Hernández-Valencia Marcelino, Zárate Arturo
Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México, Mexico.
Rev Med Inst Mex Seguro Soc. 2009 Jan-Feb;47(1):57-60.
Endometriosis is the third cause of gynecological morbidity and the complications are associated to ectopically endometrial tissue implantation. The interest on this disease is the functional disability and its association with sterility. It has been established that endometrial growth is estrogen-dependent and that progesterone inhibits the cellular proliferation mediated by estrogens, therefore in endometriosis there is not an adequate response to hormonal signals that control the proliferative activity. It has been described that peritoneal fluid in women with endometriosis has high concentrations of cytokines, growth factors and activated macrophages, which have been shown to have adverse effects on fertility. Therefore, these are not the only causes of infertility since it has been described that women with endometriosis seem to have poor ovarian reserve and ovular quality. When there is infertility, the tendency is to treat the endometriosis due to the changes caused by ectopic tissue presented at the immunological level and in the structure of genital organs, which disturbs the conception process. It has been observed that endometriosis recurs after a surgical procedure. For this reason we should be consider all therapeutic possibilities.
子宫内膜异位症是妇科发病的第三大原因，其并发症与异位子宫内膜组织植入有关。对这种疾病的关注在于其功能障碍以及与不孕的关联。已经确定子宫内膜的生长依赖于雌激素，而孕激素会抑制雌激素介导的细胞增殖，因此在子宫内膜异位症中，对控制增殖活性的激素信号没有足够的反应。据描述，患有子宫内膜异位症的女性腹腔液中含有高浓度的细胞因子、生长因子和活化巨噬细胞，这些已被证明对生育能力有不利影响。然而，这些并非不孕的唯一原因，因为据描述，患有子宫内膜异位症的女性似乎卵巢储备和卵子质量较差。当出现不孕情况时，由于异位组织在免疫水平和生殖器官结构上所引起的变化会干扰受孕过程，所以倾向于治疗子宫内膜异位症。据观察，子宫内膜异位症在手术后会复发。因此，我们应该考虑所有的治疗可能性。
