Ovarian Dysfunction in Endometriosis-Associated and Unexplained Infertility

David J Cahill, Cahill DJ, D J Cahill, Wardle PG, Peter G. Wardle, P G Wardle, L A Maile, Maile LA, Christopher R. Harlow, C. R. Harlow, Harlow CR, M.G.R. Hull, M G Hull, Hull MG
Journal of assisted reproduction and genetics · 1997 · vol. 14(10) , pp. 554–557 · doi:10.1023/a:1022568331845 · PMID:9447453 · PMC3454742 · W1499501313
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Women with endometriosis and unexplained infertility showed reduced luteinizing hormone in follicular fluid and lower fertilization rates compared to those with tubal damage.

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This study compared follicular maturation, endocrine measures, and fertilization outcomes in natural, unstimulated cycles across three groups: 18 women with minor endometriosis (41 cycles), 15 with unexplained infertility (31 cycles), and 34 with tubal damage (88 cycles). It found that the endometriosis group had a longer follicular phase and that both the endometriosis and unexplained infertility groups had reduced LH concentrations in follicular fluid compared with tubal damage. Despite these endocrine similarities, endometriosis was associated with a significantly lower fertilization rate (46%) than either unexplained infertility (65%) or tubal damage (69%). The authors conclude that the findings support continuing evidence of ovulatory dysfunction affecting fertilization in minor endometriosis, while noting the study is limited to women undergoing cycles “totally unperturbed by exogenous gonadotrophins.” This paper is centrally about endometriosis — it examines ovarian dysfunction and reduced fertilization rates in endometriosis-associated infertility during natural cycles.

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Abstract

PurposeThe impact of endometriosis and unexplained infertility on follicular function and fertilization of oocytes in cycles totally unperturbed by exogenous gonadotrophins, when compared with controls with tubal damage, were examined.MethodsIn natural cycles, without any exogenous gonadotropins, endocrine and ultrasonographic studies of follicular maturation in 18 women with minor endometriosis (41 cycles), 15 women with unexplained infertility (31 cycles), and 34 women with tubal damage (88 cycles) were performed.ResultsThe endometriosis group had a significantly longer follicular phase (median: 15, 13, and 13 days). Both endometriosis and unexplained infertility had significantly reduced LH concentrations in follicular fluid compared with tubal damage (median: 12.1, 11.5, and 15.9 IU/L, respectively). Endometriosis was associated with a significantly reduced fertilization rate compared with unexplained infertility or tubal damage (46, 65, and 69%, respectively).ConclusionsThese data show continuing evidence of ovulatory dysfunction leading to reduced fertilization rates in women with minor endometriosis.
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Abstract

Purpose: The impact of endometriosis and unexplained infertility on follicular function and fertilization of oocytes in cycles totally unperturbed by exogenous gonadotrophins, when compared with controls with tubal damage, were examined.

Methods

In natural cycles, without any exogenous gonadotropins, endocrine and ultrasonographic studies of follicular maturation in 18 women with minor endometriosis (41 cycles), 15 women with unexplained infertility (31 cycles), and 34 women with tubal damage (88 cycles) were performed.

Results

The endometriosis group had a significantly longer follicular phase (median: 15,13, and 13 days). Both endometriosis and unexplained infertility had significantly reduced LH concentrations in follicular fluid compared with tubal damage (median: 12.1, 11.5, and 15.9 IU/L, respectively). Endometriosis was associated with a significantly reduced fertilization rate compared with unexplained infertility or tubal damage (46, 65, and 69%, respectively).

Conclusions

These data show continuing evidence of ovulatory dysfunction leading to reduced fertilization rates in women with minor endometriosis. Similar content being viewed by others

