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Endometriosis and infertility: the debate continues
Johanna Trinder1, David J Cahill
1Centre for Reproductive Medicine, University of Bristol Division of Obstetrics and Gynaecology, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK.
Human Fertility (Cambridge, England)
|March 19, 2002
Summary
Minor endometriosis is linked to infertility, possibly due to pituitary-ovarian dysfunction affecting follicular growth and hormone levels. While natural fertility is reduced, in vitro fertilization remains successful for women with endometriosis.
Area of Science:
- Reproductive Endocrinology
- Gynecology
- Infertility Research
Background:
- A causal link between minor endometriosis and infertility is not definitively established, despite observed associations.
- Prevalence studies indicate a significant correlation between endometriosis and subfertility.
- Pituitary-ovarian dysfunction is investigated as a potential mechanism underlying infertility in women with minor endometriosis.
Purpose of the Study:
- To critically review evidence linking pituitary-ovarian dysfunction to subfertility in women with minor endometriosis.
- To explore methodological challenges, such as the absence of fertile endometriosis controls.
Main Methods:
- Comparative analysis of studies using tubal infertility cases as controls.
- Evaluation of data on follicular growth, hormone concentrations (estradiol, progesterone), and luteinizing hormone (LH) surge patterns.
- Assessment of in vitro steroidogenic capacity of granulosa cells and oocyte fertilization rates.
Main Results:
- Evidence suggests impaired follicular growth and altered hormone profiles (preovulatory estradiol, early luteal estradiol and progesterone).
- Disturbed luteinizing hormone (LH) surge patterns and reduced LH concentration in follicular fluid were noted.
- Lower oocyte fertilization rates (49% vs. 69%) and implantation rates (11% vs. 13%) were observed compared to controls.
Conclusions:
- An inherent disorder of follicular function is likely in women with minor endometriosis.
- Impaired LH surge may be a secondary effect of underlying follicular dysfunction.
- Reduced oocyte fertilization contributes significantly to natural subfertility, though in vitro fertilization remains effective.