An Update on Surgical versus Expectant Management of Ovarian Endometriomas in Infertile Women.

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2015-01

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Abstract

Ovarian endometriomas are a common manifestation of endometriosis that can represent a more severe stage of the disease. There is much debate over the treatment of these cysts in infertile women, particularly before use of assisted reproductive technologies. Evidence exists that supports surgical excision of ovarian endometriomas, as well as evidence that cautions against surgical intervention. Certain factors need to be examined closely before proceeding with surgery or continuing with expectant management. These include the patient's symptoms, age, ovarian reserve, size and laterality of the cyst, prior surgical treatment, and level of suspicion for malignancy. The most recent evidence appears to suggest that certain patient profiles may benefit from proceeding directly to in vitro fertilization (IVF). These include symptomatic infertile patients, especially those that are older, those that have diminished ovarian reserve, those that have bilateral endometriomas, or those that have had prior surgical treatment. Although endometriomas can be detrimental to the ovarian reserve, surgical therapy may further lower a woman's ovarian reserve. Nevertheless, the presence of an endometrioma does not appear to adversely affect IVF outcomes, and surgical excision of endometriomas does not appear to improve IVF outcomes. Regardless of treatment plan, infertile patients with endometriomas must be counseled appropriately before choosing either treatment path.

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10.1155/2015/204792

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Keyhan, Sanaz, Claude Hughes, Thomas Price and Suheil Muasher (2015). An Update on Surgical versus Expectant Management of Ovarian Endometriomas in Infertile Women. BioMed research international, 2015. 10.1155/2015/204792 Retrieved from https://hdl.handle.net/10161/17133.

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Scholars@Duke

Claude Lebernian Hughes

Consulting Professor of Obstetrics and Gynecology
Price

Thomas Michael Price

Professor Emeritus of Obstetrics and Gynecology

Dr. Price is involved in both clinical and basic science research. The main focus of the basic science molecular endocrinology laboratory is the study of novel sex steroid receptors. Currently, the work focuses on a novel progesterone receptor that localizes to the mitochondrion. Studies including RNAi in cell models and creation of transgenic mice are ongoing to discover the function of this receptor. The overall hypothesis is that progesterone modulates mitochondrial activity to meet the increased cellular energy demands of pregnancy via this receptor.
Dr. Price also participates in clinical research endeavors. These projects are constantly changing and focus on many aspects of reproductive endocrinology including ovarian preservation during chemotherapy, treatments for menorrhagia, endometriosis, leiomyomata and infertility.

Muasher

Suheil Jamil Muasher

Professor Emeritus of Obstetrics and Gynecology

I currently hold the position of Director of Graduate Learning and Academic Development.  I am responsible for the education of the second year residents rotating in REI and director of second year medical student rotation in REI.  I give ten resident lectures per year covering all the CREOG educational requirements.  I also conduct case based learning sessions for the medical students throughout the year (2 hours per week). 

I conduct journal club sessions with the fellows in REI on a weekly basis.  I conduct clinical research with the fellows that is translated into abstracts to the ASRM annual meeting and later, publications. 

I am responsible for the departmental journal club conducted twice per year (5 articles presented by residents each time). 

I overlook and co-moderate the departmental research day for the residents and fellows. 


My time is divided into 50% clinical and 50% scholarly activities. 


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