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Farland LV, Valenti M, Degnan WJ, Bertone-Johnson ER, Harris HR, DiVasta AD, Rexrode KM, Eliassen AH, Missmer SA. Laparoscopically confirmed endometriosis and anti-Müllerian hormone levels: Findings from the Nurses' Health Study II. Maturitas 2024; 183:107969. [PMID: 38489917 PMCID: PMC11186619 DOI: 10.1016/j.maturitas.2024.107969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Anti-Müllerian hormone is a reliable measure of ovarian reserve associated with menopause timing and fertility. Previous studies have observed that individuals with endometriosis have lower anti-Müllerian hormone levels than those without. However, sample sizes have been small and information is limited regarding the long-term influence of endometriosis on anti-Müllerian hormone levels among the general population, which may have important implications for menopause timing and chronic disease risk. METHODS Among 1961 premenopausal women in the Nurses' Health Study II who provided a blood sample and had not been pregnant in the last 6 months, we used generalized linear models to determine the association between laparoscopically-confirmed endometriosis and log-transformed plasma anti-Müllerian hormone level, adjusted for age (continuous and squared) and other potential confounding variables. RESULTS Participants were on average 40 years old (interquartile range 37-42 years) at blood draw. Women with endometriosis diagnosed prior to blood draw (n = 119) had a lower mean anti-Müllerian hormone level (1.6 ng/mL [SD = 2.3]) than women without known endometriosis (n = 1842) (2.8 ng/mL [SD = 3.0]). In multivariable adjusted models, women with endometriosis had 29.6 % lower anti-Müllerian hormone levels (95 % CI: -45.4, -9.2 %) than women without. This association was greater among women with a body mass index of 25 kg/m2 or more (percent difference: -44.0 % (-63.7, -13.8)), compared to those with a body mass index of under 25 kg/m2 (percent difference: -19.8 % (-41.7, 10.4)), but did not vary by parity or infertility history. CONCLUSIONS Lower anti-Müllerian hormone levels in women with endometriosis may be one mechanism through which endometriosis influences risk of infertility, younger age at menopause, and cardiovascular disease.
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, Department of Obstetrics and Gynecology, College of Medicine -Tucson, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85724, USA.
| | - Michelle Valenti
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85724, USA.
| | - William J Degnan
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85724, USA.
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, Department of Health Promotion and Policy, University of Massachusetts Amherst, 301 Arnold House, 715 North Pleasant Street, Amherst, MA 01003, USA.
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave North, Seattle, WA, 98109, USA.
| | - Amy D DiVasta
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital, Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, 181 Longwood Ave, Boston, MA, 02115, USA.
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, 15 Michigan St. NE, Grand Rapids, MI, 49503, USA.
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Burghaus S, Hildebrandt T, Fahlbusch C, Heusinger K, Antoniadis S, Lermann J, Hackl J, Häberle L, Renner SP, Fasching PA, Beckmann MW, Blum S. Standards Used by a Clinical and Scientific Endometriosis Center for the Diagnosis and Therapy of Patients with Endometriosis. Geburtshilfe Frauenheilkd 2019; 79:487-497. [PMID: 31148849 PMCID: PMC6529229 DOI: 10.1055/a-0813-4411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/30/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022] Open
Abstract
Endometriosis is one of the most common benign gynecological diseases. The extremely heterogeneous complex of symptoms complicates the diagnosis and treatment of this disease. In most patients, there is a latency period of several years between the first occurrence of symptoms and the definitive diagnosis. This paper aims (1) to evaluate standards for the diagnosis and treatment of patients with (symptoms suspicious for) endometriosis in terms of feasibility, and (2) to assess the potential use of data collected by a certified clinical and scientific endometriosis center to answer scientific questions. Standards for outpatient consultations were developed for a special endometriosis outpatient clinic. Between January 2014 and December 2017, a total of 1715 outpatients with a suspicion of endometriosis presented to this special endometriosis outpatient clinic; the diagnosis and treatment of patients was carried out in accordance with the developed standards. Data of this patient cohort obtained from patient records created during outpatient consultations and from a questionnaire recorded in an Oracle-based database was analyzed. The patient cohort was also compared with another patient cohort who had attended different outpatient clinics and had been diagnosed intraoperatively with endometriosis. 41.8% of patients examined during special outpatient consultations had surgery for suspicion or recurrence of endometriosis. Endometriosis was confirmed in 81.5% of cases. Pain symptoms were the main indication for surgery in 70.1% of cases compared to 45.1% of cases in the comparison group. The structured approach used in the special endometriosis outpatient clinic is a key aspect of the care provided by the certified clinical and scientific endometriosis center. It ensures that patients are diagnosed and treated in accordance with guideline recommendations, that diagnosis and treatment comply with certification requirements, and that the collected data can be used to answer scientific questions.
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Affiliation(s)
- Stefanie Burghaus
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Thomas Hildebrandt
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Christine Fahlbusch
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Katharina Heusinger
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Sophia Antoniadis
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Johannes Lermann
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Janina Hackl
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Lothar Häberle
- Abteilung für Biostatistik, Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan P Renner
- Frauenklinik, Klinikum Sindelfingen-Böblingen, Böblingen, Germany
| | - Peter A Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Simon Blum
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
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Izawa M, Taniguchi F, Harada T. GATA6 expression promoted by an active enhancer may become a molecular marker in endometriosis lesions. Am J Reprod Immunol 2019; 81:e13078. [PMID: 30589192 DOI: 10.1111/aji.13078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/12/2018] [Accepted: 12/12/2018] [Indexed: 01/03/2023] Open
Abstract
PROBLEM Genome-wide profiling of DNA methylation in endometriotic cells has shown a distinct facet of epigenetic backgrounds; however, specific DNA methylation sites responsible for aberrant gene expression in endometriosis were unknown. Are there specific endometriosis-associated DNA methylations that can be used as molecular markers in endometriosis lesions? METHOD OF STUDY This study used endometriotic tissues from the chocolate cyst lining of the ovaries of patients with endometriosis, and endometrial tissues from disease-free patients. For analysis, stromal cells were collected from endometrial and endometriotic tissues. Using endometrial cells as control, differentially methylated cytosine-phosphate-guanine (CpG) characteristic in endometriotic cells was extracted. Among these CpGs, we focused on a stretch of hypomethylated CpGs within GATA6 gene and examined the potential role as enhancer in endometriotic cells and tissues. RESULT(S) We identified a stretch of hypomethylated CpGs within the GATA6 gene body in endometriotic cells. Because GATA6 mRNA was highly expressed in endometriotic cells but not in endometrial cells, we then hypothesized that the hypomethylated sequence may function as an enhancer in GATA6 gene expression. Chromatin immunoprecipitation analysis predicted the presence of active enhancer within the gene body sequence in endometriotic cells. Immunohistochemistry showed a positive staining of GATA6 in ovarian chocolate cysts, while in endometrial tissues and in some peritoneal tissues with endometriosis, GATA6 staining was at a marginal level. CONCLUSION This is the first implication showing a link between an aberrant DNA methylation of cis element and gene expression in endometriosis. GATA6 expression may become a molecular marker to diagnose endometriosis lesions.
