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New Insights into Endometriosis Related Infertility

Endometriosis is a chronic inflammatory condition affecting 8-10% of women in the general population and approximately 40% of infertility patients. This enigmatic disease is associated with pain with menstrual periods, intercourse, bowel movements, urination and ovulation as well as with chronic pelvic pain and infertility. 

While it has been known for some time that the free fluid within the abdominal cavity (usually in the pelvic “cul-de-sac”) in endometriosis patients may be hostile to eggs and sperm and may play a role in infertility, new evidence suggests that a another fluid may be detrimental to egg development and diminish the likelihood for conception. In a collaborative study performed in England, it was found that egg quality may be severely compromised in endometriosis by the fluid (follicular fluid) in which it develops. Published in Scientific Reports, the study found that the ability of the egg to mature normally was blocked by endometriosis, and that follicular fluid from women with endometriosis could seriously damage egg quality.

Endometriosis was found to block egg maturation via increasing oxidative stress, that is, by generating Reactive Oxygen Species (ROS) in the egg, which damaged their DNA. This damage was significant enough to prevent normal egg maturation and fertilization. This in vitro study involved taking immature mouse eggs and incubating them in follicular fluid taken from patients who had known endometriosis. The researchers examined the amounts of oxidative stress generated relative to egg maturation. In short, they found that follicular fluid from women with endometriosis resulted in higher amounts of ROS.

The study further suggested that perhaps the damage done to eggs by follicular fluid in these endometriosis patients could be prevented by antioxidants. Two antioxidants were analyzed in this regard: resveratrol and melatonin. Resveratrol, (found in the skins of grapes and berries) and Melatonin, (a brain hormone released during sleep), were added to the fluid and were shown to reverse the negative effects of follicular fluid. Oxidative stress (ROS) was decreased and more eggs matured normally.

These research results are encouraging; however, more investigation is necessary before any specific recommendations may be made with respect to the types and dosages of antioxidants and/or other therapies.

Journal Reference:

1. 1. Mukhri Hamdan, Keith T. Jones, Ying Cheong, Simon I. R. Lane. The sensitivity of the DNA damage checkpoint prevents oocyte maturation in endometriosis. Scientific Reports, 2016; 6: 36994 DOI: 10.1038/srep36994

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