Uterotubal transport disorder in adenomyosis and endometriosis—a cause for infertility

Abstract

Objective Uterine hyperperistalsis and dysperistalsis are common phenomena in endometriosis and may be responsible for reduced fertility in cases of minimal or mild extent of disease. Since a high prevalence of adenomyosis uteri has been well documented in association with endometriosis, we designed a study to examine whether hyperperistalsis and dysperistalsis are caused by the endometriosis itself or by the adenomyotic component of the disease. Design A prospective observational study. Setting University hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 300 in vitro fertilisation/intracytoplasmatic sperm injection cycles and 350 intrauterine insemination cycles/year. Population Forty‐one subjects with infertility and with laparoscopically proven endometriosis and patent fallopian tubes. Thirty‐five subjects (85%) additionally showed signs of adenomyosis. Methods All subjects underwent T2‐weighed magnetic resonance imaging (MRI) and hysterosalpingoscintigraphy (HSSG) during the subsequent menstrual cycle. MRI revealed the extent of the adenomyotic component of the disease and the integrity of uterotubal transport capacity was evaluated by HSSG. Main outcome measures Influence of adenomyosis on uterotubal transport capacity in endometriosis. Results In 35 of the 41 subjects (85%) with endometriosis, signs of adenomyosis were detected using T2‐weighed MRI. Two of six (33%) subjects with no adenomyosis (group I) showed dysperistalsis and hyperperistalsis, compared with 14 of 24 (58%) women with focal adenomyosis (group II) and 10 of 11 (91%) women with diffuse adenomyosis (seven showed a failure in transport capacity and two contralateral transport). Conclusions Our data suggest that endometriosis is associated with impeded hyperperistaltic and dysperistaltic uterotubal transport capacity. However, adenomyosis is of even more importance, especially when diffuse adenomyosis is detected. Both forms of adenomyosis are commonly found in subjects with mild to moderate endometriosis. We suggest that the extent of the adenomyotic component in subjects with endometriosis explains much of the reduced fertility in subjects with intact tubo‐ovarian anatomy.

Endometriosis and Infertility

“…Potentially, the presence of adenomyosis may have a role, with evidence showing reduced fertility in baboons with adenomyosis [ 38 ]. Human studies point to a similar association between adenomyosis and subfertility [ 39 ] with an effect on uterine peristalsis and sperm transport [ 40 ] as well as a higher rate of implantation failure with ART [ 41 ]. Adenomyosis and endometriosis have a clinical correlation with the more advanced stages of endometriosis [ 42 ].…”

Pelvic Imaging in Reproductive Endocrinology

“…Using a 99 Tclabeled macroalbumin aggregates in a procedure referred as hysterosalpingo scintigraphy, Kissler and colleagues reported evidence of retrograde transport alterations in endometriosis and adenomyosis. 472,473 This approach is cumbersome, however, and does not lend itself to repeated measurements, nor to studies conducted in mock reproductive conditions. An advantage of HySo over x-ray-based methods for assessing tubal function is the possibility of repeating examinations.…”

“…27 In a provocative series of publications, Leyendecker's team promoted the concept that endometriosis is associated with a hyperkinetic-dyskinetic condition of the uterus 473 which impairs the retrograde transport of sperm during the follicular phase, 24,231,540 and the proper antegrade emptying of uterine content at the time of menses. 236 From their studies using the uterine displacement of 99 Tc-labeled MAA, these authors observed two pathological findings in endometriosis: (1) a pathological increase in retrograde transport at the time of menses; and (2) the loss of retrograde transport targeted toward the tube that faces the developing follicle during the late follicular phase of natural cycles.…”

Laparoscopic surgery for endometriosis-associated infertility: a pathophysiologic approach

“…Kissler et al in 2006 [4] reported that endometriosis leads to a significant restriction in uterotubal transport capacity. They concluded that impeded hyperperistalsis and dysperistalsis in uterotubal transport associated with endometriosis may be the reason of infertility in these women [4]. Severe endometriosis is also associated with pelvic adhesions and a distortion of pelvic anatomy leading to a possible mechanic or anatomic disturbance of fertility [5,6].…”