Leuven University Fertility Center

Leuven, Belgium

Leuven University Fertility Center

Leuven, Belgium
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Janssen E.B.,Leuven University Fertility Center | Rijkers A.C.M.,Leuven University Fertility Center | Hoppenbrouwers K.,Catholic University of Leuven | Meuleman C.,Leuven University Fertility Center | D'Hooghe T.M.,Leuven University Fertility Center
Human Reproduction Update | Year: 2013

Background: Endometriosis associated with pain symptoms in adolescents has been extensively reported, but the exact prevalence is unclear because pain symptoms may be atypical and endometriosis can only be diagnosed by laparoscopy. The aim of this paper is to provide a systematic review of the prevalence of endometriosis diagnosed by laparoscopy in adolescents. methods: A systematic literature search was carried out for relevant articles published between 1980 and 2011 in the databases PUBMED and EMBASE, based on the keywords 'endometriosis', 'laparoscopy', 'adolescents' and 'chronic pelvic pain (CPP)'. In addition, the reference lists of the selected articles were examined. results: Based on 15 selected studies, the overall prevalence of visually confirmed endometriosis was 62% (543/880; range 25-100%) in all adolescent girls undergoing laparoscopic investigation, 75% (237/314) in girls with CPP resistant to treatment, 70% (102/146) in girls with dysmenorrhea and 49% (204/420) in girls with CPP that is not necessarily resistant to treatment. Among the adolescent girls with endometriosis, the overall prevalence of American Society of Reproductive Medicine classified moderate-severe endometriosis was 32% (82/259) in all girls, 16% (17/108) in girls with CPP resistant to treatment, 29% (21/74) in girls with dysmenorrhea and 57% (44/77) in girls with CPP that is not necessarily resistant to treatment. Due to the quality of the included papers an overestimation of the prevalence and/or severity of endometriosis is possible.conclusions: About two-thirds of adolescent girls with CPP or dysmenorrhea have laparoscopic evidence of endometriosis. About one-third of these adolescents with endometriosis have moderate-severe disease. The value of early detection of endometriosis in symptomatic adolescents and the indications for laparoscopic investigation in adolescents require more research. © The Author 2013. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.

Platteeuw L.,Leuven University Fertility Center | D'Hooghe T.,Leuven University Fertility Center
Current Opinion in Obstetrics and Gynecology | Year: 2014

Purpose of review: Current medical treatments for endometriosis-associated pain, including oral contraceptives, progestins and GnRH agonists, are partially effective and have significant side-effects. The purpose of this review is to present new hormonal and nonhormonal treatment for endometriosis. Recent findings: At present, the ideal drug that can prevent, inhibit or stop development of endometriosis, reduce associated pain or infertility and allow conception does not exist. New drugs in development for endometriosis modulate GnRH, estrogen and/or progesterone receptors, or target endometriosis-associated inflammation, angiogenesis, adhesion and/or tissue invasion. Most have been tested in rodents, and have been evaluated in more relevant animal models like nonhuman primates (baboons), but only a few, that is GnRH antagonists, have been tested in human randomized controlled trials. Important safety and efficacy issues remain a concern, as steroid receptors, inflammation, adhesion, angiogenesis and tissue invasion are key factors in physiological events like ovulation, menstruation and embryo implantation. Summary: New drugs for the medical treatment of endometriosis targeting both hormonal (GnRH, estrogen and progesterone receptors) and nonhormonal pathways (inflammation, angiogenesis, adhesions, tissue invasion) are promising, but their efficacy and safety need to be established in randomized human trials before they can be used in clinical practice. Copyright © 2014 Lippincott Williams & Wilkins.

Wolthuis A.M.,University Hospital Gasthuisberg Leuven | Tomassetti C.,Leuven University Fertility Center
Best Practice and Research: Clinical Gastroenterology | Year: 2014

Endometriosis is a handicapping disease affecting young females in the reproductive period. It mainly occurs in the pelvis and affects the bowel in 3-37%. Endometriosis can cause menstrual and non-menstrual pelvic pain and infertility. Colorectal involvement results in alterations of bowel habit such as constipation, diarrhoea, tenesmus, and rarely rectal bleeding. A precise diagnosis about the presence, location and extent is necessary. Based on clinical examination, the diagnosis of bowel endometriosis can be made by transvaginal ultrasound, barium enema examination and magnetic resonance imaging. Multidisciplinary laparoscopic treatment has become the standard of care and depending on size of the lesion and site of involvement full-thickness disc excision or bowel resection is performed by an experienced colorectal surgeon. Anastomotic complications occur around 1%. Long-term outcome after bowel resection for severe endometriosis is good with a pregnancy rate of 50%. © 2013 Elsevier Ltd. All rights reserved.

