Endometriosis

BACKGROUND: Women with endometriosis may also have associated disorders related to autoimmune dysregulation or pain. This study examined whether the prevalence of autoimmune, chronic pain and fatigue and atopic disorders is higher in women with endometriosis than in the general female population. METHODS AND RESULTS: A cross-sectional survey was conducted in 1998 by the Endometriosis Association of 3680 USA members with surgically diagnosed endometriosis. Almost all responders had pain (99%), and many reported infertility (41%). Compared with published rates in the general USA female population, women with endometriosis had higher rates of hypothyroidism (9.6 versus 1.5%, P < 0.0001), fibromyalgia (5.9 versus 3.4%, P < 0.0001), chronic fatigue syndrome (4.6 versus 0.03%, P < 0.0001), rheumatoid arthritis (1.8 versus 1.2%, P 0.001), systemic lupus

High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis

https://www.fertstert.org/article/S0015-0282(00)00519-7/pdf

Medical management of endometriosis and infertility.

A wealth of publications proposes that endometriosis and inflammation may have an unfavorable influence on fertility. A recent meta-analysis of assisted reproductive technologies demonstrated that, once confounding factors are controlled for, the pregnancy rate in women with endometriosis is approximately 50% of the rate of women with tubal factor infertility. Peritoneal fluid of women with endometriosis contains elevated amounts of macrophages and their secreted products, such as growth factors, cytokines, and angiogenic factors. Because reproductive organs are bathed in and thus will be influenced by peritoneal fluid, these proinflammatory mediators would affect various aspects of reproduction in women with endometriosis. Advanced stages of endometriosis may have easily understandable factors, such as distortion of the anatomy, causing infertility. On the other hand, in minimal or mild endometriosis mechanisms underlying reproductive failure are subtle and remain controversial. Recent reports suggest that inflammatory factors play a role in this endometriosis-associated reproductive failure. This review provides an overview of recent data on the effects of endometriosis-associated inflammation on fertility.

Endometriosis and Inflammation in Infertility

The role of the endometrium is to establish and maintain pregnancy. Endometrial receptivity is established during the mid-secretory phase, between cycle day (CD) 20 to 24, or 6 to 10 days after ovulation. In some cases of infertility or recurrent pregnancy loss, implantation failure is due to a lack of expression of specific critical participating proteins such as cell adhesion molecules. Numerous cell adhesion molecules (including integrins, selectins, and cadherins) are expressed by the endometrium and appear to be necessary for the successful interaction of the embryo with the endometrium. One of the best-characterized cell adhesion molecules are the integrins. Integrins are transmembrane glycoproteins that belong to a large family comprising alpha and beta subunits, and are present on virtually all cells in the body. Women with various benign gynecologic disorders, including endometriosis, polycystic ovarian syndrome, hydrosalpinges, and luteal phase defect, appear to exhibit decreased uterine receptivity and abnormal expression of endometrial biomarkers. This review addresses proposed mechanisms of implantation and endocrine and paracrine signals responsible for the establishment of endometrial receptivity as well has the possible mechanisms of dysfunction in certain types of infertility in women with benign gynecologic disease.

Uterine receptivity: alterations associated with benign gynecological disease.

Minimal/mild endometriosis and infertility. A review.

SUMMARY
objective To determine whether abnormalities of pltuitary–ovarian function are associated with minor degrees of endometriosls in women with Otherwise unexplained infertility

design Comparison of pituitary–ovarian function in a group of 22 patients with that in a control group of 10 healthy fertile women

patients Twenty-two women with minimal or miid endometrlosls and otherwise Unexplained infertility

measurements Ovarian ultrasound and radloimmunoassay of pituitary and ovarian hormones

results Abnormalities, including lutelnizatlon of unruptured follicles, broad LH surges and low concentrations of progesterone during the luteal phase, were demonstrated in 82% of study cycles

conclusion Pituitary-ovarian dysfunction appears to be associated with minimal or mild endometriosis in women with otherwise unexplained infertility but the diversity of endocrine abnormalities demonstrated suggests that endometriosis is unlikely to be an aetlologlcal factor in their development

Pituitary-ovarian function in women with minimal or mild endometriosis and otherwise unexplained infertility.

https://www.bmj.com/content/bmj/295/6590/119.4.full.pdf

Successful treatment of asymptomatic endometriosis: does it benefit infertile women?

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Papers

Minimal/mild endometriosis and infertility. A review.

Pituitary-ovarian function in women with minimal or mild endometriosis and otherwise unexplained infertility.

Successful treatment of asymptomatic endometriosis: does it benefit infertile women?