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Ovarian Endometriosis and Fertility [fertile eggs]



Professor Geoff Reid. Laparoscopic excision of endometriomas (ovarian endometriosis) has been regarded as “gold standard” treatment to improve symptomatology and to improve natural fertility, with a Cochrane review (Hart et al, 2008) demonstrating reduced dysmenorrhoea, reduced dyspareunia, reduced non-menstrual pelvic pain, reduced recurrence of endometriomata, reduced requirement for further surgery and increased spontaneous conception rate.
These are impressive statistics, with approximately 50-60% of patients desiring pregnancy being successful within a 12 month period if they have open Fallopian tubes and a partner with normal seminal parameters.
The negative side is that excision of ovarian endometriosis may actually cause irreparable harm to the ovary.
Anti Müllerian hormone (AMH) is an indirect measure of egg numbers. It does not provide any information about egg quality, nor does it provide any information about ability to achieve a spontaneous pregnancy. What it does provide is information about how the ovary will respond to stimulation in an “In Vitro Fertilisation” setting.
For the 40-50% of patients who do not achieve a pregnancy after surgery for ovarian endometriosis, the damage inflicted upon the ovary by surgery becomes important.
This raises the issue of whether eggs or embryos should be stored before undergoing ovarian surgery, as insurance for the future. This is a controversial area. My presentation will address this, and provide data to assist in making appropriate decisions.

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Professor Reid is a gynaecologist with a particular interest in endometriosis and infertility. His practice is located in central and south-west Sydney and the Southern Highlands of NSW. He is the Director of Gynaecological Endoscopy at Liverpool Hospital and has VMO appointments at St Luke’s Hospital, St George Private Hospital and the Southern Highlands Private Hospital. He is an accredited doctor with Sydney IVF.

Dr Reid is a Lecturer at the University of NSW and is frequently involved in educational activities for doctors both within Australia and overseas. Geoffrey is a past Board Member of the Australian Gynaecological Endoscopy and Surgical Society, a member of the World Endometriosis Society, a member of the Indian Endometriosis Society, a member of the American Association of Gynaecological Laparoscopists, a member of the American Society for Reproductive Medicine, a member of the European Society for Human Reproduction and Embryology and a member of the International Society of Gynaecological Endoscopy.

He has been an invited speaker and surgeon in many countries including China, the Czech Republic, India, Malaysia and Singapore.
fertile eggs

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