BETTER UNDERSTANDING FOR BETTER CARE
ENDOMETRIOSIS
“Turning research
into concrete solutions
for women
through a collective effort.”
FRAME is part of
the National Endometriosis Plan,
which recognizes
this condition as
a major public health issue.
By bringing together researchers,
clinicians, engineers, patients,
and advocacy groups, FRAME
is creating a unique ecosystem
of integrated research and care
dedicated to women’s health
and their quality of life.
news
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Towards New Diagnostic Tools for Endometriosis
Improving the diagnosis of endometriosis is currently one of the major challenges in research on this disease. Due to the diversity of symptoms and the…
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Launch of the TENDANSE Study
FHU FRAME is involved in the launch of the TENDANSE study, an innovative research project aimed at improving the understanding of neurological involvement associated with…
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March : Endometriosis Awareness Month
Each year, the month of March is dedicated to raising awareness about endometriosis, a chronic gynecological disease that affects approximately one in ten women of…
our publications
Cavadias, Iphigénie; Maitrot-Mantelet, Lorraine; Perol, Sandrine; Bourdon, Mathilde; Santulli, Pietro; Marcellin, Louis; Chapron, Charles; Plu-Bureau, Geneviève
In: Acta Obstet Gynecol Scand, vol. 105, no. 2, pp. 225–237, 2026, ISSN: 1600-0412.
@article{pmid41310987,
title = {Risk of cardiovascular disease and mortality among women with endometriosis: A systematic review and meta-analysis},
author = {Iphigénie Cavadias and Lorraine Maitrot-Mantelet and Sandrine Perol and Mathilde Bourdon and Pietro Santulli and Louis Marcellin and Charles Chapron and Geneviève Plu-Bureau},
doi = {10.1111/aogs.70104},
issn = {1600-0412},
year = {2026},
date = {2026-02-01},
journal = {Acta Obstet Gynecol Scand},
volume = {105},
number = {2},
pages = {225--237},
abstract = {INTRODUCTION: Endometriosis is a chronic and estrogen-dependent disorder that affects about 10% of women of reproductive age worldwide. Endometriosis has been associated with chronic inflammation and an atherogenic lipid profile, two conditions that increase the risk of atherothrombotic cardiovascular diseases.
MATERIAL AND METHODS: A literature search for relevant studies published from the earliest record to 31 March 2025 was conducted in MEDLINE and EMBASE databases. The following MESH terms were searched: "stroke," "cerebrovascular disease," "cardiovascular disease," "coronary heart disease," "ischemic heart disease," "mortality," and "endometriosis." The results of each study were pooled, and an overall estimate of relative risk was obtained with a random-effect model. Homogeneity between studies was analyzed using I statistics. This review was not registered.
RESULTS: Ten studies were eligible for inclusion in this meta-analysis. Five studies reported an increased risk of stroke with endometriosis, with a pooled risk of 1.18 (95% confidence intervals [95% CI] [1.13-1.22]). Four studies reported an increased risk of coronary heart disease with endometriosis, with a pooled risk of 1.36 (95% CI [1.32-1.40]). Four studies reported an increased risk of composite cardiovascular disease with endometriosis, with a pooled risk of 1.16 (95% CI [1.12-1.20]). Although the homogeneity is high in results, the confounding factors considered in the different studies vary. Thus, these results must be interpreted with caution.
CONCLUSIONS: Endometriosis is associated with an increased risk of cardiovascular disease. Further research is required to confirm these findings. However, these results highlight the importance of considering primary cardiovascular prevention strategies for women with endometriosis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
INTRODUCTION: Endometriosis is a chronic and estrogen-dependent disorder that affects about 10% of women of reproductive age worldwide. Endometriosis has been associated with chronic inflammation and an atherogenic lipid profile, two conditions that increase the risk of atherothrombotic cardiovascular diseases.
MATERIAL AND METHODS: A literature search for relevant studies published from the earliest record to 31 March 2025 was conducted in MEDLINE and EMBASE databases. The following MESH terms were searched: “stroke,” “cerebrovascular disease,” “cardiovascular disease,” “coronary heart disease,” “ischemic heart disease,” “mortality,” and “endometriosis.” The results of each study were pooled, and an overall estimate of relative risk was obtained with a random-effect model. Homogeneity between studies was analyzed using I statistics. This review was not registered.
