title: Utero-tubal sperm transport and its impairment in endometriosis and adenomyosis.
abstract: The uterus is composed of different smooth muscle layers that serve various functions. First, menstrual debris is expulsed at the time of the menses. Second, sperm is transported in the preovulatory phase to maximize fertility, and third, the human embryo is placed in an adequate setting during implantation. Endometriosis is a gynecologic disorder leading to severe pain symptoms such as severe pain during menstruation (dysmenorrhea), chronic pelvic pain, pain during sexual intercourse (dyspareunia), and abnormal uterine bleeding. Besides, endometriosis is often associated with female infertility and exhibits a massive impairment in the physiology of uterine contractility that can be documented by the in vivo examination method of hysterosalpingoscintigraphy (HSSG). In addition, endometriosis is associated in 80-90% of subjects with adenomyosis and our data clearly indicate that sperm transport is disturbed by hyperperistalsis when at least one focus of adenomyosis can be detected via magnetic resonance imaging (MRI) and turns into dysperistalsis (a complete failure in sperm transport capacity) when diffuse adenomyosis affecting all myometrial uterine muscle layers is detected. Hence, dysperistalsis is significantly associated with reduced spontaneous pregnancy rates. We therefore recommend MRI and HSSG in every sterility workup.
authors.affiliation: Department Obstetrics and Gynecology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kissler
authors.forename: Stephan
authors.initials: S
authors.lastname: Zangos
authors.forename: Inka
authors.initials: I
authors.lastname: Wiegratz
authors.forename: Joachim
authors.initials: J
authors.lastname: Kohl
authors.forename: Achim
authors.initials: A
authors.lastname: Rody
authors.forename: Regine
authors.initials: R
authors.lastname: Gaetje
authors.forename: Natascha
authors.initials: N
authors.lastname: Doebert
authors.forename: Ludwig
authors.initials: L
authors.lastname: Wildt
authors.forename: Georg
authors.initials: G
authors.lastname: Kunz
authors.forename: Gerhard
authors.initials: G
authors.lastname: Leyendecker
authors.forename: Manfred
authors.initials: M
authors.lastname: Kaufmann
mesh_terms: D004715:Endometriosis / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D005187:Fallopian Tubes / Q000473:pathology / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009215:Myometrium / Q000473:pathology / Q000503:physiopathology*; D013083:Sperm Transport / Q000502:physiology*; D013094:Spermatozoa / Q000473:pathology / Q000502:physiology*; D014599:Uterus / Q000473:pathology / Q000502:physiology*