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New Theory Links Fertility Disorder, Immune System

July 14, 1987|ALLAN PARACHINI | Times Staff Writer

Endometriosis, the infertility-inducing disease characterized by cysts on the ovaries and often perceived as a bane of modern-day women, may really be an immune-system disorder.

That potentially far-reaching observation comes from a Chicago research team, the leader of which says there may be mounting evidence that not just endometriosis, but other infertility problems too may be triggered by what is called autoimmune disease. In this disorder, immune-system responses, which normally combat infection and other invasions of the body by outside organisms, mistakenly redirect themselves to battle the body's own functions.

New Theory a Major Departure

The cause of endometriosis has never been precisely identified, but the new theory about autoimmune disease is a major departure from previous speculation, which has ranged from menstrual abnormalities to oral contraceptive use--and even stress.

Now, however, a team at Chicago's Mt. Sinai Hospital, which reported its results in the journal Obstetrics and Gynecology, has found evidence of a possible autoimmune system origin in a study of 59 women.

If the theory is eventually proven, said Dr. Norbert Gleicher, head of the research team, treating endometriosis could be made far more effective by tailoring new drugs to combat the errant immune-system response--which remains unidentified. More important, though, Gleicher said in a telephone interview, there are strong indications that a wider range of infertility problems may also be related to autoimmune disease.

If that's true, he said, the relationship of the autoimmune system to infertility may be of potentially major proportions.

"It could explain what has happened to a lot of patients with so-called unexplained infertility or unexplained miscarriages," he said.

Ironically, Gleicher said, the drug danazol--currently the treatment of choice, other than surgery or pregnancy, which causes remission of endometriosis symptoms--may work not because it suppresses ovulation, as had previously been thought, but because it tampers with the autoimmune system. Separate studies, Gleicher said, are starting to indicate that danazol is an effective weapon against autoimmune irregularities.

And if that allied theory is confirmed, he said, it would be true "that we have treated the disease with the right drug, but for the wrong reasons."

In another infertility development, two unrelated articles appearing--unbeknown to the authors--in the same journal three months apart have made serious a question that might seem preposterous: Are a significant number of women made infertile by intrauterine devices that they believed had been removed but which actually hadn't?

On its face, it would seem unlikely indeed that a woman could specifically recall being told--or believe she had been told by her doctor--that her IUD had been taken out but that, for a variety of reasons, it hadn't really been removed. But in March, a team of researchers in Haifa, Israel, reported three cases of women with precisely that experience.

And while one report of such a development might be dismissed as a fluke, a team in Vancouver, Canada, now reports another three cases that occurred under nearly identical circumstances. The two episodes were described in issues of the journal Fertility and Sterility. All of the women reported in the Canadian series, the principal author of the new report said, were intelligent, aware people who kept careful track of their birth-control situations.

All three, Dr. Timothy Rowe of Vancouver's Grace Hospital said, reported that they had undergone surgical procedures in which their IUDs were taken out. One of the women had been treated at a large university medical center. But all three turned out to still have the IUDs in place, Rowe said.

Rowe declined to speculate on how widespread the problem may be, but he said the unexpected discoveries in Israel and Canada emphasize the importance of making sure a doctor is forced to clearly and specifically communicate exactly what has been done in surgery or treatment. Often, Rowe said, a physician may assume he or she has told a woman something that, in fact, has not been communicated.

As a consequence, a woman who previously used an IUD and is being seen for the first time by an infertility specialist should be examined for the presence of an IUD.

"A lot of things are understood and not stated," he said. "There is a lesson in this for women with IUDs: To have what has been done in their treatment made perfectly clear."

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