Van den broeck U.,Leuven University Fertility Center | Vandermeeren M.,Leuven University Fertility Center | Vanderschueren D.,University Hospitals Leuven | Enzlin P.,University Hospitals Leuven | And 2 more authors.
Human Reproduction Update | Year: 2013

Background: This systematic review aimed first to integrate the current body of knowledge on the demographic, institutional and psychosocial information on sperm donors, and second to provide insight into the actual experiences of men who donate and the attitudes towards potential donation. Methods: Electronic databases (PUBMED, CINAHL, PsycINFO, Embase and Web of Science) were searched with no date restriction using a specific search strategy followed by a snowball strategy. English language peer-reviewed abstracts and full texts were screened for eligibility and the risk of bias was assessed with 15 criteria. Eligibility, quality assessments and data extraction were performed by two independent researchers, resolving disagreement by discussion. Results: The initial search retrieved 857 studies and after quality assessment, 29 studies were retained for data extraction. Data from nine countries were obtained. The review synthesis revealed differences and similarities between actual and potential sperm donors on demographic characteristics, financial compensation and attitudes towards anonymity, disclosure and providing information to potential offspring. A number of methodological shortcomings have been identified in the studies investigating sperm donors. Conclusions: Institutional factors (such as recruitment procedures, altruism versus compensation of sperm donors, anonymity versus open-identity donation) and the impact of changing legislation have largely dominated the studies on sperm donation. Furthermore, studies from countries with a bias towards white Western ideology and interpretation were over-represented. This has resulted in a profile of potential and actual sperm donors in terms of demographics, recruitment strategies, motivation for donation and attitudes regarding anonymity, disclosure, recipients and offspring. However, the psychosocial needs and experiences of the donor, and their follow-up and counselling are largely neglected. This review has identified key issues to inform current practice and the development of pathways of care for sperm donors that reflect the multidimensional nature of sperm donation. © The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.

Indekeu A.,Catholic University of Leuven | Dierickx K.,Catholic University of Leuven | Schotsmans P.,Catholic University of Leuven | Daniels K.R.,University of Canterbury | And 2 more authors.
Human Reproduction Update | Year: 2013

Background: In recent years, changes in attitudes towards (non-)disclosure of donor conception to offspring and/or others have been observed. Studies have started to identify possible factors that contribute to these changes that are relevant for clinics, counsellors and policymakers in their approach to the disclosure process. The aim of this systematic review was to integrate the existing knowledge on factors that influence the disclosure decision-making process of donor conception to offspring and/or others in heterosexual couples, and to discuss future trends and concerns. Methods: Abibliographic search of English, French, German and Dutch language publications of five computerized databaseswas undertaken from January 1980 to March 2012. A Cochrane Database systematic review approach was applied. Results: A total of 43 studies met the inclusion criteria, and these represented 36 study populations. The review shows that the parents' disclosure decision-making process is influenced by amyriad of intrapersonal, interpersonal, social and family life cycle features. These influenceswere not necessarily independent but rather were interwoven and overlapping. Theoretical frameworks have not yet been used to explain how the different factors influenced disclosure.Methodological limitations of the original publications (lack of information, several factors included in one study, descriptive character of studies) and this review (multiple factors that may interact) which hindered integration of the findings are outlined. © The Author 2013. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.

Meuleman C.,Leuven University Fertility Center | Tomassetti C.,Leuven University Fertility Center | D'Hooghe T.M.,Leuven University Fertility Center
Current Opinion in Obstetrics and Gynecology | Year: 2012

