Sigmoid endometriosis and ovarian stimulation

In-vitro fertilization (IVF) and ovarian stimulation are frequently perform ed in patients with endometriosis, Although endometriosis is a hormone-depe ndent disease, the rate of NF complications related to endometriosis is low . We report four cases of severe digestive complications due to the rapid g rowth of sigmoid endometriosis under ovarian stimulation. In three patients , sigmoid endometriosis was diagnosed at laparoscopy for sterility. Because of the absence of digestive symptoms or repercussion on the bowel, no bowe l resection was performed before ovarian stimulation. All patients experien ced severe digestive symptoms during ovarian stimulation, and a segmental s igmoid resection had to be performed. Analysis of endoscopic and radiologic al data demonstrated that bowel lesions of small size may rapidly enlarge a nd become highly symptomatic under ovarian stimulation. At immunohistochemi stry, these infiltrating lesions displayed high populations of steroid rece ptors and a high proliferative index (Ki-67 activity), suggesting a strong dependence on circulating ovarian hormones and a potential for rapid growth under supraphysiological oestrogen concentrations. Clinicians should be aw are of this rare but severe digestive complication of ovarian stimulation. The early diagnosis of such lesions may help the patients to avoid months o f morbidity falsely attributed to ovarian stimulation side effects. Further experience is necessary to determine the optimal attitude when diagnosing a small and asymptomatic endometriotic bowel lesion before ovarian stimulat ion.