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Affiliation(s)
- Masao Izawa
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
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Ota Y, Andou M, Ota I. Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis. Asian J Endosc Surg 2018; 11:7-14. [PMID: 29444547 DOI: 10.1111/ases.12464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/10/2018] [Indexed: 01/11/2023]
Abstract
Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis. It causes chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, dyschezia, and dysuria, markedly impairing the quality of life of women of reproductive age. A number of randomized controlled trials on surgical and medical treatments to reduce the pain associated with endometriosis have been reported, but few have focused on this in DIE. DIE causes not only pain but also functional invasion to the urinary organs and bowel, such as hydronephrosis and bowel stenosis. In addition to DIE resection, surgical treatment involves adhesion separation as well as resection and reconstruction of the urinary organs and bowel; high-level skills are required. The severity of DIE should be evaluated preoperatively as accurately as possible. Using ENZIAN in conjunction with the AFS (The revised American Fertility Society classification of endometriosis) classification makes a more detailed assessment of DIE possible. The operative procedures used for laparoscopic resection of urinary DIE and reconstruction of the urinary organs are chosen based on the type of lesion (intrinsic/extrinsic) and length of stenosis. In addition to ureteroneocystostomy, the psoas bladder hitch and Boari bladder flap procedures are applied when necessary to extend the urinary tract. Bowel resection for bowel endometriosis is classified into classic segmental resection and conservative approaches (shaving/discoid). When these procedures are employed, it is advisable to work in consultation with urologists and gastroenterologists and to inform the patients of the associated risks and outcomes. Furthermore, postoperative medication is essential because it is difficult to conduct repeated surgeries.
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Affiliation(s)
| | | | - Ikuko Ota
- Kurashiki Heisei Hospital, Kurashiki, Japan
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Menstrual characteristics in Korean women with endometriosis: a pilot study. Obstet Gynecol Sci 2017; 61:142-146. [PMID: 29372161 PMCID: PMC5780310 DOI: 10.5468/ogs.2018.61.1.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/11/2017] [Accepted: 07/20/2017] [Indexed: 11/08/2022] Open
Abstract
Objective This study aimed to determine whether the menstrual characteristics are different in Korean women with or without ovarian endometrioma. Methods We selected 95 premenopausal women aged below 39 years who underwent laparoscopic surgery for ovarian endometrioma (n=46) or other benign ovarian tumors (n=49) between April 2016 and February 2017. We excluded those with uterine diseases that could potentially affect the menstrual characteristics and those on anticoagulants or hormonal medication. At admission, menstrual characteristics such as cycle length, cycle regularity, and menstrual duration, were collected. In addition, amount of menstrual bleeding and severity of dysmenorrhea were recorded using a pictorial blood loss assessment chart (PBAC) and visual analogue scale, respectively. Results Age and parity were similar in both women with ovarian endometrioma and women with other benign ovarian tumors. Body mass index (BMI) was significantly lower (median, 20.9 vs. 22.1 kg/m2; P=0.031) in women with ovarian endometrioma. The amount of menstrual bleeding (median PBAC score, 183 vs. 165), menstrual duration (median, 6 vs. 6 days), and cycle length in women with regular cycle (median, 29.0 vs. 29.2 days) were not different between the 2 groups. Pain score was significantly higher (median, 4 vs. 3; P=0.005) in women with ovarian endometrioma. Conclusion We found that the menstrual characteristics between women with ovarian endometrioma and women with other benign ovarian tumors were similar. We also observed that low BMI may be one of the risk factor for endometriosis.
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Rashidi BH, Amanlou M, Lak TB, Ghazizadeh M, Eslami B. A case-control study of bisphenol A and endometrioma among subgroup of Iranian women. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:7. [PMID: 28400829 PMCID: PMC5361444 DOI: 10.4103/1735-1995.199086] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/07/2016] [Accepted: 10/26/2016] [Indexed: 11/17/2022]
Abstract
Background: Endometriosis is a multifactorial hormonally related complex disease with unknown etiology. Epidemiologic data were suggested the possible effects of endocrine disrupting chemicals such as bisphenol A (BPA) on endometriosis. BPA is similar to endogenous estrogen and has the ability to interact with estrogen receptors and stimulate estrogen production. Our aim was to evaluate the relationship between urinary BPA concentrations in women with endometrioma. Materials and Methods: This case–control study consisted of fifty women who have been referred to gynecology and infertility center with endometrioma and were candidates for operative laparoscopy and ovarian cystectomy as cases. Fifty women who had not any evidence of endometrioma in clinical and ultrasound evaluation and came to the same clinic for routine check-up were selected as controls. One-time urine sample was collected after receiving informed consent before surgery and medical intervention. Total BPA in urine was measured with high-performance liquid chromatography method and detection limit was 0.33 ng/mL. Results: Percentage of urine samples containing BPA was 86% of cases and 82.4% of control. Urinary BPA showed a right-skewed distribution. The mean concentration of BPA was 5.53 ± 3.47 ng/mL and 1.43 ± 1.57 ng/mL in endometriosis and control group, respectively (P < 0.0001, Mann–Whitney U-test). The logistic regression showed that the odds ratio of the BPA was 1.74 (95% confidence interval: 1.40–2.16) after adjustment of age, parity, body mass index <30, and educational status. Conclusion: This study showed a positive association between urinary BPA concentrations and endometrioma. However, further large-scale studies are needed to confirm this hypothesis.
