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Introductory remarks
SYMPOSIUM Pathophysiology of Infertility Associated with Endometriosis Guest Editors Yuji Taketani, MD, PhD Naoki Terakawa, MD, PhD Hiroshi Hoshiai, MD, PhD
The publication of these proceedings is supported by an educational grant from Tokyo Tanabe Co., Ltd.
Introductory remarks Yuji Taketani, MD, PhD, Naoki Terakawa, MD, PhD, and Hiroshi Hoshiai, MD, PhD Tokyo, Yonago, and Osaka,Japan
Despite all the research accumulated over the years regarding endometriosis, the cause, pathophysiology, natural course, and other aspects of this disease remain enigmatic. In particular, of the variety of clinical problems that affect patients who have endometriosis, the most perplexing problem for all gynecologists is the treatment of infertility associated with endometriosis. Although a close link between endometriosis and infertility has long been recognized, a direct cause-andeffect relationship between endometriosis and infertility has not yet been proved. Thus far many plausible mechanisms for endometriosis-associated infertility have been postulated. However, no single mechanism can explain the cause for infertility in every case. This may reflect the complexity of the pathophysiology of endometriosis, the multifactorial mechanisms involved in endometriosis-associated infertility, or both. Indeed, the clinical link between endometriosis and infertility does not always exist. For instance, some women who have severe endometriosis may also have normal reproductive performance. In contrast, we know of many patients who cannot conceive despite long-standing treatment for infertility. Many gynecologists may be inclined to use medical or surgical methods to treat infertile women who have endometriosis, without being certain of the efficacy of these treatments when all routine treatments for infertility have failed. However, it
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has not yet been established whether the treatment of endometriosis per se benefits patients who have impaired reproductive performance. The answer to this question must wait for the elucidation of the mechanisms involved in endometriosis-associated infertility. With this in mind, we held a conference on the "Pathophysiology of infertility associated with endometriosis" in Hakone, Japan, on September 6,1991. At the conference we attempted to address this issue from various standpoints and placed special emphasis on the immunologic aspects of the pathogenesis of endometriosis-associated infertility. To this end we called for a comprehensive and fundamental review of the involvement of immunology in reproduction. As a whole these proceedings not only emphasize the complexity of the problem, but they raise some new concepts for the understanding of endometriosis-associated infertility. We are grateful to Professor Masahiko Mizuno, Chairman of the Department of Obstetrics and Gynecology, University of Tokyo, for his advice and constant encouragement. We also thank all the contributors for their participation in the Second Hakone Conference on Endometriosis, and we gratefully acknowledge the educational grants from Tokyo Tanabe Co., Ltd., which made the conference and the publication of these proceedings possible.
The publication of these proceedings is supported by an educational grant from Tokyo Tanabe Co., Ltd.
Introductory remarks Yuji Taketani, MD, PhD, Naoki Terakawa, MD, PhD, and Hiroshi Hoshiai, MD, PhD Tokyo, Yonago, and Osaka,Japan
Despite all the research accumulated over the years regarding endometriosis, the cause, pathophysiology, natural course, and other aspects of this disease remain enigmatic. In particular, of the variety of clinical problems that affect patients who have endometriosis, the most perplexing problem for all gynecologists is the treatment of infertility associated with endometriosis. Although a close link between endometriosis and infertility has long been recognized, a direct cause-andeffect relationship between endometriosis and infertility has not yet been proved. Thus far many plausible mechanisms for endometriosis-associated infertility have been postulated. However, no single mechanism can explain the cause for infertility in every case. This may reflect the complexity of the pathophysiology of endometriosis, the multifactorial mechanisms involved in endometriosis-associated infertility, or both. Indeed, the clinical link between endometriosis and infertility does not always exist. For instance, some women who have severe endometriosis may also have normal reproductive performance. In contrast, we know of many patients who cannot conceive despite long-standing treatment for infertility. Many gynecologists may be inclined to use medical or surgical methods to treat infertile women who have endometriosis, without being certain of the efficacy of these treatments when all routine treatments for infertility have failed. However, it
250
has not yet been established whether the treatment of endometriosis per se benefits patients who have impaired reproductive performance. The answer to this question must wait for the elucidation of the mechanisms involved in endometriosis-associated infertility. With this in mind, we held a conference on the "Pathophysiology of infertility associated with endometriosis" in Hakone, Japan, on September 6,1991. At the conference we attempted to address this issue from various standpoints and placed special emphasis on the immunologic aspects of the pathogenesis of endometriosis-associated infertility. To this end we called for a comprehensive and fundamental review of the involvement of immunology in reproduction. As a whole these proceedings not only emphasize the complexity of the problem, but they raise some new concepts for the understanding of endometriosis-associated infertility. We are grateful to Professor Masahiko Mizuno, Chairman of the Department of Obstetrics and Gynecology, University of Tokyo, for his advice and constant encouragement. We also thank all the contributors for their participation in the Second Hakone Conference on Endometriosis, and we gratefully acknowledge the educational grants from Tokyo Tanabe Co., Ltd., which made the conference and the publication of these proceedings possible.