Pituitary-ovarian dysfunction and endometriosis.

Area of Science:

• Reproductive Endocrinology
• Gynecology

Background:

• Endometriosis is significantly associated with infertility, but a causal link remains unestablished.
• Prevalence studies indicate a correlation, necessitating investigation into underlying mechanisms of subfertility.

Purpose of the Study:

• To review evidence linking pituitary-ovarian dysfunction to subfertility in endometriosis.
• To explore potential causes of impaired follicular function and oocyte fertilization in affected individuals.

Main Methods:

• Review of existing literature comparing women with endometriosis to controls (tubal infertility cases).
• Analysis of studies examining follicular growth, hormone concentrations (estradiol, progesterone, LH), and oocyte fertilization rates.
• Evaluation of data on implantation rates and outcomes of in-vitro fertilization (IVF).

Main Results:

• Impaired follicular growth and reduced pre-ovulatory estradiol and early luteal phase estradiol/progesterone levels observed.
• Disturbed luteinizing hormone (LH) surge patterns and reduced LH in follicular fluid noted.
• Significantly lower oocyte fertilization rates (49% vs. 69%) and slightly reduced implantation rates (11% vs. 13%) in endometriosis patients.

Conclusions:

• Findings suggest an inherent disorder of follicular function in endometriosis, with LH surge impairment potentially secondary.
• Reduced oocyte fertilization chance likely contributes significantly to endometriosis-associated subfertility.
• IVF success may stem from increased oocyte yield via stimulation, bypassing inherent follicular dysfunction.