Endometriosis and infertility

The Association between endometriosis and infertility is well known. The frequency of infertility with endometriosis, according to various authors, ranging from 30-40 to 60-80 % [Marbiz A. M., Rodina I. E., 1973; G. Belyaeva, N., 1976; Petersohn L., 1970; Weed D., J. Holland, 1977, and others].
According to S. Garcia (1964), endometriosis is found in 1/3 of the women subjected to laparotomy for infertility.
A. N. The summary (1985) believes that in genital endometriosis different localization every second, third patient is observed infertility. From 459 patients with primary infertility, examined at the Johns Hopkins University, at 114 (about 25%) was detected endometriosis [Jones N., Rock J., 1976].
Among the many causes of primary and secondary infertility, endometriosis is one of the leading places, second only to inflammatory processes of female genital mutilation. It should be taken into account that some chronic periodically worsening of adnexitis caused genital endometriosis and not infection.
Have accumulated enough information to help you understand the cause of the high percentage of primary and secondary infertility with endometriosis. However O. Spangler et al. (1971) argued that no man can never ever explain, what exactly is the dependence of infertility from endometriosis.
A similar view is taken by A. Acosta et al. (1973).
However, there is ample reason to believe that the leading role in the development of infertility with endometriosis play disturbances in the hypothalamic-pituitary-ovarian system, the consequence of which are anovulation, the lack of yellow body, and the violation of the ratio of oestrogen factions in the direction of increase of the concentration of estrone and estradiol.
A. N. The summary (1975, 1977, 1980-1985), J. N. Belyaeva (1976), R. Kistner et al. (1977) and others attach great importance inferiority luteal phase of the menstrual cycle in an bespoke in patients with endometriosis. Syndrome luteinization of neskryvaemoy (Novoulyanovsk) follicle, but the opinion of J. Brosens et al. (1978, 1983) and others, may be a primary cause of infertility in patients with endometriosis.
Studies have shown L. Century Adamyan (1977), in patients with endometrioid ovarian cysts during the ovulatory menstrual cycle is a violation of the laws of dynamics secretion of progesterone during normal concentrations in the period of the functional activity of the yellow body.
J. N. Belyaeva (1976) established the role of functional inferiority of the endometrium in the Genesis of infertility, namely: endometriosis patients, even for two-phase of the menstrual cycle, has delayed transformation of the endometrium of the proliferative phase in secretory, no friendly secretory response glands, violation of the content and distribution of glycogen and CHIC-positive substances, misallocation of nucleic acids and alkaline phosphatase. Added to this is the role of glandular hyperplasia and polyps of the endometrium, often observed with adenomyosis of the uterus.
3. P. Sokolova (1982) in the pathogenesis of infertility in patients with internal endometriosis attaches importance to the violation of the mechanism cytoplasmic binding progesterone and strengthening of the biological action of androgens on the mucous membrane of the uterus that, despite the persistence of ovulation, worsens the conditions for implantation and nedachi eggs.
And the smallest value from our point of view, have the anatomical changes caused by endometriosis, pelvic and, in particular, obstruction of the fallopian tubes. Because the vast majority of women with endometriosis (according to A. Turunen, 1954,up to 86%) remains the patency of the fallopian tubes. When examining patients with endometriosis method GHA and during laparotomy, we see that the patency of the fallopian tubes persists almost 90 % of patients with endometriosis, despite expressed anatomical changes in the pelvic area.
The role of tubal factor in causing infertility in patients with endometriosis deeply studied by A. N. Strizhakova (1977, 1984), A. N. Strizhakova et al. (1975, 1985). Method kinografika pertubative he showed that every second patient with normal tubal patency was reduced and discoordination Oxytocics them; a 29.8 % of patients were observed difficulties with uterine tubes patency and 20.2 % - spasm in isthmic-Anulare Department.
What reasons can explain the violation of the transport function of the fallopian tubes in retained their cross-country, in addition to the effects of inflammatory process? Obviously, they are very diverse. So, a well-known dependence peristalsis fallopian tubes on ovarian function and regulating their activity centers. A. N. The summary in a number of works (1980-1985, showed the variety of deviations in the hypothalamic-pituitary-ovarian-adrenal system in patients with infertility and their dependence on localization of endometriosis. When retro-cervical endometriosis showed a significant violation of the level and rhythm of the concentration of FSH and LH, namely the reduction of ovulatory peak L G, messy emissions of this hormone in the luteal phase of the cycle. In addition, changed and excretion of steroid hormones (increase in blood plasma content of estradiol in both phases of the cycle and reducing the concentration of progesterone during the luteal phase of the cycle).
In patients with endometrioid ovarian cysts A. N. The summary set the activation of follicle-stimulating pituitary function. In addition, it was revealed increased levels of estradiol during 4-3 day to ovulatory peak, while in healthy women, the increasing concentration of estradiol observed on the day of ovulation, and since ovulatory peak LH increases the amount of progesterone and is broken dynamics secretion of progesterone during normal concentrations.
The obtained results have reason to believe that the infertility with endometriosis, ovarian not involve a violation of the process of ovulation and the changes steroidogeneza in the ovaries, especially in the luteal phase of the cycle, which causes the pathological changes of the endometrium and the violation of the functional activity of the fallopian tubes [Summary A. N., 1985].

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