Endometriosis and infertility

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Endometriosis--a condition in which cells from the uterine lining grow outside the uterus--is a common cause of infertility, but precisely how it impairs fertility isn't clear. Now, an investigation by a group of researchers from the University of North Carolina at Chapel Hill has yielded a possible connection--a protein called beta-3.

In an study published in the August 1994 issue of the Journal of Clinical Endocrinology and Metabolism, the team found that beta-3 was missing from the surface of the endometrium at a critical point in the menstrual cycle of 22 infertile women. Nineteen of these were later found to have mild cases of endometriosis. The protein, which the researchers believe is necessary for the fertilized egg to implant in the wall of the uterus, routinely appeared on the 19th and 20th days of the menstrual cycles--when implantation would normally occur--in the 20 fertile women they studied.

The role that the beta-3 protein plays in implantation is unknown, but according to the researchers, it could either be necessary for implantation or simply a "marker" for another process that is crucial to implantation.

In either case, the discovery has paved the way for the development of a nonsurgical test for endometriosis in women who are having severe menstrual pain or other symptoms. Although moderate and severe cases of endometriosis can be diagnosed via ultrasound, mild and minimal cases are much more difficult to detect. Currently, the only accurate diagnosis is made through laparoscopy, in which a camera is inserted through a tiny abdominal incision while the patient is under general anesthesia. The beta-3 test, which may be available within a year, would require only an endometrial biopsy performed in a doctor's office.

A woman who has no beta-3 has only a 10% chance of becoming pregnant in a 3-year period according to the researchers.

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