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The pathogenesis of adenomyosis and its impact on fertility: a literature review

https://doi.org/10.23946/2500-0764-2024-9-3-130-139

Abstract

Adenomyosis, an ingrowth of endometrial tissue into the uterine wall, is a benign gynecological disease associated with infertility, pelvic pain, and abnormal uterine bleeding, having serious consequences for a woman's health and quality of life. Diagnosis of adenomyosis is often challenging due to the concomitant endometrial hyperplasia. The pathogenesis of adenomyosis has not yet been fully evaluated and requires further fundamental and clinical research. Here we analyze an impact of local and systemic immunity on the development and progression of adenomyosis. Several studies highlight the role of immune cell activation and excessive release of both proinflammatory and anti-inflammatory cytokines. Women with adenomyosis exhibit an imbalance in the interferon system, elevated levels of certain growth factors, defensins, and chemokines. Immune system disorders well correlate with the clinical symptoms of adenomyosis and entail adverse consequences for the female reproductive system. Oxidative stress that occurs in adenomyosis leads to an excess of free radicals that can damage the embryo. Alterations in cell adhesion levels prevent implantation, and morphological changes in the myometrium lead to a violation of its peristalsis and impede the sperm transport. Changes in the cytokine profile and the levels of transport proteins in women with adenomyosis may serve as predictors of the assisted reproductive technology outcomes. This review discusses the recent literature on adenomyosis and its impact on women reproductive function.

About the Authors

V. V. Likhacheva
Novokuznetsk State Institute for Postgraduate Medical Education – Branch of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation
Russian Federation

Prof. Victoria V. Likhacheva, MD, DSc, Professor, Department of Obstetrics and Gynecology

5, Novokuznetsk, Stroiteley Prospekt, 654005



O. V. Azarova
Medical Center "Expert"
Russian Federation

Dr. Olga V. Azarova, MD, Reproductologist

17a, Kutuzova Street, Novokuznetsk, 654041



L. V. Renge
Novokuznetsk State Institute for Postgraduate Medical Education – Branch of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation
Russian Federation

Prof. Lyudmila V. Renge, MD, DSc, Professor, Head of the Department of Obstetrics and Gynecology

5, Novokuznetsk, Stroiteley Prospekt, 654005



P. Yu. Motyreva
Medical Center "Avicenna"
Russian Federation

Mrs. Polina Yu. Motyreva, Senior Biologist

17, Communisticheskaya Street, Novosibirsk, 630007



N. A. Khonina
Research Institute of Fundamental and Clinical Immunology
Russian Federation

Prof. Natalia A. Khonina, MD, DSc, Leading Researcher, Laboratory of Cellular Immunotherapy, Institute of Fundamental and Clinical Immunology

14, Yadrintsevskaya Street, Novosibirsk, 630099

 



B. I. Ayzikovich
Novosibirsk National Research State University
Russian Federation

Prof. Boris I. Ayzikovich, MD, DSc, Professor, Department of Basic Medicine

2, Pirogova Street, Novosibirsk, 630090



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Likhacheva V.V., Azarova O.V., Renge L.V., Motyreva P.Yu., Khonina N.A., Ayzikovich B.I. The pathogenesis of adenomyosis and its impact on fertility: a literature review. Fundamental and Clinical Medicine. 2024;9(3):130-139. (In Russ.) https://doi.org/10.23946/2500-0764-2024-9-3-130-139

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