Reproductive Health Information - Endometriosis
Information on Endometriosis. Research and treatment. Also, click here for blog posts related to Endometriosis.
Endometriosis General
What is endometriosis? Symptoms, pain, signs, of endometriosis. Infertility & pregnancy with endometriosis. Causes of endometriosis.
Endometriosis (from endo, "inside", and metra, "womb") is a gynecological medical condition in which endometrial-like cells appear and flourish in areas outside the uterine cavity, most commonly on the ovaries. (wikipedia)
Endometriosis Diet
Dietary recommendations for endometriosis.
Endometriosis Recipes
Dietary recipes based on a paleolithic style diet that may help Endometriosis, from holistic nutritionist Susan Carlson
Salad
6 Tbs. sliced raw almonds
4 cups trimmed organic frisée leaves (12 oz.)
2 heads Belgian endive (8 oz.), leaves thinly sliced
2 stalks organic celery, cut in thin, 3-inch-long strips
Vinagrette
3 Tbs. cold pressed, extra virgin olive oil
1 Tbs. red wine vinegar
1/2 Tbs. fresh lemon juice
1 clove organic garlic
1/2 cup pitted kalamata olives, coarsely chopped
1/8 cup chopped parsley
Directions:
To make Salad: Toast almonds in heavy-bottomed small skillet over medium heat, stirring often, 5 to 7 minutes, or until golden. Set aside.
Combine frisée, endive and celery in large bowl; toss to mix.
To make Vinaigrette: Put olive oil, vinegar, lemon juice, garlic and pepper to taste in blender or food processor, and blend until smooth. Add olives and parsley, and pulse to combine.
Add dressing to greens, and toss well. Divide salad among serving plates, and sprinkle each with almonds.
Benefits to this recipe:
Frisee- this chicory green is very high in folic acid (a small serving supplies almost half the daily RDA- crucial in pregnancy) and the antioxidant vitamin C, which helps in the formation and maintenance of collagen and support to the immune system.
Endive- This bitter green is also high in Vitamin C and folic acid. It provides lots of Vitamin A as well, which contributes to healthy skin and mucous membranes (especially cervix mucousa).
Almonds- A great source of calcium, helping with bone and teeth integrity, as well as a good source of vitamin E, known to boost prostate and ovarian health. Almonds are also chalked full of menstruated fats, contributing to cardiovascular vitality.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
1 large thin pita bread
1 clove garlic
a squeeze of fresh lemon juice
12 ounces organic, good quality plain yogurt, full fat or 2%
1 28oz can or overnight soaked chickpeas
pinch of cumin
3 chopped organic tomatoes
Organic parsley
Directions:
Preheat oven to 450 F. Seperate the pita bread in half and toast in the oven until golden brown and toasted, but not burned. Set aside until cool enough to handle, then break into bite-size pieces.
Meanwhile, empty chickpeas into a saucepan with their liquid and bring to a simmer. Cook chickpeas until completely tender- most canned chickpeas are too firm and I find they take about 15-20 minutes of simmering before they are tender enough to smush easily between your fingers.
Place yogurt in a bowl. Crush garlic in a mortar and pestle or press garlic through a garlic press. Add the garlic to the yogurt along with a pinch of salt and a squeeze of lemon juice. Stir to combine.
If your yogurt is on the thick side, add a touch of water to make your yogurt pourable consistency.
Divide half the crumbled pita between two individual-size bowls. Spoon half the chickpeas over the pita pieces, allowing a little of the warm chickpea liquid to soak the bread pieces. Pour half the yogurt mixture over the bread and chickpeas, sprinkle with a pinch of cumin. Repeat the layering in the bowls: bread, chickpeas, yogurt, pinch of cumin. Top with chopped tomatoes and parsley (or sauteed pine nuts, if you prefer). Serve immediately.