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Affiliation(s)
- Batool Hossein Rashidi
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Massoud Amanlou
- Department of Medicinal Chemistry, Faculty of Pharmacy, Drug Design and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahere Behrouzi Lak
- Department of Obstetrics and Gynecology, Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mahya Ghazizadeh
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Eslami
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Burks-Wicks C, Cohen M, Fallbacher J, Taylor RN, Wieser F. A Western Primer of Chinese Herbal Therapy in Endometriosis and Infertility. WOMENS HEALTH 2016; 1:447-63. [DOI: 10.2217/17455057.1.3.447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endometriosis is a disease that affects approximately 10% of all reproductive-aged women and the prevalence rises to 20–50% in infertile women. There is growing evidence that medicinal Chinese herbs with pain-alleviating and anti-inflammatory properties may be useful in the treatment of endometriosis and infertility, but the mechanisms of action of these herbs have yet to be investigated. In addition, studies of adequate design, sample size and appropriate control are lacking. Therefore, prospective randomized, controlled studies to evaluate the efficacy, mechanism of action and toxicities of Chinese herbs in the treatment endometriosis and infertility are needed.
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Affiliation(s)
- Carla Burks-Wicks
- Department of Obstetrics and Gynecology, University of California, 513 Parnassus Ave, San Francico, CA, USA,
| | - Misha Cohen
- Institute for Health & Aging, University of California, 513 Parnassus Ave, San Francisco, CA, USA, Tel.: +1 415 864 7234; Fax: +1 415 864 9653
| | - Josef Fallbacher
- ARGE-TCM, Albertgasse 33/1, A-1080, Vienna, Austria, Tel.: +43 1 409 2323; Fax: +43 1 406 0213
| | - Robert N Taylor
- Department of Gynecology and Obstetrics, Emory School of Medicine, WMB, 1639 Pierce Drive, Room 4217, Atlanta, Georgia 30322, USA, Tel.: +1 404 727 9106; Fax: +1 404 727 8609
| | - Fritz Wieser
- Division of Endocrinology & Reproductive Medicine, Dept. of Gynecology & Obstetrics, University of Vienna, Vienna, Austria,
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Omori S, Yoshida S, Kennedy SH, Negoro K, Hamana S, Barlow DH, Maruo T. Polymorphism at Codon 72 of the p53 Gene Is Not associated With Endometriosis in a Japanese Population. ACTA ACUST UNITED AC 2016; 11:232-6. [PMID: 15120697 DOI: 10.1016/j.jsgi.2003.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Endometriosis is inherited as a complex trait, which means that multiple susceptibility genes interact with each other and the environment to produce the phenotype. Previous studies have implicated p53, a tumor suppressor gene, as a factor in the development of the disease. In a Japanese population, we investigated the frequency of the p53 polymorphism in women affected with endometriosis. METHODS We compared the distribution of the p53 codon 72 polymorphism in endometriosis cases (n = 111) and population controls consisting of female neonates (n = 180) by using polymerase chain reaction restriction fragment-length polymorphism analysis in a Japanese population. RESULTS The frequencies of the three p53 genotypes, Arginine (Arg)/Arg, Arg/Proline (Pro), and Pro/Pro in controls were 39.4%, 41.7%, and 18.9 %, respectively. The crude genotype frequencies in the endometriosis cases were similar to those of the controls (35.2%, 48.6%, and 16.2%, respectively). Using the Arg/Arg genotype as the reference, the odds ratios of the Arg/Pro and Pro/Pro genotypes were 1.30 (95% confidence interval [CI] 0.72-1.86, P =.33) and 0.96 (95% CI 0.47-1.94, P =.91), respectively. Thus, there were no significant differences in the frequency of the p53 codon 72 polymorphism between endometriosis cases and controls in this population. The endometriosis cases with severe disease only were also evaluated, but no significant difference was observed in the frequency of the polymorphism between this subgroup and the controls. CONCLUSION Our findings suggest that the p53 codon 72 polymorphism is unlikely to be associated with endometriosis in Japanese women.
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Affiliation(s)
- Shinya Omori
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Japan
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Prescott J, Farland LV, Tobias DK, Gaskins AJ, Spiegelman D, Chavarro JE, Rich-Edwards JW, Barbieri RL, Missmer SA. A prospective cohort study of endometriosis and subsequent risk of infertility. Hum Reprod 2016; 31:1475-82. [PMID: 27141041 DOI: 10.1093/humrep/dew085] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/08/2016] [Indexed: 12/20/2022] Open
Abstract
STUDY QUESTION Is there a temporal relationship between endometriosis and infertility? SUMMARY ANSWER Endometriosis is associated with a higher risk of subsequent infertility, but only among women age <35 years. WHAT IS KNOWN ALREADY Endometriosis is the most commonly observed gynecologic pathology among infertile women undergoing laparoscopic examination. Whether endometriosis is a cause of infertility or an incidental discovery during the infertility examination is unknown. STUDY DESIGN, SIZE, DURATION This study included data collected from 58 427 married premenopausal female nurses <40 years of age from 1989 to 2005, who are participants of the Nurses' Health Study II prospective cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS Our exposure was laparoscopically confirmed endometriosis. Multivariate Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for infertility risk (defined as attempting to conceive for >12 months) among women with and without endometriosis. MAIN RESULTS AND THE ROLE OF CHANCE We identified 4612 incident cases of infertility due to any cause over 362 219 person-years of follow-up. Compared with women without a history of endometriosis, women with endometriosis had an age-adjusted 2-fold increased risk of incident infertility (HR = 2.12, 95% CI = 1.76-2.56) that attenuated slightly after accounting for parity. The relationship with endometriosis was only observed among women <35 years of age (multivariate HR <35 years = 1.77, 95% CI = 1.46-2.14; multivariate HR 35-39 years = 1.20, 95% CI = 0.94-1.53; P-interaction = 0.008). Risk of primary versus secondary infertility was similar subsequent to endometriosis diagnosis. Among women with primary infertility, 50% became parous after the endometriosis diagnosis, and among all women with endometriosis, 83% were parous by age 40 years. LIMITATIONS, REASONS FOR CAUTION We did not have information on participants' intentions to conceive, but by restricting the analytic population to married women we increased the likelihood that pregnancies were planned (and therefore infertility would be recognized). Women in our cohort with undiagnosed asymptomatic endometriosis will be misclassified as unexposed. However, the small proportion of these women are diluted among the >50 000 women accurately classified as endometriosis-free, minimizing the impact of exposure misclassification on the effect estimates. WIDER IMPLICATIONS OF THE FINDINGS This study supports a temporal association between endometriosis and infertility risk. Our prospective analysis indicates a possible detection bias in previous studies, with our findings suggesting that the infertility risk posed by endometriosis is about half the estimates observed in cross-sectional analyses. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Institutes of Health (grant numbers: UM1 CA176726, HD52473, HD57210, T32DK007703, T32HD060454, K01DK103720). We have no competing interests to declare.
