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Horizons in Endometriosis: Proceedings of the Montreux Reproductive Summit, 14-15 July 2023

A. Vallée1*, E. Saridogan2*, F. Petraglia3, J. Keckstein4, N. Polyzos5, C. Wyns6, L. Gianaroli7, B. Tarlatzis8, J. M. Ayoubi9, A. Feki10

On behalf of the Montreux Reproductive Summit Working Group (alphabetic order).
* Equal contribution, Joint first authors.

1 Department of Epidemiology and Public Health, Foch Hospital, 92150 Suresnes, France
2 University College London, Elizabeth Garrett Anderson Institute for Women’s Health, London, United Kingdom. University College London Hospital, Women’s Health Division, London, United Kingdom
3 Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
4 (SEF), Stiftung Endometrioseforschung, Westerstede, Germany. Gynecological Clinic, Gynecological Clinic Drs Keckstein, Villach, Austria. Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany
5 Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain. Faculty of Medicine and Health Sciences, Ghent University (UZ Gent), Gent, Belgium
6 Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
7 SISMER, Reproductive Medicine Unit, Via Mazzini 12, 40138 Bologna, Italy
8 Professor Emeritus of Obstetrics – Gynecology and Human Reproduction, School of Medicine, Aristotle University of Thessaloniki, Greece
9 Department of Obstetrics, Gynaecology and Reproductive Medicine, Foch Hospital, Suresnes, France. Medical School, University of Versailles, Saint-Quentin-en-Yvelines (UVSQ), Versailles, France
10 Department of Obstetrics and Gynecology, HFR—Fribourg, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland. Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.

Montreux Reproductive Summit Working Group (alphabetic order)

B. Ata11, M. Brännström12, C. Calhaz-Jorge13, H. B. Carvalho Ferreira14, R. Campo15, R. L. De Wilde16, M. Fehr Peter17, A. Fruscalzo10, G. Grimbizis18, B. Guani10, T. Gurgan19, N. Lambalk20, I. Lebbi21, P. Levi Setti22, A. Makrigiannakis23, C. Marti10, G. Moawad24, T. Motrenko Simic25, M. Mueller26, M. Nisolle27, N. Pluchino28, C. Racowsky29, C. Simon30, E. Somigliana31, V. Tanos32, K. Terras33, C. Tomassetti34, D. Wunder10.

11 ART Fertility Clinics, Dubai, United Arab Emirates. Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
12 Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
13 Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
14 Gynecology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal
15 Life Expert Centre, Schipvaartstraat 4, 3000 Leuven, Belgium
16 University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, Germany
17 Frauenklinik, Kantonsspital Graubünden, Chur, Switzerland
18 1st Department of Obstetrics & Gynecology, “Papageorgiou” Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece
19 Bahcesehir University, Faculty of Medicine, Department of Obstetrics and Gynecology Istanbul, Turkey
20 Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
21 Ob-Gyn and Fertility Private Clinic, Dream Center, Tunis, Tunisia
22 Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
23 Department of Obstetrics and Gynecology, University of Crete Medical School, Heraklion, Greece
24 Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20037, USA. The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA
25 Human Reproduction Center Budva, Budva, Montenegro
26 Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
27 Department of Obstetrics and Gynecology, Hospital the Citadelle, University of Liege, 4000 Liege, Belgium
28 Division of Gynaecology, Lausanne University Hospitals and the Faculty of Medicine of Lausanne, Lausanne, Switzerland
29 Department of Obstetrics, Gynecology, and Reproductive Medicine Hospital Foch Suresnes, France
30 Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain
31 Infertility Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
32 Aretaeio Hospital and St Georges Medical School, Nicosia University, Nicosia, Cyprus
33 IVF Center of the Hannibal International Clinic, Tunis, Tunisia
34 Department of Obstetrics and Gynaecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium

Keywords:

Endometriosis, prevention, biomarkers, classification, fertility, menopause, artificial intelligence, diagnosis, treatment


Published online: Apr 11 2024

https://doi.org/10.52054/FVVO.16.s1.011

Abstract

Endometriosis is a complex and chronic gynaecological disorder that affects millions of women worldwide, leading to significant morbidity and impacting reproductive health. This condition affects up to 10% of women of reproductive age and is characterised by the presence of endometrial-like tissue outside the uterus, potentially leading to symptoms such as chronic pelvic pain, dysmenorrhoea, dyspareunia, and infertility. The Montreux summit brought a number of experts in this field together to provide a platform for discussion and exchange of ideas. These proceedings summarise the six main topics that were discussed at this summit to shed light on future directions of endometriosis classification, diagnosis, and therapeutical management. The first question addressed the possibility of preventing endometriosis in the future by identifying risk factors, genetic predispositions, and further understanding of the pathophysiology of the condition to develop targeted interventions. The clinical presentation of endometriosis is varied, and the correlation between symptoms severity and disease extent is unclear. While there is currently no universally accepted optimal classification system for endometriosis, several attempts striving towards its optimisation - each with its own advantages and limitations - were discussed. The ideal classification should be able to reconcile disease status based on the various diagnostic tools, and prognosis to guide proper patient tailored management. Regarding diagnosis, we focused on future tools and critically discussed emerging approaches aimed at reducing diagnostic delay. Preserving fertility in endometriosis patients was another debatable aspect of management that was reviewed. Moreover, besides current treatment modalities, potential novel medical therapies that can target underlying mechanisms, provide effective symptom relief, and minimise side effects in endometriotic patients were considered, including hormonal therapies, immunomodulation, and regenerative medicine. Finally, the question of hormonal substitution therapy after radical treatment for endometriosis was debated, weighing the benefits of hormone replacement.