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Hum. Reprod. Advance Access originally published online on December 19, 2007
Human Reproduction 2008 23(3):530-537; doi:10.1093/humrep/dem399
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Endometriosis and human infertility: a new investigation into the role of eutopic endometrium

Francesca Minici1,{dagger}, Federica Tiberi2,4,{dagger}, Anna Tropea1, Mariateresa Orlando1, Maria Francesca Gangale1, Federica Romani1, Sebastiano Campo1, Adriano Bompiani2, Antonio Lanzone3 and Rosanna Apa1

1 Cattedra di Fisiopatologia della Riproduzione Umana, Università Cattolica del Sacro Cuore (UCSC), 00168 Roma, Italy 2 Istituto Scientifico Internazionale (ISI) ‘Paolo VI’, UCSC, 00168 Roma, Italy 3 Istituto di Ricerca ‘Associazione OASI Maria SS ONLUS’, 94018 Troina (EN), Italy

4 Correspondence address. Tel: +39-06-30155297; Fax: +39-06-30155205. E-mail: fm1810{at}inwind.it

BACKGROUND: Endometriosis is related to infertility even in the absence of mechanical alterations of the reproductive tract. Even though the pathogenesis of this phenomenon is still unclear, an impaired endometrial receptivity has been recently suggested. The aim of the present study was to investigate if endometriotic peritoneal fluids (EPF) could interfere with endometrial stromal cell (ESC) decidualization and if tumor necrosis factor (TNF)-{alpha} could be involved in the EPF effect.

METHODS: Eutopic ESC were isolated from patients with or without endometriosis. ESC were treated with 17β-estradiol 10–8 M and 6{alpha}-methyl-17{alpha}-hydroxyprogesteroneacetate 2x10–7 M for 16 days. In vitro decidualization was morphologically and biochemically assessed. We analysed whether ESC decidualization could be affected by EPF or peritoneal fluids from control patients (CPF), with or without soluble TNF-{alpha} receptor 1 (sTNFR-1).

RESULTS: Compared with ESC from control patients, eutopic ESC from patients with endometriosis showed an impaired decidualization. Decidualization of normal ESC was morphologically normal but biochemically abnormal in the presence of EPF, which was able to decrease the secretion of decidualization markers. sTNFR-1 was able to partially counteract this effect.

CONCLUSIONS: In endometriosis, the milieu surrounding the uterine cavity may be involved in impaired eutopic ESC decidualization, partially due to increased peritoneal levels of TNF-{alpha}.

Key words: endometriosis/endometrial receptivity/decidualization

{dagger} These authors contributed equally to the work.

Submitted on July 12, 2007; resubmitted on October 4, 2007; accepted on November 21, 2007.


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