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Aydin Arici - One of the best experts on this subject based on the ideXlab platform.

  • Endometriosis and Infertility epidemiology and evidence based treatments
    Annals of the New York Academy of Sciences, 2008
    Co-Authors: Sebiha Ozkan, William Murk, Aydin Arici
    Abstract:

    Endometriosis is an estrogen-dependent disorder defined as the presence of endometrial tissue outside of the uterine cavity. A leading cause of Infertility, Endometriosis has a prevalence of 0.5-5% in fertile and 25-40% in infertile women. The optimal choice of management for Endometriosis-associated Infertility remains obscure. Removal or suppression of endometrial deposits by medical or surgical means constitutes the basis of Endometriosis management. Current evidence indicates that suppressive medical treatment of Endometriosis does not benefit fertility and should not be used for this indication alone. Surgery is probably efficacious for all stages of the disease. Controlled ovarian hyperstimulation with intrauterine insemination is recommended in early-stage and surgically corrected Endometriosis when pelvic anatomy is normal. In advanced cases, in vitro fertilization is a treatment of choice, and its success may be augmented with prolonged gonadotropin-releasing hormone analog treatment. Further randomized clinical trials focusing on diverse etiopathogenic mechanisms and therapeutic innovation are necessary to find more conclusive, evidence-based answers regarding this enigmatic disease.

  • New advances in the understanding of Endometriosis related Infertility.
    Journal of reproductive immunology, 2002
    Co-Authors: Neal G Mahutte, Aydin Arici
    Abstract:

    The association between Endometriosis and Infertility is complex. Nevertheless, in the absence of tubal distortion considerable evidence suggests four principle factors likely to contribute to subfertility. These include impaired folliculogenesis, decreased fertilization, inflammatory factors in follicular, peritoneal and reproductive tract fluid, and implantation defects. The potential impact of each of these is critically examined. The role of endometriomas, prior surgeries and donor oocytes is also discussed.

Stacey A. Missmer - One of the best experts on this subject based on the ideXlab platform.

  • a prospective cohort study of Endometriosis and subsequent risk of Infertility
    Human Reproduction, 2016
    Co-Authors: Jennifer Prescott, Robert L. Barbieri, Leslie V Farland, Deirdre K Tobias, Audrey J Gaskins, Donna Spiegelman, Jorge E Chavarro, Janet W Richedwards, Stacey A. Missmer
    Abstract:

    Study question Is there a temporal relationship between Endometriosis and Infertility? Summary answer Endometriosis is associated with a higher risk of subsequent Infertility, but only among women age What is known already Endometriosis is the most commonly observed gynecologic pathology among infertile women undergoing laparoscopic examination. Whether Endometriosis is a cause of Infertility or an incidental discovery during the Infertility examination is unknown. Study design, size, duration This study included data collected from 58 427 married premenopausal female nurses Participants/materials, setting, methods Our exposure was laparoscopically confirmed Endometriosis. Multivariate Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for Infertility risk (defined as attempting to conceive for >12 months) among women with and without Endometriosis. Main results and the role of chance We identified 4612 incident cases of Infertility due to any cause over 362 219 person-years of follow-up. Compared with women without a history of Endometriosis, women with Endometriosis had an age-adjusted 2-fold increased risk of incident Infertility (HR = 2.12, 95% CI = 1.76-2.56) that attenuated slightly after accounting for parity. The relationship with Endometriosis was only observed among women Limitations, reasons for caution We did not have information on participants' intentions to conceive, but by restricting the analytic population to married women we increased the likelihood that pregnancies were planned (and therefore Infertility would be recognized). Women in our cohort with undiagnosed asymptomatic Endometriosis will be misclassified as unexposed. However, the small proportion of these women are diluted among the >50 000 women accurately classified as Endometriosis-free, minimizing the impact of exposure misclassification on the effect estimates. Wider implications of the findings This study supports a temporal association between Endometriosis and Infertility risk. Our prospective analysis indicates a possible detection bias in previous studies, with our findings suggesting that the Infertility risk posed by Endometriosis is about half the estimates observed in cross-sectional analyses. Study funding/competing interests This work was supported by the National Institutes of Health (grant numbers: UM1 CA176726, HD52473, HD57210, T32DK007703, T32HD060454, K01DK103720). We have no competing interests to declare.

