Metzger D A, Haney A F
University of Connecticut, Farmingham.
Clin Obstet Gynecol. 1988 Dec;31(4):801-12. doi: 10.1097/00003081-198812000-00006.
The risk for developing endometriosis begins at puberty and extends to menopause in women of all races. The major pathway in the pathogenesis of this disease is the transplantation of endometrial cells to the pelvis and other abdominal organs via retrograde menstruation. Although retrograde menstruation appears to be a near universal occurrence, those women who are at particular risk for developing the disease have menstrual characteristics that increase the amount and duration of menstrual contamination of the pelvis. The ability of the body's immune system to remove this debris may play a significant independent role. In spite of the apparent association of infertility and endometriosis, there is a paucity of evidence to identify a clear cause-and-effect relationship or to clarify the specific mechanism(s) of infertility due to this enigmatic disease. Areas that warrant additional attention include the effect of endometriosis on ovulation, the impact of the immune system on the development of endometriosis, and the effect of peritoneal inflammation on reproduction. A better understanding of these areas will lead to more efficacious and specific therapies for endometriosis-associated infertility.
患子宫内膜异位症的风险始于青春期，并贯穿于所有种族女性的绝经前阶段。该疾病发病机制的主要途径是子宫内膜细胞通过逆行月经移植到盆腔和其他腹部器官。尽管逆行月经似乎几乎普遍存在，但那些患该疾病风险特别高的女性具有一些月经特征，这些特征会增加盆腔月经污染的量和持续时间。人体免疫系统清除这些碎片的能力可能起着重要的独立作用。尽管子宫内膜异位症与不孕症明显相关，但缺乏证据来确定明确的因果关系或阐明这种神秘疾病导致不孕的具体机制。值得进一步关注的领域包括子宫内膜异位症对排卵的影响、免疫系统对子宫内膜异位症发展的影响以及腹膜炎症对生殖的影响。对这些领域的更好理解将带来针对子宫内膜异位症相关不孕症更有效、更具特异性的治疗方法。
