Fertility after expanded polytetrafluoroethylene use after endometrioma  cystectomy: a pilot study

Patrick P Yeung Jr; Melody S Su; John Voltz; Jeffrey A Gavard

doi:10.3389/frph.2023.1231029

Reproductive Surgery · Adhesion Prevention

Fertility after expanded polytetrafluoroethylene use after endometrioma cystectomy: a pilot study

Yeung PP Jr, Su MS, Voltz J, Gavard JA

Published December 11, 2023 Frontiers in Reproductive Health, 5, 1231029

DOI 10.3389/frph.2023.1231029 PMID 38076007 PMC PMC10703387

RRM Academy Synopsis

Gore-Tex ovary barrier trended toward more pregnancies after surgery

A small self-selected cohort of 29 women with severe endometriosis found that about 6 out of 10 women given a Gore-Tex barrier around the ovaries reported a pregnancy, against 4 out of 10 without. The gap was not statistically significant. All had endometrioma cysts of 3 cm or more removed.

Key Findings

10 of 18 women (55.6%) who received expanded polytetrafluoroethylene (ePTFE) and 4 of 11 (36.4%) who did not reported a pregnancy after surgery (p = 0.54).
Among women infertile before surgery, 8 of 16 (50.0%) with ePTFE and 2 of 7 (28.6%) without became pregnant (p = 0.41).
Lifetable cumulative 4-year pregnancy rates in the whole group were 85% with ePTFE and 65% without (p = 0.69).
In the infertile-before-surgery subgroup, cumulative 4-year pregnancy rates were 83% with ePTFE and 33% without (p = 0.89).
Most pregnancies happened during the first two years after surgery.

Interpretation

The study was a prospective cohort at one center. Women chose whether to receive ePTFE, and the groups were small. The authors call the study underpowered, and no comparison reached statistical significance. Infertility before surgery was more common in the ePTFE group (94.1% against 63.6%), and the median time from surgery to the follow-up survey was 24 months against 12 months. Eight women needed fertility drugs or IVF to conceive, six of them in the ePTFE group. A design like this cannot show that ePTFE caused any difference in pregnancy.

RRM Context

Restorative reproductive medicine aims to treat the disease and protect fertility. Adhesion prevention after excision fits that aim. The surgeon excised (cut out) all visible lesions, then added the ePTFE barrier for women who chose it. The authors call it the first known study linking adhesion prevention in endometriosis to pregnancy rates.

Our editorial summary of this paper, not the article's abstract.

Abstract

Introduction

Pregnancy rates after the placement of expanded polytetrafluoroethylene (ePTFE, trade name Gore-Tex®) for adhesion prevention following cystectomy of endometriomas ≥3 cm and excision of endometriosis were analyzed in this pilot study.

Methods

A prospective cohort study was performed at a single tertiary care center. 56 women qualified for the study and underwent surgery. Expanded polytetrafluoroethylene placement around affected ovaries was self-selected. Inclusion criteria for analysis were pathology-confirmed endometrioma ≥3 cm, no hysterectomy at time of surgery, ≥1 year of postoperative survey completion, and absence of strategies to avoid pregnancy. 18 women in the ePTFE group and 11 women in the control group met inclusion criteria for analysis. 16 of the 18 women in the ePTFE group and 7 of the 11 women in the control group were affected by infertility. Absolute pregnancy rates and cumulative 4-year pregnancy rates, which are based on survival analysis using lifetables and adjust for varying follow-up times, were calculated for all women as well as for women with infertility only.

Results

High cumulative 4-year pregnancy rates were observed for women with expanded polytetrafluoroethylene compared to women without (85% vs. 65%, p = 0.69). High cumulative 4-year pregnancy rates for women with infertility prior to surgery were observed for women with expanded polytetrafluoroethylene compared to women without (83% vs. 33%, p = 0.89).

Discussion

There are consistent trends, although not statistically significant, seen in pregnancy rates for women with ePTFE compared to women without, particularly in those with a history of infertility prior to ePTFE use. This is the first study examining how adhesion prevention strategy targeting the adnexa during surgery for endometriosis affects pregnancy rates. The trend towards increased pregnancy rates with expanded polytetrafluoroethylene use, particularly in patients with a history of infertility, is promising and warrants further study with larger groups.

Topics

Reproductive Surgery › Adhesion Prevention › Barrier Agents · Endometriosis › Fertility and Outcomes › Conception After Excision

Patrick P Yeung Jr, Melody S Su, John Voltz, Jeffrey A Gavard

Pat Yeung, P Yeung, M Su, Jack Voltz, J Voltz, Jeff Gavard, J Gavard

PMID 38076007 38076007 DOI 10.3389/frph.2023.1231029 10.3389/frph.2023.1231029 Yeung Jr et al. 2023, Yeung Jr 2023