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Over the past few years, a new topic in the field of endometriosis has emerged: the potential impact of the disease on pregnancy outcomes. This review aims to summarize in detail the available evidence on the relationship between endometriosis, particularly deep endometriosis (DE), and obstetrical outcomes. Acute complications of DE, such as spontaneous hemoperitoneum, bowel perforation, and uterine rupture, may occur during pregnancy. Although these events represent life-threatening conditions, they are rare and unpredictable. Therefore, the current literature does not support any kind of prophylactic surgery before pregnancy to prevent such complications. Results on the impact of DE on obstetrical outcomes are debatable and characterized by several limitations, including small sample size, lack of adjustment for confounders, lack of adequate control subjects, and other methodologic flaws. For these reasons, it is not possible to draw conclusions on this topic. The strongest evidence shows that DE is associated with higher rates of placenta previa; for other obstetrical outcomes, such as miscarriage, intrauterine growth restriction, preterm birth and hypertensive disorders, results are controversial. Although it is unlikely that surgery of DE may modify the impact of the disease on the course of pregnancy, no study has yet investigated this issue., (Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To report the first successful refreezing of ovarian tissue recovered more than 3 years after transplantation in a woman previously treated for early-stage ovarian cancer., Design: Evaluation of cryopreserved and grafted ovarian tissue., Setting: University hospital., Patient(s): A 23-year-old woman diagnosed with stage 1C ovarian mucinous cystadenocarcinoma., Intervention(s): The patient underwent ovarian tissue cryopreservation for fertility preservation and subsequent heterotopic transplantation for fertility restoration 9 years after freezing. After a successful IVF twin pregnancy, grafted tissue was laparoscopically removed for safety reasons. The recovered tissue was refrozen., Main Outcome Measure(s): Live birth and histologic evaluation of the distribution of pre-antral follicle stages., Result(s): The previously grafted ovarian tissue was successfully refrozen, presenting follicular survival 4 weeks after xenografting. The follicular distribution in the recovered grafts showed a shift toward growing-stage follicles compared with the fresh tissue. The patient subsequently entered menopause, and histologic evaluation revealed a total of five follicles in two remaining grafts which had supported ovarian function a few months earlier., Conclusion(s): This is the second case of delivery following heterotopic grafting as well as the second case of successful transplantation of ovarian tissue from a patient with early-stage ovarian cancer. The recovered grafts showed that a lower number of functional follicles than previously estimated can actually support ovarian function. Removing and refreezing grafted tissue could be a new way of handling not only cancer patients with a risk of malignant cell recurrence, but also certain groups of patients with genetic conditions., (Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To study the impact of first-line antineoplastic treatment on ovarian reserve in young girls returning for ovarian tissue cryopreservation (OTC) in connection with a relapse., Design: Retrospective case-control study., Setting: University hospitals., Patient(s): Sixty-three girls under the age of 18 years who underwent OTC before (group 1: 31 patients) and after (group 2: 32 patients) their initial cancer treatment., Intervention(s): None., Main Outcome Measure(s): Follicular densities (follicles/mm 3 ) measured from an ovarian cortical biopsy before OTC. The ovarian volume (mL) of entire ovaries excised for OTC was also monitored., Result(s): There was no statistically significant difference in the mean age or follicular density between groups 1 and 2 (334 ± 476/mm 3 vs. 327 ± 756/mm 3 ). In contrast, the ovarian volume and total number of ovarian cortex chips cryopreserved were statistically significantly lower in patients who received gonadotoxic treatment before OTC (mean ± standard deviation [SD]: ovarian volume, 5.3 ± 3.1 mL vs. 2.9 ± 2.1 mL, respectively; number of cortex chips: 21.3 ± 8.1 vs. 15.2 ± 7.1, respectively). The reduction in the estimated ovarian reserve ranged from 10% to 20% in children to around 30% in adolescent girls (>10 years)., Conclusion(s): Girls under the age of 10 tolerate a gonadotoxic insult better than adolescents, who may experience up to a 30% reduction in the ovarian reserve via first-line gonadotoxic treatment, which at present is considered to have little effect on the follicle pool. This information will improve counseling of young female cancer patients in deciding whether to undergo fertility preservation treatment., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)