Benefits of this recipe:
Chickpea-a great source of plant protein (crucial for pregnant women) and B12. Vegans and vegetarians are often lacking in B12, a vitamin vital to the developing embryo and a healthy fetus.
Natural yogurt- Many studies suggest that dairy products help increase fertility. Look for a plain yogurt (especially greek yogurt) with high bacterial content, the probiotics contribute to intestinal, and immune health.
Tomato- High in the antioxidant betacarotene and the power compound Lycopene. Lycopene has been show to help the reproductive system in women (studies show it also helps reduce endometriosis) and consuming tomatoes helps boost lycopene levels in sperm, enhancing motility.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
This warming dish can be prepared ahead of time in a crockpot/ slow cooker, or simply simmered on the stovetop. It is gluten free and surprisingly filling!
1 pound dry black beans
1 1/2 quarts filtered water
1 organic carrot, chopped
1 stalk organic celery, chopped
1 large organic red onion, chopped
8 cloves garlic, crushed
2 green bell peppers, chopped
2 jalapeno pepper, seeded and minced (optional)
1/4 cup dry lentils
1 (28 ounce) can peeled and diced tomatoes (use 4 fresh tomatoes if available)
2 tablespoons chili powder
2 teaspoons ground cumin
1/2 teaspoon dried oregano
1/2 teaspoon ground black pepper
3 tablespoons red wine vinegar
1 tablespoon sea salt
1/2 cup uncooked brown rice
Directions:
In a large pot over medium-high heat, place the beans in three times their volume of water. Bring to a boil, and let boil 10 minutes. Cover, remove from heat and let stand 1 hour. Drain, and rinse.
In a slow cooker, combine soaked beans and 1 1/2 quarts fresh water. Cover, and cook for 3 hours on High.
Stir in carrot, celery, onion, garlic, bell peppers, jalapeno pepper, lentils, and tomatoes. Season with chili powder, cumin, oregano, black pepper, red wine vinegar, and salt. Cook on Low for 2 to 3 hours. Stir the rice into the slow cooker in the last 20 minutes of cooking. Puree about half of the soup with a blender or food processor, then pour back into the pot before serving.
Benefits to this recipe:
Black beans- a good low-glycemic food that provides disease fighting antioxidants. They are also rich in iron, which supports fertility and ovulation.
Lentils- also high in fertility supporting iron, as well as supplying folic acid to the body, which is crucial to embryonic development.
Garlic- a natural anti-bacterial/anti-viral root, with allelic compounds that help regulate hormone levels. Garlic is also high in selenium, which in some studies has been shown to decrease the risk of miscarriages.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
Pre soaking the rice makes this meal very easy for your body to digest, and it can be served piping hot which comforts in the winter weather, served chilled as a light side dish in the summer months!
2 cups filtered water
1 cup soaked wild rice
1 cup organic mushrooms, chopped
1 organic onion, diced
1 1/2 cups vegetable broth
1 pound organic asparagus, trimmed and chopped
1 tbsp extra virgin, cold pressed olive oil
1 1/2 tbsp balsamic vinegar
1 tsp organic lemon juice
Sea salt and pepper to taste
Directions:
Bring the water to a boil in a medium saucepan. Add the rice and allow to simmer until rice is finished cooking, about 20 to 30 minutes.
In a large frying pan or skillet, simmer the mushrooms and onions in 3/4 cup of vegetable broth until mushrooms are cooked and browned, about 8 to 10 minutes. Add the asparagus and the remaining 3/4 cup
vegetable broth. Cook for just a few minutes, until asparagus is slightly soft.
In a small bowl, whisk together the olive oil, balsamic vinegar and lemon juice to make a dressing. Toss together the rice, vegetables and olive oil dressing, stirring to combine well. Season generously
with salt and pepper. Serve hot or cold.
Benefits to this Recipe:
Asparagus- not only do these vegetables help detoxify our system, and prevent birth defects, but they are also considered an aphrodisiac in many people.
