Endometriosis as a Barrier to Fertility

"Acta Obstetricia et Gynecologica Scandinavica (AOGS)" June 2017 issue aims to emphasize the effects of endometriosis on women's reproductive health

Key Points

Highlights: 

This Editor's message from the journal "Acta Obstetricia et Gynecologica Scandinavica (AOGS) June 2017 issue offers a comprehensive report on the current understanding of endometriosis and its impact on women's quality of life and sexual health. 

Importance: 

Endometriosis is a common disease that has a significant impact on the well-being and reproductive health of many women. As such, further studies are needed to offer an explanation as to why some women with endometriosis experience dyspareunia (pain during sexual intercourse) and infertility and what treatment options are being developed to address these issues.

Key Results:

Articles included in the June 2017 issue of AOGS have discussed and studied the following:

• Surgical removal of endometriotic lesions does not significantly improve reproductive outcomes. As such, "Assisted Reproductive Technology" (ART) may be beneficial in improving fertility outcomes.
• High-Intensity Focused Ultrasound (HIFU) may be a future treatment option for women with endometriosis invading the myometrium (adenomyosis) and has been seen to alleviate pain and improve fertility.
• Environmental toxins and estrogen-like compounds may have a possible role in the development of progesterone resistance resulting in endometriosis. 
• Endometriosis has been seen to be associated with an increased risk of epithelial ovarian cancer. The early molecular mechanisms of which are still being explored.
• Mothers with endometriosis have been associated to give birth to neonates who are characterized as preterm (birth before 28 weeks of pregnancy).

What’s done here?

This editor's message reviews the current obstacles being faced by women with endometriosis and infertility. Additionally, it summarizes key points discussed in the AOGS June 2017 issue and hopes to encourage further studies that aim to research the impact of endometriosis on women's reproductive health.

Lay Summary

Some of the articles in the from the journal "Acta Obstetricia et Gynecologica Scandinavica (AOGS) issue are discussed in further detail below:

Pain caused by endometriosis has been seen to significantly impact women's physical, psychosocial, and sexual health. Although endometriosis has been documented and theorized since the early 20th century, the current understanding of its pathophysiology and molecular triggers is limited. In this issue of AOGS (Acta Obstetricia et Gynecologica Scandinavica), the emphasis is placed on studies that aim to elucidate the effects of endometriosis on fertility and possible treatments that address these problems.

A number of studies in this issue aim to assess methods that improve fertility in women with endometriosis. One systematic review (Laursen et al.) pointed out that removal of endometriotic lesions does not significantly improve reproductive outcomes. Thus, they have suggested that assisted reproductive technology (ART) may be beneficial in improving fertility outcomes for women who only face subfertility. In another article by Zhang et al., the efficacy, safety, and fertility improvement of image-guided High-Intensity Focused Ultrasound (HIFU) therapy are discussed for women who suffer from adenomyosis. They argue that HIFU has been seen to alleviate pain, improve fertility, and may be a future non-invasive treatment option for adenomyosis. However, randomized controlled clinical trials are still required to validate HIFU's use in the clinical practice. In an article explaining the possible mechanisms involved in progesterone resistance, Patel et al. review some of the environmental toxins and estrogen-like compounds that have been currently studied in the setting of endometriosis. Compounds like dioxin, xenoestrogens, and phytoestrogens are discussed but need to be further evaluated to assess their direct role in the development of endometriosis.

In a very large study assessing the neonatal outcomes of over 19,000 deliveries in Denmark, Berlac et al. found that women with endometriosis had a higher risk of severe preeclampsia, hemorrhage during pregnancy, placental abruption (placenta that peels away from the inner wall of the uterus), placenta previa (misaligned placenta), premature rupture of membranes, and retained placenta. Furthermore, the study demonstrated that neonates delivered by mothers with endometriosis were at increased risk to be preterm (birth before 28 weeks of pregnancy). 

The development of non-hormonal and non-surgical treatments has been offset by the fact that endometriosis is a poorly understood and heterogenous disease. While endometriosis has been seen to be associated with an increased risk of epithelial ovarian cancer, the early molecular mechanisms that instigate its progression and clinical presentation are still being explored. Thus, clinical trials are still needed to assess the link between endometriosis and subfertility.

A list of articles included in the AOGS June 2017 issue are listed here: http://obgyn.onlinelibrary.wiley.com/hub/issue/10.1111/aogs.2017.96.issue-6/

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28556123