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Affiliation(s)
- J Prescott
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - L V Farland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - D K Tobias
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - A J Gaskins
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - D Spiegelman
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - J E Chavarro
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - J W Rich-Edwards
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - R L Barbieri
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - S A Missmer
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Tokmak A, Yildirim G, Öztaş E, Akar S, Erkenekli K, Gülşen P, Yilmaz N, Uğur M. Use of Neutrophil-to-Lymphocyte Ratio Combined With CA-125 to Distinguish Endometriomas From Other Benign Ovarian Cysts. Reprod Sci 2015; 23:795-802. [DOI: 10.1177/1933719115620494] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Aytekin Tokmak
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Gulçin Yildirim
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Efser Öztaş
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Serra Akar
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Kudret Erkenekli
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Pınar Gülşen
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Nafiye Yilmaz
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Mustafa Uğur
- Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
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Cohen J, Ziyyat A, Naoura I, Chabbert-Buffet N, Aractingi S, Darai E, Lefevre B. Effect of induced peritoneal endometriosis on oocyte and embryo quality in a mouse model. J Assist Reprod Genet 2015; 32:263-70. [PMID: 25399065 PMCID: PMC4354196 DOI: 10.1007/s10815-014-0390-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/06/2014] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess the impact of peritoneal endometriosis on oocyte and embryo quality in a mouse model. METHODS Peritoneal endometriosis was surgically induced in 33 B6CBA/F1 female mice (endometriosis group, N = 17) and sham-operated were used as control (sham group, N = 16). Mice were superovulated 4 weeks after surgery and mated or not, to collect E0.5-embryos or MII-oocytes. Evaluation of oocyte and zygote quality was done by immunofluorescence under spinning disk confocal microscopy. RESULTS Endometriosis-like lesions were observed in all mice of endometriosis group. In both groups, a similar mean number of MII oocytes per mouse was observed in non-mated mice (30.2 vs 32.6), with a lower proportion of normal oocytes in the endometriosis group (61 vs 83 %, p < 0.0001). Abnormalities were incomplete extrusion or division of the first polar body and spindle abnormalities. The mean number of zygotes per mouse was lower in the endometriosis group (21 vs 35.5, p = 0.02) without difference in embryo quality. CONCLUSIONS Our results support that induced peritoneal endometriosis in a mouse model is associated with a decrease in oocyte quality and embryo number. This experimental model allows further studies to understand mechanisms of endometriosis-associated infertility.
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Affiliation(s)
- J Cohen
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, GRC 6-UPMC Centre Expert en Endométriose (C3E), Paris, France,
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12
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Place de la robotique dans l’endométriose pelvienne profonde : à propos du registre de la SERGS. ACTA ACUST UNITED AC 2014; 42:744-8. [DOI: 10.1016/j.gyobfe.2014.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/09/2014] [Indexed: 11/17/2022]
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13
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Collinet P, Leguevaque P, Neme RM, Cela V, Barton-Smith P, Hébert T, Hanssens S, Nishi H, Nisolle M. Robot-assisted laparoscopy for deep infiltrating endometriosis: international multicentric retrospective study. Surg Endosc 2014; 28:2474-9. [DOI: 10.1007/s00464-014-3480-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 02/03/2014] [Indexed: 12/21/2022]
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14
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Moini A, Malekzadeh F, Amirchaghmaghi E, Kashfi F, Akhoond MR, Saei M, Mirbolok MH. Risk factors associated with endometriosis among infertile Iranian women. Arch Med Sci 2013; 9:506-14. [PMID: 23847674 PMCID: PMC3701984 DOI: 10.5114/aoms.2013.35420] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 10/23/2012] [Accepted: 11/10/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endometriosis is defined as overgrowth of endometrial tissue outside the uterine cavity. Endometriosis may be asymptomatic or associated with dysmenorrheal symptoms, dyspareunia, pelvic pain, abnormal uterine bleeding and infertility. The aim of this study was to explore the risk factors related to endometriosis among infertile Iranian women. MATERIAL AND METHODS In this case control study, infertile women referred for laparoscopy and infertility workup to two referral infertility clinics in Tehran, Iran were studied. According to the laparoscopy findings, women were divided into case (women who had pelvic endometriosis) and control (women with normal pelvis) groups. The case group was divided into two subgroups: stage I and II of endometriosis were considered as mild while stage III and IV were categorized as severe endometriosis. A questionnaire was completed for each patient. RESULTS Logistic regression showed that age, duration of infertility, body mass index (BMI), duration of menstrual cycle, abortion history, dyspareunia, pelvic pain and family history of endometriosis are independent predictive factors for any type of endometriosis. In addition, it was shown that education, duration of infertility, BMI, amount and duration of menstrual bleeding, menstrual pattern, dyspareunia, pelvic pain and family history of endometriosis are independent predictive factors of severe endometriosis. The AUCs for these models were 0.781 (0.735-0.827) and 0.855 (0.810-0.901) for any type of endometriosis and severe endometriosis, respectively. CONCLUSIONS It seems that any type of endometriosis and severe ones could be predicted according to demographic, menstrual and reproductive characteristics of infertile women.
