Endometriosis still an enigmatic disease dr. sharda jain

Endometriosis still an enigmatic disease dr. sharda jain

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  ENDOMETRIOSIS STILLAN ENIGMATIC DISEASE: Introduction …Caring hearts, healing hands DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKER
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  “Endometriosis remains ariddle wrapped in a mystery inside an enigma” …Caring hearts, healing hands
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  ENDOMETRIOSIS: THE BITTERTRUTH Prevalence rate as high as 35%–50% in women experiencing pain or infertility Elusive Pathogenesis Healthcare costs are estimated to exceed $70 billion every year Acien P, Velasco I. Endometriosis: A Disease That Remains Enigmatic. ISRN Obstetrics and Gynecology. 2013; http://dx.doi.org/10.1155/2013/242149 Donnez J. Endometriosis: enigmatic in the pathogenesis and controversial in its therapy. (Fertil Steril. 2012;98:509–10 …Caring hearts, healing hands
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  CONTROVERSIAL DESPITE….. Existence ofa journal and various regular international congresses & dedicated forums / societies specifically to the disease Current scientific and technological advances Publication of a large number of manuscripts Acien P, Velasco I. Endometriosis: A Disease That Remains Enigmatic. ISRN Obstetrics and Gynecology. 2013; http://dx.doi.org/10.1155/2013/242149 Donnez J. Endometriosis: enigmatic in the pathogenesis and controversial in its therapy. (Fertil Steril. 2012;98:509–10 …Caring hearts, healing hands
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  Adolescent Endometriosis  Togo ahead for surgery or not  Only surgery or complimented by medical treatment or only medical treatment?  Controversy: Use of GnRH analog can alleviate the need for surgical procedure  Surgically diagnosed endometriosis refractory to other medication on this prolonged GnRH agonist with add-back for over 10 years  But will add back therapy be cost effective and affect compliance  Is it safe to use GnRH analogues in adolescent population for short duration (< 6 months)? 47% incidence of disease in adolescent girls undergoing laparoscopy for chronic pelvic pain Dessole M et al. Endometriosis in Adolescence. Obstetrics and Gynecology International. 2012; doi:10.1155/2012/869191 Laufer MR et al. Adolescent Endometriosis: Diagnosis and Treatment Approaches. J Pediatr Adolesc Gynecol. 2003;16:S3-S11 …Caring hearts, healing hands
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  ENDOMETRIOSIS AND INFERTILITY 25-50% of infertile women have endometriosis and 30-50% of women with endometriosis are infertile  No evidence routine surgery before IVF will increase conception rate (Hamdan et al., 2015); individual cases may benefit  Limited evidence that 3 months of GnRH agonist use may improve chance of conception Does surgical or Medical treatment before IVF improve chances of conception? Choice of downregulation before IVF (Ultralong or long or short ) Ovarian Endometrioma Before IVF…. Way Ahead?? Middle East Fertility Society Journal . 2006; 11(1): 24-29 Young K et al. Endometriosis and fertility: women’s accounts of healthcare. 2016; 0(0): 1-9 …Caring hearts, healing hands
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  ELDERLY and RECURRENTEndometriosis  How frequent is endometriosis in the 40s?  Continuation of pharmacological therapy till menopause?  Surgical Considerations: Criteria  GnRH analogues complimented with surgical therapy: Expert opinion Recurrence rate of endometriosis after primary surgery has been reported as high as 30% to 50% within 5 years after surgery Recurrence of Ovarian Endometrioma a Major Clinical Dilemma Control of recurrence : Postoperative Medication Guo SW et al. Recurrence of endometriosis and its control. 2009; 15(4): 441-61 …Caring hearts, healing hands
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  GnRH Analogues inEndometriosis  Different mechanisms of action of GnRH analogues in endometriosis  Infertility or pain relief? What drives the usage of GnRH analogues in endometriosis  Selection of a GnRH analogue: Pharmacokinetic considerations, long term efficacy and safety concerns  Expert opinion on usage of leuprolide, goserelin and triptorelin Hashim HA. Gonadotrophin-releasing hormone analogues and endometriosis: current strategies and new insights. Gynecological Endocrinology, 2012; 28(4): 314–321 …Caring hearts, healing hands
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  Clinical Evidence ofTriptorelin  Pharmacodynamic and pharmacokinetic advantage  Postoperative use  Long term downregulation before IVF  Efficacy in dyspareunia  Comparison with Leuprolide …Caring hearts, healing hands
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  SEARCH CONTINUES FORAN IDEAL PHARMACOLOGICAL AGENT….  High effectiveness in blocking disease progression and symptoms  Capacity to inhibit and suppress established lesions  High specificity  Safety on long term use Donnez J. Endometriosis: enigmatic in the pathogenesis and controversial in its therapy. (Fertil Steril. 2012;98:509–10 …Caring hearts, healing hands
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  Controversies in SurgicalManagement  Compromised fertility due to traumatic surgery  Overaggressive surgery can lead removal of healthy follicles with reduced ovarian volume and decreased AFC and AMH levels  Benefits in terms of pregnancy rates and pain relief are largely dependent on surgeon skill and experience  Evidence that endometriosis surgery needs to be 100% complete is lacking Donnez J. Endometriosis: enigmatic in the pathogenesis and controversial in its therapy. (Fertil Steril. 2012;98:509–10 …Caring hearts, healing hands
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  Conclusions  Endometriosis remainsone of the most perplexing diseases for patients, physicians and researchers  Poor understanding of pathophysiology leads to difficulty in coping with, treating and understanding this disease  Majority of current therapies are not ideal and their side effects are not tolerated by most of them …Caring hearts, healing hands
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  ADDRESS 11 Gagan Vihar,Near Karkari Morh Flyover, Delhi - 51 Helpline 9650588339, 011-22414049, 011-22058865 WEBSITE : www.lifecarecentre.in www.drshardajain.com www.lifecareivf.com E-MAIL ID [email protected] [email protected] [email protected] &
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