Sabino, Ron Diaz by Carlos Alberto Petta
Dr. Carlos Alberto Petta
Hello everybody. My name is Dr. Carlos Petta. I am from Brazil and now we are at the Sao Paulo meeting, joint meeting of ISGE and the Brazilian Society of Endometriosis and we have two doctors here, Dr. Ron Diaz from Sao Paulo and Dr. Sabino from Porto Alegre. It is in the south of the country and we are going now to discuss infertility and endometriosis. Dr. Sabino, what is the relationship about endometriosis and infertility?
Dr. Sabino
Endometriosis is associated with infertility. A 30% of the patients with infertility have some kind of endometriosis and on the other hand, patients with endometriosis have an increased prevalence of infertility or subfertility. Patients without endometriosis who have 20%-25% of fertility by _ and patients with endometriosis will be pregnant in 2% or 4% per month. So it is a very close relationship between endometriosis and infertility or subfertility.
Dr. Carlos Alberto Petta
Dr. Diaz, all women with endometriosis have infertility? How much time would you wait before indicating a surgical treatment for this probable or possible endometriosis?
Dr. Ron Diaz
Hi, everybody. Carlos, actually we know that those women who are trying to conceive for at least one year when they are in front of us and what is in our opinion is that most important thing is thinking about the infertile patients, if she has pain or not and for us the symptoms of pain are very, very important on the time and when we are going to perform a laparoscopy.
Dr. Carlos Alberto Petta
We know that one of the big problems in the results of treatment is the patient's age. How do you manage this patient based on age, it means when do you indicate a surgery, when do you indicate reproductive techniques to improve fertility based on age?
Dr. Sabino
Usually you should see as a patient and as a couple, so we have to do the correct diagnosis of infertility, what is causing infertility in these patients with endometriosis to perform some kind of investigation in husband's sperm and we have some resumes in the patients who are more or less than 30-35 years old. So in patients with more older than 35 years old, it is much difficult, it is very hard to be pregnant compared to patients younger. So you can cutoff 35 years old as a kind of cutoff to do some progressive or some more aggressive treatment.
Dr. Carlos Alberto Petta
John, after you have done surgery and you have a patient below 35 years and you are happy with your surgical procedure, what are the next steps for these patients to get pregnant, how much time do you wait until you try any technique of assisted reproduction?
Dr. Ron Diaz
Well, if we have a gold surgery, it means that we have fixed everything on the pelvis of the patient, we can wait if she is under 35 for up to six months until we can move to another kind of treatment. It means that if the patient is okay and her husband also has semen analysis that is nice, we can wait until six months for that.
Dr. Carlos Alberto Petta
Sabino, what do you feel about repetitive surgeries for endometriosis? Do you think they can enhance fertility after you have tried once?
Dr. Sabino
Well, I think that is a good treatment for endometriosis, one surgery with basic treatment, so the first surgery is the most important step in the treatment of this kind of patient. We have to do our part to control or to treat the disease in the first surgery and after that we can do something to improve the pregnancy rate of this group of patients doing some ovarian stimulation or even doing some kind of IRT treatment.
Dr. Carlos Alberto Petta
Dr. Diaz, what is your workup with the patient that you suspect of endometriosis? Do you think that we still have places for the diagnostic laparoscopy or how do you prepare yourself to go to your surgical procedure?
Dr. Ron Diaz
We are _. Nowadays, we think that the diagnostic laparoscopy is a procedure that has not an indication anymore. We can clearly know considering the symptoms, considering the medical examination, and mainly with images by transvaginal ultrasound or MRI or an echo endoscopy to properly diagnose where is the disease and now we can be prepared, preparing our team with, call the proctological surgeon or an urological surgeon to perform the best we can for our patients.
Dr. Carlos Alberto Petta
Well, we have seen the importance of having the patient going to workup with these patients before indicating a surgery, to have a semen analysis, to have some hormonal assays and after to have very well established protocols. So it is very important not to lose time, losing time means increasing with age and decreasing fertility. I would like to thank Dr. Ron Diaz and Dr. Sabino for their presence here.
