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Budi Wiweko
wiwekobudi@yahoo.co.id
budi.wiweko@gmail.com
Academic Health System Universitas Indonesia - Indonesian Medical Education and Research Institute
Faculty of Medicine Universitas Indonesia
Dr. Cipto Mangunkusumo General Hospital
Jakarta
Endometriosis
The presence of endometrial like tissue outside uterine cavity
intramyometrial presence of endometrial mucosa
ADENOMYOSIS (glands and stroma)
QUESTIONS
2 PRESERVE FERTILITY
Identify patients who will really benefit and find the best time for surgery
Importance of post surgical maintenance
Symptoms
endometriosis Peritoneum Endometrium
(1927)
Management
menstrual regurgitation
Take home
messages
MOLECULAR PATHWAYS IN THE PATHOPHYSIOLOGY OF ENDOMETRIOSIS
How
endometriosis
happened ?
Endometrial cell
Symptoms
endometriosis
Management
Take home
messages
Symptoms
endometriosis
They can develop, grow and be implanted out side uterine cavity
Take home
messages
No CHARACTERISTIC
Symptoms
1 Able to escape from immune system
endometriosis
2 Produce estrogen by themselves
3 Able to develop and infiltrate surrounding tissue
4 Rich of perfusion and vascularization
Management
Take home
messages
How
endometriosis
happened ?
Symptoms
endometriosis
NYERI
Management
PROGESTERONE RESISTANCE
How
endometriosis
happened ?
Symptoms
endometriosis
Management
Take home
messages
INFERTILITY PAIN
Symptoms
endometriosis
ENDOMETRIOSIS PAIN
The most common pelvic pain:
Management Dysmenorrhea
Dyspareunia
Dischezia
Dysuria
Take home
messages
Effects of endometriosis on human reproduction
How
endometriosis
happened ? 2 3
Symptoms
endometriosis
Management
Take home
messages
1
Symptoms
endometriosis
Management
Take home
messages
How
endometriosis
happened ?
Objective
To evaluate the adverse effects of endometriomas on ovarian reserve
Management
Laparoscopic cystectomy is recommended for endometriomas larger than
4 cm, but the side effects of this surgery in terms of preservation of
ovarian reserve after surgery have been questioned
Take home
messages
Symptoms
endometriosis
BIOPSY
Management
Ovarian cortical tissue was Ovarian cortical tissue from the
excised using scissors contralateral healthy ovary was also
1 cm away biopsied
Management
DO ENDOMETRIOMAS INDUCE
AN INFLAMMATORY REACTION
Symptoms
IN NEARBY FOLLICLES ?
endometriosis
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
NON IVF IVF
Management
Symptoms
endometriosis
Management
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 IVFET can improve the overall pregnancy rate
Take home
messages
Pedro N Barri, Buenaventura Coroleu, Rosa Tur, Pedro N Barri Soldevila, Ignacio Rodrguez
How
endometriosis
happened ?
Moderate and severe endometriosis is often associated with anatomic
distortion, tubal obstruction, pelvic adhesions, and ovarian endometriomas
Symptoms
endometriosis
Expectant management has been associated with a low
cumulative conception rate (025%)
PREGNANCY OUTCOME
Management
Symptoms
endometriosis
Management
Patients should be advised to start trying to conceive naturally soon after
laparoscopic surgery
If pregnancy does not occur within 912 months, they should move to an
Take home
messages
IVFET program
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
n = 85 patients
Pregnancy
Etiology Success rate (%)
Yes (n=57) No (n=144)
Symptoms Male Factor 7 39 15,2
endometriosis
Tubal factor 5 14 26.3
Endometriosis 6 9 40,0
PCOS 7 7 50,0
Management
Poor responder 14 34 29.1
Unexplained 11 29 27.5
Combined factor 7 12 36.8
Take home
messages
Symptoms
endometriosis
Management
Symptoms
endometriosis
Management
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
How
endometriosis
happened ? Second surgery for recurrent endometriomas is more harmful to
healthy ovarian tissue and ovarian reserve than first surgery
Symptoms
endometriosis
Management
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
Symptoms
endometriosis
Management
Because there is follicular loss during surgery, ultrasonography-
guided transvaginal aspiration has emerged as a surgical option
for the treatment of recurrent ovarian endometrioma.