Mushrooms- have some anti-oxidants and help reduce inflammation in the body. Also the fiber and particular enzymes in them also help lower cholesterol levels.
Wild Rice- Supplies blood sugar stabilizing complex carbohydrate, increasing satiety and decreasing appetite. Wild mushrooms are also very effective in preventing cancer of breast and prostate. This is due to presence of Beta-Glucans and conjugated Linoleic acid present, that has anti carcinogenic effects.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
If you own a slowcooker, this is such a yummy, yet simple dessert- perfect for the holiday season. Can even add raw carob or cacao in place of the cranberries.
1/2 cup long-grain organic brown rice (basmati rice works nicely)
1/2 -14 oz. can sweetened condensed milk (I cut the original recipe requirements in half to avoid sugar and decrease the amount of lactose present)
4 cups unsweetened organic coconut milk
2 tsp. ground cinnamon
1/2 cup sweetened dried cranberries or raisins
Directions:
Mist the slow cooker stoneware with cooking spray. Rinse rise.
Add all of the ingredients to the crockpot, and stir. Cover, and cook on high for 3-5 hours or low for 5-7 hours. Makes about 4 servings.
Note: The length of cooking time depends on the size, shape and temperature of your crockpot as well as the type of rice you use for this recipe. Newer slow cookers tend to cook faster and at a higher temperature, so check the rice pudding at the shortest cooking time to see if it's done.
Benefits to this recipe:
Coconut milk- source of the medium chain fatty acid: Lauric acid, which makes coconut a great anti-viral, anti-bacterial, anti-microbial and anti-fungal. Coconut milk helps boost the immune system!
Basmati rice- way better to stabolize blood sugar levels and keep insulin levels steady. This is crucial when trying to conceive, and energy maintenance in general. This brown rice is also high in Maganese, which is essential for bone formation and protein metabolism.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
This is a good recipe that uses Autumn vegetables, and is quite warming to the soul!
It is a vegetarian based meal, however, on occasion you can add Canadian back bacon.
4 tbsp cold pressed, extra virgin olive oil, divided
1 tbsp fresh organic thyme leaves
1 lb organic fingerling or baby potatoes, cut in half, lengthwise
2 bunches garden carrots, trimmed and peeled, halved lengthwise if large (about
2 lbs/1 kg after trimming)
½ lb cremini mushrooms, halved or quartered
salt and pepper, to taste
1 tbsp chopped fresh tarragon
*2 oz bacon, cut into 1-in. (2.5-cm) pieces - Pork addition is optional*
Directions:
Mix 3 tbsp EVOO with salt, pepper and thyme. Toss half this mixture with potatoes and half with carrots. On separate parchment-lined baking sheets, spread potatoes and carrots. In a preheated 400°F (200°C) oven, roast potatoes for 40 to 45 minutes, and carrots for 25 to 30 minutes, until browned outside and tender inside.
Heat remaining oil in a large deep skillet. Add bacon and cook until crisp. Discard most of the fat, leaving a thin film on the bottom of the pan. Add mushrooms and cook for 8 to 10 minutes, until browned.
Stir in roasted carrots and potatoes. Cook for 5 minutes to heat thoroughly. Add salt and pepper to taste and stir in tarragon.
Benefits to this Recipe:
Fingerling potatoes- a good source of iron. This mineral is important to both men and women to enhance fertility hormones.
Carrots- As most of us know, they are exceptionally high in vitamin A and beta carotine, crucial for health, but carrots help to decrease inflammation in the body as well.
Crimini mushrooms- offer a good dose of selenium, which protects the body from toxins and heavy metals that may accumulate in the liver or reproductive system.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
Great for a light, yet satisfying lunch!
