Abstract
Approximately, 10–15% of women of reproductive age are affected by endometriosis, which often leads to infertility. Endometriosis often has an inherited component, and several causative predisposing factors are hypothesized to underlie the pathogenesis of endometriosis. One working hypothesis is the theory of retrograde menstruation. According to the theory of retrograde menstruation, components of refluxed blood, including apoptotic endometrial tissue, desquamated menstrual cells, lysed erythrocytes, and released iron, induce inflammation in the peritoneal cavity. This in turn activates macrophage release of reactive oxygen species (ROS), leading to oxidative stress via the respiratory burst. Refluxed blood promotes the Fenton reaction, terminating in the production of hydroxyl radical, the most potently destructive ROS. In this article, we review the papers that demonstrate decreased quantity and quality of oocytes and embryos retrieved from IVF/ICSI patients with endometriosis. We discuss literature data demonstrating that ROS are generated in endometriotic tissues that have physical proximity to gametes and embryos, and demonstrating adverse impacts on oocyte, sperm and embryo microtubule apparatus, chromosomes, and DNA. Data that addresses the notions that endometriosis causes oocyte and fetal aneuploidy and that these events are mediated by ROS species are also discussed. Literature data are also discussed that employ use of anti-oxidant molecules to evaluate the importance of ROS-mediated oxidative damage in the pathogenesis of endometriosis. Studies are discussed that have employed anti-oxidants compounds as therapeutics to improve oocyte and embryo quality in infertile subjects, and improve fertility in patients with endometriosis.
Highlights
Endometriosis is a disease in which endometrial cells migrate outside the uterine cavity and form “implants” that colonize in distal tissues
For patients with American Society of Reproductive Medicine (ASRM) I and II endometriosis there is a good prognosis for successful infertility treatment using either surgical, or medical treatment and/or assisted reproductive techniques (ART)
We discuss evidence that highly reactive free radical species, especially reactive oxygen species (ROS) generated in endometriosis patients damage intracellular structures and genomic material to adversely impact the structural integrity and viability of oocytes, sperm, and embryos, evaluate literature data that implicates oocyte and fetal aneuploidy as contributing factors for infertility caused by endometriosis, and we discuss therapeutic horizons for treatment of endometriosis patients with antioxidant therapies
Summary
Endometriosis is a disease in which endometrial cells migrate outside the uterine cavity and form “implants” that colonize in distal tissues. These include but are not limited to the fallopian tube, the ovary, and peritoneum [1]. For patients with ASRM I and II endometriosis there is a good prognosis for successful infertility treatment using either surgical, or medical treatment and/or assisted reproductive techniques (ART). While there is a 60–70% cumulative clinical pregnancy rate for ASRM I/II patients undergoing ART, the other treatments could be successful and to date there is no unified view as to what kind of therapy should be recommended for these patients [5]. We discuss evidence that highly reactive free radical species, especially reactive oxygen species (ROS) generated in endometriosis patients damage intracellular structures and genomic material to adversely impact the structural integrity and viability of oocytes, sperm, and embryos, evaluate literature data that implicates oocyte and fetal aneuploidy as contributing factors for infertility caused by endometriosis, and we discuss therapeutic horizons for treatment of endometriosis patients with antioxidant therapies
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