ENDOMETRIC FACTOR OF ENDOMETRIOSIS-ASSOCIATED INFERTILITY

In: Reproductive Medicine · 2020 · pp. 28–38 · doi:10.37800/rm2020-1-22 · W3211184459
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This review examines molecular genetic features of the endometrium in endometriosis-associated infertility, highlighting progesterone resistance and estrogen overproduction as key pathogenic factors.

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The paper reviews molecular-genetic features of the endometrium in endometriosis-associated infertility, drawing on searches of domestic and international publications from the past 1–16 years. It focuses on how altered endometrial receptivity is linked to progesterone resistance and excess estrogen production as key mechanisms contributing to infertility, and it provides a theoretical rationale for hormonal preimplantation preparation of compromised endometrium. A major caveat stated is that there is no unified opinion or consistent approach for defining endometrial receptivity and its role in implantation disorders in endometriosis, and the pathogenesis of endometriosis-associated infertility remains incompletely understood. This paper is centrally about endometriosis-associated infertility — specifically, molecular/genetic endometrial receptivity changes (including progesterone resistance and estrogen excess) and their theoretical implications for hormonal preimplantation preparation.

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Abstract

BACKGROUND Despite numerous studies and a not decreasing amount of endometriosis and associated infertility, the study of endometriosis- associated infertility does not lose its relevance, and the characteristics of the endometrium is appeared to be central and predictive factors that determine the success of overcoming infertility. OBJECTIVE To reflect the molecular genetic features of the state of the endometrium with endometriosis associated with infertility, expand the understanding of its pathogenesis, substantiate theoretical aspects of the use of hormonal preimplantation preparation of the endometrium in endometriosis-associated infertility. MATERIALS AND METHODS To write this review, we searched for domestic and foreign publications in Russian and international search systems (eLIBRARY, PubMed, MedLine, Crossref, etc.) over the past 1–16 years. RESULTS The model of changes in endometrial receptivity is examined the mechanisms of resistance to progesterone and overproduction of estrogens as key endometrial factors in the pathogenesis of endometriosis-associated infertility and theoretical justification for the use of hormonal therapy for the preimplantation preparation of compromised endometrium is given. CONCLUSION Despite the large number of publications, there is no consensus and the same approaches to determining the receptivity of the endometrium and its role in implantation disorders in endometriosis, as well as clear ideas about the pathogenesis of endometriosis-associated infertility. A personalized approach in the management of patients with endometriosis-associated infertility will lead to a common denominator of many factors affecting reproduction and determine their potential role in both the diagnosis and treatment of a particular patient.
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Эндометриальный фактор эндометриоз-ассоциированного бесплодия DOI: https://doi.org/10.37800/RM2020-1-22Ключевые слова: эндометриоз, бесплодие, рецептивность эндометрия, имплантация, резистентность к прогестерону, дидрогестеронАннотация АКТУАЛЬНОСТЬ: Несмотря на многочисленные исследования и не снижающееся количество эндометриоза и связанной с ним инфертильности, изучение эндометриоз-ассоциированного бесплодия не теряет своей актуальности, а особенности состояния эндометрия представляются центральными и предиктивными факторами, определяющими успех преодоления бесплодия. ЦЕЛЬ: Отразить молекулярно-генетические особенности состояния эндометрия при эндометриозе, ассоциированным с бесплодием, расширить представления о его патогенезе, обосновать теоретические аспекты применения гормональной предимплантационной подготовки эндометрия при эндометриоз-ассоциированном бесплодии. МАТЕРИАЛЫ И МЕТОДЫ: Для написания данного обзора был осуществлен поиск отечественных и зарубежных публикаций в российских и международных системах поиска (eLIBRARY, PubMed, MedLine, Crossref и пр.) за последние 1–16 лет. РЕЗУЛЬТАТЫ: На модели изменения рецептивности эндометрия рассмотрены механизмы резистентности к прогестерону и гиперпродукции эстрогенов в качестве ключевых эндометриальных факторов в патогенезе эндометриоз-ассоциированного бесплодия, дано теоретическое обоснование применение гормональной терапии с целью предимплантационной подготовки скомпрометированного эндометрия. ЗАКЛЮЧЕНИЕ: Несмотря на большое количество публикаций не существует единого мнения и одинаковых подходов к определению рецептивности эндометрия и его роли в имплантационных нарушениях при эндометриозе, а также четких представлений о патогенезе эндометриоз-ассоциированного бесплодия. 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