Selma Oransay, MD

Dr. ORANSAY is 35 years experienced clinician in OB/ GYN. She worked in the main national maternity educational hospital of Turkey for 20 years than she moved to İstanbul and worked in private hospitals. Her published articles are mostly on topics of menopause and infertility. She is also experienced as a voluntary OB/GYN doctor in African healthcare program.

Improvement of the quality of life after surgery for deep infiltrating endometriosis.

Deeply infiltrating endometriosis is the most severe form among the endometriosis types. The required laparoscopic approach is the appropriate excision of endometriotic foci from pelvis, by consideration of failure and side effects of the medical treatments. The specialist endometriosis centers showed good evidence of the safety and effectiveness of laparoscopic surgery for deep infiltrating endometriosis patients. Improved the quality of life at 6 months after surgery could be achieved and be maintained at 2 years in these specialized endometriosis  centers.…

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Postoperative long-term estro-progestin therapy for endometrioma

After the removal of ovarian endometriomas, the major concern is the high recurrence rate of symptoms and endometriotic cysts. The estimated recurrence rate of endometriomas is up to 50% at 5 years after surgery. To prevent the recurrence, postoperatively long-term combined or single hormone as progestins are generally advised. Del Forno and colleagues from Bologna University, Italy planned this retrospective cohort study to evaluate the efficacy of hormone therapy on their collection of 18 years of data. The paper is recently…

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Fertilization rate and pregnancy outcome in IVF cycles of endometriosis.

Endometriosis affects the pelvic cavity, uterus, ovaries and causes impaired fertility as a result. The chronic inflammatory nature of this disease negatively impacts the oocyte quality, maturation, and fertilization. Obviously, fewer oocytes can be harvested in the IVF cycles of endometriotic women when compared to controls. Data in the literature for the fertilization rates of endometriotic women are confusing. Prof. Jansen group from the Department of Gynecology, Leiden University, the Netherlands, studied IVF cycles of infertile endometriotic women to compare…

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Endometriosis, ART, fertility preservation

This review entitled "The impact of endometriosis on the outcome of assisted reproductive techniques: role of fertility preservation" was written by Necula et al. from Gynecology and Obstetrics Unit, Biel, Switzerland, and recently published in the journal "Hormone, Molecular Biology and Clinical Investigation". Endometriosis is a major cause of infertility. Although different types of endometriosis may require different types of therapy, recent understanding shows that individual treatment for every patient is important. The development of ART techniques facilitates to get conceived, however, the application…

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Endometriosis and possible cardiovascular outcomes

A retrospective population-based cohort study from the Institute of Applied Health Research, University of Birmingham, Birmingham, the UK, investigated the long-term cardiovascular outcomes of women with endometriosis. The study included 279,759 women in total, 20,1% (>56.000) were patients with surgically confirmed endometriotic patients, and the remaining 79,9% was the control group, matched with the endometriosis group in terms of age, body mass index, and health situation. Although the annual overall incidence of endometriosis remained stable throughout the 20 years of follow-up,…

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Environmental to occupational exposure, and possible risk factors for endometriosis.

Many objects in daily use are made of plasticizing agents. Studies suggest that chronic exposure to these agents are toxic to reproductive organs and cause metabolic disorders. For example, diethyl phthalate is still in use in cosmetic products.  Caporossi et al. from the Department of Epidemiology and Hygiene, Monte Porzio Catone, Italy, planned to examine the agents that cause the onset of endometriosis, and carried out a literature search for this purpose. Papers published from 1995 to 2020 in PubMed and…

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Endometriosis and the risk of Systemic lupus Erythematosus: A report from Taiwan

Systemic Lupus Erythematosus (SLE) is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage that affects mostly women, with an M:F ratio of 1:9. Recent evidence has also shown that endometriosis is a disease associated with immune system dysfunction. The association between those two diseases is not clear due to the limited number of cohort studies in the literature. Fan et al., from Taiwan Chung Sang Medical University, used the Taiwan nationwide population-based…

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The improvement of fertility rate and symptoms of superficial endometriosis following laparoscopic peritoneal stripping

Pain, in the form of diverse entities, including dyspareunia, dysuria, dyschezia, is the main symptom of endometriosis patients. The severity of pain is independent of the extent and the location of the disease, and generally causes a negative impact on the physical, mental, and social wellbeing of the patient. Due to the complex nature of pain and heterogeneity of the underlying disease, the diagnosis, and the differential diagnosis are difficult.  There is no consensus for the treatment of peritoneal endometriosis. It…

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Antioxidant therapy for the endometriosis pain

Ts the protective defense mechanism of cells, hence the destruction of balance between oxidants and antioxidants in our body is called "redox imbalance".  The major oxidants are reactive oxygen species (ROS) that are involved in multiple cellular processes by physiologically transporting signals. Our body has also an antioxidant defense system that includes a complex network of enzymes and co-enzymes. Additionally, we could intake externally suppliable antioxidants like vitamin E, carotenoids, etc. for further antioxidant needs.   Endometriosis is a chronic inflammatory…

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Ovarian, breast and endometrial cancer coexisting with endometriosis.

The invasive nature of endometriosis results in calling the disease " benign cancer". The transformation of endometriosis to malignancy is rare, but when compared to the general population, the relative risk of developing ovarian cancer is 4.2 times greater especially in women with long-lasting endometriosis. Based on this important fact, a retrospective, cross-sectional study was planned by a group of researchers from the Department of Obstetrics and Gynecology of Christian Medical School, Vellore, India, to determine the predictive risk factors of…

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What is the cause of Dienogest-resistance in patients with endometrioma?