2 - 15 ounce cans white beans, drained
3 cloves raw garlic, minced
1 organic red onion, minced
1/2 cup chopped fresh garden parsley
2 tbsp cold pressed, extra virgin olive oil
2 large roma tomatoes, diced
1/3 cup rinsed and sliced black olives
2 tbsp red wine vinegar
1 tsp lemon juice
salt and pepper to taste
Directions:
Over low heat, combined beans, garlic, onion and parsley in olive oil. Heat for just one minute, or until fragrant.
Remove from heat and combine with remaining ingredients.
Benefits to this Recipe:
Beans- rich in Folate. Not only does this B vitamin help avoid birth defects, but it also increases sperm count and density.
Parsley- extremely high in vitamin K! in fact, one 2 tbsp serving of parsley contains almost 100% of your daily RDA. Vitamin k is essential for blood clot formation, assisting with normal mense flow, and also helping bone formation and maintenance.
Black Olives- high in nervous system protective mono-saturate fats, which also improve hormone sensitivity.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
This delicious dessert can be vegan friendly if you use a vegan style crust. Homemade or store bought crust work fine!
14 oz container soft tofu
14 oz container firm or extra-firm tofu
24-oz can sweet potatoes in syrup * Or use very ripe organic sweet potatoes*
2 tsp cinnamon
1 tsp ginger
1/2 tsp nutmeg
Directions:
Preheat oven to 350 degrees. Blend all the ingredients (except the pie crust!) in a blender or food processor until free of lumps. Pour into the pie shell and bake for 1 1/2 hours, or until toothpick inserted in the center comes out clean.
Benefits to this recipe:
Sweet potato- the vitamin A powerhouse! One serving of sweet potatoes usually provides over 200% of your daily recommend intake. This vitamin is crucial for the development of bones and teeth in babies, while keeping these areas strong through old age. This vegetable is also a source of vitamin C, which contributes to a healthy immune system.
Tofu- Provides lots of essential Calcium which as well as keeping teeth and bones healthy, aids in muscle and nerve development. Adequate calcium in the bloodstream is needed to avoid several types of birth defects. Their is a high serving of soy within this tasty recipe, but like all things, soy should be eaten in moderation. Soy provides the body with phytoestrogens, plant-like compounds that may mimic estrogen, but are only harmful if excessively consumed. Soy is a great source of all 9 essential amino acids, being a complete vegetable protein source.
Cinnimon- is a tasty root that helps to stabolize blood sugar levels.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
A delicious and light salad, great for potlucks!
1 cup organic quinoa, rinsed
1/2 cup sliced almonds
1/2 cup coarsely chopped apple
1/2 cup coarsely chopped dried apricots
1/4 cup toasted unsalted sunflower seeds
1/4 cup dried cranberries
1/4 cup raisins
2 tbsp finely chopped fresh mint
Maple Vinaigrette
1/3 cup pure maple syrup
1/4 cup cider vinegar
1/4 cup honey mustard
2 tbsp extra virgin, cold pressed olive oil
Directions:
1. In a medium saucepan, combine quinoa and 2 cups (500 mL) water; bring to a boil over high heat. Reduce heat to low, cover and simmer for about 20 minutes or until liquid is absorbed and quinoa is tender. Let stand for 5 minutes. Fluff with a fork.
2. Transfer quinoa to a large bowl. Add almonds, apple, apricots, sunflower seeds, cranberries, raisins and mint; toss to combine.
3. Vinaigrette: In a small bowl, whisk together maple syrup, vinegar, mustard, oil and 2 tbsp (30 mL) water. Pour 1/2 cup (125 mL) of the vinaigrette over the salad, reserving the remainder for another use. Toss salad gently to coat
Benefits to this recipe:
Quinoa- a gluten free hearty ancient grain that is high in protein to satisfy hunger, and yet relatively low on the Glycemic index. It also provides the essential trace mineral Maganese, which is required for fetal brain development.
Almonds and Sunflower seeds- A great source of Magnesium, which is good at balancing PMS symptoms and alieviating muscle cramps.
