Histomorphological Aspects of the Ovarian Cortex Regarding Ovarian Reserve and Local Pelvic Inflammation

Abstract: The ovaries of women of reproductive age may show specific histological structures that may relate to the maintenance of primordial follicles and the regulation of early follicular development, which are keys to understanding the dynamics of ovarian reserve. The pelvic environment of women is frequently exposed to physiological or pathological inflammatory stimuli. Endometriosis is a disorder that should be viewed as a chronic inflammatory disease manifested by pelvic pain and infertility. Inflammation surrounding the normal ovarian cortex may alter the histological structure which possesses primordial and early growing follicles. Fibrotic changes in histological niches in the nest of primordial follicles may provoke activation of dormant follicles and concomitant atresia. Along with decline in AMH, which is produced by early growing follicles, fibrotic changes may accelerate the demise of primordial follicles which has been described as “burn-out by inflammation”. As a result, women with endometriosis may suffer from diminished ovarian reserve, a possible cause of endometriosis-related infertility.