IMMUNOLOGICAL ASPECTS OF ENDOMETRIOSIS

During the past decade, evidence has accumulated indicating an associa tion between endometriosis and changes in humoral and cell-mediated im munity. However, it is not clear whether immune changes are the sequel ae or play a role in the etiopathogenesis of the disease. The latter c oncept is supported by the observation that exposure of rhesus monkeys to radiation or immunotoxicants leads several years later to an incre ase in frequency and severity of endometriosis. Studies from our labor atories support the theory that endometrial cells misplaced during men ses can implant in ectopic locations only in women with genetically or environmentally altered cell-mediated immune function. Development of endometriosis may then prompt a humoral response in some women, which results in the production of autoantibodies to endometrial cells or c ell-derived antigens. These autoantibodies may cross-react with the ut erine endometrium, interfere with implantation, and cause infertility or early spontaneous abortions. We recently observed that the presence of autoantibodies in endometriosis was associated with significantly lower in vitro fertilization/embryo transfer pregnancy rates. Interest ingly, in about 30% of women with unexplained infertility, immune chan ges characteristic of endometriosis were also present, suggesting a su bclinical form of this disease. We conclude that: (1) women with unexp lained infertility should have studies of the immune function to rule out subclinical form of endometriosis; (2) evaluation of infertility i n women with endometriosis should include an assessment of autoantibod y status; and (3) treatment methods involving autoantibody suppression should be considered in women with endometriosis positive for autoant ibodies.