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Immunology and Endometriosis

Authors

  • Murat Berkkanoglu,

    1. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT, USA
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  • Aydin Arici

    1. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT, USA
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Address reprint requests to Aydin Arici, MD, Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8063, USA.
E-mail: aydin.arici@yale.edu

Abstract

Problem: Accumulating data suggests that aberrant immune responses during retrograde menstruation may be involved in the development of endometriosis.

Method of Study: The role of immunology in the etiology of endometriosis is reviewed and summarized from the available literature.

Results: Immunologic factors may affect a woman's susceptibility to implantation of exfoliated endometrial cells. Immune alterations include increased number and activation of peritoneal macrophages, decreased T cell reactivity and natural killer cell cytotoxicity, increased circulating antibodies, and changes in the cytokine network.

Conclusion: There is substantial evidence that immunologic factors play a role in the pathogenesis of endometriosis and endometriosis-associated infertility. Decreased natural killer cell cytotoxicity leads to an increased likelihood of implantation of endometriotic tissue. In addition, macrophages and a complex network of locally produced cytokines modulate the growth and inflammatory behavior of ectopic endometrial implants.

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