References

Cahill DJ, Wardle PG, Maile LA, Harlow CR, Hull MGR: Pituitary-ovarian dysfunction as a cause for endometriosis-associated and unexplained infertility. Hum Reprod 1995;10:3142–3146 Wardle PG, Mitchell JD, McLaughlin EA, Ray BD, McDermott A, Hull MGR: Endometriosis and ovulatory disorder: Reduced fertilisation in vitro compared with tubal and unexplained infertility. Lancet 1985;2:236–239 Mills MS, Eddowes HA, Cahill DJ, Fahy UM, Abuzeid MIM, McDermott A, Hull MGR: A prospective controlled study of in-vitro fertilization (IVF), gamete intrafallopian transfer (GIFT) and intrauterine insemination (IUI) combined with superovulation. Hum Reprod 1992;7:490–494 Hull MGR: Clinical disorders affecting ovulation and oocyte quality. In Cambridge Reviews in Human Reproduction: Gametes—The Oocyte, JG Grudzinskas et al. (eds). Cambridge, Cambridge University Press, 1995, pp 292–328 World Health Organisation: WHO Laboratory Manual for the Examination of Human Semen and Sperm-Mucus Interaction, 3rd Ed. Cambridge, Cambridge University Press, 1992, p 44 American Fertility Society: Revised American Fertility Society Classification of endometriosis. Fertil Steril 1985;43:351–352 Testart J, Frydman R, Feinstein MC, Thebault A, Roger M, Scholler R: Interpretation of plasma luteinizing hormone assay for the collection of mature oocytes from women definition of a luteinizing hormone surge initiating rise. Fertil Steril 1981;36:50–54 Harlow CR, Cahill DJ, Maile LA, Talbot WM, Mears J, Wardle PG, Hull MGR: Reduced preovulatory granulosa cell steroidogenesis in women with endometriosis. J Clin Endocrinol Metab 1996;8:426–429 O'Herlihy C, De Crespigny LCh, Robinson H: Monitoring ovarian follicular development with real-time ultrasound. Br J Obstet Gynaecol 1980;87:613–618 Altman DG: Practical Statistics for Medical Research. London, Chapman & Hall, 1991 Doody MC, Gibbons WE, Buttram VC: Linear regression analysis of ultrasound follicular growth series: Evidence for an abnormality of follicular growth in endometriosis patients. Fertil Steril 1988;49:47–51 Tummon IS, Macklin VM, Radwanska E, Binor Z, Dmowski WP: Occult ovulatory dysfunction in women with minimal endometriosis or unexplained infertility. Fertil Steril 1988;50:716–720 Mahadevan MM, Trounson AO, Leeton JF: The relationship of tubal blockage, infertility of unknown cause, suspected male infertility, and endometriosis to success of in-vitro fertilisation and embryo transfer. Fertil Steril 1983;40:755–762 Matson PL, Yovich JL: The treatment of infertility associated with endometriosis by in vitro fertilisation. Fertil Steril 1986;46:432–434 Mahmood TA, Arumugam K, Templeton AA: Oocyte and follicular fluid characteristics in women with mild endometriosis. Br J Obstet Gynaecol 1991;98:573–577 Dlugi AL, Loy RA, Dieterle S, Bayer SR, Seibel MM: The effect of endometriomas on in vitro fertilization outcome. J In Vitro Fert Embryo Transfer 1989;6:338–341 Lelaider C, Caetano JAJ, Frydman R: In vitro fertilization and endometriosis. In Current Status of Endometriosis—Research and Management (Proceedings, 3rd World Congress on Endometriosis), I Brosens, J Donnez (eds). Camforth, UK, Parthenon, 1993, pp 419–424 Cahill DJ, Wardle PG, Harlow CR, Hull MGR: Effect of progestogen therapy on follicular development related hormone concentrations and fertilization in vitro in unstimulated cycles and unexplained and endometriosis-associated infertility. Hum Reprod 1996;11:647–650 Author information Authors and Affiliations Rights and permissions About this article Cite this article Cahill, D.J., Wardle, P.G., Maile, L.A. et al. Ovarian Dysfunction in Endometriosis-Associated and Unexplained Infertility. J Assist Reprod Genet 14, 554–557 (1997). https://doi.org/10.1023/A:1022568331845 Issue date: DOI: https://doi.org/10.1023/A:1022568331845

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Infertility, Female Ovary Adult Endometriosis Endometriosis Estradiol Estradiol Estradiol Female Fertilization in Vitro Follicle Stimulating Hormone Follicle Stimulating Hormone Follicle Stimulating Hormone Follicular Fluid Follicular Fluid Humans Infertility, Female Luteinizing Hormone Luteinizing Hormone

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