Aretaeio Hospital, University of Nicosia Medical School, Nicosia, Cyprus.
St George's, University of London, London, UK.
Hum Fertil (Camb). 2022 Feb;25(1):4-12. doi: 10.1080/14647273.2020.1720316. Epub 2020 Feb 6.
Junctional zone endometrium (JZE) thickness and contractility seem to determine gamete and embryo transportation and implantation. Proper function depends on concentration levels, mode and timing of oestrogen and progesterone production. Most probably, the remodelling of spiral arteries, and the development of endometrium and decidua are also highly dependent on JZE activity. Fibroids that are adjacent to JZE affect JZE contractility contributing to abnormal or failed implantation. Disruption of the JZE continuity provokes adenomyosis, a condition that causes chronic inflammation and fibrosis, which negatively affects the normal function of JZE. Imaging by magnetic resonance imaging and three-dimensional sonography can diagnose JZE abnormal appearance, alterations in thickening and contractility frequency, usually in the advanced stage of the disease. Failures of assisted reproduction, and adverse early pregnancy outcomes have also been associated with abnormal JZE. Altered uterine contractions due to JZE changes are strongly associated with poor reproductive outcome and early pregnancy loss. Endometriosis and adenomyosis prevalently co-exist, with clear relation and negative effects on the JZE. The presence of endometriosis should alert to the possibility of coexisting adenomyosis. Co-existence of endometriosis may mask the extent of the negative impact of adenomyosis in infertility.
交界带子宫内膜（JZE）的厚度和收缩似乎决定了配子和胚胎的运输和着床。适当的功能取决于雌激素和孕激素的产生浓度、模式和时间。螺旋动脉的重塑、子宫内膜和蜕膜的发育也极有可能高度依赖于 JZE 的活性。邻近 JZE 的肌瘤会影响 JZE 的收缩性，导致异常或着床失败。JZE 连续性的破坏会引发子宫腺肌病，这是一种导致慢性炎症和纤维化的疾病，会对 JZE 的正常功能产生负面影响。磁共振成像和三维超声成像可以诊断 JZE 的异常外观、增厚和收缩频率的改变，通常在疾病的晚期。辅助生殖的失败和不良的早期妊娠结局也与异常的 JZE 有关。由于 JZE 变化引起的子宫收缩异常与不良的生殖结局和早期妊娠丢失密切相关。子宫内膜异位症和子宫腺肌病普遍共存，且与 JZE 有明确的关系和负面影响。子宫内膜异位症的存在应引起对并存的子宫腺肌病的可能性的警觉。子宫内膜异位症的共存可能掩盖了子宫腺肌病对不孕的负面影响的程度。