RESULTS: Ten studies were eligible for inclusion in this meta-analysis. Five studies reported an increased risk of stroke with endometriosis, with a pooled risk of 1.18 (95% confidence intervals [95% CI] [1.13-1.22]). Four studies reported an increased risk of coronary heart disease with endometriosis, with a pooled risk of 1.36 (95% CI [1.32-1.40]). Four studies reported an increased risk of composite cardiovascular disease with endometriosis, with a pooled risk of 1.16 (95% CI [1.12-1.20]). Although the homogeneity is high in results, the confounding factors considered in the different studies vary. Thus, these results must be interpreted with caution.
CONCLUSIONS: Endometriosis is associated with an increased risk of cardiovascular disease. Further research is required to confirm these findings. However, these results highlight the importance of considering primary cardiovascular prevention strategies for women with endometriosis.
MATERIAL AND METHODS: A literature search for relevant studies published from the earliest record to 31 March 2025 was conducted in MEDLINE and EMBASE databases. The following MESH terms were searched: “stroke,” “cerebrovascular disease,” “cardiovascular disease,” “coronary heart disease,” “ischemic heart disease,” “mortality,” and “endometriosis.” The results of each study were pooled, and an overall estimate of relative risk was obtained with a random-effect model. Homogeneity between studies was analyzed using I statistics. This review was not registered.
RESULTS: Ten studies were eligible for inclusion in this meta-analysis. Five studies reported an increased risk of stroke with endometriosis, with a pooled risk of 1.18 (95% confidence intervals [95% CI] [1.13-1.22]). Four studies reported an increased risk of coronary heart disease with endometriosis, with a pooled risk of 1.36 (95% CI [1.32-1.40]). Four studies reported an increased risk of composite cardiovascular disease with endometriosis, with a pooled risk of 1.16 (95% CI [1.12-1.20]). Although the homogeneity is high in results, the confounding factors considered in the different studies vary. Thus, these results must be interpreted with caution.
CONCLUSIONS: Endometriosis is associated with an increased risk of cardiovascular disease. Further research is required to confirm these findings. However, these results highlight the importance of considering primary cardiovascular prevention strategies for women with endometriosis.
Ferreux, Lucile; Ducreux, Bastien; Firmin, Julie; Chargui, Ahmed; Pocate-Cheriet, Khaled; Maignien, Chloé; Santulli, Pietro; Borensztein, Maud; Fauque, Patricia; Patrat, Catherine
In: Hum Reprod Update, vol. 32, no. 1, pp. 33–57, 2026, ISSN: 1460-2369.
@article{pmid40891422,
title = {Transcript profiling and gene regulation of the human pre-implantation embryo: parental effects and impact of ARTs},
author = {Lucile Ferreux and Bastien Ducreux and Julie Firmin and Ahmed Chargui and Khaled Pocate-Cheriet and Chloé Maignien and Pietro Santulli and Maud Borensztein and Patricia Fauque and Catherine Patrat},
doi = {10.1093/humupd/dmaf022},
issn = {1460-2369},
year = {2026},
date = {2026-01-01},
journal = {Hum Reprod Update},
volume = {32},
number = {1},
pages = {33--57},
abstract = {BACKGROUND: Infertility is a growing global challenge, with ARTs significantly improving birth rates for infertile couples. However, ART conceptions are associated with a higher risk of negative obstetrical and perinatal outcomes, with potential long-term effects on offspring health. Many pre-implantation embryos exhibit abnormal morphokinetics, implantation failure, or arrested development. ART procedures and parental factors are suspected to perturb the embryonic transcriptome, potentially affecting molecular and epigenetic events during gametogenesis and early development. The timing and mechanisms of these perturbations remain unclear. Genome-wide transcriptomic misregulation in ART-conceived human pre-implantation embryos may provide important insights into observed differences between ART and naturally conceived offspring.
OBJECTIVE AND RATIONALE: This narrative review aims to explore how the transcriptome of the human pre-implantation embryo is influenced by parental characteristics, ART conditions, and embryonic factors, with the characterization of the temporal sequence of acquisition of lineage-specific markers at the blastocyst stage serving as a prerequisite. The primary objective is to compile changes in gene expression resulting from parental and intrinsic characteristics or from ART-specific interventions. A secondary aim is to identify common dysregulated molecular pathways across all factors studied.
SEARCH METHODS: A comprehensive PubMed search (up to December 2024) was conducted to identify studies assessing transcriptomic profiles in human blastocysts. Studies were included based on parental infertility characteristics (e.g. age, polycystic ovary syndrome (PCOS), endometriosis, diminished ovarian reserve (DOR), sperm alterations, unexplained infertility (UI), and obesity), ART interventions (e.g. hormonal stimulation, IVM, IVF, culture conditions, and vitrification), and intrinsic embryo factors (e.g. morphology, ploidy, sex, and developmental arrest). Differentially expressed genes between different embryo groups were compared across studies, and Gene Ontology analysis identified common or specific pathways. Single-cell RNA sequencing data were used to map lineage-specific transcriptomic patterns in human blastocysts, categorizing expression changes by cell lineages (epiblast, primitive endoderm, and trophectoderm). Where human data on blastocysts were limited, animal studies or other cleaved stages were discussed.
