Uterine and ovarian function in endometriosis

Nicolás Garrido; Antonio Pellicer; José Remohí; Carlos Simón

doi:10.1055/s-2003-41325

Endometriosis Fertility and Outcomes

Uterine and ovarian function in endometriosis

Garrido N, Pellicer A, Remohí J, Simón C

Published May 2003 Seminars in Reproductive Medicine, 21(2), 183-192

DOI 10.1055/s-2003-41325 PMID 12917788

RRM Academy Synopsis

Endometriosis is linked to lower implantation, with eggs suspected

A 2003 narrative review from an IVF institute reports that endometriosis is linked to lower implantation and pregnancy rates. The authors' oocyte donation studies point to the egg as the likelier source.

Key Findings

In the authors' IVF data, women with endometriosis had significantly lower pregnancy rates per cycle and per transfer and lower implantation rates than women with tubal infertility. Oocyte numbers and fertilization matched.
In oocyte donation, implantation rates were significantly lower in recipients of oocytes from donors with endometriosis. A prospective study also found lower pregnancy rates per transfer in that group.
In a matched case-control study, one healthy donor gave sibling oocytes to one recipient with and one without endometriosis. Pregnancy, implantation, miscarriage and live birth rates did not differ between the recipients.
In the authors' study, granulosa cells purified to more than 98% purity showed no differences in progesterone, IL-6 or VEGF between women with and without endometriosis. Earlier differences could not be replicated.
In preliminary results from 10 women without and 8 with endometriosis, 206 genes were differentially expressed in the endometrium: 91 up-regulated and 115 down-regulated.

Interpretation

This narrative review combines the authors' own IVF, oocyte donation and endometrial studies. Women with endometriosis had lower pregnancy and implantation rates. Oocytes from donors with endometriosis led to lower implantation in recipients. The endometrium showed altered gene expression. The authors note that their donation studies did not include a group where both donor and recipient had endometriosis. The findings support larger, controlled studies that separate the egg's role from the endometrium's role.

RRM Context

The authors write that pelvic fluid seems to play a key role between embryo and endometrium. They say it may interfere with natural conception. Pelvic fluid sits in the pelvis, where endometriosis grows. IVF bypasses the pelvis and proceeds without finding out why conception fails. Restorative reproductive medicine evaluates both partners and treats endometriosis itself. Excision is the surgical standard.

Our editorial summary of this paper, not the article's abstract.

Abstract

Although numerous studies have attempted to elucidate the implication of endometriosis for infertility, this matter still remains unexplained. Diverse clinical approaches based on assisted reproduction techniques have produced conflicting results on this issue. Nevertheless, impairment of implantation and pregnancy rates seems to affect women who suffer from endometriosis. Whether this effect is due to alteration of the oocyte/embryo or the endometrium still remains to be elucidated, although actual data allude to deficiencies in both. Infertility due to poor quality embryos derived from impaired oocytes obtained from malfunctioning ovaries have been described by some groups. Endometrial defects have been argued by others. Adding more confusion to this topic, the influence of peritoneal fluid in women with endometriosis and/or mixed causes also needs to be considered. The aim of this review is to describe the current situation in the endometriosis-related infertility literature.

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

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.

22 min read

Topics

Endometriosis

Fertility and Outcomes Ovarian Reserve

Endometriosis › Fertility and Outcomes › Ovarian Reserve

Nicolás Garrido, Antonio Pellicer, José Remohí, Carlos Simón

N Garrido, A Pellicer, J Remohí, C Simón

PMID 12917788 12917788 DOI 10.1055/s-2003-41325 10.1055/s-2003-41325 Garrido et al. 2003, Garrido 2003

Keywords

Ascitic Fluid/metabolism, Endometriosis/physiopathology, Female, Humans, Ovary/physiopathology, Uterus/physiopathology

Uterine and ovarian function in endometriosis

Endometriosis is linked to lower implantation, with eggs suspected

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

By this author

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Keywords