Ramey, J. W., & Archer, D. F. (1993). Peritoneal fluid: its relevance to the development of endometriosis. Fertility and Sterility, 60(1), 1-14. https://doi.org/10.1016/s0015-0282(16)56027-0
Ramey JW, Archer DF. Peritoneal fluid: its relevance to the development of endometriosis. Fertil Steril. 1993;60(1):1-14. doi:10.1016/s0015-0282(16)56027-0
Ramey, Jacques W., and David F. Archer. "Peritoneal fluid: its relevance to the development of endometriosis." Fertility and Sterility, vol. 60, no. 1, 1993, pp. 1-14.
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Peritoneal fluid in endometriosis contains growth factors
A 1993 narrative review of lab, animal and human studies reports that the peritoneal fluid of women with endometriosis contains angiogenic and other growth factors. These may help the ectopic endometrium grow. The authors found no conclusive evidence of a factor in the fluid that creates new endometrial tissue.
Key Findings
Growth factors that promote blood vessel formation, along with other growth factors, are present in the peritoneal fluid of women with endometriosis and may help the ectopic tissue multiply.
Some studies found higher fluid levels of prostaglandins, complement components C 3c and C 4, interleukin-1 and tumor necrosis factor than in fertile women. Prostaglandin and cytokine results conflicted.
Progesterone and estradiol concentrations in peritoneal fluid are the same with or without endometriosis. Infertile women with endometriosis appear to have more peritoneal macrophages than fertile women.
In the authors' own unpublished rat experiment, pooled peritoneal fluid produced no endometrium-like tissue. It produced capillary and mesothelial cell growth, which the authors read as inflammation.
Interpretation
The paper is a narrative review. The authors built the review from a MEDLINE search and a manual scan of major reproductive journals, and most of the studies they reviewed evaluated how the fluid may adversely affect fertility. The authors call the evidence for an inducing factor suggestive but inconclusive. They suggest conflicting results may reflect sample size, patient differences, cycle variation and assay variability. They judge the transplantation theory the best-supported explanation for how endometriosis begins. In that theory, shed menstrual tissue implants outside the uterus.
RRM Context
The review portrays endometriosis as a disease with a local chemical setting that can be studied. Endometriotic implants are named as one source of prostaglandins and growth factors in the pelvis. Restorative reproductive medicine seeks root causes, and excision removes the lesions that help build this setting.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To review and evaluate published studies that have examined the role of peritoneal fluid (PF) in the development of endometriosis.
Design
Important studies related to this topic have been identified through a computerized bibliographical search (MEDLINE), as well as by manually scanning the published literature of major reproductive journals over the last several years.
Main Outcome Measures
Studies that examined the effect of PF or its components on the pathophysiology of endometriosis are discussed. These include reported effects on the histogenesis, maintenance and proliferation of endometriosis, as well as related actions on infertility.
Results
The majority of investigations into the role PF plays in the pathogenesis of endometriosis have evaluated how it may adversely affect fertility. Suggestive but inconclusive data in the literature indicate that degenerating endometrial tissue may release a biochemical factor(s) into the peritoneal environment that is capable of inducing ectopic endometrium formation. Peritoneal fluid itself contains growth factor that may play a role in the implantation and maintenance of the ectopic endometrium.
Conclusions
The PF of women with endometriosis has been shown to contain angiogenic as well as other growth factors. These compounds may contribute to the proliferation of the ectopic endometrium.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
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