CAUSES OF INFERTILITY DUE TO ENDOMETRIOSIS

Prolactin problems

Prolactin is a hormone that is secreted by the pituitary gland which helps to control ovulation. Research has shown that the levels of prolactin in women with endometriosis are higher than that found in women in general. The high levels of prolactin may contribute to infertility in women with endometriosis but the role that they play is unknown.

Luteinised unruptured follicle syndrome

Luteinised unruptured follicle syndrome, usually known as LUF syndrome, occurs when the ovarian follicle matures and prepares itself for ovulation but at the time of ovulation the follicle fails to rupture and release the ovum.

LUF syndrome is very hard to detect because the usual methods of determining whether or not ovulation has taken place, such as basal body temperature charts and measuring progesterone levels in the second half of the cycle, all indicate that ovulation has occurred. It can only be reliably detected by inspecting the follicle during a laparoscopy or by measuring the size of the follicle during repeated ultrasound scans. In the past many researchers thought that the LUF syndrome was a major cause of infertility in women with endometriosis. However, now many researchers believe that it does not play a significant role and some believe that the LUF syndrome is probably just a random event which occurs in most women from time to time.

Prostaglandins

Prostaglandins are substances that are produced by many tissues throughout the body, including endometrial implants. One of their functions is to control the contraction and relaxation of the muscles in many of the internal organs of the body, including the uterus and fallopian tubes.

It is thought that women with endometriosis have higher concentrations of prostaglandins in their peritoneal fluid and that these higher concentrations may contribute to infertility by hindering or preventing conception and implantation in a number of ways.

It is possible that prostaglandins interfere with the functioning of the ovaries and prevent the release of the ovum thereby preventing fertilization.

Prostaglandins may affect the sperm as they move towards the ovum by slowing down their movement and thus reducing the number of healthy sperm that can reach the ovum in time for fertilization.

Prostaglandins help the ovum move along the fallopian tube.

If the fertilized ovum is propelled too rapidly along the tube the ovum will reach the uterus too quickly. Therefore, when the fertilized ovum reaches the uterus it may not be mature enough to implant itself in the endometrium or the endometrium may not be ready to accept the fertilized ovum. If the fertilized ovum is propelled too slowly down the fallopian tube it may not reach the uterus in time to embed itself in the endometrium.

Prostaglandins may also affect the relaxation and contraction of the uterus. If they produce excessive contractions of the uterus they may prevent implantation of the fertilized ovum or they may cause it to be expelled soon after implantation.

Macrophages

Macrophages, sometimes referred to as scavenger cells, are a special type of white blood cell which are found throughout the body. The function of these cells is to consume or ‘eat up’ and eliminate any unwanted debris or foreign material in the body, including sperm cells.

Women with endometriosis have an increased number of macrophages in their bodies, particularly in their pelvic cavity and fallopian tubes. Consequently, the macrophages are able to consume and destroy larger numbers of sperm than normally occurs, reducing the number of sperm available for fertilization of the ovum.

Auto-immune response

Some women with endometriosis develop an abnormal immune response against their endometrial implants. It is thought that the immune system of these women for some, as yet unknown, reason thinks that the implants are foreign material and therefore begins to produce antibodies against them in an attempt to destroy them. The immune system also perceives the normal endometrium in the uterus as being foreign material and therefore produces antibodies against it as well in an attempt to destroy it. If the immune reaction is strong enough the antibodies produced in the uterine endometrium may prevent implantation of the fertilized ovum.

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