Peritoneal endometriosis and infertility - interconnection of pathogenethics processes

Abstract

Objective. To estimate the role of hormone-dependent changes of the microrelief of endometrial epitheliocytes in pathogenesis of infertility associated with peritoneal endometriosis.

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Methods. Laparoscopy, biopsy of endometrial and peritoneal samples with/without endometriosis, aspirat of peritoneal fluid with/without endometriosis, organotypic culture of endometrium and peritoneal samples into diffusion chambers with millipore filters implanted subcutaneously to ovarioectomized rats and substitution therapy with sex steroids, light and scanning electron microscopy.

Results. In peritoneal endometriosis and deficiency of the ovarian function in secretory phase of the cycle endometrium has pathological condition in both structural level (defective modifications of glands, stroma and vessels) and ultrastructural level (deficiency of secretory transformation of the microrelief of endometrial epitheliocytes - persistence of microvilli and cilia). At total damage of the endometrium epitheliocytes the uterine infertility arises. Mosaic damage of a microrelief leads to formation of heterogenous structure of preovulatory endometrium at which implantation of blastocyst in the given cycle is possible, but in the further there is a high risk of pregnancy loss. At the beginning of menstruation viable cells with microvilli and cilia are kept in endometrium. These cells have increased adhesive potential, high proliferative activity and ability to survive geterotopically for a long time. Deficiency of the ovarian function is the reason of retrograde menstruation. In case of retrograde reflux in peritoneum cavity of the endometrium’ aggressive cells with the raised ability to intercellular interactions, invasion and ectopic proliferation the peritoneal endometriosis is formed. Active spots of endometriosis maintain ovarian deficiency and establish conditions for uterine infertility.

Conclusions. Peritoneal endometriosis and associated infertility are pathogenetically interconnected. Chronic deficiency of the ovarian function forms the basis of these pathogenic processes. The persistence of microvillous relief of endometrial epitheliocytes in late secretory phase of the cycle in peritoneal endometriosis indicates the deficiency of endometrial secretory transformation, deficiency of the ovarian function and results in a disorder of the ovicell implantation, infertility or pregnancy loss.