F.Petraglia1,5

BACKGROUND: Emerging evidence suggests a potential role for ubiquitous environmental contaminants in the physiopathology of endometriosis. Di-(2-ethylhexyl)-phthalate (DEHP), the most commonly used plasticizer in ¯ex-ible polyvinylchloride (PVC) formulations, is a widespread environmental contaminant with potentially adverse effects on fertility in animal models. In the present study, we tested the hypothesis that DEHP and/or and its main metabolite, mono-ethylhexyl phthalate (MEHP), play a role in the pathogenesis of endometriosis. METHODS: Specimens of blood and peritoneal ¯uid were collected in a group of women with endometriosis (n = 55), and in age-matched control women (n = 24). Concentrations of DEHP and MEHP were measured in plasma and peritoneal ¯uid by using high performance liquid chromatography (HPLC). Differences between groups were tested using the Fisher's exact test, Wilcoxon-test, and Kruskal±Wallis analysis of variance. RESULTS: Endometriotic women showed signi®cantly higher plasma DEHP concentrations than controls (median 0.57 mg/ml, interquartile range: 0.06±1.23; values range: 0±3.24 versus median 0.18 mg/ml, interquartile range: 0±0.44; values range: 0±1.03; P = 0.0047) and 92.6 % of them had detectable DEHP and /or MEHP in the peritoneal ¯uid. No signi®cant differences in either the DEHP/MEHP plasma concentrations (P> 0.31) or DEHP/MEHP peritoneal ¯uid concentrations (P>