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Affiliation(s)
- Ashraf Moini
- Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Gynecology and Obstetrics, Roointan Arash Women's Health Research and Educational Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Malekzadeh
- Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Epidemiology and Reproductive Health at Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Elham Amirchaghmaghi
- Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Immunology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Kashfi
- Department of Epidemiology and Reproductive Health at Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Reza Akhoond
- Statistics Department, Mathematical Science and Computer Faculty, Shahid Charan University, Ahwaz, Iran
| | - Maryam Saei
- Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Sohler F, Sommer A, Wachter DL, Agaimy A, Fischer OM, Renner SP, Burghaus S, Fasching PA, Beckmann MW, Fuhrmann U, Strick R, Strissel PL. Tissue remodeling and nonendometrium-like menstrual cycling are hallmarks of peritoneal endometriosis lesions. Reprod Sci 2012; 20:85-102. [PMID: 22878529 DOI: 10.1177/1933719112451147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We identified differentially expressed genes comparing peritoneal endometriosis lesions (n = 18), eutopic endometrium (n = 17), and peritoneum (n = 22) from the same patients with complete menstrual cycles using microarrays (54 675 probe sets) and immunohistochemistry. Peritoneal lesions and peritoneum demonstrated 3901 and 4973 significantly differentially expressed genes compared to eutopic endometrium, respectively. Peritoneal lesions significantly revealed no correlation with a specific menstrual cycle phase by gene expression and histopathology, exhibited low expressed proliferation genes, and constant levels of steroid hormone receptor genes. Tissue remodeling genes in cytoskeleton, smooth muscle contraction, cellular adhesion, tight junctions, and O-glycan biosynthesis were the most significant to lesions, including desmin and smooth muscle myosin heavy chain 11. Protein expression and location of desmin, alpha-actin, and h-caldesmon in peritoneal lesions discriminated between smooth muscle hyperplasia and metaplasia. Peritoneal lesions demonstrate no menstrual cycle phasing but constant steroid hormone receptor expression where a slow but steady growth is linked with tissue remodeling. Our study contributes to the molecular pathology of peritoneal endometriosis and will help to identify clinical targets for treatment and management.
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Affiliation(s)
- Florian Sohler
- Global Drug Discovery, Target Discovery, Bayer Healthcare Pharmaceuticals, Berlin, Germany
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Burghaus S, Klingsiek P, Fasching PA, Engel A, Häberle L, Strissel PL, Schmidt M, Jonas K, Strehl JD, Hartmann A, Lermann J, Boosz A, Thiel FC, Müller A, Beckmann MW, Renner SP. Risk Factors for Endometriosis in a German Case-Control Study. Geburtshilfe Frauenheilkd 2011; 71:1073-1079. [PMID: 25253901 DOI: 10.1055/s-0031-1280436] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 11/07/2011] [Accepted: 11/07/2011] [Indexed: 12/31/2022] Open
Abstract
Objective: The etiology of endometriosis is still a research field in which few consistent data are available. Large case-control studies or even cohort studies are rare, and most of the published data are conflicting. The aim of the present study was therefore to examine common epidemiological and endometriosis-specific risk factors in a German case-control study. Design: From 2001 to 2010, a pool of 595 laparoscopically confirmed cases and 475 controls were recruited in a hospital-based setting. After matching for age, 298 cases and 300 controls remained in the pool. Age at menarche, menstrual cycle length, duration of menstrual bleeding, number of pregnancies, live births, miscarriages, use of contraceptive pills, body mass index (BMI), and smoking status were analyzed with logistic regression models predicting endometriosis case-control status. Results: Menstrual cycle length, duration of menstrual bleeding, number of pregnancies, number of miscarriages, and smoking status, as relevant predictors for endometriosis case-control status, were identified as risk factors for endometriosis. Other factors such as age at menarche, number of live births, ever having used contraceptive pills, and BMI were not predictive. Conclusions: This hospital-based case-control study reproduced most of the familiar risk factors. Comparison of this study with others reveals a wide variety of effect sizes and directions of association with risk factors and may increase the information available about the characteristics of the patient population being treated in the relevant hospital setting.
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Affiliation(s)
- S Burghaus
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - P Klingsiek
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - P A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - A Engel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - L Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - P L Strissel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - M Schmidt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - K Jonas
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - J D Strehl
- Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - A Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - J Lermann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - A Boosz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - F C Thiel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - A Müller
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - M W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - S P Renner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
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Rachlin K, Hansbury G, Pardo ST. Hysterectomy and Oophorectomy Experiences of Female-to-Male Transgender Individuals. Int J Transgend 2010. [DOI: 10.1080/15532739.2010.514220] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Correlation of high-risk human papilloma viruses but not of herpes viruses or Chlamydia trachomatis with endometriosis lesions. Fertil Steril 2010; 93:1778-86. [DOI: 10.1016/j.fertnstert.2008.12.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 11/24/2008] [Accepted: 12/16/2008] [Indexed: 11/20/2022]
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Cinar O, Seval Y, Uz YH, Cakmak H, Ulukus M, Kayisli UA, Arici A. Differential regulation of Akt phosphorylation in endometriosis. Reprod Biomed Online 2010; 19:864-71. [PMID: 20031030 DOI: 10.1016/j.rbmo.2009.10.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Protein kinase B (PKB/Akt), a serine/threonine kinase, regulates the function of many cellular proteins involved in apoptosis and proliferation. It was postulated that there is a higher Akt activity in endometriosis compared with normal endometrium, and that oestrogen may be one of the factors responsible for the high Akt activation in endometriotic cells. Phospho-Akt (pAkt) concentrations in normal, eutopic and ectopic endometrial tissues were compared by immunohistochemistry, and a higher pAkt immunoreactivity was revealed in eutopic and ectopic endometrium compared with normal endometrium, in vivo. Higher Akt phosphorylation in stromal cells from eutopic endometrium was observed, when compared with normal, in vitro (P < 0.05). Akt phosphorylation was rapidly (2-10 min) stimulated when endometrial stromal cells from normal and endometriosis patients were treated with 17 beta-oestradiol. In endometrial stromal cells from the endometriosis group, ICI 182,780 (ICI, a specific oestrogen receptor antagonist) failed to antagonize the effect of oestradiol when combined with oestradiol, and revealed a stimulatory effect on Akt phosphorylation when given alone (P < 0.05). In conclusion, since Akt affects cell survival, it is suggested that increased Akt phosphorylation may be related to the altered apoptosis/proliferation harmony in endometriosis, and therefore Akt may play a critical role in the pathogenesis of endometriosis.
