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Objectives: Patients with RA have a higher prevalence of infertility than the general population. This study sought to examine the impact of RA disease activity and treatments on ovarian reserve measured by serum anti-Müllerian hormone (AMH) levels in the ESPOIR cohort. We sought to better define the indications for fertility preservation., Methods: Patients and serum analysis data were derived from the French national cohort ESPOIR. Enrolled patients (n = 102; 18-37-year-olds) fulfilled ACR/EULAR 2010 criteria for RA. Serum AMH levels were measured at T0, T6, T12, T24 and T36 months post-diagnosis. The impacts of RA activity (DAS28 and CRP level) and treatments (MTX only or with other medications) were evaluated at each study visit., Results: A gradual decrease in patients' serum AMH levels was observed over time, in line with the descending curve described for healthy women. Serum AMH levels of RA patients in comparison with the values considered normal for age did not reveal any significant differences (P > 0.05). We did not observe any impact of RA treatments. We demonstrated an inverse correlation between AMH variation and disease activity (DAS28: r = -0.27, P = 0.003; CRP: r = -0.16, P = 0.06)., Conclusion: This is the first study to determine serum AMH levels of a large cohort of RA patients over 36 months. Rapid disease activity control appears to be required to limit changes in the ovarian reserve. Fertility preservation is not likely to be necessary if inflammation is promptly controlled., Clinicaltrials.gov Identifier: NCT03666091., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Ovarian endometrioma is very common. Ovarian endometrioma induces ovarian damages. Laparoscopic surgery is the gold standard to treat it. However surgical treatment may be difficult. A laparoscopic microsurgical technique is required to perform a cystectomy. This procedure may be impossible, even in expert hands. In such cases, the cystectomy should be abandoned and the cyst may be treated using an ablation technique. Ovarian preservation should be considered before the surgical treatment of ovarian endometrioma. Expectant management, long term medical treatment and sclerotherapy have been proposed as alternative treatments. Actually, they are often indicated because of fears and or of beliefs of the physician. Obviously, the management should be decided accounting for the clinical symptoms of the patients. But even when following this basic rule, several alternatives may often be proposed. Patients are neither not looking for questions nor for answers based on unsolved questions. Surgery is the current standard in the treatment of ovarian endometrioma. All the proposed alternatives should be compared to it in large and well-designed studies. These evaluations, which will take years, are mandatory and unavoidable to improve the immediate and long-term management of our patients! [ABSTRACT FROM AUTHOR]

International guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP. All women should be informed about the benefit/risk balance of oocyte vitrification—in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalized counseling for FP. [ABSTRACT FROM AUTHOR]