Endometriosis affects millions of women worldwide, yet it remains a widely misunderstood condition. Characterised by the presence of endometrial-like tissue outside the uterus, it can lead to severe pain, infertility, and other complications. Understanding its symptoms and diagnostic methods is crucial for early detection and effective management (Saunders & Horne, 2021). Endometriosis has the potential to hinder fertility by inducing peritoneal inflammation, disrupting endocrine function, and interfering with the follicular fluid. These mechanisms can adversely impact ovarian function, leading to a decline in oocyte quality (Hu et al., 2023).
Diagnosis
Diagnosing endometriosis often requires a comprehensive approach. While ultrasound can offer some insights, laparoscopy remains the gold standard for definitive diagnosis. If a general practitioner suspects endometriosis, they may recommend keeping a symptom diary and conducting abdominal and pelvic examinations. Importantly, a normal ultrasound or pelvic exam does not rule out the possibility of endometriosis, emphasising the need for thorough evaluation (Nisenblat et al., 2016).
Key Insights
Oestrogen Dependence: Endometriosis is influenced by oestrogen, but other factors are also at play. Even with normal oestrogen levels, the condition can still manifest, highlighting its complex nature (McCallion et al., 2022).
Inflammatory Factors: Oestrogen and histamine play roles in inflammation within the female reproductive tract, impacting pain sensitivity and exacerbating symptoms (McCallion et al., 2022).
IVF clinical pregnancy outcomes in endometriosis patients and the role of Vitamin D
25-hydroxyvitamin D3 (Vitamin D) is crucial for follicular development. The relationship between the level of Vitamin D in endometriosis patients and pregnancy outcomes of IVF is an area of ongoing research.
A recent study by Hu et al. (2023) explored pregnancy outcomes in endometriosis patients and the role of Vitamin D. It revealed that there are decreased levels of Vitamin D in both serum and follicular fluid samples of endometriosis patients. Specifically, the deficient group (< 20 ug/ml) exhibited fewer transferable embryos, lower embryo quality, and decreased clinical pregnancy rates. Conversely, higher levels of Vitamin D were associated with increased live birth rates among these patients.
Future research should focus on conducting randomised, double-blind, placebo-controlled clinical trials aimed at supplementing endometriosis patients with vitamin D. Subsequent follow-up would provide valuable insights into the potential impact of vitamin D supplementation on IVF pregnancy outcomes in this population.
References:
Hu, R., Li, L., Liang, L., Qi, Y., Ma, X., & Yang, Y. (2023). 25(OH)D3 improves granulosa cell proliferation and IVF pregnancy outcomes in patients with endometriosis by increasing G2M+S phase cells. Reproductive Biology and Endocrinology, 21(1). https://doi.org/10.1186/s12958-023-01165-8
McCallion, A., Nasirzadeh, Y., Lingegowda, H., Miller, J. E., Khalaj, K., Ahn, S., Monsanto, S. P., Bidarimath, M., Sisnett, D. J., Craig, A. W., Young, S. L., Lessey, B. A., Koti, M., & Tayade, C. (2022). Estrogen mediates inflammatory role of mast cells in endometriosis pathophysiology. Frontiers in Immunology, 13. https://doi.org/10.3389/fimmu.2022.961599
Nisenblat, V., Bossuyt, P. M. M., Farquhar, C., Johnson, N., & Hull, M. L. (2016). Imaging modalities for the non-invasive diagnosis of endometriosis. The Cochrane Database of Systematic Reviews, 2(2), CD009591. https://doi.org/10.1002/14651858.CD009591.pub2
Saunders, P. T. K., & Horne, A. W. (2021). Endometriosis: Etiology, pathobiology, and therapeutic prospects. Cell, 184(11), 2807–2824. https://doi.org/10.1016/j.cell.2021.04.041