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Affiliation(s)
- Ozgur Cinar
- Centre for Assisted Reproductive Medicine and IVF, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara 06010, Turkey
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Fertility and clinical outcome after bowel resection in infertile women with endometriosis. Reprod Biomed Online 2010; 20:602-9. [PMID: 20359953 DOI: 10.1016/j.rbmo.2009.12.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 07/27/2009] [Accepted: 12/03/2009] [Indexed: 11/20/2022]
Abstract
Bowel resection for endometriosis improves pain symptoms and quality of life in symptomatic women. However, little is known about fertility after surgery, particularly after such treatment in women suffering from infertility. The aim of the present study was to evaluate post-operative fertility and long-term clinical outcome after laparoscopic colorectal resection for endometriosis in infertile women. This study reports clinical outcomes in 62 infertile women who underwent laparoscopic excision of endometriosis with segmental bowel resection performed for severe intestinal symptoms. Among women younger than 30 years trying to conceive spontaneously, the cumulative pregnancy rate was 58% and the cumulative pregnancy rate was 45% in those aged 30-34 years. The total pain recurrence was 9.7% (six cases) and endometriosis recurrence was diagnosed by ultrasound in 14.5% (nine cases) during the follow-up period. Four of these patients needed further surgery because of severe symptoms. The surgical treatment of bowel endometriosis seems to improve pain symptoms and patients' satisfaction rates, and it could also be indicated in infertile women.
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21
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Vaginal micronized progesterone versus intramuscular progesterone for luteal support in women undergoing in vitro fertilization–embryo transfer. Fertil Steril 2010; 93:554-69. [DOI: 10.1016/j.fertnstert.2009.02.047] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 01/24/2009] [Accepted: 02/14/2009] [Indexed: 11/23/2022]
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Calcagno M, Bellati F, Pastore M, Plotti F, Palaia I, Panici PB. Patient's fertility desire should be taken into consideration in the surgical treatment algorithm of infiltrating endometriosis. Fertil Steril 2009; 93:e3-4; author reply e5. [PMID: 20004391 DOI: 10.1016/j.fertnstert.2009.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 10/30/2009] [Indexed: 11/16/2022]
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23
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Renner SP, Ekici AB, Maihöfner C, Oppelt P, Thiel FC, Schrauder M, Uenluehan N, Bani MR, Strissel PL, Strick R, Beckmann MW, Fasching PA. Neurokinin 1 receptor gene polymorphism might be correlated with recurrence rates in endometriosis. Gynecol Endocrinol 2009; 25:726-33. [PMID: 19903051 DOI: 10.3109/09513590903159631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Dysmenorrhoea is the major symptom in women with endometriosis. Recently, pain modulation through Neurokinin-1-receptor (NK1R) pathways have been investigated in neuropathic pain patients. Aim of this study was, therefore, to examine the effect of a single nucleotide polymorphism (SNP) of the NK1R gene on the susceptibility for endometriosis and the disease free survival (DFS) after surgery for endometriosis. MATERIAL AND METHODS A case-control study was conducted and germline DNA was isolated. Patients were followed up for a recurrence of the disease up to 4 years. Case-control analyses were performed for parameters of the medical history and the genotype of the NK1R-SNP rs881. Furthermore, DFS probabilities were calculated. RESULTS Concerning the DFS preoperative pain levels and the NK1R genotype were independent predictors for a recurrence with hazard ratios of 2.55 (95% CI: 1.32-4.95) for patients with a high preoperative pain level and 0.44 for patients with a heterozygous or homozygous variant genotype in rs881 (95% CI: 0.21-0.88). CONCLUSION The polymorphism rs811 seems to be associated with a lower recurrence risk in endometriosis patients. Thus, there might be a clinical relevant role of the NK1 pathway in the pain perception of endometriosis patients.
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Affiliation(s)
- Stefan P Renner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
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Porpora MG, Pallante D, Ferro A, Crisafi B, Bellati F, Benedetti Panici P. Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Fertil Steril 2008; 93:716-21. [PMID: 19061997 DOI: 10.1016/j.fertnstert.2008.10.018] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 10/06/2008] [Accepted: 10/09/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s). DESIGN Prospective observational study. SETTING Tertiary care university hospital. PATIENT(S) One-hundred sixty-six consecutive women affected by uni- or bilateral ovarian endometrioma(s). INTERVENTION(S) Laparoscopic conservative treatment of endometriosis. MAIN OUTCOME MEASURE(S) Patient demographic characteristics, surgical findings, and surgical results were prospectively recorded. Postoperative follow-ups were carried out every 3 months to identify pain and/or endometrioma recurrence for a minimum of 3 years. RESULT(S) Dysmenorrheal, dyspareunia, and chronic pelvic pain recurred in 14.5%, 6%, and 5.4% of women, respectively. Prior surgery for endometriosis, adhesion extension, and use of ovarian stimulation drugs (OSD) were unfavorable prognostic factors for pain symptoms. Ovarian endometrioma recurred in 9.6% of cases; negative factors were prior surgery for endometriosis, OSD, pelvic adhesions, and high American Society for Reproductive Medicine disease scores. Postoperative pregnancy showed a significant protective effect on pain and disease recurrences. CONCLUSION(S) Prior surgery, presence of adhesions, and ovulation drugs are negative prognostic factors. Pregnancy has a protective effect on disease and pain recurrence.
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Affiliation(s)
- Maria Grazia Porpora
- Department of Gynecology and Obstetrics, University of Rome Sapienza, Viale Regina Elena, 324-00161 Rome, Italy.
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Lobo VLR, Júnior JMS, de Jesus Simões M, dos Santos Simões R, de Lima GR, Baracat EC. Does gestrinone antagonize the effects of estrogen on endometrial implants upon the peritoneum of rats? Clinics (Sao Paulo) 2008; 63:525-30. [PMID: 18719766 PMCID: PMC2664131 DOI: 10.1590/s1807-59322008000400019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 04/16/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the effects of estrogen treatment in combination with gestrinone on an experimental rat model of endometriosis. METHODS Uterine transplants were attached to the peritoneum of female Wistar rats via a surgical autotransplantation technique. The implanted area was measured during the proestrus phase and after hormonal treatment. We performed morphometric analysis and examined the macroscopic and morphometric alterations of endometrial implants after hormonal treatment in ovariectomized rats. RESULTS The high dose of estrogen caused macroscopic increases in the endometrial implant group compared with other groups, which were similar to increases in the proestrus phase. The low dose showed morphometric development of implants, such as an increase in number of endometrial glands, leukocyte infiltration and mitosis. Gestrinone antagonized both doses of estrogen. CONCLUSION Our findings suggest that gestrinone antagonizes estrogen's effects on rat peritoneal endometrial implants.
