PITUITARY-OVARIAN DYSFUNCTION AS A CAUSE FOR ENDOMETRIOSIS-ASSOCIATEDAND UNEXPLAINED INFERTILITY

This study examines circulating and follicular hormone concentrations and fertilization of oocytes in cycles totally unperturbed by exogenou s gonadotrophins in 10 women (25 cycles) with untreated minimal-mild e ndometriosis and nine women (23 cycles) with prolonged unexplained inf ertility compared with 16 women (50 cycles) with tubal damage as funct ional controls, Endometriosis was associated with a significantly long er follicular phase (median 15, 12, 13 days respectively) and reduced oestrogen secretion (median index area under the curve 3063 3842, 3805 units respectively) compared with controls, Both endometriosis and un explained infertility had significantly reduced serum luteinizing horm one (LH) surges [median peak serum (LH) 43, 39, 55 IU/I respectively a nd median area under the curve 661, 687, 823 units respectively] and r educed LH concentrations in follicular fluid (median 19.6, 10.6, 9.2 I U/I respectively), These findings suggest that infertility associated with minor endometriosis and of apparently unexplained aetiology share a common pathophysiology in impaired LH surge secretion, Whether that represents a primary pituitary disorder or is secondary to a defectiv e ovarian signal is discussed.