Apple and apricots- Provide fiber to help rid toxins therefore increase your ability to get pregnant. Because fiber helps to stabolize blood sugar, it can reduce the risk of gestational diabetes while pregnant also.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
The addition of pears add a fresh taste to the pilaf in this warming fall entree!
1 whole chicken (about 3 1/2 pounds) *free range, organic* cut into 8 pieces
4 teaspoons extra-virgin olive oil *cold pressed*
1/4 teaspoon ground black pepper
1/2 teaspoon sea salt, divided
1 tablespoon maple syrup
1 small organic onion, chopped & 1 rib celery, thinly sliced
2 cloves garlic, finely chopped
1 1/2 cups brown and wild rice mix
3 cups low-sodium chicken broth
2 organic Bartlett pears, peeled, cored and chopped
Directions:
1. Preheat oven to 400°F. Place chicken in a roasting pan or on a rimmed baking sheet.
2. Coat 1 teaspoon chopped fresh thyme leaves with 2 teaspoons olive oil, sprinkle with pepper and 1/4 teaspoon salt; bake 45 minutes or until cooked through.
3. Remove from oven and brush with maple syrup. Meanwhile, in a medium saucepan, heat remaining olive oil over medium-high heat.
4. Add onion, celery and garlic and cook until golden, 5 to 7 minutes. Stir in rice and broth; bring to a boil.
5. Reduce heat to low, cover and simmer 35 minutes.
6. Stir in pears, thyme and remaining salt and continue to cook 10 minutes or until rice is tender and liquid is absorbed. Serve rice with chicken.
Benefits to this recipe:
chicken- If organic and ethically raised, poultry is naturally high in the Selenium, an antioxidant mineral, essential to male fertility and prostate health.
pears- Fresh Bartlett pears offer a high level of vitamin C which is also a great overall antioxidant as well. Studies have shown a diet high in this vitamin specifically help defend sperm from harmful free radicals generated in the body. Vitamin C is also present in the seminal plasma to aid in transmission.
wild & brown rice- Provide a high amount of The B-vitamin folate, or folic acid, supports healthy physical development during pregnancy and can help prevent birth defects.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
Want a tasty and satisfying mid day snack? try this!
2 cups water
1/2 to 3/4 pound bunch kale (Russian red kale preferred), 6 to 8 cups, stems thinly sliced, leaves chopped
1/2 teaspoon extra virgin olive oil
2 garlic cloves, minced or pressed
1/4 cup raisins
1 tablespoon water
1/4 teaspoon sea salt
2 teaspoons toasted pine nuts (baked at 300° until golden, about 8 minutes)
Directions:
1. Bring water to boil in a 3-quart pot. Add the kale and cook covered over high heat, stirring occasionally, until tender, 5 to 7 minutes. Remove and drain.
2. Rinse out and dry the pot, then heat the olive oil over medium heat, tilting the pan to coat. Add garlic and sauté for 15 seconds. Add raisins, water and salt, stir, then cover to cook for a minute. Raisins should be glossy and slightly puffed.
3. Add greens and stir to combine. Cover for a minute until greens are heated through. Serve hot, garnished with nuts.
Benefits to this recipe:
kale- a member of the brassica family that provides the indole-3-carbinol compound. This is proven to reduce toxic estrogen dominance in men and woman, and reduceing reproductive cancers.
pine nuts- a great source of omega-3s. These help in restoring the proper estrogen:prgesterone ratio, enhancing the ability to concieve.
raisins- Raisins are known to stimulate libido and induce arousal, primarily due to presence of an amino acid called Arginine, which is beneficial in treating problems with erectile dysfunction.
Susan Carlson BSc. RHN, is a Registered Holistic Nutritionist working closely with Dr. Pentland at Qi Integrated Health in Kitsilano. She believes in the power of preventative nutrition and supplementing the body to improve many chronic health conditions, including problems with fertility. Check out her webpage www.choicewellbeing.com. Contact her at the clinic 604-742-8383, or by email scarlson@qiintegratedhealth.com
Endometriosis Research
Research about symptoms, causes, & treatment of endometriosis with acupuncture & Chinese medicine, surgery, drugs, herbs.
