Human Reproduction, Vol. 18, No. 7, 1512-1515,
July 2003
© 2003 European Society of Human Reproduction and Embryology
High plasma concentrations of di-(2-ethylhexyl)-phthalate in women with endometriosis
1 Chair of Obstetrics and Gynecology, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, 2 Neonatal Intensive Care Unit, Division of Paediatrics, Perrino Hospital, Clinical Physiology Institute (IFC-CNR) National Research Council of Italy, Lecce Section, Brindisi, 3 Neonatal Intensive Care Unit, Department of Pediatrics, Obstetrics and Reproductive Medicine University of Siena, Siena and 4 Department of Chemistry, Chemical Engineering and Materials, University of L’Aquila, L’Aquila, Italy
5 To whom correspondence should be addressed at: Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy. e-mail: petraglia{at}unisi.it
BACKGROUND: Emerging evidence suggests a potential role for ubiquitous environmental contaminants in the physiopathology of endometriosis. Di-(2-ethylhexyl)-phthalate (DEHP), the most commonly used plasticizer in flexible polyvinylchloride (PVC) formulations, is a widespread environmental contaminant with potentially adverse effects on fertility in animal models. In the present study, we tested the hypothesis that DEHP and/or and its main metabolite, mono-ethylhexyl phthalate (MEHP), play a role in the pathogenesis of endometriosis. METHODS: Specimens of blood and peritoneal fluid were collected in a group of women with endometriosis (n = 55), and in age-matched control women (n = 24). Concentrations of DEHP and MEHP were measured in plasma and peritoneal fluid by using high performance liquid chromatography (HPLC). Differences between groups were tested using the Fisher’s exact test, Wilcoxon-test, and Kruskal–Wallis analysis of variance. RESULTS: Endometriotic women showed significantly higher plasma DEHP concentrations than controls (median 0.57 µg/ml, interquartile range: 0.06–1.23; values range: 0–3.24 versus median 0.18 µg/ml, interquartile range: 0–0.44; values range: 0–1.03; P = 0.0047) and 92.6% of them had detectable DEHP and /or MEHP in the peritoneal fluid. No significant differences in either the DEHP/MEHP plasma concentrations (P ≥ 0.31) or DEHP/MEHP peritoneal fluid concentrations (P ≥ 0.66) were observed in the endometriotic patients as a function of the disease stage at the time of diagnosis. CONCLUSIONS: The present findings showed for the first time an association between DEHP plasma concentrations and endometriosis, suggesting a possible role for phthalate esters in the pathogenesis.
Key words: Di-(2-ethylhexyl)-phthalate/endometriosis/environmental hazards/mono-ethylhexyl phthalate/plasticizers
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