Endometriosis and Infertility A Review of the Pathogenesis and Treatment of Endometriosis-associated Infertility

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA.
Obstetrics and Gynecology Clinics of North America (Impact Factor: 1.38). 12/2012; 39(4):535-49. DOI: 10.1016/j.ogc.2012.10.002
Source: PubMed


Endometriois has been associated with infertility; however, the mechanisms by which it affects fertility are still not fully understood. This article reviews the proposed mechanisms of endometriosis pathogenesis, its effects on fertility, and treatments of endometriosis-associated infertility. Theories on the cause of the disease include retrograde menstruation, coelomic metaplasia, altered immunity, stem cells, and genetics. Endometriosis affects gametes and embryos, the fallopian tubes and embryo transport, and the eutopic endometrium; these abnormalities likely all impact fertility. Current treatment options of endometriosis-associated infertility include surgery, superovulation with intrauterine insemination, and in vitro fertilization. We also discuss potential future treatments for endometriosis-related infertility.

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    • "Despite considerable investigation, the precise etiology and pathogenesis of endometriosis is unknown. To date, the leading theories are retrograde menstruation, coelomic metaplasia, embryonic cell rest, and lymphovascular metastasis [2]. However, none of them can annotate the pathogenesis to a point for all types of endometriosis. "
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    ABSTRACT: Background The precise etiology of endometriosis is not fully understood; the involvement of stem cells theory is a new hypothesis. Related studies mainly focus on stemness-related genes, and pluripotency markers may play a role in the etiology of endometriosis. We aimed to analyze the transcription pluripotency factors sex-determining region Y-box 2 (SOX2), Nanog homeobox (NANOG), and octamer-binding protein 4 (OCT4) in the endometrium of reproductive-age women with and without ovarian endometriosis. Methods We recruited 26 women with laparoscopy-diagnosed ovarian endometriosis (endometriosis group) and 16 disease-free women (control group) to the study. Endometrial and endometriotic samples were collected. SOX2, NANOG, and OCT4 expression were analyzed with quantitative real-time polymerase chain reaction, western blotting, and immunohistochemistry. Results Compared to the control group, SOX2 mRNA and protein expression was significantly higher in the eutopic endometrium of participants in the endometriosis group. In the endometriosis group, SOX2 and NANOG mRNA and protein expression were significantly increased in ectopic endometrium compared with eutopic endometrium; there was a trend towards lower OCT4 mRNA expression and higher OCT4 protein expression in ectopic endometrium. Conclusions The transcription pluripotency factors SOX2 and NANOG were overexpression in ovarian endometriosis, their role in pathogenesis of endometriosis should be further studied.
    Reproductive Biology and Endocrinology 05/2014; 12(1):42. DOI:10.1186/1477-7827-12-42 · 2.23 Impact Factor
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    • "Possible signaling pathways in human endo- metriosis The exact role of the peritoneum in the establishment and maintenance of endometriosis has been elusive, as recently reviewed [4]. Multiple molecules and signaling pathways have been speculated to participate in the pathogenic progression of endometriosis lesions [3] [4] [5] [7], including 17β-hydroxysteroid- dehydrogenases [67] [68], steroid receptor coactivator-1 [69], adhesion/attachment/invasion proteins [70] [71], disintegrin and metalloproteinases [72], nuclear factor-kappa B [73], Wnt/β-catenin [74], and the mitogen-activated protein kinase and phosphatidylinositol 3'-kina- se/AKT [75] signaling pathways. These molecules and signaling pathways are either directly linked to estrogen synthesis and ER and PR activation or interact with ER and PR signaling pathways at different levels through signaling molecules downstream of the receptor. "
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    ABSTRACT: Endometriosis is a complex and challenging disease that involves aberrant adhesion, growth, and progression of endometrial tissues outside of the uterine cavity, and there is evidence to suggest that estrogen plays a key role in its development and progression. Numerous in vivo clinical studies have described the ectopic expression and regulation of estrogen receptor (ER) and progesterone receptor (PR) in the different types of endometriosis compared to normal or eutopic endometrium. However, we have noticed that conflicting and contradictory results have been presented in terms of ER subtype (ERα and ERβ) and PR isoform (PRA and PRB) expression. Both ER and PR are transcription factors and ER/PR-mediated responses depend on the coordinated, opposing, and compensatory functions of ER subtypes and PR isoforms. Moreover, analysis of the uterine phenotypes of ERα/ERβ and PRA/PRB knockout mice indicates that different ER subtypes and PR isoforms mediate distinct responses to steroid hormones and play different roles in uterine function. In this review, we outline studies that have elucidated the molecules and signaling pathways that are linked to ER and/or PR signaling pathways in the development and progression of endometriosis.
    American Journal of Translational Research 02/2014; 6(2):104-113. · 3.40 Impact Factor
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    ABSTRACT: In this month's issue of Biology of Reproduction, Afshar et al. report on the effects of endometriosis on gene expression in the baboon endometrium.
    Biology of Reproduction 01/2013; 88(2). DOI:10.1095/biolreprod.113.107722 · 3.32 Impact Factor
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