Utero‐Tubal Sperm Transport and Its Impairment in Endometriosis and Adenomyosis

Abstract

The uterus is composed of different smooth muscle layers that serve various functions. First, menstrual debris is expulsed at the time of the menses. Second, sperm is transported in the preovulatory phase to maximize fertility, and third, the human embryo is placed in an adequate setting during implantation. Endometriosis is a gynecologic disorder leading to severe pain symptoms such as severe pain during menstruation (dysmenorrhea), chronic pelvic pain, pain during sexual intercourse (dyspareunia), and abnormal uterine bleeding. Besides, endometriosis is often associated with female infertility and exhibits a massive impairment in the physiology of uterine contractility that can be documented by the in vivo examination method of hysterosalpingoscintigraphy (HSSG). In addition, endometriosis is associated in 80-90% of subjects with adenomyosis and our data clearly indicate that sperm transport is disturbed by hyperperistalsis when at least one focus of adenomyosis can be detected via magnetic resonance imaging (MRI) and turns into dysperistalsis (a complete failure in sperm transport capacity) when diffuse adenomyosis affecting all myometrial uterine muscle layers is detected. Hence, dysperistalsis is significantly associated with reduced spontaneous pregnancy rates. We therefore recommend MRI and HSSG in every sterility workup.

Pelvic Imaging in Reproductive Endocrinology

“…It is of note, however, that ultrasound-based analysis of UC displacement have never been validated by comparing ultrasound findings against the actual propagation of the pressure wave, as measured by multiple IUP recorders 230 or displacement of the uterine contents. 231 UC amplitude and uterine resting tone also evade ultrasound-based analyses. 157,232 Uterine Contractility During the Menstrual Cycle:…”

“…231,238,239 Thus, UCs and possible disruption of their patterns, may, therefore, play a key role in the reproductive process and in certain forms of infertility. However, as stated above, echographic analyses of UC direction have never been shown to correlate with the actual displacement of uterine contents.…”

“…In these studies, UC displacement was evaluated on fast plays of ultrasound sequences, or by analyzing the propagation of the increase in the IUP signal. 231 Yet, determining the UC direction is complicated by two unknowns: (1) While the contractile structure that is responsible for UCs is the subendometrial portion of the myometrium, the visualized phenomenon on ultrasound images is the result of the displacement of the endometrium. Hence, the parameter that is analyzed is an indirect reflection of the contractile process.…”

Potential Etiologies of Unexplained Infertility in Females

“…Data have shown that endometriosis is associated with uterine hyperperistalsis and dysperistalsis, which may cause impaired or total failure in sperm transport capacity respectively, especially when diffuse adenomyosis is also detected [103]. Dysperistalsis is associated with reduced natural conception rates [104,105] and consequently IVF/ICSI may be required even in couples with otherwise patent fallopian tubes and normal semen parameters.…”

Importance of genital endometriosis in pathogenesis of infertility

“…Кроме того, железо, являясь прооксидантом, играет роль в развитии воспалительной реакции при эндоме-триозе [27,55,66]. Также существуют данные о нарушении транспорта спермы, что может приво-дить к нарушению фертильности у женщин, стра-дающих этим заболеванием [48].…”