Endometriosis is often associated with
infertility, which might be a consequence of intraperitoneal macrophage activation and various immunological events related to it. To determine what triggers macrophage activation and what immunologic conditions occur in the peritoneal cavity of a patient with
endometriosis, we measured the amounts of
phospholipase A2,
cholesterol fractions (HDL,
LDL, and VLDL),
interleukins (IL)-1 and 6,
granulocyte-macrophage-colony stimulating factor (
GM-CSF), and
phosphatidylserine in peritoneal fluid. Peritoneal-fluid samples were collected during laparoscopy or
laparotomy from 14 patients with
endometriosis and from 11 patients with other diseases (5 with
myoma uteri, 5 with benign
ovarian cysts and 1 with a
double uterus) as controls. With regard to
phospholipase A2, there were no significant differences between the
endometriosis group and the control group.
LDL was significantly lower in the
endometriosis group than in the control (p < 0.05). The levels of
IL-1 and
GM-CSF were similar in both groups;
IL-6, however, was higher in 7
endometriosis patients with associated
infertility than in the 9 non-
endometriosis fertile patients. These findings suggest that inflammatory tissues are not related to the activation of intraperitoneal macrophages in
endometriosis patients.
Cholesterol fractions (HDL or
LDL) might participate in macrophage activation in these patients, but this remains to be clarified. The high
IL-6 levels observed in infertile
endometriosis suggest that some immunological events that prevent patients from becoming pregnant take place in women with
endometriosis-associated
infertility.