Department of Obstetrics and Gynecology, Sao Paulo University, Sao Paulo, Brazil.
Int J Gynaecol Obstet. 2013 Dec;123 Suppl 2:S18-24. doi: 10.1016/j.ijgo.2013.09.008. Epub 2013 Sep 11.
The main female anatomical causes of infertility include post-infectious tubal damage, endometriosis, and congenital/acquired uterine anomalies. Congenital (septate uterus) and acquired (myomas and synechiae) diseases of the uterus may lead to infertility, pregnancy loss, and other obstetric complications. Pelvic inflammatory disease represents the most common cause of tubal damage. Surgery still remains an important option for tubal factor infertility, with results in terms of reproductive outcome that compare favorably with those of in vitro fertilization. Endometriosis is a common gynecologic condition affecting women of reproductive age, which can cause pain and infertility. The cause of infertility associated with endometriosis remains elusive, suggesting a multifactorial mechanism involving immunologic, genetic, and environmental factors. Despite the high prevalence of endometriosis, the exact mechanisms of its pathogenesis are unknown. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. In the majority of cases, surgical treatment of endometriosis has promoted significant increases in fertilization rates. There are obvious associations between endometriosis and the immune system, and future strategies to treat endometriosis might be based on immunologic concepts.
女性不孕的主要解剖学原因包括感染后输卵管损伤、子宫内膜异位症和先天性/获得性子宫畸形。先天性（纵隔子宫）和获得性（子宫肌瘤和粘连）子宫疾病可导致不孕、流产和其他产科并发症。盆腔炎是输卵管损伤的最常见原因。手术仍然是治疗输卵管性不孕的重要选择，其生殖结局与体外受精相当。子宫内膜异位症是一种常见的妇科疾病，影响育龄妇女，可引起疼痛和不孕。与子宫内膜异位症相关的不孕原因仍不清楚，提示涉及免疫、遗传和环境因素的多因素机制。尽管子宫内膜异位症的患病率很高，但其发病机制的确切机制尚不清楚。特定的医疗、手术和心理治疗组合可以改善子宫内膜异位症患者的生活质量。在大多数情况下，子宫内膜异位症的手术治疗显著提高了受精率。子宫内膜异位症与免疫系统之间存在明显关联，未来治疗子宫内膜异位症的策略可能基于免疫概念。