  • Endometriosis and Infertility
    Annals of the New York Academy of Sciences, 2002
    Co-Authors: Robert L. Barbieri, Stacey A. Missmer
    Abstract:

    : Two major methodological problems that impact clinical research in Endometriosis are the absence of a low-cost, highly reliable method for diagnosing Endometriosis and the possibility that Endometriosis is actually multiple different diseases that we have not yet been able to differentiate. Animal models of Endometriosis clearly demonstrate that advanced Endometriosis causes reduced fertility. In humans, Endometriosis and Infertility are commonly associated. However, few data from high-quality clinical trials demonstrate that Endometriosis causes Infertility in humans. Future research should focus on the implications of the observation that, in ovarian Endometriosis cysts, the epithelium is monoclonal. This observation suggests that nonrandom somatic mutations cause ovarian Endometriosis cysts. If somatic mutations cause ovarian Endometriosis cysts, it is likely that a small number of genes can be identified that play a central role in pathogenesis of this disease.

Yu-li Qian - One of the best experts on this subject based on the ideXlab platform.

  • Prolonged gonadotropin-releasing hormone agonist therapy reduced expression of nitric oxide synthase in the endometrium of women with Endometriosis and Infertility.
    Fertility and sterility, 2006
    Co-Authors: Jian-hua Wang, Minyue Dong, Fu-zhen Zhou, Yu-li Qian
    Abstract:

    Objective To determine whether endometrial expression of endothelial nitric oxide synthase (eNOS) or inducible NOS (iNOS) protein in women with Endometriosis-associated Infertility is different from that in the fertile controls, whether GnRH agonist (GnRH-a) regulates the endometrial expression of NOS in women with Endometriosis-associated Infertility, and whether there is a correlation between serum E 2 or P levels, and the endometrial expression of eNOS or iNOS. Design Prospective controlled study. Setting University hospital for reproductive medicine and gynecologic endocrinology. Patient(s) Thirty patients with Endometriosis-associated Infertility and 19 patients with carcinoma in situ of the cervix. Intervention(s) Endometrial biopsy specimens and blood samples. Main Outcome Measure(s) Endometrial eNOS and iNOS protein relative levels and serum concentrations of E 2 or P. Result(s) By Western blot analysis, iNOS was not detected, and a unique menstrual cycle-dependent expression of eNOS was observed. Eutopic endometrium in women with Endometriosis-associated Infertility before GnRH-a treatment showed higher levels of eNOS than that of the control group. After 3 months of GnRH-a therapy, eNOS levels in the endometrium were reduced. In addition, a significant positive correlation was found between serum E 2 or P concentrations, and the endometrial expression of eNOS. Conclusion(s) The GnRH-a treatment attenuated the endometrial expression of eNOS in women with Endometriosis-associated Infertility. Endogenous ovarian steroids influence endometrial eNOS expression.

  • Peritoneal fluid concentrations of interleukin-17 correlate with the severity of Endometriosis and Infertility of this disorder.
    BJOG : an international journal of obstetrics and gynaecology, 2005
    Co-Authors: Xinmei Zhang, Jun Lin, Yu-li Qian, Lin Deng
    Abstract:

    This prospective study aimed to determine whether patients with Endometriosis are having different level of interlukin-17 (IL-17) in peritoneal fluid when compared with patients without Endometriosis. The patients with minimal/mild Endometriosis had a significantly higher level of IL-17 in peritoneal fluid compared with those with moderate/severe Endometriosis or without Endometriosis. The concentration of IL-17 in peritoneal fluid was significantly higher when Endometriosis and Infertility coexist. However, the concentration of IL-17 in peritoneal fluid did not correlate with the phase of the menstrual cycle in the patients with or without Endometriosis. Our study suggested that IL-17 might play an important role in the pathogenesis of early Endometriosis and Endometriosis-associated Infertility.

Minyue Dong - One of the best experts on this subject based on the ideXlab platform.

  • Prolonged gonadotropin-releasing hormone agonist therapy reduced expression of nitric oxide synthase in the endometrium of women with Endometriosis and Infertility.
    Fertility and sterility, 2006
    Co-Authors: Jian-hua Wang, Minyue Dong, Fu-zhen Zhou, Yu-li Qian
    Abstract:

    Objective To determine whether endometrial expression of endothelial nitric oxide synthase (eNOS) or inducible NOS (iNOS) protein in women with Endometriosis-associated Infertility is different from that in the fertile controls, whether GnRH agonist (GnRH-a) regulates the endometrial expression of NOS in women with Endometriosis-associated Infertility, and whether there is a correlation between serum E 2 or P levels, and the endometrial expression of eNOS or iNOS. Design Prospective controlled study. Setting University hospital for reproductive medicine and gynecologic endocrinology. Patient(s) Thirty patients with Endometriosis-associated Infertility and 19 patients with carcinoma in situ of the cervix. Intervention(s) Endometrial biopsy specimens and blood samples. Main Outcome Measure(s) Endometrial eNOS and iNOS protein relative levels and serum concentrations of E 2 or P. Result(s) By Western blot analysis, iNOS was not detected, and a unique menstrual cycle-dependent expression of eNOS was observed. Eutopic endometrium in women with Endometriosis-associated Infertility before GnRH-a treatment showed higher levels of eNOS than that of the control group. After 3 months of GnRH-a therapy, eNOS levels in the endometrium were reduced. In addition, a significant positive correlation was found between serum E 2 or P concentrations, and the endometrial expression of eNOS. Conclusion(s) The GnRH-a treatment attenuated the endometrial expression of eNOS in women with Endometriosis-associated Infertility. Endogenous ovarian steroids influence endometrial eNOS expression.

