Endometriosis, endometrium, implantation and fallopian tube

Abstract

Study question: To determine the prevalence and the extension of DIE in a large population of infertile women who were unaware of having endometriosis. Further, to demonstrate themost frequent affected pelvic sites. Summary answer: In this large series of infertile women, DIE was present in 72.7% of the patients. The posterior compartment was the most common area affected by pelvic endometriosis. The addition of the DIE lesions located in the posterior compartment to the intestinal diseasemake up for 75.4% of all diagnosed DIE. What is known already: Clinical presentation of DIE includes dysmenorrhea, dyspareunia, dyschezia, and infertility. DIE typically appears as a nodular mass or an irregular thick, fibrotic reaction which arecharacterized by a difficult and delayed diagnosis. TVSBP allows for mapping of the pelvic sites affected like bladder, vesicouterine pouch, round ligaments, retrocervical space, vagina, ureters and rectosigmoid colon. TVSBP has been used by several radiologists and gynecologists as the first-line imaging for the evaluation of women with suspected endometriosis. Study design, size, duration: Prospective observational study including 1141 consecutive infertile women. All patients were routinely submitted to TVSBP by the same radiologist regardless of the medical history and pelvic examination findings from08/2010 to 12/2012. All womensigned approved informed consent. Participants/materials, setting, methods: Women aged 19-44 years old with infertility length varying1-5 years. Bowel preparation was accomplished with the use ofa low-residue diet, oral laxative anda rectal enema 1 hour before the examination. Transvaginal USwas performed with aVoluson E-8 and 5-9-MHz transducer at a Radiological Clinic. Main results and the role of chance: Absence of DIE in311 women (27.3%). Presence of DIE in 72.7% of women. Distribution according to the number of lesions: 1(347-30.5%); 2(181-15.8%); 3(140-12.3%); 4(97-8.5%); 5(48-4.4%); >=6(5-1.3%). DIE presence distributed as compartments: anterior (237-20.8%); posterior(594-52.6%); endometriomas (179-15.7%); and intestinal (131-20.2%). Limitations, reason for caution: TVSBP should be performed by a trained specialist in the endometriosis field using high resolution ultrasound. Minor discomfort caused by bowel preparation should be taken into consideration. Wider implications of the findings: DIE was present in 72.7% of the infertile women exhibiting at least 1 site affected in 30.5% of the cases. This study also highlights the need for the assessment of virtually allinfertile women seeking infertility care. Therefore, theuse of TVSBP as the first line-imaging exam seems pertinent and appropriate.Moreover, this key information will contribute for a more comprehensive patient counseling and treatment.