Take home
messages
Overview of included studies investigating the treatment of recurrent ovarian
endometrioma by ultrasonography-guided aspiration with or without sclerotherapy
Symptoms
endometriosis
Management
The first aim of this study was to evaluate the ovarian response to COH for IVF-ET/ICSI
and the outcome of ART in patients with a history of endometriosis that have been
treated once with laparoscopy with or without cystectomy.
Take home The secondary aim was to investigate whether aspiration of recurrent ovarian
messages endometriomas before COH improved the prognosis of IVF-ET/ICSI cycles.
Group of subjects
How
endometriosis
happened ?
q Group A consisted of 176 women with pelvic endometriosis but without
ovarian endometriomas diagnosed by laparoscopy.
Symptoms
endometriosis
Management
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
This study was done on 27 women (18 endometriosis patients and 5 non-
Symptoms
endometriosis) who underwent IVF in Yasmin Clinic of Dr. Cipto
endometriosis Mangunkusumo General Hospital Jakarta.
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
How
endometriosis
happened ?
Sperm Fallopian tube Ovarian reserve
Emergency IVF
Surgery
Management
Minimal - mild Moderate - severe
Insemination
Take home
messages
IVF
Wiweko, 2015
Pharmacologic therapies in endometriosis:
a systematic review
How
endometriosis
happened ?
Symptoms
endometriosis
1. High effectiveness in blocking disease progression and symptoms
2. Ability to inhibit and suppress established lesions
3. High specificity, not interfering with physiologic processes in
which the same molecules that are targeted in the treatment are
Management involved
4. Demonstrated safety for long-term use in humans
5. High lingering effect in the inhibition of endometriotic lesions
Take home
messages
Symptoms
endometriosis
Felice Petraglia. Society of Endometriosis and Uterine Disorders 1st Conference. Paris, 2015
PILIHAN PENANGANAN ENDOMETRIOSIS
How
endometriosis
happened ?
Symptoms
endometriosis
Management DIENOGEST
Take home
messages
Take home
messages
Symptoms
endometriosis
Management
Dienogest may improve progesterone resistance in endometriotic tissue by
increasing the relative expressions of PR-B and PR-A, and decreasing the
relative expressions of ER and ER.
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
Momoeda M, Harada T, Terakawa N, et al. Long-term use of dienogest for the treatment of
endometriosis. J Obstet Gynaecol Res. 2009
Endometriosis is a chronic, recurrent disease, represents a challenge
How to health-care providers and a burden on the health care system
endometriosis
happened ?
Symptoms
endometriosis
Management
Take home
messages
Symptoms
endometriosis
Management
Take home
messages
Menyerupai turunan
Menyerupai turunan progesteron Sifat khas dienogest
testosteron
Tidak ada akumulasi (waktu Tidak memiliki efek terhadap Tidak mengganggu protein
paruh 10 jam) kardiovaskular dan metabolik pembawa hormon
Memiliki efek transformasi Mempertahankan kadar estradiol antara Kadar hormon bebas berkisar
endometrium yang kuat 30 - 50 pg/ml 10%
Ketersediaan hayati yang tinggi Memiliki aktivitas anti androgen Menekan estradiol secara
(> 90%) Tidak memiliki efek mineralokortikoid langsung (moderate)
Symptoms
endometriosis
Immunologists
Nutritionist
Psychologists / counsellors ENDOMETRIOSIS PATIENTS
Pain management
Nurses
Complementary therapies
Symptoms
3. Treatment of endometriosis is mainly targeted on patients problem (infertility or
endometriosis pain).
Management
5. Second surgery of recurrent endometrioma is more harmful to ovarian healthy
tissue.