  • increased nitric oxide in peritoneal fluid from women with idiopathic Infertility and Endometriosis
    Journal of Reproductive Medicine, 2001
    Co-Authors: Minyue Dong, Yifu Shi, Qi Cheng, Min Hao
    Abstract:

    OBJECTIVE To verify whether nitric oxide in peritoneal fluid is associated with Endometriosis and Infertility. STUDY DESIGN Twenty-five women with idiopathic Infertility and 38 with Endometriosis were recruited, and 18 cases of uterine myomata and 2 cases of ovarian cyst served as controls. Peritoneal fluid samples were aspirated from the pouch of Douglas during laparoscopy or laparotomy. Metabolites of nitric oxide (nitrite and nitrate) in peritoneal fluid were determined by a method using nitrate reductase and the Griess reaction. RESULTS Peritoneal concentrations of nitrate/nitrite in both infertile women (42.02 +/- 12.98 mmol/L) and patients with Endometriosis (41.75 +/- 16.42 mmol/L) were significantly higher than that in controls (33.96 +/- 13.07, P .5). Peritoneal levels of nitrate/nitrite were comparable among patients with Endometriosis at different stages (P > .5). Patients with Endometriosis had more peritoneal fluid than controls and idiopathic infertile women, while controls and idiopathic infertile women had comparable amounts of peritoneal fluid. CONCLUSION An increased peritoneal level of nitric oxide is a common alteration in Endometriosis, Endometriosis-associated Infertility and idiopathic Infertility and may be associated with the pathogenesis of these diseases.

Bruce A. Lessey - One of the best experts on this subject based on the ideXlab platform.

  • characterization of uterine nk cells in women with Infertility or recurrent pregnancy loss and associated Endometriosis
    American Journal of Reproductive Immunology, 2014
    Co-Authors: Emma Giuliani, Bruce A. Lessey, Kirstin L Parkin, Steven L Young, Asgerally T Fazleabas
    Abstract:

    PROBLEM Uterine natural killer cells (uNK) have been thought to play a key role in Endometriosis and Infertility. We investigated the expression of CD56, CD16, and NKp46 in endometrial tissues from 61 women with unexplained recurrent pregnancy loss (uRPL) or Infertility (UI) and correlated this with the presence or absence of Endometriosis. The results from the patients with subfertility were compared with those from 10 fertile patients. METHOD OF STUDY Mid-secretory phase endometrial biopsies were obtained, and the endometrial expression of CD56, CD16, or NKp46 was identified by immunohistochemistry and quantified (ImageJ Software). RESULTS The percentage of CD16(+) cells was higher in women with uRPL (7.9 ± 3.2) and UI (9.0 ± 5.5), even when these conditions were associated with Endometriosis (8.9 ± 5.3), compared with fertile patients (5.6 ± 2.4, P < 0.05). Likewise, the ratio of NKp46(+) :CD56(+) cells was higher in women with uRPL (0.28 ± 0.25) and UI (0.21 ± 0.2), even when these conditions were associated with Endometriosis (0.19 ± 0.14), compared with fertile patients (0.1 ± 0.1, P < 0.05). No differences were observed when comparing CD56. CONCLUSIONS Women, with or without Endometriosis, who have larger populations of cytotoxic CD16(+) uNK cells and/or higher populations of NKp46(+) CD56(+) cells may be at greater risk of Infertility disorders resulting from an inflammatory environment occurring during implantation or later during decidualization.

  • Medical management of Endometriosis and Infertility.
    Fertility and sterility, 2000
    Co-Authors: Bruce A. Lessey
    Abstract:

    Abstract Objective: To review the literature on the use of medical management of Endometriosis and Infertility. Design: Literature review. Result(s): Endometriosis is a common finding in women with Infertility, but the mechanism by which it renders a woman infertile remains unclear. Despite many years of controversy and debate, there remains a strong bias against medical treatment for Endometriosis-associated Infertility. A review of the current literature suggests that medical management of Endometriosis may be effective in selected patients and in certain settings, including patients undergoing IVF. Conclusion(s): A closer look at the question of medical management of Endometriosis reveals that much remains to be learned before a final decision can be made about the use of medical therapies, such as GnRH agonists, for Endometriosis and associated Infertility.