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G. A. J. Dunselman, P. X. J. M. Bouckaert, and J. L. H. Evers

Summary. Peritoneal fluid volume was determined and concentrations of C-reactive protein, α1-antitrypsin, acid-α1-glycoprotein, α2-macroglobulin, haptoglobin, complement factors C3 and C4, IgG, IgA and IgM were measured in the supernatant of the peritoneal fluid and in serum by means of a radial-immunodiffusion technique in 25 patients with and in 45 patients without endometriosis. Peritoneal fluid volume was not different between the two groups. The peritoneal fluid:serum ratios for the proteins determined showed a significant inverse correlation with their molecular weight in both groups, indicating that their presence in peritoneal fluid is governed by exudation according to their molecular weight, rather than by active production in, or selective release into, the peritoneal cavity. In control patients only, the ratios of most of the individual proteins studied were significantly higher in the luteal than in the follicular phase. We suggest that the high values of peritoneal fluid:serum ratios in endometriosis patients in the follicular phase reflects an additional contribution by endometriotic tissue and peritoneal macrophages. In the luteal phase, the cycle-dependent increase of protein exudation obscures this additional contribution.

We conclude that endometriosis does not cause marked intra-abdominal inflammatory changes. If the presence of endometriosis lowers fecundity, the mechanism probably does not involve acute-phase protein synthesis.

Keywords: endometriosis; acute-phase proteins; peritoneal fluid; man

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P. X. J. M. Bouckaert, J. L. H. Evers, W. H. Doesburg, L. A. Schellekens, P. H. Brombacher, and R. Rolland

Summary. During a laparoscopy that was performed between Day –6 and Day +9 of the cycle as related to the day of the LH peak (Day 0), the peritoneal fluid of 100 healthy female volunteers of proven fertility was collected and analysed. Peritoneal fluid volume and concentrations of total protein, albumin, α1-, α2-, β- and γ-globulins, IgA, IgG, IgM, haptoglobulin, acid-α1-glycoprotein, α1-antitrypsin, α2-macroglobulin, C3-, C4- and C-reactive protein were determined. The peritoneal fluid volume and the concentrations of most proteins analysed showed an increase during the post-ovulatory phase of the period investigated. The peritoneal fluid:serum ratio of each individual protein showed a significant inverse correlation with its molecular weight. This confirms the assumption that peritoneal fluid is mainly an exudation product, most probably of ovarian origin.

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J. C. M. Dumoulin, J. L. H. Evers, M. Bras, M. H. E. C. Pieters, and J. P. M. Geraedts

Summary. The effect of various taurine concentrations in modified Tyrode's medium on in vitro fertilization of mouse oocytes was examined. No significant difference in fertilization rate was found at concentrations of 0, 0·1, 1, 5, 10 and 20 mm taurine. In a second series of experiments, the effect of taurine on preimplantation embryonic development after fertilization in vitro was studied. At concentrations of 1, 5, 10 and 20 mm taurine, significantly more two-cell embryos reached the blastocyst stage compared with medium without taurine. Culture in the presence of 5 mm or 10 mm taurine resulted in blastocysts with the highest mean number of cells. The positive effect of taurine on embryonic development was found to be more pronounced both in a second medium (human tubal fluid medium) which has a higher potassium concentration than Tyrode's medium, and in a modified Tyrode's medium with an increased potassium concentration. In addition to these in vitro studies, it is reported that taurine comprised about 59% of the total free amino acid content in mouse oviduct flushings, compared with 17% in mouse serum.

Keywords: taurine; in vitro fertilization; embryonic development; mouse

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G. A. J. Dunselman, J. A. Land, P. X. J. M. Bouckaert, and J. L. H. Evers

Summary. In 25 rabbits (Group E) endometrium from the right uterine horn was transplanted onto the peritoneum. In 25 rabbits (Group C) fat was transplanted. After a recovery period of 12 weeks the does were mated, and killed 24 h later. In Group E the implants had changed into cysts of 5–15 mm in diameter. Histological examination revealed endometrial glands and stroma in every specimen. Periadenexal adhesions did not develop in any animal. No differences were found between Groups C and E in the number of corpora lutea, the recovery rate, the fertilization rate and the transport of fertilized ova. These findings indicate that endometrial implants in the rabbit have no influence on the ovulatory mechanism, the pickup function of the oviduct, the fertilization rate or on the transport of fertilized ova. Taking into account the restrictions of a rabbit model, it is suggested that the decreased fecundity in mild endometriosis in the human may be caused by disturbances in post-fertilization events, i.e. development of the pre-implantation embryo or implantation.

Keywords: endometriosis; ovulation; ovum pickup; fertilization; tubal transport

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G. A. J. Dunselman, M. G. R. Hendrix, P. X. J. M. Bouckaert, and J. L. H. Evers

Summary. Peritoneal fluid was collected in the periovulatory phase of the cycle from 25 women undergoing laparoscopy. Endometriosis was diagnosed in 13 patients (AFS score 1, N = 9; AFS score 2, N = 4) and 12 patients without endometriosis served as controls. In endometriosis patients the total peritoneal fluid cell number and cell concentration was significantly higher than in controls, indicating peritoneal irritation by endometrial implants. Peritoneal fluid macrophages in patients with endometriosis showed significantly increased erythrophagocytosis and lower chemiluminescence than in controls, suggesting an advanced differentiation of the macrophages in endometriosis patients. The macrophages in this stage of differentiation may interfere with gametes and embryos and thus contribute to endometriosis-associated subfertility.

Keywords: endometriosis; peritoneal macrophages; phagocytosis; chemiluminescence; women