Endometriosis is a chronic inflammatory disease affecting women's health. Pain and infertility are the major symptoms caused by a hormonal/immunological dysfunction, which causes an endometrial impairment. The same pathogenetic mechanisms are also associated with preterm birth: hormones, cytokines, neurohormones, and growth factors interact in modulating extracellular matrix and prostaglandin secretion, thus activating the inflammatory process in placental membranes and myometrium. An overlap of molecules and mechanisms may explain the evidence that preterm birth is a common outcome in pregnant patients with endometriosis.
"The presence of endometriosis induces a chronic inflammatory condition capable of influencing pregnancy outcome
 and, although the condition can be asymptomatic, according to a recent statement by the American Society for Reproductive Medicine "typically presents with pelvic pain, infertility, or an adnexal mass, and may require surgery"
. The prevalence of endometriosis in women undergoing laparoscopy for evaluation of infertility has been estimated between 9 and 50% and its presence is 6 to 8 times more frequent in infertile women
[Show abstract][Hide abstract] ABSTRACT: Aim of this prospective, case-control study was to evaluate uterine arteries' blood flow before and after laparoscopic surgery in patients with ovarian endometriosis and its possible correlation with infertility.
We prospectively enrolled 110 women of reproductive age; 69 with ovarian endometriomas and scheduled for surgery, and 41 controls. At enrolment, a detailed medical, gynecologic and obstetric history was collected. Fertility and pregnancy desire were assessed. All patients underwent complete physical and gynecologic examination. Transvaginal ultrasound with Doppler color flow was performed to evaluate Resistance Index (RI) of uterine arteries during the secretory phase, at enrolment (T0) and 3 months after laparoscopic surgery (T1).
Among cases, 27 patients were excluded because they did not meet the inclusion criteria. At enrolment (T0) unilateral or bilateral flow alterations (RI >= 0.8) were found in 38 out of 42 patients with ovarian endometriosis (90%), whereas in the control group only 17 women (41%) had Doppler alterations. The difference in uterine artery RI values between cases and controls was statistically significant (P < 0.0001). A statistically significant improvement in uterine artery flow (P <0.0001) was found 3 months after surgical treatment of endometriosis. Nineteen patients with endometriosis (45%) were infertile before surgery; all of them presented uterine artery Doppler alterations at T0. After surgery the pregnancy rate was significantly higher in patients who presented uterine artery flow normalization than in those with persistent uterine artery flow alterations (p = 0.002).
A strong correlation was found between uterine artery flow abnormalities and ovarian endometriosis. Uterine artery flow improvement following surgery seems to increase the probabilities of achieving pregnancy.
Journal of Ovarian Research 01/2014; 7(1):1. DOI:10.1186/1757-2215-7-1 · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract This review introduces a potential unifying concept involving the risk of chronic diseases in which early-life exposure to endocrine-disrupting chemicals (EDCs) can program host responses for misregulated inflammation. Inflammation is a part of host defense against pathogenic challenges and one of the processes necessary for normal tissue homeoregulation and for reproduction (e.g., implantation, labor). Deviations from tightly regulated inflammation present a significant health risk because unresolved inflammation can compromise tissue function and increase the risk for later-life cancer in the affected target tissue. The critical windows of innate immune vulnerability during prenatal and neonatal maturation are when developmental programming and the trajectory for childhood and adult inflammatory responses are largely established. Misregulated inflammation is a common thread that links most significant chronic diseases and conditions across all physiologic systems as well as the associated comorbid conditions. As a result, chronic diseases exist both as a myriad of conditions and as an integrated, dysfunctionally connected unit. Because the hormone microenvironment exerts a significant effect on resident innate immune cell function, endocrine disruption is likely to produce misregulated inflammation in tissues. Among the factors determining specific health risks and disease outcomes across a lifetime are the age of exposure, sex, genetic background, and transgenerational epigenetic experiences. Additional research into early-life EDC exposure and misregulation of inflammation appears to be a useful avenue for reducing environmental health risks.
Reviews on environmental health 10/2012; 27(2-3):117-131. DOI:10.1515/reveh-2012-0020
[Show abstract][Hide abstract] ABSTRACT: To improve the still fragmented understanding of endometriosis a life-cycle approach is adopted that revealed unexpected aspects of the natural history of the disease throughout a woman's life. Three age related stages of endometriosis are distinguished. In premenarcheal and adolescent endometriosis two types can be distinguished: a "classic form", namely that can occur before the menarche and a "congenital obstructive form" that is caused by uterine anomaly and outflow obstruction. The lesions include superficial peritoneal implants, but adhesions and endometrioma can also occur. It is suggested that premenarcheal and possibly adolescent endometriosis develop by activation of resting stem cells shed at the time of neonatal retrograde uterine bleeding. In the adult endometriosis can be related to uterine preconditioning by cyclic menstruations acting as a priming mechanism for deep placentation. In adult life the typical lesions are peritoneal, ovarian and deep or adenomyotic endometriosis. More recently, endometriosis has been associated with endometrial dysfunction and myometrial junctional zone hyperplasia. These uterine changes can be linked with some major obstetrical syndromes. In the post-menopause, endometriosis can develop or be re-activated both in the presence or absence of exogenous estrogens and can spread to a variety of organs and structures causing constrictive lesions.
American journal of obstetrics and gynecology 03/2013; 209(4):307-16. DOI:10.1016/j.ajog.2013.03.009 · 4.70 Impact Factor
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