OUTCOMES: Maternal age was the most significant contributor to misregulated gene expression in human blastocysts, affecting metabolic and developmental processes. Variations in culture medium impacted cell cycle regulation, carbohydrate metabolism, and RNA biosynthesis. Blastocyst morphology mostly influenced metabolic process changes. Blastocyst aneuploidy induced significant changes in developmental pathways and pluripotency gene expression in the epiblast. Evidence on the effects of PCOS, endometriosis, DOR, sperm alterations, UI, and ART technologies remains limited. Dysregulated pathways commonly involve metabolic, cellular, reproductive, and developmental processes. Dysregulation of genomic imprinting and chromatin-modifier genes was also observed across at least two conditions.
WIDER IMPLICATIONS: This review highlights the complexity of interpreting gene expression in human pre-implantation embryos due to diverse influences, including parental age, ART conditions, developmental stage, and embryo sex. ART procedures may have cumulative effects on the blastocyst transcriptome. Modifiable factors, such as culture conditions, offer opportunities for improving IVF outcomes. Epigenetic modifications may also be sensitive to these diverse influences and involved in observed transcriptomic changes, opening further research investigation to clarify long-term health effects.
REGISTRATION NUMBER: n/a.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Infertility is a growing global challenge, with ARTs significantly improving birth rates for infertile couples. However, ART conceptions are associated with a higher risk of negative obstetrical and perinatal outcomes, with potential long-term effects on offspring health. Many pre-implantation embryos exhibit abnormal morphokinetics, implantation failure, or arrested development. ART procedures and parental factors are suspected to perturb the embryonic transcriptome, potentially affecting molecular and epigenetic events during gametogenesis and early development. The timing and mechanisms of these perturbations remain unclear. Genome-wide transcriptomic misregulation in ART-conceived human pre-implantation embryos may provide important insights into observed differences between ART and naturally conceived offspring.
OBJECTIVE AND RATIONALE: This narrative review aims to explore how the transcriptome of the human pre-implantation embryo is influenced by parental characteristics, ART conditions, and embryonic factors, with the characterization of the temporal sequence of acquisition of lineage-specific markers at the blastocyst stage serving as a prerequisite. The primary objective is to compile changes in gene expression resulting from parental and intrinsic characteristics or from ART-specific interventions. A secondary aim is to identify common dysregulated molecular pathways across all factors studied.
SEARCH METHODS: A comprehensive PubMed search (up to December 2024) was conducted to identify studies assessing transcriptomic profiles in human blastocysts. Studies were included based on parental infertility characteristics (e.g. age, polycystic ovary syndrome (PCOS), endometriosis, diminished ovarian reserve (DOR), sperm alterations, unexplained infertility (UI), and obesity), ART interventions (e.g. hormonal stimulation, IVM, IVF, culture conditions, and vitrification), and intrinsic embryo factors (e.g. morphology, ploidy, sex, and developmental arrest). Differentially expressed genes between different embryo groups were compared across studies, and Gene Ontology analysis identified common or specific pathways. Single-cell RNA sequencing data were used to map lineage-specific transcriptomic patterns in human blastocysts, categorizing expression changes by cell lineages (epiblast, primitive endoderm, and trophectoderm). Where human data on blastocysts were limited, animal studies or other cleaved stages were discussed.
OUTCOMES: Maternal age was the most significant contributor to misregulated gene expression in human blastocysts, affecting metabolic and developmental processes. Variations in culture medium impacted cell cycle regulation, carbohydrate metabolism, and RNA biosynthesis. Blastocyst morphology mostly influenced metabolic process changes. Blastocyst aneuploidy induced significant changes in developmental pathways and pluripotency gene expression in the epiblast. Evidence on the effects of PCOS, endometriosis, DOR, sperm alterations, UI, and ART technologies remains limited. Dysregulated pathways commonly involve metabolic, cellular, reproductive, and developmental processes. Dysregulation of genomic imprinting and chromatin-modifier genes was also observed across at least two conditions.
