Endometriosis – It’s influence on obstetric and birth outcomes and the potential role of reactive oxygen species

The gynaecological conditions of endometriosis and adenomyosis are believed to affect up to 10% of women of child-bearing age in the UK and can cause debilitating pain, infertility and significant burden on healthcare economics. Many important aspects of the pathogenesis and health impacts of the diseases remain elusive. One more recently discovered culprit is that of reactive oxygen species which has been linked not only to the pathogenic process but also to progression of the diseases and their impact on both pain and fertility. Reactive oxygen species are difficult to measure and study in vivo and their relationship with endometriosis therefore remains undetermined. What remains lacking in our knowledge of two prevalent and debilitating diseases is a full understanding of the pathogenesis and disease progression, how they cause pain and infertility, how they impact on pregnancy and health of any offspring and a reliable non-invasive test and effective treatment. Reactive oxygen species may play a key role across all of these themes. This thesis sets out to investigate 1) the influence of endometriosis on the reproductive process from fertility parameters to perinatal outcomes and explore a possible role of Developmental Origins of Health and Disease theory in women with the disease 2) whether reactive oxygen species levels are different in women with endometriosis compared to women without endometriosis and whether levels of reactive oxygen species are improved following surgical treatment of disease and 3) how reactive oxygen species affect the oocyte using a reproductive fluid of women affected by endometriosis in an ethically approved human study and murine model.