PURPOSE OF REVIEW: To present the clinical outcome after laparoscopic radical excision of deeply infiltrative endometriosis (DIE) with colorectal extension and laparoscopic segmental bowel resection. RECENT FINDINGS: In three different studies including mostly patients with recurrent DIE with colorectal extension, we showed that radical reconstructive CO 2 laser laparoscopic resection of DIE with colorectal extension in a multidisciplinary setting resulted in a low complication rate, a low cumulative reintervention and recurrence rate and a high cumulative pregnancy rate, also when bowel resection reanastomosis was performed. In a systematic review to assess the clinical outcome of surgical treatment of DIE with colorectal involvement, data were reported in such a way that comparison of different surgical techniques was not possible. A checklist is proposed to achieve standardized reporting of presenting symptoms, preoperative tests, inclusion criteria, preoperative and postoperative care, complications, follow-up, patient-centered assessment of pain and quality of life, fertility and recurrence corrected for postoperative use of hormonal suppression or infertility treatment. SUMMARY: CO 2 laser laparoscopic radical excision of DIE with colorectal extension and laparoscopic segmental bowel resection in centers of expertise is associated with good clinical outcome. To make real progress, international agreement is needed on terms and definitions used in surgical endometriosis research. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

De Graaff A.A.,Maastricht University | D'hooghe T.M.,Leuven University Fertility Center | Dunselman G.A.J.,Maastricht University | Dirksen C.D.,Maastricht University | And 2 more authors.
Human Reproduction | Year: 2013

STUDY QUESTIONTo what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease?SUMMARY ANSWERMany women with endometriosis had impaired quality of life and continued to suffer from endometriosis-associated symptoms even though their endometriosis has been managed in tertiary care centres.WHAT IS KNOWN ALREADYThe existing literature indicates that quality of life and work productivity is reduced in women with endometriosis. However, most studies have small sample sizes, are treatment related or examine newly diagnosed patients only.STUDY DESIGN, SIZE, DURATIONA cross-sectional questionnaire-based survey among 931 women with endometriosis treated in 12 tertiary care centres in 10 countries.PARTICIPANTS/MATERIALS, SETTING, METHODSWomen diagnosed with endometriosis who had at least one contact related to endometriosis-associated symptoms during 2008 with a participating centre were enrolled into the study. The study investigated the effect of endometriosis on education, work and social wellbeing, endometriosis-associated symptoms and health-related quality of life, by using questions obtained from the World Endometriosis Research Foundation (WERF) GSWH instrument (designed and validated for the WERF Global Study on Women's Health) and the Short Form 36 version 2 (SF-36v2).MAIN RESULTS AND THE ROLE OF CHANCEOf 3216 women invited to participate in the study, 1450 (45%) provided informed consent and out of these, 931 (931/3216 = 29%) returned the questionnaires. Endometriosis had affected work in 51% of the women and affected relationships in 50% of the women at some time during their life. Dysmenorrhoea was reported by 59%, dyspareunia by 56% and chronic pelvic pain by 60% of women. Quality of life was decreased in all eight dimensions of the SF-36v2 compared with norm-based scores from a general US population (all P < 0.01). Multivariate regression analysis showed that number of co-morbidities, chronic pain and dyspareunia had an independent negative effect on both the physical and mental component of the SF-36v2.LIMITATIONS, REASONS FOR CAUTIONThe fact that women were enrolled in tertiary care centres could lead to a possible over-representation of women with moderate-to-severe endometriosis, because the participating centres typically treat more complex and referred cases of endometriosis. The response rate was relatively low. Since there was no Institute Review Board approval to do a non-responder investigation on basic characteristics, some uncertainty remains regarding the representativeness of the investigated population.WIDER IMPLICATIONS OF THE FINDINGSThis international multicentre survey represents a large group of women with endometriosis, in all phases of the disease, which increases the generalizability of the data. Women still suffer from frequent symptoms, despite tertiary care management, in particular chronic pain and dyspareunia. As a result their quality of life is significantly decreased. A patient-centred approach with extensive collaboration across disciplines, such as pain specialists, psychologists, sexologists and social workers, may be a valuable strategy to improve the long-term care of women with endometriosis.STUDY FUNDING/COMPETING INTEREST(S)The WERF EndoCost study is funded by the World Endometriosis Research Foundation (WERF) through grants received from Bayer Schering Pharma AG, Takeda Italia Farmaceutici SpA, Pfizer Ltd and the European Society of Human Reproduction and Embryology. The sponsors did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. L.H. is the chief executive and T.D. was a board member of WERF at the time of funding. T.D. holds the Merck-Serono Chair in Reproductive Medicine and Surgery, and the Ferring Chair in Reproductive Medicine at the Katholieke Universiteit Leuven in Belgium and has served as consultant/research collaborator for Merck-Serono, Schering-Plough, Astellas and Arresto. © The Author 2013.

