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Hum. Reprod. Advance Access published online on March 10, 2005
Human Reproduction, doi:10.1093/humrep/deh796
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Human Reproduction © European Society of Human Reproduction and Embryology 2005; all rights reserved
Received June 10, 2004
Revised December 17, 2004
Accepted January 16, 2005

Article

A predictive model for endometriosis

M.M. Wölfler 1, F. Nagele 2, A. Kolbus 2, S. Seidl 3, B. Schneider 4, J.C. Huber 2, and W. Tschugguel 2*

1 Department of Obstetrics and Gynaecology, Division of Gynaecological Endocrinology and Reproductive Medicine, Austria; Department of Obstetrics and Gynaecology, Medical Faculty of the Technical University of Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
2 Department of Obstetrics and Gynaecology, Division of Gynaecological Endocrinology and Reproductive Medicine, Austria
3 Department of Internal Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
4 Department of Medical Statistics, Vienna University, Schwarzspanierstrasse 6, 1090 Vienna, Austria and

* To whom correspondence should be addressed.
W. Tschugguel, E-mail: walter.tschugguel{at}meduniwien.ac.at


  Abstract

BACKGROUND: Aromatase is the key enzyme in the process of estrogen biosynthesis from the precursor androgen. Recently, aromatase has been found to be aberrantly expressed in eutopic endometrium of patients suffering from endometriosis. This finding has prompted speculation about the contribution of this enzyme to the prediction of this disease. METHODS: We prospectively aimed to evaluate whether endometrial biopsy, prior to laparoscopy in symptomatic women to screen for the presence of aromatase by real-time RT-PCR and immunohistochemistry, combined with select patients' characteristics, is of value to predict endometriosis. RESULTS: Of 48 consecutive symptomatic and eligible patients, 25 (52.1%) exhibited endometriosis and 23 (47.9%) were disease-free. A multiple logistic regression model revealed that 95.5% of patients whose eutopic endometrium was found to be positive for aromatase mRNA as well as immunohistochemically detected protein and who were additionally suffering from moderate to severe dysmenorrhoea (visual analogue scale score >4/10) exhibited endometriosis at laparoscopy. CONCLUSIONS: These findings provide direct evidence that screening for eutopic endometrial aromatase in combination with clinical data could be of discriminative value in the prediction of disease.

Keywords: aromatase; endometriosis; endometrium; menstrual characteristics; predictive model.
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