Uterotubal transport disorder in adenomyosis and endometriosis--a cause for infertility.
OBJECTIVE
Uterine hyperperistalsis and dysperistalsis are common phenomena in endometriosis and may be responsible for reduced fertility in cases of minimal or mild extent of disease. Since a high prevalence of adenomyosis uteri has been well documented in association with endometriosis, we designed a study to examine whether hyperperistalsis and dysperistalsis are caused by the endometriosis itself or by the adenomyotic component of the disease.


METHODS
A prospective observational study.


METHODS
University hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 300 in vitro fertilisation/intracytoplasmatic sperm injection cycles and 350 intrauterine insemination cycles/year.


METHODS
Forty-one subjects with infertility and with laparoscopically proven endometriosis and patent fallopian tubes. Thirty-five subjects (85%) additionally showed signs of adenomyosis.


METHODS
All subjects underwent T2-weighed magnetic resonance imaging (MRI) and hysterosalpingoscintigraphy (HSSG) during the subsequent menstrual cycle. MRI revealed the extent of the adenomyotic component of the disease and the integrity of uterotubal transport capacity was evaluated by HSSG.


METHODS
Influence of adenomyosis on uterotubal transport capacity in endometriosis.


RESULTS
In 35 of the 41 subjects (85%) with endometriosis, signs of adenomyosis were detected using T2-weighed MRI. Two of six (33%) subjects with no adenomyosis (group I) showed dysperistalsis and hyperperistalsis, compared with 14 of 24 (58%) women with focal adenomyosis (group II) and 10 of 11 (91%) women with diffuse adenomyosis (seven showed a failure in transport capacity and two contralateral transport).


CONCLUSIONS
Our data suggest that endometriosis is associated with impeded hyperperistaltic and dysperistaltic uterotubal transport capacity. However, adenomyosis is of even more importance, especially when diffuse adenomyosis is detected. Both forms of adenomyosis are commonly found in subjects with mild to moderate endometriosis. We suggest that the extent of the adenomyotic component in subjects with endometriosis explains much of the reduced fertility in subjects with intact tubo-ovarian anatomy.
Kissler
S
S
Division of Gynaecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynaecology, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany. stefan.kissler@kgu.de
Hamscho
N
N
Zangos
S
S
Wiegratz
I
I
Schlichter
S
S
Menzel
C
C
Doebert
N
N
Gruenwald
F
F
Vogl
T J
TJ
Gaetje
R
R
Rody
A
A
Siebzehnruebl
E
E
Kunz
G
G
Leyendecker
G
G
Kaufmann
M
M
D018194:Adenomyoma / Q000150:complications* / Q000503:physiopathology; D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000503:physiopathology; D005184:Fallopian Tube Diseases / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D011446:Prospective Studies; D014594:Uterine Neoplasms / Q000150:complications* / Q000503:physiopathology