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Affiliation(s)
| | - José Maria Soares Júnior
- Laboratório de Investigação Médica (LIM-58) da Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo – São Paulo/SP, Brazil
| | | | | | | | - Edmund C Baracat
- Laboratório de Investigação Médica (LIM-58) da Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo – São Paulo/SP, Brazil
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Fuchs F, Raynal P, Salama S, Guillot E, Le Tohic A, Chis C, Panel P. Fertilité après chirurgie cœlioscopique de l'endométriose pelvienne chez des patientes en échec de grossesse. ACTA ACUST UNITED AC 2007; 36:354-9. [PMID: 17399914 DOI: 10.1016/j.jgyn.2007.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Revised: 01/17/2007] [Accepted: 02/26/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate fertility outcome after laparoscopic management of endometriosis in an infertile population. MATERIALS AND METHODS A retrospective analysis of 64 patients presenting more than one year infertility and a pregnancy-wish associated with minimal to severe endometriotic lesions (stage I to IV according to the revised American Fertility Society (rAFS) classification), treated using laparoscopic surgery in order to remove the entire lesions. We excluded women under 20 years and over 40, as well as those with other infertility factors (tubal non endometriosis-related, hormonal or sperm). Fertility of the remaining 34 patients was studied in relation to endometriosis stage and to pregnancy's mode (spontaneous or induced). RESULTS Pregnant women percentage was 65% (22 patients) within a 8.5 months (quartiles: 3; 15.5) [range: 1; 52] post-surgical time, and 86.5% pregnancies issued with a delivery. The rate of pregnant women depended on stage of endometriosis (89% for stages I-II, and 56% for stages III-IV). Sixty percent pregnancies were spontaneous within a 5 months (3; 9) [1; 52] post-surgical time to pregnancy average. When pregnancies were obtained with assisted reproductive techniques, the median post-surgical time to pregnancy was 12 months (9; 22) [2; 31]. Among women with stages I-II endometriosis, the median post-surgical time to pregnancy was 2 months when spontaneous and 20.5 months when induced (P=0.007). In case of stages III-IV endometriosis, pregnancy's delay was 8 and 12 months respectively (P=0.79). Among the 21% women who had had an induced pregnancy failure before surgery, 71% became pregnant and 80% spontaneously. Eighteen patients (53%) had an ovarian endometrioma and 50% of them became pregnant. Among the 4 patients who had colorectal endometriosis requiring colorectal resection, 1 pregnancy was obtained. CONCLUSIONS These findings suggest that in a context of more than one year infertility only related to endometriosis, it is reasonable to offer these patients a complete operative laparoscopic treatment of their lesions, which enables 65% of them to be pregnant within a 8.5 months post-surgical median time to pregnancy and spontaneously in 60%. In case of stages I-II endometriosis we suggest a spontaneous pregnancy try during 8 to 12 months before starting induced pregnancy therapeutics instead of stages III-IV endometriosis where induced methods should be used after only 6 or 8 months.
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Affiliation(s)
- F Fuchs
- Service de gynécologie obstétrique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le-Chesnay, France.
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27
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Wu Y, Strawn E, Basir Z, Halverson G, Guo SW. Aberrant expression of deoxyribonucleic acid methyltransferases DNMT1, DNMT3A, and DNMT3B in women with endometriosis. Fertil Steril 2007; 87:24-32. [PMID: 17081533 DOI: 10.1016/j.fertnstert.2006.05.077] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 05/19/2006] [Accepted: 05/19/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Since endometriosis is a persistent disease with substantial gene dysregulation, there must be cellular memory of some sort that constitutes a unique cell identity for endometriotic cells. Epigenetic regulation, especially through DNA methylation, is a flexible, yet stable, mechanism for maintaining such a cellular memory. The aim of this study was to determine gene expression levels of DNMT1, DNMT3A, and DNMT3B, the three genes coding for DNA methyltransferases that are responsible for methylation. DESIGN Cross-sectional measurements of gene expression levels of DNMT1, DNMT3A, and DNMT3B on endometriotic tissue. SETTING Academic. PATIENT(S) Seventeen patients with laparoscopically confirmed endometriosis and 8 healthy women who underwent tubal sterilization who were free of endometriosis were recruited for the study. INTERVENTION(S) Epithelial cells were harvested from tissue samples by laser capture microdissection and messenger RNA abundance was measured by quantitative real-time reverse transcription-polymerase chain reaction. MAIN OUTCOME MEASURE(S) The expression levels of these genes in epithelial cells from 13 ectopic endometrial tissue samples, 10 eutopic endometrial tissue samples taken from women with endometriosis, and 8 normal endometrial tissue samples from women without endometriosis. RESULT(S) The genes DNMT1, DNMT3A, and DNMT3B were over-expressed in the ectopic endometrium as compared with normal control subjects or the eutopic endometrium of women with endometriosis, and their expression levels were correlated positively with each other. CONCLUSION(S) The aberrant expression of these genes suggests that aberrant methylation may be rampant in endometriosis. This also provides a strong piece of evidence that endometriosis ultimately may be an epigenetic disease.
