Autoimmunity in endometriosis: Relevance to infertility

PROBLEM: Endometriosis is a complicated multi-factorial disease. Genetic and immunologic factors play a key role in its pathophysiology. We were the first to describe endometrial and ovarian autoimmunity in women with endometriosis in 1981. METHODS OF STUDY: ELISA and Western blot analysis. It is accepted that women with endometriosis have autoimmunity to endometrial, ovarian and nuclear antigens. We have now established that: 1. The endometrial autoantigens to which the endometriosis patients have autoimmune reactions are endometrial transferrin and alpha 2-HS glycoprotein. 2. Levels of antibodies to both these proteins are specifically elevated in women with endometriosis, thus making them important candidates for developing an endometrial antibody assay for a non-invasive diagnosis of endometriosis. 3. Levels of transferrin and alpha 2-HS glycoprotein are significantly elevated in the peritoneal fluid of women with endometriosis. 4. Antibodies to transferrin and alpha 2-HS glycoprotein also inhibit in vitro sperm motility. CONCLUSION: These data strongly suggest the possibility of endometrial autoantibodies playing an important role in the infertility often associated with endometriosis.