Endometriosis is a benign gynecologic disorder characterized by the presence of endometrial cells outside the endometrium (tissue normally lining the uterus) and causing infertility. It has been found that half of infertile women have endometriosis in the USA (1). disrupted implantation due to altered endometrial receptivity
Ovaries and oocytes released during ovulation are exposed to and influence by the peritoneal fluid.
Endometriosis is characterized by a pelvic inflammation resulting from endometriotic lesions. This pelvic inflammation can in return induces the proliferation and adhesion of ectopic tissue through the production of cytokines (2-4).
Many factors, negatively affecting the oocyte quality, have already been identified in the peritoneal fluid of patients with endometriosis including prostaglandins, pro-inflammatory cytokines such as TNFα, IL-1, RANTES, or ROS reactive oxygen species (5-8).
In this new study, peritoneal fluid compositions of infertile women surgically diagnosed with endometriosis (ENDO group) has been compared to those of infertile women with no endometriosis (ENDO-free group) with a focus on sphingolipids, molecules with pleiotropic effects on cell proliferation, cell differentiation and apoptosis (9).
A specific subset of sphingolipids, namely ceramides, has been found to be significantly increased in the PF of infertile patients with ENDO as compared to infertile women in the ENDO-free group. Particularly, three ceramides, C22:0 Cer, C24:0 Cer and C24:1 Cer can be used as predictors of severe endometriosis.
Ceramides have been found to be toxic to oocytes and embryos both in vivo and in vitro (10).
So, the authors of the study, looked at the effect of these ceramides on the oocyte maturation in vitro using mice oocytes.
Interestingly, when incubated with increasing dose of Ceramide C24:1, oocytes did not further develop.
Oocyte arrest is dependent on ceramides C24:1 dose, the higher the concentration, the earlier the oocyte development arrest will take place.
Further analysis has shown that the anti-maturation effects of ceramides C24:1 on oocyte is mediated through the production of reactive oxygen species as seen by increased levels of superoxide in the oocyte mitochondria.
Most interestingly, resveratrol, a potent anti-oxidant, can counteract the increase of superoxide dismutase thus minimizing oxidative stress and restoring oocyte development and maturation.
Very elevated ROS levels in endometriosis may adversely affect oocyte and embryo development in vivo (11-12) as well as pregnancy outcomes (13).
The good news here is that resveratrol can counteract ROS production thus promoting oocyte maturation in patients affected by endometriosis.
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