Evaluation of the Phthalate Esters in South Indian Women with Endometriosis

Background: To evaluate the possible association between phthalate esters (PEs) and the occurrenceof endometriosis. Blood samples were collected from 99 infertile women with endometriosis (studygroup); 135 age-matched women without endometriosis (control group) but with infertility relatedto tubal defects, fibroids, polycystic ovaries, idiopathic infertility and pelvic inflammatory diseasesdiagnosed by laparoscopy with no evidence of endometriosis or other gynecological disordersduring laparoscopic sterilization.Materials and Methods: This is a prospective case-control study, which recruited womenundergoing infertility treatment at three collaborating centers (BMMHRC: Bhagwan MahavirMedical Hospital and Research Centre, MHRT: Maternal Health and Research Trust, and OwaisiHospital and Research Center) of Reproductive Medicine Hyderabad, which receives cases fromall over the region of Andhra Pradesh, India. The concentrations of Phthalate Esters were measuredby using the High Performance Liquid Chromatography (HPLC).Evaluation of Phthalate Esters concentrations in women with endometriosis compared with womenwho are free from the disease.Results: Women with endometriosis showed significantly higher concentrations of Phthalate esters(Dimethyl phthalate (DMP), Diethyl phthalate (DEP), Di-n-butyl phthalate (DnBP), Butyl benzylphthalate (BBP) and Bis (2-ethylhexyl) phthalate (BEHP)) compared with control group. Wefound that (38%) of the cases with endometriosis and (21%) of the control group. The correlationbetween the concentrations of Phthalate esters and different severity of endometriosis was strongand statistically significant at p<0.05 for all five compounds (DMP): r=+0.57, p<0.0001; DnBPr=+0.39, p<0.0001; BBP: r=+0.89, p<0.0001; DnOP: r=+0.66, p<0.0001 and BEHP: r=+0.33,p<0.0014.Conclusion: This study for the first time from Indian subcontinent demonstrates that possiblyPhthalate Esters might have a role in etiology of endometriosis.