Endometriosis may cause infertility in women, leading to adhesions in the pelvis, besides affecting the ovaries. Clinicians concern about the child-bearing desire of their patients when treating them surgically or with hormonal therapy. Dienogest (DNG) is a kind of progestin, and its clinical effect is similar to GnRH antagonists when it is used long-term in endometriosis patients. When compared to patients treated by cyclic oral estrogen-progestin, dienogest was reported to be significantly effective in reducing the size of the endometrioma…

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High-dose progestin intake and sexual functions in endometriosis patients

Dr. Oppenheimer et al. from the Department of Reproductive Medicine and Fertility Preservation of Antoine Beclere University Hospital, Clamart, France, recently published this bi-center observational prospective study in "Acta Obstetrica et Gynecologica Scandinavica". The study was designed to put forth the effect of high-dose progestin intake on sexual functions and includes 214 women who are sexually active and diagnosed with endometriosis. Every single patient completed the French version of the specific sexual activity questionnaire (SAQ) at the beginning and after…

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Deep endometriosis treatment options based on the patient's decision

Deep endometriosis, defined as endometriotic lesions penetrating deeper than 5 mm into the peritoneum comprise approximately 20% of all endometriosis cases. This invasive disease causes a significant reduction in the quality of life, social participation, and sexual health of affected women. Conservative therapy and surgical approach could be discussed with the women who faced to cope with the disease. Failure of hormonal therapy, and the side effects such as weight gain, a decrease of libido, mood swings, headache, and the…

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Laparoscopic Approach to Rectus Muscle Endometriosis and Inguinal Endometriosis - Ted Lee, MD

Rectus muscle endometriosis and inguinal endometriosis are two rare types of endometriosis. Operation room videos of several patients with different rectus muscle endometriosis and inguinal endometriosis are shared during the presentation of Dr. Lee to clarify the methods of the laparoscopic approach to these diseases. More than seventeen percent of abdominal wall endometriosis involves rectus muscles. The main symptom is cyclic abdominal pain with or without palpable mass on rectus muscles and this pain is worsening with activities that engage…

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Further Evidence that endometriosis is related to tubal or ovarian cancer - Togas Tulandi, MD

Most authors suggest an association of endometriosis mainly with clear cell, low-grade serous, and endometrioid ovarian cancer.  But in two large cohort studies, no correlation between them is reported (Olson et al. 2002 and Tseng et al. 2019) Dr. Tulandi and his collaborators used the Healthcare Cost and Utilization Project data, which is the largest collection of longitudinal hospital care data in the United States, and checked nearly 77 million patients between 2005-2014 to identify the relation between endometriosis and adnexal cancers.…

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Insoluble Dilemma of Adenomyosis: Diagnosis, Management, and Treatment  - Errico Zupi, MD

The prevalence of adenomyosis has been reported to range from 1% to 70% in different studies. This large range can be explained by the lack of standard diagnostic criteria by imaging modalities or pathological analyses. Sixty-five% of the women with adenomyosis have clinical symptoms of abnormal uterine bleeding and dysmenorrhea. Additionally, there is an increasing diagnosis of adenomyosis among young women who consult infertility clinics. The FIGO group declared adenomyosis as a disease that is responsible for abnormal uterine bleeding in the…

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Fixing holes: prevention and treatment of complications - Jon Einarsson, MD, MPH

Dr. Einarsson shared his operating room video screens during his speech for discussing four major complications (ureter, bladder,  bowel, and vascular) of endometriosis surgery and the ways to repair them. Fixing the ureter damage: Endometriotic nodules may settle on the tract of ureters, and their removal may cause ureteral damage. The best way to approach this is to cut them from their healthy surface and restore end-to-end anastomosis. Separation of the ureter surface very carefully and passing a stent while constructing…

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Limits of endometrioma surgery in infertility patients - Liselotte Mettler, MD, PhD

The removal of endometrioma may affect ovarian reserve because healthy follicles near endometrioma could also be excised during this procedure. Another concern about the ovarian reserve is that it may be already low before the surgery. Anti Mullerian Hormone (AMH) is an indicator of ovarian reserve, and it always surges down after excision of endometrioma.  If the patient wishes to get pregnant, the gynecologist is concerned not only with the number of healthy follicles but also with the quality of…

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Endometriosis and the sexual relations of the couples

From the viewpoint of endometriotic women, the pain during the penetration is not the only complaint. They also have growing depression and anxiety leading to difficulties with their social and sexual relationship, work, and study. The emotional impact of sub-infertility, the uncertainty of future related repeated surgeries, and the long duration of treatment all aggravate their psychological disturbance. The need to investigate the psychological impact of endometriosis on women was highlighted in the 2013 ESHRE meeting.  Published studies on this…

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Endometriosis and chronic opioid use

The members of the American College of Obstetricians and Gynecologists have declared that gynecologists prescribe opioids after laparoscopic hysterectomy, or for relieving endometriosis pain, although guidelines are not available for when or how to use opioids for the treatment of endometriosis-associated pain, and the data on the potential negative consequences of opioid use in the general population is rising. To identify the potential risk factors for opioid use and long-term addiction, Dr. Lamvu et al., from Orlando Veterans Affairs Medical Center,…

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