CONCLUSION: immune inflammatory markers that increase in ovarian cells when endometriosis is present and decrease egg quality were improved with the use of Chinese herbal formulation Qu Yu Jie Du granule. 2 other studies show an improvement in follicular fluid, and a reduction in 2 cell embryo toxicity with the same herbs.
OBJECTIVE: To observe the effects of Quyu Jiedu Granule, a compound traditional Chinese herbal medicine for removing blood stasis and expelling superficial evils, on the quality of oocytes and the expressions of tumor necrosis factor-alpha (TNF-alpha)and interleukin-6 (IL-6) mRNAs in ovarian granulosa cells of endometriosis (EM) rats.
METHODS: Forty EM rats were randomly divided into two groups: experimental group and control group. There were 20 EM rats in each group. The uteri of another 20 SD rats were drawn in sham-operated group. The number and percentage of high quality oocytes and the levels of TNF-alpha and IL-6 mRNA expressions in the granulosa cells of EM rats were detected by using reverse transcription-polymerase chain reaction.
RESULTS: The number and percentage of high quality oocytes in the experimental group were significantly higher than those in the control group (P<0.05), and the levels of TNF-alpha and IL-6 mRNAs in granulose cells in the experimental group were significantly lower than those in the control group (P<0.05).
CONCLUSION: The increase of the TNF-alpha and IL-6 mRNA expressions in ovarian granulose cells of EM rats leads to the decrease of the oocyte (egg) quality. The mechanism of Quyu Jiedu Granule in improving the quality of oocytes may be related to the decrease of TNF-alpha and IL-6 mRNA expressions in ovarian granulosa cells.
Red Rattan or Dragons blood- Xue Jie 15 g
Rose- Mei Gui Hua 6 g
Honeysuckle- Jin Yin Hua 10 g
weeping forsythia- Lian Qiao 10 g
salvia miltiorrhiza- Dan Shen 10 g
herbaceous peony- Chi Shao 10 g
peony tree bark- Mu Dan Pi 10 g.
CONCLUSION: infertility in patients with endometriosis may have alterations within the follicle which, in turn, result in oocytes and embryos of lower quality. In addition, these embryos have a reduced ability to implant. These alterations may be induced by functional changes in the process of folliculogenesis that affect steroid synthesis, as well as by cytokine release by ovarian and blood cells.
Several retrospective analyses of IVF and oocyte donation programmes, performed to gain clinical knowledge of the factors implicated in the aetiology of endometriosis-associated infertility, have demonstrated that the quality of the embryo is affected in patients with endometriosis. To understand the mechanisms of this alteration, the endocrine, paracrine and autocrine conditions induced during folliculogenesis in women with and without endometriosis were investigated. The first approach was to study ovarian steroid secretion in women undergoing IVF. Progesterone concentrations in follicular fluid increased with the severity of the disease and an increase in progesterone accumulation in vitro was observed in basal and hCG-stimulated granulosa cell cultures. It is proposed that the pattern of progesterone secretion may be related to changes in the release of cytokines by ovarian and white blood cells. Hence, a second trial measured interleukin 1 (IL-1), IL-6 and vascular endothelial growth factor (VEGF) concentrations in serum, follicular fluid and granulosa cell cultures. IL-6 concentrations in serum were higher in the natural cycles of women with endometriosis than in women in the control group, and were modulated by ovarian stimulation, decreasing significantly in serum from stimulated cycles. In addition, IL-6 concentrations were higher in the follicular fluid of women with endometriosis than in those in the control group and IL-6 was released in higher amounts by granulosa luteal cells of patients with endometriosis. VEGF was accumulated in lower concentrations in the follicular fluid of patients with endometriosis.



