Atualizações acerca dos mecanismos etiopatogênicos que promovem a infertilidade associada a endometriose: uma revisão de literatura

Today, it is known that endometriosis is a chronic gynecological disease, of an inflammatory nature, marked by the presence of endometrial tissue outside the uterus (ectopic), dependent on estrogen. Endometriosis can be classified as superficial, ovarian and deep, in addition to extrapelvic and is mainly marked by dyspareunia, dysmenorrhea, dysuria, dyschezia and infertility (a challenge for 30 to 50% of these women). Objective: To identify the etiopathogenic mechanisms that could explain the prevalence of infertility in women with endometriosis. Materials and Methods: This is an integrative literature review about the new evidence that justifies infertility in women with endometriosis. The PICO strategy was used to prepare the guiding question. In addition, the descriptors “endometriosis”, “infertility”, “pathogenesis” and “etiology” were crossed in the databases National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (SCIELO), Google Scholar and Biblioteca Virtual Health (VHL). Results and Discussion: The environment provided by endometriosis promotes several changes, including: the high inflammatory character, cytokine imbalance, oxidative stress and changes in follicular and peritoneal fluid. The immune system seems to be impaired, with changes in the function of most immune cells. Hormonal imbalance, genetic and epigenetic factors are also fundamental. Conclusion: The association between infertility and endometriosis seems to impair conception due to changes in follicular fluid and folliculogenesis, reduced oocyte quality, changes in implantation window, sperm changes and ciliary cell dysfunction.

Bedaiwy M. A. (2022). Endometrial cytokines, endometriosis and infertility: a deeper dive into the endometrial immune microenvironment. Fertility and sterility, 117(3), 641–642. https://doi.org/10.1016/j.fertnstert.2022.01.023 Bonavina, G., & Taylor, H. S. (2022). Endometriosis-associated infertility: From pathophysiology to tailored treatment. Frontiers in endocrinology, 13, 1020827. https://doi.org/10.3389/fendo.2022.1020827 Broi, M. G. D., Ferriani, R. A., & Navarro, P. A. (2019). Ethiopathogenic mechanisms of endometriosis-related infertility. JBRA assisted reproduction, 23(3), 273–280. https://doi.org/10.5935/1518-0557.20190029 Cardoso, J. K, Machado, D. E., Silva, M. C., Berardo, P. T., Ferrari, R., Abrão, M. S., & Perini, J. A. (2020). Perfil epidemiológico de mulheres com endometriose: um estudo descritivo retrospective. Revista Brasileira de Saúde Materna. 20(4), 1069-1079. Coccia, M. E., Nardone, L., & Rizzello, F. (2022). Endometriosis and Infertility: A Long-Life Approach to Preserve Reproductive Integrity. International journal of environmental research and public health, 19(10), 6162. https://doi.org/10.3390/ijerph19106162 De Souza, T. M., Da Silva, D. M., & De Carvalho, R. (2010). Revisão integrativa: o que é e como fazer. Einstein, 8(1). https://doi.org/10.1590/S1679-45082010RW1134 Duarte, A. N., & Righi, G. G. (2021). A associação entre endometriose e infertilidade feminina: uma Revisão de literature. Acta Elit Salutis. 4(1). Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) (2021). Endometriose. FEBRASGO, 2021 (Protocolo FEBRASGO-Ginecologia, n. 78/Comissão Nacional Especializada em Endometriose). Filip, L., Duică, F., Prădatu, A., Crețoiu, D., Suciu, N., Crețoiu, S. M., Predescu, D. V., Varlas, V. N., & Voinea, S. C. (2020). Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches. Medicina (Kaunas, Lithuania), 56(9), 460. https://doi.org/10.3390/medicina56090460. Hodgson, R. M., Lee, H. L., Wang, R., Mol, B. W., & Johnson, N. (2020). Interventions for endometriosis-related infertility: a systematic review and network meta-analysis. Fertility and sterility, 113(2), 374–382.e2. https://doi.org/10.1016/j.fertnstert.2019.09.031 Horne, A. W., & Missmer, S. A. (2022). Pathophysiology, diagnosis, and management of endometriosis. BMJ (Clinical research ed.), 379, e070750. https://doi.org/10.1136/bmj-2022-070750 Lamceva, J., Uljanovs, R., & Strumfa, I. (2023). The Main Theories on the Pathogenesis of Endometriosis. International journal of molecular sciences, 24(5), 4254. https://doi.org/10.3390/ijms24054254 Leonardi, M., Gibbons, T., Armour, M., Wang, R., Glanville, E., Hodgson, R., Cave, A. E., Ong, J., Tong, Y. Y. F., Jacobson, T. Z., Mol, B. W., Johnson, N. P., & Condous, G. (2020). When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis. Journal of minimally invasive gynecology, 27(2), 390–407.e3. https://doi.org/10.1016/j.jmig.2019.10.014 Li, H., Han, Y., Cai, Y., Su, X., & Tan, L. (2023). Clinical effects of laparoscopic surgery for the treatment of endometriosis and endometriosis-fertility: A retrospective study of 226 cases. Frontiers in surgery, 9, 1049119. https://doi.org/10.3389/fsurg.2022.1049119 Saunders, P. T. K., & Horne, A. W. (2021). Endometriosis: Etiology, pathobiology, and therapeutic prospects. Cell, 184(11), 2807–2824. https://doi.org/10.1016/j.cell.2021.04.041 Smolarz, B., Szyłło, K., & Romanowicz, H. (2021). Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). International journal of molecular sciences, 22(19), 10554. https://doi.org/10.3390/ijms221910554 Tanbo, T., & Fedorcsak, P. (2017). Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta obstetricia et gynecologica Scandinavica, 96(6), 659–667. https://doi.org/10.1111/aogs.13082 Thomas, C., Metello, J. L. (2019). Endometriose e infertilidade – onde estamos? Acta Obstétrica e Ginecológica Portuguesa. 13(4), 235-241. Vannuccini, S., Clemenza, S., Rossi, M., & Petraglia, F. (2022). Hormonal treatments for endometriosis: The endocrine background. Reviews in endocrine & metabolic disorders, 23(3), 333–355. https://doi.org/10.1007/s11154-021-09666-w Kanellopoulos, D., Karagianni, D., Pergialiotis, V., Nikiteas, N., Lazaris, A. C., & Iliopoulos, D. (2022). Endometriosis and Subfertility: A Literature Review. Maedica, 17(2), 458–463. https://doi.org/10.26574/maedica.2022.17.2.458 Kolanska, K., Alijotas-Reig, J., Cohen, J., Cheloufi, M., Selleret, L., d'Argent, E., Kayem, G., Valverde, E. E., Fain, O., Bornes, M., Darai, E., & Mekinian, A. (2021). Endometriosis with infertility: A comprehensive review on the role of immune deregulation and immunomodulation therapy. American journal of reproductive immunology (New York, N.Y: 1989), 85(3), e13384. https://doi.org/10.1111/aji.13384 Downloads Published Issue Section License Copyright (c) 2023 Beatriz Tassi Coutinho; Lívia Paiva Ferreira; Márcio José Rosa Requeijo This work is licensed under a Creative Commons Attribution 4.0 International License. Authors who publish with this journal agree to the following terms: 1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. 2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. 3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.