Which of the following best explains the mechanism by which peritoneal endometriosis impairs fertility even when tubes are patent and ovulation is normal?
- A Elevated peritoneal fluid prostaglandins and activated macrophages impairing gamete and embryo function ✓
- B Complete mechanical blockage of the fallopian tube lumen
- C Premature ovarian failure from autoimmune destruction of follicles
- D Thickening of the zona pellucida preventing fertilisation
Correct answer: A. Elevated peritoneal fluid prostaglandins and activated macrophages impairing gamete and embryo function
Explanation
Mild to moderate endometriosis reduces fecundity through a hostile peritoneal environment: increased volume of peritoneal fluid, activated macrophages, and raised prostaglandins and cytokines that impair sperm motility, fertilisation and early embryo development, and may affect tubal motility. Complete tubal blockage applies to severe disease with adhesions, not minimal disease. Ovarian reserve may decline with endometriomas but premature ovarian failure is not the mechanism here.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.