S.Salehpour

Professor Ob/gyn

Infertility fellowship

Medical director

Gyn ward and IVF center

Taleghani hospital

SBMU

Tehran_ Iran

• Personilized medicine is important in the treatment of pain

• Future medication:

local neurogenesis

central sensitization

genetics

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjhrJWIuM_XAhWEGuwKHbBbC08QjRwIBw&url=http://www.akairan.com/foto-aka/tabiat/18128.html&psig=AOvVaw2mONE05X7VuHO1xv62z8qP&ust=1511345818606449

• 11%-%19 no reduction of pain

• 5%-59% pain remaining

• 17%-34% recurrence of pain after stop of therapy

• 5%-16% discontinuation because of adverse effect

• CONCLUSION: Limited or intermittent benefit for medical therapy of endometriosis pain

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiewvbLuM_XAhVB2aQKHYKWAK4QjRwIBw&url=http://www.hamandishi-dini.ir/%D8%B9%DA%A9%D8%B3-%D9%87%D8%A7%DB%8C%DB%8C-%D8%A7%D8%B2-%DA%AF%D9%84-%D9%87%D8%A7%DB%8C-%D8%B2%DB%8C%D8%A8%D8%A7-4/&psig=AOvVaw2mONE05X7VuHO1xv62z8qP&ust=1511345818606449

• GnRh or laparoscopic excision or ?ablation?

Increased pregnancy rate

• Lower oocyte number, lower quality, lower fertilization

• GnRh (3 months) before IVF , low evidence

• Depo progesterones ↑PR before IVF

Ovarian cystectomy

no improvement of ART outcome

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwig0_-0uM_XAhUHGOwKHfmYDIkQjRwIBw&url=https://www.tasnimnews.com/fa/media/1394/02/22/737616/%D8%B3%DB%8C%D8%B2%D8%AF%D9%87%D9%85%DB%8C%D9%86-%D9%86%D9%85%D8%A7%DB%8C%D8%B4%DA%AF%D8%A7%D9%87-%D8%A8%DB%8C%D9%86-%D8%A7%D9%84%D9%85%D9%84%D9%84%DB%8C-%DA%AF%D9%84-%D9%88-%DA%AF%DB%8C%D8%A7%D9%87-%D8%AA%D9%87%D8%B1%D8%A7%D9%86&psig=AOvVaw2mONE05X7VuHO1xv62z8qP&ust=1511345818606449