Significance of metabolomic disorders in infertility and miscarriage in patients with endometriosis

BACKGROUND: Despite numerous studies, the causal relationships of endometriosis, associated infertility and miscarriage have not yet been clarified.

AIM: This article discusses the significance of insulin-like growth factor 1, matrix metalloproteinase 9 and activin A levels in the blood serum and peritoneal fluid of patients of reproductive age with endometriosis in the clinical aspects of infertility and miscarriage and as per stages of the disease.

MATERIALS AND METHODS: The overall group consisted of patients with endometriosis (group I: stages I–II, n = 25; group II: stages III–IV, n = 38). The control group comprised patients without the disease (group III: n = 25). The stage of endometriosis was classified during laparoscopy in accordance with revised American Society for Reproductive Medicine classification (1996).

RESULTS: In endometriosis, primary infertility predominated (up to 40.8% of cases), while secondary infertility occured in 21.2% of cases. Primary infertility accounted for 68.0% of cases in stages I–II versus 39.5% of cases in stages III–IV. Secondary infertility accounted for 28.0% versus 23.0% of cases, respectively. In minimal stages of the disease, non-developing pregnancies (12.0%) and spontaneous miscarriages (4.0%) occurred in 16.0% of cases. In severe stages, these nosologies occurred in an equal percentage of cases (5.2%).

The group of patients with endometriosis showed multidirectional changes in activin A levels in the blood serum and peritoneal fluid, a decrease in matrix metalloproteinase 9 level by 27% in the peritoneal fluid and an increase in insulin-like growth factor 1 level by 36% in the blood serum. In minimal stages of endometriosis, the tendencies of changes in the parameters remained intact as compared to the overall group, the correspondence of matrix metalloproteinase 9 levels to the control values in the blood serum and peritoneal fluid being noteworthy. Stages III–IV of the disease implied more significant changes as compared to the control or the overall group of patients. We found a decrease in insulin-like growth factor 1 level by 56% in the peritoneal fluid, a decrease in activin A level by 19% in the blood serum with an increase in the parameter by 27% in the peritoneal fluid, and a decrease in matrix metalloproteinase 9 level by 4% in the peritoneal fluid.

CONCLUSIONS: Modifications of the studied compounds activin A, MPP-9 and IPFR-1 are associated with infertility and miscarriage in patients with endometriosis.