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Review
. 2019 Aug 22;23(3):273-280.
doi: 10.5935/1518-0557.20190029.

Ethiopathogenic mechanisms of endometriosis-related infertility

Michele Gomes Da Broi  1 , Rui Alberto Ferriani  1   2 , Paula Andrea Navarro  1   2
Affiliations
Review

Ethiopathogenic mechanisms of endometriosis-related infertility

Michele Gomes Da Broi et al. JBRA Assist Reprod. .

Abstract

Endometriosis is a highly prevalent disease among women of reproductive age and is frequently associated to infertility. However, the mechanisms underlying endometriosis-related infertility are still not completely known. Several studies have been conducted in order to elucidate this question. Besides anatomical changes that may impair gametes and embryo transport along the tubes; a smaller ovarian reserve due to advanced endometriosis and endometriomas; and a dysregulated hypothalamic-pituitary-ovarian axis, there are pieces of evidence suggesting that the peritoneal ectopic endometrial foci may induce a local inflammatory response, with the recruitment of macrophages, cytokine release, and reactive oxygen species generation, leading to a pro-oxidant peritoneal microenvironment. These alterations may be systemically reflected and also affect the follicular microenvironment. A harmful follicular fluid may disrupt cumulus cells functions and, consequently, compromise oocyte competence. There is also evidence suggesting that the peritoneal fluid of women with endometriosis may alter sperm function. Reduced endometrial receptivity is also pointed as a possible mechanism involved in endometriosis-related infertility, which needs further investigation.

Keywords: endometriosis; etiopathogenesis; infertility.

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