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Affiliation(s)
- Yan Wu
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226-0509, USA
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Guo SW, Wang Y. Sources of heterogeneities in estimating the prevalence of endometriosis in infertile and previously fertile women. Fertil Steril 2006; 86:1584-95. [DOI: 10.1016/j.fertnstert.2006.04.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 04/12/2006] [Accepted: 04/12/2006] [Indexed: 10/24/2022]
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Renner SP, Strick R, Oppelt P, Fasching PA, Engel S, Baumann R, Beckmann MW, Strissel PL. Evaluation of clinical parameters and estrogen receptor alpha gene polymorphisms for patients with endometriosis. Reproduction 2006; 131:153-61. [PMID: 16388018 DOI: 10.1530/rep.1.00787] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endometriosis is a chronic inflammatory disease, which is especially found in women with subfertility problems with an incidence of up to 30%. The disease is considered an estrogen-dependent disorder, where DNA polymorphisms of the estrogen receptor α (ERα) in connection with endometriosis are controversially discussed. From a German population of women, clinical data associated with the disease, including the American Fertility Society (AFS) I–IV classification, and non-clinical parameters were evaluated statistically in endometriosis patients (n= 98) and in control women (n= 98) without endometriosis. Using a multivariate statistical analysis, significant associations of endometriosis with dysmenorrhea (P< 0.001) and allergies against medicaments (P= 0.042) were found. A positive trend between first grade family history of endometriosis and allergies against medicaments was also observed, suggesting a genetic relationship. From both collectives, DNA from peripheral blood was analyzed for the frequency of the ERα DNA polymorphisms Xba1 (A/G) and PvuII (T/C) in intron 1 and the ERα exonic DNA polymorphism (G229A) with an amino acid exchange (Gly77Ser) in the transactivation domain. DNA samples from endometriosis lesions and control tissues from the same collectives were also analyzed for the exonic G229A polymorphism. Only homozygote wild-type alleles for the polymorphism G229A were found, making it a rare polymorphism in mid-European individuals. Allele types for the PvuII and Xba1 polymorphisms were analyzed with the observed statistically significant clinical parameters and showed no significant association with endometriosis; however a trend with AFS IV was noted, which could contribute to lesion severity. In conclusion, the analyzed polymorphisms in the ERα do not have a functional role concerning specific clinical parameters associated with endometriosis.
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Affiliation(s)
- S P Renner
- Department of Gynecology and Obstetrics, University-Clinics Erlangen, Laboratory for Molecular Medicine, Universitaetsstr. 21-23, D-91054 Erlangen, Germany
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Daraï E, Marpeau O, Thomassin I, Dubernard G, Barranger E, Bazot M. Fertility after laparoscopic colorectal resection for endometriosis: preliminary results. Fertil Steril 2005; 84:945-50. [PMID: 16213848 DOI: 10.1016/j.fertnstert.2005.04.037] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 04/11/2005] [Accepted: 04/11/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine fertility, reproductive outcomes, and determinants of fertility after laparoscopic segmental colorectal resection for endometriosis. DESIGN Retrospective longitudinal study. SETTING Tertiary university gynecology unit. PATIENT(S) The study population consisted of 34 women with colorectal endometriosis, of whom 22 wished to conceive. Demographic, surgical, and histological characteristics of 10 women who conceived were compared with those of 12 women who failed to conceive. INTERVENTION(S) Laparoscopic colorectal resection for endometriosis. MAIN OUTCOME MEASURE(S) Rates of pregnancy and live birth. RESULT(S) Mean follow-up after segmental colorectal resection was 24 months (range 6-42 months), and the pregnancy rate was 45.5%. The median time to conceive was 8 months (range 3-13 months). Twelve pregnancies occurred in 10 women, comprising nine spontaneous singleton pregnancies (7 vaginal deliveries, 1 cesarean section, and 1 ongoing pregnancy), and three pregnancies obtained by IVF (one miscarriage, one ongoing twin pregnancy, and one triplet pregnancy necessitating cesarean section at 29 weeks for premature rupture of the membranes, with two surviving infants). The live birth rate was 82%. The women who did and did not conceive did not differ in terms of mean follow-up, mean age, body mass index (BMI), parity, smoking, use and duration of oral contraception (OC), duration of infertility, or the length of the resected colorectal segment. Uterine adenomyosis was the main determinant of pregnancy after colorectal resection. CONCLUSION(S) These preliminary results suggest that extensive laparoscopic segmental colorectal resection for endometriosis can enhance fertility, with high rates of spontaneous pregnancy and live birth.
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Affiliation(s)
- Emile Daraï
- Service de Gynécologie, Hôpital Tenon, AP-HP, Paris, France.
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Sharpe-Timms KL, Young SL. Understanding endometriosis is the key to successful therapeutic management. Fertil Steril 2004; 81:1201-3. [PMID: 15136076 DOI: 10.1016/j.fertnstert.2003.09.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Revised: 09/30/2003] [Accepted: 09/30/2003] [Indexed: 11/22/2022]
Abstract
Understanding endometriosis on a molecular, biochemical, and genetic level will lead to better methods for the diagnosis and therapeutic management of this enigmatic disease.
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Affiliation(s)
- Kathy L Sharpe-Timms
- Department of Obstetrics and Gynecology, School of Medicine, University of Missouri-Columbia, Columbia, Missouri 65212, USA.
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Cunha-Filho JS, Gross JL, Bastos de Souza CA, Lemos NA, Giugliani C, Freitas F, Passos EP. Physiopathological aspects of corpus luteum defect in infertile patients with mild/minimal endometriosis. J Assist Reprod Genet 2003; 20:117-21. [PMID: 12735387 PMCID: PMC3455587 DOI: 10.1023/a:1022625106489] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We describe a physiopathological model to the luteal insufficiency of infertile patients with mild/minimal endometriosis with normal hormone measurements in the early follicular phase. METHODS We designed a case-control study with 24 patients, 14 fertile with in-phase endometrium (control group) and 10 infertile with mild/minimal endometriosis and luteal insufficiency (study group). The histologic dating of endometrium was performed during cycle days 23-25 and serum TSH, FSH, LH, prolactin, and estradiol levels were measured during the early follicular phase (cycle day 3). Progesterone serum levels were measured in three different occasions during the luteal phase. RESULTS Patients with out-of-phase endometrium have lower estradiol levels (P = 0.031) and decreased progesterone secretion (P = 0.012) during the late luteal phase. Serum prolactin, TSH, FSH, and LH levels were similar between the groups (P > 0.05). CONCLUSIONS The physiopathology of luteal phase defect in infertile patients with mild/minimal endometriosis is associated with a small and large luteal cells dysfunction, characterized by abnormal follicular phase (lower estradiol serum levels) and lower progesterone LH-dependent secretion.
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Affiliation(s)
- João Sabino Cunha-Filho
- Obstetrics and Gynecology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
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