Gupta Sajal, Goldberg Jeffrey M, Aziz Nabil, Goldberg Eric, Krajcir Natalie, Agarwal Ashok
Reproductive Research Center, Department of Obstetrics and Gynecology and Glickman Urological Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
Fertil Steril. 2008 Aug;90(2):247-57. doi: 10.1016/j.fertnstert.2008.02.093.
To review the mechanisms by which endometriosis may affect reproductive function.
Review of the English literature from 1986 to 2007 after searching Medline, EMBASE, Cochrane, and BIOSIS, as well as relevant meeting abstracts.
Fertility research center and obstetrics and gynecology department in a tertiary care hospital.
RESULT(S): There is compelling evidence in the literature that endometriosis has detrimental effects on ovarian and tubal function and uterine receptivity, resulting in female infertility. The mechanisms of infertility associated with endometriosis remain controversial and include abnormal folliculogenesis, elevated oxidative stress, altered immune function, and hormonal milieu in the follicular and peritoneal environments, and reduced endometrial receptivity. These factors lead to poor oocyte quality, impaired fertilization, and implantation.
CONCLUSION(S): Through unraveling the mechanisms by which endometriosis leads to infertility, researchers are sure to find a nonsurgical means to diagnose endometriosis, most likely through serum and peritoneal markers. Cytokines, interleukins, oxidative stress markers, and soluble cellular adhesion molecules all show potential to be used as a reliable marker for diagnosing endometriosis. After analyzing the pathogenic mechanisms of endometriosis, it seems that the future treatment of this entity may include cyclo-oxygenase-2 inhibitors, immunomodulators, or hormonal suppressive therapy to eliminate the need for surgical treatment of endometriosis.
综述子宫内膜异位症可能影响生殖功能的机制。
检索1986年至2007年的英文文献，检索数据库包括Medline、EMBASE、Cochrane和BIOSIS，以及相关会议摘要。
一家三级护理医院的生育研究中心及妇产科。
文献中有确凿证据表明，子宫内膜异位症对卵巢和输卵管功能以及子宫容受性有不利影响，导致女性不孕。与子宫内膜异位症相关的不孕机制仍存在争议，包括卵泡发生异常、氧化应激升高、免疫功能改变、卵泡和腹膜环境中的激素环境，以及子宫内膜容受性降低。这些因素导致卵母细胞质量差、受精受损和着床失败。
通过阐明子宫内膜异位症导致不孕的机制，研究人员肯定能找到一种非手术方法来诊断子宫内膜异位症，很可能是通过血清和腹膜标志物。细胞因子、白细胞介素、氧化应激标志物和可溶性细胞黏附分子都显示出有潜力用作诊断子宫内膜异位症的可靠标志物。在分析了子宫内膜异位症的发病机制后，未来对该疾病的治疗似乎可能包括使用环氧化酶-2抑制剂、免疫调节剂或激素抑制疗法，从而无需对子宫内膜异位症进行手术治疗。