Meuleman C.,Leuven University Fertility Center | Tomassetti C.,Leuven University Fertility Center | D'Hoore A.,University Hospital Leuven | Van Cleynenbreugel B.,University Hospital Leuven | And 3 more authors.
Human Reproduction Update | Year: 2011

Background: Treatment of colorectal endometriosis is difficult and challenging. We reviewed the clinical outcome of surgical treatment of deeply infiltrating endometriosis (DIE) with colorectal involvement. Methods: Review was based upon a literature search using following search terms: (1) 'surgery' and 'colorectal endometriosis', (2) 'bowel' and 'endometriosis' and 'surgery'. Inclusion criteria: clear explanation of surgical technique and follow-up data on at least one of the following items: complications, pain, quality of life (QOL), fertility and recurrence. Results: Most of the 49 studies included complications (94%) and pain (67%); few studies reported recurrence (41%), fertility (37%) and QOL (10%); only 29% reported (loss of) follow-up. Out of 3894 patients, 71% received bowel resection anastomosis, 10% received full-thickness disc excision and 17% were treated with superficial surgery. Comparison of clinical outcome between different surgical techniques was not possible. Post-operative complications were present in 0-3% of the patients. Although pain improvement was reported in most studies, pain evaluation was patient-based in <50% (Visual Analogue Scale in only 18%). While QOL was improved in most studies, prospective data were only available for 149 patients. Pregnancy rates were 23-57% with a cumulative pregnancy rate of 58-70% within 4 years. The overall endometriosis recurrence rate in studies (>2 years follow-up) was 5-25% with most of the studies reporting 10%. Owing to highly variable study design and data collection, a CONSORT-inspired checklist was developed for future studies. Conclusions: Prospective studies reporting standardized and well-defined clinical outcome after surgical treatment of DIE with colorectal involvement with long-term follow-up are needed. © The Author 2011. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.

Laux-Biehlmann A.,Bayer AG | D'hooghe T.,Leuven University Fertility Center | Zollner T.M.,Bayer AG
Trends in Pharmacological Sciences | Year: 2015

Endometriosis is a chronic, hormone-dependent, inflammatory disease, characterized by the presence and growth of endometrial tissue outside the uterine cavity. It affects 5-10% of the female population of reproductive age and is frequently associated with moderate to severe pain, subfertility, and a marked reduction in health-related quality of life. Here, we propose a new pathophysiological concept of endometriosis, summarizing recent findings in one unifying picture. We propose menstruating tissue as the trigger for inflammatory pain in endometriosis through the activation of innate immune cells and peripheral nerve endings. We speculate how innovative treatment modalities beyond hormonal treatment will improve patients' lives. © 2015 Elsevier Ltd. All rights reserved.

Simoens S.,Catholic University of Leuven | Meuleman C.,Leuven University Fertility Center | Dhooghe T.,Leuven University Fertility Center
Human Reproduction | Year: 2011

Background This study aims to quantify the non-health-care costs of endometriosis in a sample of Belgian patients over a 30-month period. Methods a longitudinal study enrolled patients who underwent surgical treatment for endometriosis in University Hospitals Leuven. Self-reported patient questionnaires measured costs at 1 month prior to surgical treatment and at 6, 12, 18 and 24 months following treatment. The number of days of work absence was valued using gross monthly income to estimate costs of productivity loss. Analysis included patient expenditure on support with household activities. The costs per patient over 6 months were obtained by linear extrapolation. Results Of 394 eligible patients, 180 participated in the study (response rate of 46). The highest productivity loss was incurred during the 6 months preceding surgical treatment (€1514 ± 2576) and the 6 months following treatment (€2496 ± 4144). Mean costs dropped to €115€225 during the following 6-month periods. Similarly, costs of support with household activities peaked during the 6 months preceding surgical treatment (€982 ± 908) and during the subsequent 6 months (€981 ± 1085), after which they dropped to €500€675 during the following 6-month periods. Patients with severe endometriosis (Stage IV) (€4943) had higher total non-health-care costs over the 30-month period than patients with minimal-to-moderate endometriosis (Stages IIII) (€4510) (P = 0.048). Conclusions As our study did not include a control population of women without endometriosis, patients were asked to report non-health-care costs associated with endometriosis only. Results show that the highest non-health-care costs associated with endometriosis are incurred during the 6 months prior to and following surgical treatment. © 2011 The Author.

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