Endometriosis, LUF & Infertility

Several different factors enter into the equation when it comes to deciphering the problem of infertility in women with endometriosis. So many areas of a woman's body and cycle are affected by the disease that it can often be very difficult to determine what contributes to infertility and what does not.

The Many Different Effects Of Endometriosis

Even a very mild form of the disease may interfere with fertility. Endometriosis may result in anovulation, may cause luteal phase defect, which interferes with implantation of the fertilized egg in the uterus, or it may cause a luteinized unruptured follicle. There are two predominant hormones involved in the follicular and luteinizing phases of a normal cycle. FSH (follicle stimulating hormone) and LH (luteinizing hormone), along with autocrine and papacrine factors, control the follicular phase. A dominant follicle is selected from a cohort, or group, of follicles that are released by the ovary and the rest atrophy while the dominant follicle continues to grow.

What Affects Ovulation

Ovulation is associated with a number of significant hormonal changes. The ovulation process is primarily controlled by the luteinizing hormone. An LH surge induces ovulation and an increased amount of prostaglandins along with other enzymes weaken the wall of the follicle leading it to rupture. The egg is then released into the fallopian tube to be fertilized. When all of this happens, the secretion of progesterone prepares the endometrium in the uterus for the implantation of the fertilized egg. If pregnancy does not happen, the activity diminishes and when steroid levels fall, menstruation begins.

When The Follicle Doesn't Rupture, An Egg Is Not Released

In some women, the follicle will not rupture, although the luteinizing process has been undertaken and the LH surge has taken place. The endometrium is prepared as the hormones are released, but since there is no release of the egg because the follicle did not rupture, pregnancy cannot occur. Everything, if studied, will be consistent with ovulation, but ovulation did not occur. This phenomenon is called the luteinized unruptured follicle (LUF). According to several studies, LUF is more prevalent in women who have endometriosis. The diagnosis of LUF is made with laparoscopy, which checks for ovulatory changes in the ovaries.

LUF Is More Prevalent In Women With Endometriosis

In cases of LUF, 63 percent of the women who have dealt with it also have endometriosis and luteinized unruptured follicle is seen in 35 percent of women with endometriosis. Yet, even though the diagnosis is done through laparoscopy and ultrasound, the results can still be very subjective suggesting the diagnosis of this condition to be complicated.

So many problems with infertility can be traced to endometriosis. However, since the disease is relatively new in terms of being studied, the results of some findings remain suspect. Until researchers are able to pinpoint and standardize certain findings, some of the information about infertility and endometriosis may remain vague.


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