PubMed · 8156885
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K Mohr. 1994-04-08. Buserelin.. https://doi.org/10.1055/s-0029-1235042
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Proximal tube occlusion (PTO) accounts for 20% of tubal factor cases. The classification into nodular (salpingitis isthmica nodosa or endometriosis), non-nodular (true fibrotic occlusion) and so-called pseudo occlusion (detritus, polyps, hypoplastic tubes) is essential. Using falloposcopy, PTO that is already diagnosed by laparoscopy and hysterosalpingography (HSG) can be confirmed or bypassed (false PTO); patients with false PTO were placed on a temporary waiting period. Nodular and pseudo occlusion patients were pre-treated with gonadotrophin-releasing hormone analogue (GnRH-a) for at least 6 weeks to shrink the underlying pathology, after which tubal re-catheterization was performed. In a prospective study starting in July 1993, 53 patients prediagnosed as having PTO were examined by falloposcopy. Three of these patients had non-nodular occlusion and were directed to microsurgical repair (conservative treatment not possible). A total of 19 cases revealed patent tubes with healthy mucosa and no underlying pathology (false PTO). Of the remaining 31 patients, 18 were classified as nodular and 13 as pseudo occlusion. In all of these patients at least one tube was patent after GnRH-a treatment. After a 6 month period, 37% of the false PTO patients achieved a spontaneous pregnancy (6% per cycle). The spontaneous pregnancy rate in the true PTO group was significantly lower (10% per patient, 1.6% per month; P < 0.05). Using assisted reproduction techniques, in particular gamete intra-Fallopian transfer (GIFT), as a subsequent treatment for the true PTO group, a pregnancy rate of 50% per cycle was achieved. A retrospective analysis of our entire PTO population (n = 109) showed a spontaneous pregnancy rate after achieving tubal patency (using falloposcopy and GnRH-a) that was dramatically low (1.8%), with no difference between the nodular and pseudo groups. The chance for pregnancy can be enhanced significantly (P < 0.001) using assisted reproduction techniques (GIFT) following tubal re-catheterization and GnRH-a treatment.
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OBJECTIVES: The aim of this study was to assess the treatment of endometriosis with a gonadotropin-releasing hormone (GnRH) agonist in terms of changes to the extent of disease and to CA 125 levels as well as to recurrence during follow-up. METHODS: The levels of serum CA 125 were evaluated in 66 patients with endometriosis diagnosed and staged by laparoscopy according to the revised American Fertility. Society classification, who received a 6-month course of a GnRH agonist. Serum CA 125 levels were measured before, during (3 and 6 months after the initiation of therapy) and 6 months after cessation of therapy. RESULTS: Patients with minimal and mild endometriosis had significantly higher mean pretreatment values than control subjects in the luteal phase of the cycle or than postmenopausal women (P < 0.05), but the overall mean value was still below 35 U/ml. Levels of CA 125 fell during treatment to those found in normal controls, but rose again after the end of treatment. The sensitivity and specificity of CA 125 were 75% and 83.3%, respectively, and its positive predictive value as a marker of recurrence was 46.36%. CONCLUSION: These data suggest that CA 125 may be a reliable indicator for monitoring the efficacy of GnRH agonist treatment of endometriosis, but its value as a predictor of recurrence is low, probably due to the suppression of all CA 125 sources such as endometrium, ovaries and implants.