Immunological factors in endometriosis-associated reproductive failure: studies in fertile and infertile women with and without endometriosis

Immunopathophysiological mechanisms in endometriosis-associatedreproductive failure were studied in appropriate populations: infertile andfertile women with and without endometriosis. The incidence of serapositive for any of the autoantibodies tested among infertile women withendometriosis (n = 25) was similar to that observed in the three controlgroups [unexplained infertility patients (n = 25) and fertile women with (n= 10) and without (n = 25) endometriosis]. The mean volume of peritonealfluid was significantly elevated in women with endometriosis (both fertileand infertile) as compared with patients without endometriosis (fertile orinfertile). The concentration of peritoneal fluid leukocytes and thepercentage of cells positive for macrophage markers were significantlyincreased and the percentage of T lymphocytes significantly decreased ininfertile women with endometriosis but not in patients with unexplainedinfertility and fertile women with endometriosis, as compared with fertilecontrols without endometriosis. Macrophages from infertile patients withendometriosis had higher sperm phagocytosis than did those from infertilewomen without endometriosis or fertile subjects with or withoutendometriosis. Incidences of serum and peritoneal fluid samples embryotoxicto the in-vitro development of 2-cell mouse embryos were significantlyhigher in infertile patients with endometriosis than in unexplainedinfertility patients and fertile women with or without endometriosis. It isconcluded that immunological mechanisms of endometriosis-associatedinfertility exist but that these peritoneal immunological factors ininfertile women with endometriosis are related to their subfertility ratherthan to the presence of ectopic endometrial implants. This is supported bythe lack of immunological abnormalities observed among fertile women withendometriosis. These immunological abnormalities are lacking in patientswith unexplained infertility.