Endometriosis is an estrogen-dependent gynecological disease, where ectopic growth of endometrial tissues causes severe pain and infertility. The pathophysiology of endometriosis involves cellular invasion and transitions such as epithelial-mesenchymal transition (EMT). Matrix metalloproteinase (MMP)-3 and transforming growth factor (TGF)-β pathway are two important regulators of the process. In this report, we studied 12 control women without endometriosis and 24 women with ovarian endometriosis (12 early and 12 late stages) for evaluation of serum and tissue levels of MMP3 and TGFβ1. Serum levels of MMP3 and TGFβ1 were significantly elevated in patients with endometriosis compared to control women. Late stage (III and IV) endometriosis patients displayed significantly higher levels of serum MMP3 and TGFβ1 than early stage (I and II) patients. We found a positive correlation between serum MMP3 and TGFβ1 levels. Ectopic endometriotic tissues exhibited higher MMP3 expressions as compared to eutopic endometrium and were increasingly expressed with severity of the disease. In vitro studies using Chinese hamster ovarian epithelial (CHO) cells found TGFβ1 treatment upregulated MMP3 levels. TGFβ1 treatment promoted cellular invasion of CHO cells in a MMP dependent manner. Present study highlights an association of MMP3 in TGFβ1-mediated promotion of cellular invasion in endometriosis.
Introduction: Voluntary physical activity reduces lesion development and inflammatory parameters in experimental endometriosis, though the mechanisms remain unclear. Peroxisome proliferator-activated receptor γ (PPAR-γ), a regulator of inflammation and nociception, may mediate these effects. We previously observed PPAR-γ overexpression in lesions of endometriosis animals and hypothesized that it underlies exercise-induced benefits. Methods: Adult female Sprague-Dawley rats were randomized to three groups ( n = 12/group): endometriosis-vehicle, endometriosis-vehicle + exercise, or endometriosis + PPAR-γ antagonist + exercise. Endometriosis was induced by suturing four uterine horn fragments on the intestinal mesentery (day 0). Exercised animals had continuous access to a running wheel. Pain behaviors (Von Frey, hot plate) were assessed, and vesicles, blood, peritoneal fluid, and tissues were collected on day 61. Results: Exercised rats had higher food consumption ( p < 0.001) without differences in body weight at sacrifice, and a reduced fat-to-body weight ratio ( p < 0.0001). All groups showed higher pain sensitivity after surgery, unaffected by PPAR-γ antagonism. Exercise significantly reduced vesicle development and colonic damage compared to the non-exercised group, while these effects were abrogated by the PPAR-γ antagonist. Serum MIP3 alpha levels increased in exercised rats (p<0.05), with no significant differences in other cytokines. Conclusion: Our results indicate that PPAR-γ signaling contributes to the beneficial effects of exercise on endometriotic lesion growth.
Background: Endometriosis is a chronic gynecological disorder associated with infertility, diminished ovarian reserve, and variable outcomes after assisted reproductive technology (ART). However, its effects on oocyte competence, embryo quality, implantation, and live birth remain controversial. Objective: To critically synthesize current evidence regarding the impact of endometriosis on ovarian reserve, oocyte and embryo competence, and ART outcomes, with emphasis on ovarian endometrioma (OMA), disease stage, adenomyosis, surgery, and pretreatment strategies before IVF/ICSI. Methods: We conducted a targeted narrative literature review using PubMed, Embase, and Scopus for studies published between 2014 and 2025. We prioritized systematic reviews, meta-analyses, randomized trials, large cohort studies, guidelines, and clinically relevant recent publications on endometriosis-associated infertility and ART outcomes. This article is a critical narrative review rather than a systematic review; therefore, we did not report PRISMA flow or conduct a formal risk-of-bias assessment. Results: Endometriosis is consistently associated with reduced ovarian reserve and lower oocyte yield, particularly in women with OMA or previous ovarian surgery. Evidence on oocyte and embryo competence remains heterogeneous, although recent studies suggest that embryo euploidy and per-transfer live birth are often preserved when good-quality embryos are available. In contrast, cumulative live birth rate may decline because repeated ART cycles yield fewer oocytes and embryos. Adenomyosis appears to impair implantation and cumulative outcomes independently. Conclusions: Endometriosis predominantly affects oocyte quantity rather than uniformly impairing embryo competence. Routine surgery or prolonged medical pretreatment before IVF is not supported for all patients and should be individualized.
Background: Severe chronic pelvic pain of endometriosis is associated with worse quality of life (QoL) and women may use self-management strategies for relief. The aim of the study was to describe this association among Jamaican women living with endometriosis and the use self-management strategies. Methods: A cross-sectional online survey was conducted August 2021–March 2022 to include women aged 18–49 years, residing in Jamaica and confirmed endometriosis diagnosis. Survey items included visual analog scale (VAS) pain scale, Endometriosis Health Profile core component for QoL score (EHP-5-core QoL), Pelvic Pain Impact Questionnaire (PPIQ) for Total impact score and self-management strategies used. Data analysis involved descriptive (mean ± standard deviation, percentages with 95%confidence intervals); and Spearman’s rho correlation. Results: Participants completing the survey ( n = 84) represented women from all counties across Jamaica; 80% reported severe monthly pelvic pain (VAS ⩾ 7). EHP-5-core QoL was 69% (95%confidence interval, 65%—73%); worst contributing item was ‘Social Support’, 3.3 ± 0.8. Total PPIQ Score was 18.6 ± 7.6 and worst PPIQ item was ‘Mood’ 2.7 ± 1.1. There was a strong correlation between Total PPIQ and EHP-5-core QoL (0.687; p < 0.001). Most participants (63/84, 75%) reported use of self-management strategies; herbal preparations (62/63, 98%) were most used, followed by rest (48/63, 68%). Ginger tea was the most common tea reported (46/63, 73%). Use of self-management strategies correlated with impact of chronic pelvic pain on sleep (0.349; p < 0.01) and level of intimacy (0.261; p < 0.05). Conclusion: For Jamaican women living with endometriosis, severe chronic pelvic pain correlated with the worst quality of life. While mood was most impacted by the pelvic pain, self-management strategies to relieve the impact of pelvic pain on sleep and level of intimacy were of significance. There was preferred reliance on herbal preparations.
