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- W2043915478 abstract "We wish to comment on the “findings at laparoscopy among 92 oligo-ovulatory infertile patients failing to conceive after four ovulatory cycles on clomiphene citrate” presented by Capelo et al. (1Capelo F.O Kumar A Steinkampf M.P Azziz R Laparoscopic evaluation following failure to achieve pregnancy after ovulation induction with clomiphene citrate.Fertil Steril. 2003; 80: 1450-1453Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar). Of special interest were the eight patients who, at subsequent laparoscopy, had endometriomas and were all staged as III or IV endometriotic disease. This called to mind the experience of Gabos (2Gabos P Clomiphene citrate therapy and associated ovarian endometrial cysts.Obstet Gynecol. 1979; 53: 763-765PubMed Google Scholar) who, in 1979, reported four patients with palpably normal pelves who developed “unusually large” endometrial cysts that involved both ovaries after clomiphene citrate (CC) 50 mg daily for 5 days for two courses, “strongly implicating clomiphene citrate as a cause of ovarian endometrial cyst formation.” All four were treated by laparotomy. Gabos cited Soules et al. (3Soules M.R Malinak L.R Bury R Poindexter A Endometriosis and ovulation a coexisting problem in the infertile female.Am J Obstet Gynecol. 1976; 1125: 412-417Google Scholar) who, in 1976, had reported that 75% of women whom they operated for endometriosis had previously been treated with CC compared with 25% who had not.Given that prescription of CC to infertile women before laparoscopy is a common and accepted cost-effective medical practice, and given the empirical evidence presented by Soules et al., Gabos, and Capelo et al., that suggests a causal relation between administration of CC in infertile women and the development of large endometriotic cysts and advanced stages of endometriosis, it would be ideal if women at potential risk could be identified in a cost-effective way.The investigators are to be commended for their use of historic predictors to attempt to identify endometriosis before treatment. Given recent refinements in physical diagnosis for endometriosis, may we suggest examination for presumptive signs of endometriosis before each course of CC? These signs may be elicited by inspection for lateral displacement of the cervix from its normal midline position (4Propst A.M Storti K Barbieri R.L Lateral cervical displacement is associated with endometriosis.Fertil Steril. 1998; 70: 568-570Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar), inserting a “cotton swab” into the cervix to rule out stenosis of the external os (5Barbieri R.L Stenosis of the external os an association with endometriosis in women with chronic pelvic pain.Fertil Steril. 1998; 70: 571-573Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar), gentle vaginal palpation posteriorly along the upper half of the vagina to detect tenderness of the rectovaginal pouch, and bimanual abdominal–rectal examination to elicit tenderness of the uterosacral ligaments and ovaries and ovarian enlargement. Ultrasound is an alternative to examination. We offer these suggestions in light of the adverse experience of Canis et al. (6Canis M Pouly J.L Wattiez A Manhes H Mage G Bruhat M.A Incidence of bilateral adnexal disease in severe endometriosis (revised American Fertility Society [AFS], stage IV) should a stage V be included in the AFS classification?.Fertil Steril. 1992; 57: 691-692Abstract Full Text PDF PubMed Google Scholar), who achieved no pregnancies in patients with stage IV endometriosis–grade 85 or higher, and in the hope of detecting and treating endometriosis in infertile women before they undergo a therapeutic trial of CC. We wish to comment on the “findings at laparoscopy among 92 oligo-ovulatory infertile patients failing to conceive after four ovulatory cycles on clomiphene citrate” presented by Capelo et al. (1Capelo F.O Kumar A Steinkampf M.P Azziz R Laparoscopic evaluation following failure to achieve pregnancy after ovulation induction with clomiphene citrate.Fertil Steril. 2003; 80: 1450-1453Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar). Of special interest were the eight patients who, at subsequent laparoscopy, had endometriomas and were all staged as III or IV endometriotic disease. This called to mind the experience of Gabos (2Gabos P Clomiphene citrate therapy and associated ovarian endometrial cysts.Obstet Gynecol. 1979; 53: 763-765PubMed Google Scholar) who, in 1979, reported four patients with palpably normal pelves who developed “unusually large” endometrial cysts that involved both ovaries after clomiphene citrate (CC) 50 mg daily for 5 days for two courses, “strongly implicating clomiphene citrate as a cause of ovarian endometrial cyst formation.” All four were treated by laparotomy. Gabos cited Soules et al. (3Soules M.R Malinak L.R Bury R Poindexter A Endometriosis and ovulation a coexisting problem in the infertile female.Am J Obstet Gynecol. 1976; 1125: 412-417Google Scholar) who, in 1976, had reported that 75% of women whom they operated for endometriosis had previously been treated with CC compared with 25% who had not. Given that prescription of CC to infertile women before laparoscopy is a common and accepted cost-effective medical practice, and given the empirical evidence presented by Soules et al., Gabos, and Capelo et al., that suggests a causal relation between administration of CC in infertile women and the development of large endometriotic cysts and advanced stages of endometriosis, it would be ideal if women at potential risk could be identified in a cost-effective way. The investigators are to be commended for their use of historic predictors to attempt to identify endometriosis before treatment. Given recent refinements in physical diagnosis for endometriosis, may we suggest examination for presumptive signs of endometriosis before each course of CC? These signs may be elicited by inspection for lateral displacement of the cervix from its normal midline position (4Propst A.M Storti K Barbieri R.L Lateral cervical displacement is associated with endometriosis.Fertil Steril. 1998; 70: 568-570Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar), inserting a “cotton swab” into the cervix to rule out stenosis of the external os (5Barbieri R.L Stenosis of the external os an association with endometriosis in women with chronic pelvic pain.Fertil Steril. 1998; 70: 571-573Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar), gentle vaginal palpation posteriorly along the upper half of the vagina to detect tenderness of the rectovaginal pouch, and bimanual abdominal–rectal examination to elicit tenderness of the uterosacral ligaments and ovaries and ovarian enlargement. Ultrasound is an alternative to examination. We offer these suggestions in light of the adverse experience of Canis et al. (6Canis M Pouly J.L Wattiez A Manhes H Mage G Bruhat M.A Incidence of bilateral adnexal disease in severe endometriosis (revised American Fertility Society [AFS], stage IV) should a stage V be included in the AFS classification?.Fertil Steril. 1992; 57: 691-692Abstract Full Text PDF PubMed Google Scholar), who achieved no pregnancies in patients with stage IV endometriosis–grade 85 or higher, and in the hope of detecting and treating endometriosis in infertile women before they undergo a therapeutic trial of CC." @default.
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- W2043915478 date "2004-06-01" @default.
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- W2043915478 title "Potential cofounders in the laparoscopic detection of endometriosis" @default.
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- W2043915478 doi "https://doi.org/10.1016/j.fertnstert.2004.04.001" @default.
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