Medical Health Encyclopedia

Direct Effect of Endometrial Cysts. Endometrial cysts may directly prevent infertility in a number of ways.

• If implants occur in the fallopian tubes, they may block the egg's passage.
• Implants that occur in the ovaries prevent the release of the egg.
• Severe endometriosis can eventually form rigid webs of scar tissue (adhesions) between the uterus, ovaries, and fallopian tubes, thereby preventing the transfer of the egg to the tube.

Immune Factors and the Inflammatory Response. Researchers are focusing on defects in the immune system that not only may be responsible for endometriosis in the first place but may also cause the infertility associated with endometriosis. Even in early stage endometriosis, investigators have observed increased immune system activity. It is possible that in such cases, the body perceived this foreign endometrial implants as hostile, and launches an attack.

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In this process, the body over produces specific immune factors that contribute to infertility, such as the following:

• Cytokines. Cytokines are very potent immune factors that, when overproduced, cause damage and inflammation in the very regions that are directed to protect. Such damage could produce scarring and obstructions that interfere with implantation and development of a fertilized egg. In severe endometriosis, researchers have also observed inflammation in the fluid surrounding the uterus, which could create a hostile environment for the sperm. In one laboratory test, slower sperm were noted in fluid taken from women with moderate or severe endometriosis, although not in mild endometriosis.
• Prostaglandins. Elevated levels of these factors not only produce inflammation but increase uterine contractions. (Women with endometriosis have a higher than average risk for miscarriage.)
• Other Immune Factors. Growth factors (which stimulate growth of new blood vessels) and toxins produce by the implants could impair fertility.