Study On The Correlation Between Endometriosis,Endometrial Polyps And Hydrosalpinx In Infertile Patients

Part ?Study on the correlation between endometriosis and endometrial polyps in infertile patients Background:Until now,the exact pathogenesis of endometriosis is still not clear,and there are many possible mechanisms.The "theory of ectopic implantation" has been widely recognized,and the hypothesis of "eutopic endometrium determinism" has also gained more and more attention.Endometriosis is considered to be related to estrogen level.The estrogen metabolism of endometrium for endometriosis is different from that of normal endometrium.Ectopic endometrium can also weaken the inactivation of local estrogen and promote its self proliferation besides autocrine estrogen.Endometrial polyps are considered to be associated with inflammation,endocrine disorders and hormone levels.In fact,there are many causes of endometrial polyps and the pathogenesis is still unclear.The etiology and pathogenesis of endometrial polyps are closely related to hormone and cytokine.Endometriosis and endometrial polyps are all related to estrogen level.Some characteristics of these two diseases cause a correlation between them.Some studies have shown that patients with endometriosis usually have a higher prevalence of endometrium polyps.As far as we know,there are few studies on the correlation between endometriosis and endometrial polyps in infertility patients,and the study on pathological types of endometrial polyps in infertility patients with endometriosis and endometrial polyps is rare.Objective:To determine if there is a higher prevalence of endometrial polyps in infertility patients with endometriosis and to clarify the pathological characteristics of endometriosis associated polyps.Methods:Infertile patients who had undergone both hysteroscopy and laparoscopy in Reproductive Hospital Affiliated with Shandong University from January 2014 to May 2017 were enrolled.A total of 3462 cases,including 414 cases of patients with endometriosis,3048 cases without endometriosis,1107 cases of patients with endometrial polyps,2355 cases without endometrial polyps.The clinical data of each group were collected,including age,infertility duration,age of menarche,body mass index,infertility(primary,secondary),polycystic ovary syndrome history,and history of uterine abnormalities.Staging of endometriosis was performed according to r-AFS staging.Endometrial polyps were classified according to the diagnostic criteria prescribed by Zhong-nian Chen et al.Results:There were 414 patients in the endometriosis group and 3048 in the non-endometriosis group,the two groups had significant differences in age,BMI,infertility(primary,secondary),and PCOS history;In 1107 cases of endometrial polyps diagnosed by hysteroscopy,the prevalence was significantly higher in the endometriosis group than in the non-endometriosis group(P<0.001);In 899 cases of endometrial polyps diagnosed by pathological diagnosis,the prevalence of endometrial polyps in the endometriosis group was still higher than in the non-endometriosis group.There was no significant difference in endometrial polyp prevalence between patients with different stages of endometriosis(P=0.580).No significant difference was found between early stages(?+?)and late stages(?+?)(P=0.229).The pathological diagnosis of endometrial polyps in infertile patients with endometriosis was mainly polyps combined with simple hyperplasia.Conclusions:The infertile patients with endometriosis had a higher prevalence of endometrial polyps,and those polyps are often combined with simple hyperplasia.Part IIStudy on the correlation between endometriosis and hydrosalpinx in infertile patientsBackground:Now the exact etiology and pathogenesis of endometriosis are still unclear.Sampson's theory of ectopic implantation is the earliest known and recognised.Then domestic scholars put forward the theory of eutopic endometrial determinism,and gradually gained more and more attention.Endometriosis is also considered to be an inflammatory disease with abnormal immune response.Some scholars have confirmed that the related immune cells have an important role in promoting the development and maintenance of ectopic lesions.Hydrosalpinx is a common complication of chronic salpingity.Tubal infertility is one of the main causes of infertility in women of childbearing age.On the impact of hydrosalpinx on pregnancy,there are many research theories have been proposed,including the mechanical barrier created by intrauterine accumulation of refluxed fluid;increased uterine peristalsis;the damage of.endometrial receptivity and the toxic action to the embryos.Endometriosis and hydrosalpinx are all inflammation related diseases.Endometriosis can lead to pelvic adhesions,and adhesions will eventually lead to the occurrence of hydrosalpinx.However,in our clinical work,the incidence of hydrosalpinx in endometriosis patients seems to be lower than that of non-endometriosis patients.It is speculated that the relationship between these two diseases may be related to the retrograde menstruation.There is no study on the possible relationship between endometriosis and hydrosalpinx.Objective:Via comparing the prevalence of hydrosalpinx in infertile patients with endometriosis and non endometriosis,we analyzed the correlation between the two diseases.Methods:We performed a retrospective,database-searched cohort study.Infertile patients who had undergone both hysteroscopy and laparoscopy in Reproductive Hospital Affiliated with Shandong University from January 2014 to June 2017 were enrolled.A total of 3585 cases,including 430 cases of patients with endometriosis,3155 cases without endometriosis,1021 cases of patients with hydrosalpinx,2564 cases without hydrosalpinx.1021 patients with hydrosalpinx were further divided into two groups,including unilateral hydrosalpinx(314 cases)and bilateral hydrosalpinx patients(707 cases).The clinical data of patients in each group were collected,including age,infertility duration,age at menarche,BMI,infertility(primary,secondary),PCOS history,history of uterine abnormalities et al.The severity of endometriosis is divided into 4 stages according to the r-AFS method.Results:The prevalence of hydrosalpinx in endometriosis group was lower than that of non-endometriosis group,and the difference was statistically significant.Compared with the control group,the prevalence of endometriosis in the hydrosalpinx group was also lower.The prevalence of hydrosalpinx in patients with stage ? of endometriosis was significantly higher than that of stage ? The prevalence of hydrosalpinx in patients with mild endometriosis(?+?)was significantly lower than those with severe endometriosis(?+?).The prevalence of endometriosis in unilateral hydrosalpinx group was significantly higher than that in bilateral hydrosalpinx group,but lower than that in non-hydrosalpinx group.Conclusions:The infertile patients with pelvic endometriosis have a lower prevalence of hydrosalpinx than with non-endometriosis.The prevalence of endometriosis in hydrosalpinx group was significantly lower than that in non-hydrosalpinx group.