Bruno Lunenfeld, MD, PhD

click           here for RealAudio/Video version

     "You mentioned that there's mechanical endometriosis, and the shift is     coming to better understand the biochemical nature and the bioactivity of     endometriotic lesions as they may pertain to infertility. Clinically, when     we approach patients, we have our eyes and a laparoscope. Do you see new     methods coming out that will clinically help us manage our patients based on     the importance of this biologic understanding?"
             
             

     "When I teach my students in any situation, I say - first engage your     brain. Maybe get a good history, make up some kind of hypothesis, then start     using your hands to confirm or to destroy your hypothesis. Once you've     finished this, you start using the laboratory and visual methodology, and     not the other way around like, unfortunately, some of the people are doing     today by taking advantage of technology because laboratory and imaging     techniques, as well as pathology, are confirmatory. It should not be used as     a primary diagnosis but as a confirmatory diagnosis. If we then go further,     once I have a suggestion of endometriosis, which history alone can tell me a     lot about it; I then use a laparoscope. If I use a laparoscope, I will see     the foci because my eye also has to see the microscopic nature of the     lesion. If it is red, black, or white - it is already a lot of information     but the mix forms are there. I have to have a good pathological diagnosis     before I should really decide on my treatment. But again, I will make the     decision when I look with the laparoscope. I need my laparoscope to look     together with the biopsy to make my diagnosis, and then I start going into     sophisticated situations because I'm quite sure that quite a lot of the     things are done. So this is again confirmative to decide what kind of     treatment I will do when. Again my treatment will be different if the woman     is half a year infertile, or married, if she's one of the happiest married,     if she's 35-years-old, or if she's 27-years-old. So I need all these things     to consider. I really believe in what we call today "evidence based     medicine" and evidence based medicine has to be number one on your     brain and your intellect because - I think the nice thing and why I love to     go into medicine - it is a continuous intellectual exercise. Only after I've     made my intellectual diagnosis, I will go to confirmative methods first     using my hands, then using the laboratory, and then using machinery like     imaging."

Articles

OBGYN.net Conference CoverageFrom 5th International Symposium onGnRH Analogues in Cancer and Human Reproduction inGeneva, Switzerland

Current Concepts in the Diagnosis & Therapy of Endometriosis

click             here for RealAudio/Video version

     "If you surgically evaluate patients with infertility - transvaginal     hydrolaparoscopy - the advantages of the technique is that you can gain     access earlier and potentially less costly and with less morbidity. That is     the theory or the hypothesis that is being proposed in the attempts to sell     the equipment. While the technique demonstrates good visualization of the     posterior pelvis, it does not show visualization of the anterior pelvis. Do     you believe that the trade off of earlier visualization because of economics     is an acceptable trade off to visualization of anterior or the live     visualization of the anterior pelvis?"
             
             

 "At my age and at my     level of profession I am sometimes allowed to say I don't know. So in this     respect - I don't know, I'm not sure. I believe as I said when we discussed     the AV meter earlier - I believe in prevention. I see endometriosis as a     disease, which will always progress. If I can treat endometriosis earlier, I     will save money and pain, and I will increase the quality of life. So     whatever I can do to make an early diagnosis of endometriosis and prevent     the progression of the disease because I want to come back again and say -     once endometriosis always endometriosis. And endometriosis is a progressive     disease but we have to take all the means to keep the progression of     endometriosis under full control so that we can have a very good quality of     life even though we have this disease."

THL & Early Diagnosis of Endometriosis

     "The topic we'd like to discuss is your thoughts on the issue of     minimal endometriosis and whether it's the cause of infertility in light of     the information we have from the Endo-Can Study."
     
     

 "If we discuss     endometriosis in relation to infertility, pain, or to any therapy,     unfortunately, the old classification which was ruled out is not sufficient     because infertility depends not only on the size of the endometrium foci but     also on the localization and the quality of the lesions. I'll give you some     examples - infertility - if the localization is precise it may mechanically     interfere either through pushing or pulling or changing the two graphical     directions between the different organs inside the body, or the lesions may     set up blocking situations - then this may cause mechanical infertility. If     they are white-like forms, for instance, they may even not respond to any     anti-hormonal therapy, and would have to be taken out surgically. If they     are red forms and they're active, in the light of this situation, we can     treat them very quickly by reducing the hormone status with GnRH analogues.     The same thing is true for pain; if these locations sit in areas which are     painful - they will create pain but they may not create infertility. So I     think that sight, localization, and quality of the lesions is extremely     important. We cannot just classify endometriosis according to size, as there     it isn't any in the present official endometriosis classification system.     Now the other part is mechanical endometriosis - we know that we have at     least two main mechanisms of the formation of mechanical problems. The first     of which is the immunomodulation mechanism, which I always discuss with my     students. I'll tell them once we have learned to control the adhesion,     invasion, and the moon-like expulsion - then the creation or genesis at the     local site will be resolved as far as the formation of endometriosis. But we     have already solved the problem in medicine with ovulation and probably to     the implantation. If I were forty-five years younger, I would probably go     into this field where I should have gone because my boss at the Weizmann     Institute asked me to work with implantation and not with ovulation. I     refused, I liked ovulation more and it was easier. Now the second part of     endometriosis is about the chemical part - we know very well today that     endometriosis foci are chronic inflammations, and in chronic inflammation we     have biochemical materials. Biochemical material can very effectively     interfere in many of the processes of this complex situation which we call     conception. Therefore, any endometriosis from minimum to maximum depending     on the quality of the endometrial site, the size of the area, and the     location - can produce difficulties in the silent outcome of     conception."

Bruno Lunenfeld, MD, PhD

Articles

Current Concepts in the Diagnosis & Therapy of Endometriosis

THL & Early Diagnosis of Endometriosis

The relationship between endometriosis and infertility