano, Italy

On the other hand, Dr Edgardo Somigliano (Milano, Italy) stressed that the clinical management of women with endometriosis today is simple, effective, and affordable in the vast majority of affected women.

Dr Somigliano emphasised:

Drugs don’t cure endometriosis; but for many women medical therapy can control symptoms for a time period – just as drugs can do for other chronic inflammatory disorders.

Pursuing the holy grail for the perfect drug may be less important than finding the drug that is useful for the individual woman.

 

To operate or not in women with deep endometriosis…?

A well-presented debate between Drs Horace Roman (Rouen, France) and Francois Goffer (Lyon, France) on the pros and cons on surgery versus IVF in infertile women with deep endometriosis yielded no other conclusion than each individual case has to be evaluated towards “tailored surgery”:

Finding the balance between the absolute benefit of surgery and its related morbidity.

The same pertains to IVF:

It is important to consider the morbidity of repeated IVF procedures, in particular in women, who also have pain, and where surgery to remove deep lesions is subsequently delayed with a risk of progression of the disease.

A challenge in this particular debate is that no randomised controlled trial has ever been performed to provide a definite answer to this important question. The jury thus remains out.

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