Mark Surrey, MD

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Dr. Surrey is one of the pioneers of In-Vitro Fertilization and  		Embryo Replacement. He trained in England and assisted in creating the  		first successful program there. He is also an Associate Professor at  		UCLA and an internationally recognized educator and speaker.

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Articles

OBGYN.net Conference CoverageSLS, Society of Laparoendoscopic Surgeons Annual Meeting 13th International Congress and Endo ExpoSeptember 29-October 2, 2004 - New York, New York

Introduction to Preimplantation Genetic Diagnosis (PGD)

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"The question has been       raised as to the impact and relevance of minimal endometriosis, how it's       managed, and what its implications are for the infertile female. It is       indeed a very controversial issue. The significance of it is much in       doubt, particularly when it does not seem to relate to the mechanics of       tubo-ovarian pick-up. However, there's been some information suggesting       that there certainly is a correlation with decreased fertility rates and       minimal endometriosis.
       
       There are some older studies, which suggests that there's the same impact       in minimal disease as there is in moderate disease, the perspective of       fertility rates before and after therapy. And for that reason, we treat       minimal endometriosis and moderate disease in much the same way, in so       much as that we initially surgically de-bulk it. With minimal disease we       attempt to excise it, first to make a histological diagnosis of the       suspected lesions themselves. In addition we attempt to get some histology       from areas of the peritoneum, proximate to the suspected lesions, from the       perspective of how to then subsequently manage the patient. Management, I       think, can be divided into four categories post-operatively.
       
       One would be expectant management - where you essentially do nothing. The       second would be some form of medical therapy, ranging from GnRH agonists       therapy to ovulation suppression with a progestational based combinational       contraceptive. The third management is a controlled ovarian stimulation       rationale, particularly perhaps for older women who have an increased       infertility rate. And the fourth management, I think, would be one of the       assisted reproductive procedures, specifically since you've just done a       laparoscopy, perhaps some vitro-fertilization.
       
       I think the management largely needs to be individualized depending upon a       number of different issues. The aggressiveness of which, I think, would be       determined in part by the patient's age, in so much as we will manage a       40-year-old patient with minimal endometriosis much more aggressively than       we'll manage a 30-year-old with minimal disease. I think the 30-year-old       we would be more inclined to manage expectantly and the 40-year-old more       aggressively. There has been a lot of controversy recently as to whether       patients with minimal disease require or benefit by medical therapy       postoperatively. There are a certain percentage of physicians that are       assuming this could be a systemic disease and the local manifestations of       that disease are sort of "the tip of the ice berg". They tend to       want to manage all patients medically regardless of the appearance       laparoscopically of the disease. On the other hand, if there's no other       evidence of disease present, it's probably - particularly in the older       patient - not rational to give them any significant amount of time of       postoperative suppression.
       
       So I think that it's a question that is a bit of an enigma to us       clinically. We don't have a good handle on any set management scheme, and       I think there's a certain art to medicine that comes in here in       individualizing all of the treatment of your patient with minimal       endometriosis."

OBGYN.net Conference CoverageFrom 5th International Symposium on GnRH Analogues in Cancer and Human Reproduction in Geneva, Switzerland

Treatment of Minimal Endometriosis

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Author | Mark Surrey, MD

Articles

Introduction to Preimplantation Genetic Diagnosis (PGD)

Introduction to Preimplantation Genetic Diagnosis (PGD)

Treatment of Minimal Endometriosis

GnRH Agonist and Addback Therapy