ENDOMETRIOSIS: WHAT ARE THE MECHANISMS RESPONSIBLE FOR INFERTILITY?

摘要

INTRODUCTION: ENDOMETRIOSIS IS ONE OF THE MOST IMPORTANT CAUSES OF INFERTILITY IN REPRODUCTIVE AGE PATIENTS, BUT WHAT ARE THE MECHANISMS INVOLVED? THIS ARTICLE DESCRIBES STEP BY STEP THE PSYSIOPATHOLOGY BACKGROUND THAT LEADS TO PREGNANCY ACHIEVING IMPAIRMENT. METHODS: WE PERFORMED A REVIEW OF THE INTERNATIONAL SPECIALTY LITERATURE. RESULTS: ENDOMETRIOSIS DETERMINES MODIFICATION OF NEOANGIOGENESIS AND CELLULAR MEDIATED RESPONSE BY HIGH CONCENTRATIONS OF INFLAMMATORY CYTOKINES (IL1, IL6, TNF ALPHA, PROSTAGLANDIN, PROTEASES) AND ANGIOGENIC FACTORS (IL8 AND VEGF). THESE CAUSE ALTERATION OF THE PELVIC ANATOMY AND, IN ADDITION TO LOWERING ΑVΒ3 INTEGRIN ADHESION MOLECULE AND THE L-SELECTIN LIGAND, CONTRIBUTES TO ASSOCIATED IMPLANTATION FAILURE. NEVERTHELESS, OVULATION IMPAIRMENT BY MECHANICAL DISTRUCTION OR ALTERATION OF GRANULLAR CELLS FUNCTION WITH ESTROGEN AND PROGESTERONE SECRETION DEFICIENCY AND LUTEAL PHASE MODIFICATIONS HAVE A FERTILITY NEGATIVE IMPACT. THE EMBRYOTOXICITY EFFECT COMES IN ADDITION TO THIS WITH AN INCREASED ABORTION RATE. ALTERATION OF SPERMATOZOA MOBILITY AND ENDOMETRIAL RECEPTIVITY, INCREASED UTERINE CONTRACTILITY AND FALLOPIAN TUBES OBSTRUCTION COMPLETE THE PICTURE OF INFERTILITY IN THE ENDOMETRIOSIS PATIENT. CONCLUSIONS: ENDOMETRIOSIS AFFECTS FERTILITY THROUGH MULTIPLE MECHANISMS, AND IN ORDER TO TREAT AND GET PREGNANCY IN THESE PATIENTS, IT IS NECESSARY TO UNDERSTAND THEM.