WIDER IMPLICATIONS: This review highlights the complexity of interpreting gene expression in human pre-implantation embryos due to diverse influences, including parental age, ART conditions, developmental stage, and embryo sex. ART procedures may have cumulative effects on the blastocyst transcriptome. Modifiable factors, such as culture conditions, offer opportunities for improving IVF outcomes. Epigenetic modifications may also be sensitive to these diverse influences and involved in observed transcriptomic changes, opening further research investigation to clarify long-term health effects.
REGISTRATION NUMBER: n/a.
OBJECTIVE AND RATIONALE: This narrative review aims to explore how the transcriptome of the human pre-implantation embryo is influenced by parental characteristics, ART conditions, and embryonic factors, with the characterization of the temporal sequence of acquisition of lineage-specific markers at the blastocyst stage serving as a prerequisite. The primary objective is to compile changes in gene expression resulting from parental and intrinsic characteristics or from ART-specific interventions. A secondary aim is to identify common dysregulated molecular pathways across all factors studied.
SEARCH METHODS: A comprehensive PubMed search (up to December 2024) was conducted to identify studies assessing transcriptomic profiles in human blastocysts. Studies were included based on parental infertility characteristics (e.g. age, polycystic ovary syndrome (PCOS), endometriosis, diminished ovarian reserve (DOR), sperm alterations, unexplained infertility (UI), and obesity), ART interventions (e.g. hormonal stimulation, IVM, IVF, culture conditions, and vitrification), and intrinsic embryo factors (e.g. morphology, ploidy, sex, and developmental arrest). Differentially expressed genes between different embryo groups were compared across studies, and Gene Ontology analysis identified common or specific pathways. Single-cell RNA sequencing data were used to map lineage-specific transcriptomic patterns in human blastocysts, categorizing expression changes by cell lineages (epiblast, primitive endoderm, and trophectoderm). Where human data on blastocysts were limited, animal studies or other cleaved stages were discussed.
OUTCOMES: Maternal age was the most significant contributor to misregulated gene expression in human blastocysts, affecting metabolic and developmental processes. Variations in culture medium impacted cell cycle regulation, carbohydrate metabolism, and RNA biosynthesis. Blastocyst morphology mostly influenced metabolic process changes. Blastocyst aneuploidy induced significant changes in developmental pathways and pluripotency gene expression in the epiblast. Evidence on the effects of PCOS, endometriosis, DOR, sperm alterations, UI, and ART technologies remains limited. Dysregulated pathways commonly involve metabolic, cellular, reproductive, and developmental processes. Dysregulation of genomic imprinting and chromatin-modifier genes was also observed across at least two conditions.
WIDER IMPLICATIONS: This review highlights the complexity of interpreting gene expression in human pre-implantation embryos due to diverse influences, including parental age, ART conditions, developmental stage, and embryo sex. ART procedures may have cumulative effects on the blastocyst transcriptome. Modifiable factors, such as culture conditions, offer opportunities for improving IVF outcomes. Epigenetic modifications may also be sensitive to these diverse influences and involved in observed transcriptomic changes, opening further research investigation to clarify long-term health effects.
REGISTRATION NUMBER: n/a.
Fertility preservation in endometriosis: current strategies and outcomes
Bourdon, Mathilde; Fornelli, Gianfranco; Maignien, Chloé; Parpex, Guillaume; Marcellin, Louis; Melka, Léa; Patrat, Catherine; Chapron, Charles; Santulli, Pietro
In: Minerva Obstet Gynecol, 2025, ISSN: 2724-6450.
@article{pmid41424262,
title = {Fertility preservation in endometriosis: current strategies and outcomes},
author = {Mathilde Bourdon and Gianfranco Fornelli and Chloé Maignien and Guillaume Parpex and Louis Marcellin and Léa Melka and Catherine Patrat and Charles Chapron and Pietro Santulli},
doi = {10.23736/S2724-606X.25.05766-5},
issn = {2724-6450},
year = {2025},
date = {2025-12-01},
journal = {Minerva Obstet Gynecol},
abstract = {Endometriosis is a frequent chronic estrogen-dependent condition that can significantly impair fertility and reduce the quality of life in affected individuals. Women with endometriosis face a 30-50% risk of infertility. Multifactorial factors such as peritoneal inflammation, altered ovarian reserve, impaired tubal function and modified endometrial receptivity have been proposed to contribute to infertility. Endometriosis has been highlighted as a condition that may require a fertility preservation to safeguard reproductive potential. This review aims to provide a comprehensive update on fertility preservation for women with endometriosis. A comprehensive literature search was conducted using PubMed, focusing on peer-reviewed studies. Key words included "endometriosis," "fertility preservation," "oocytes," and "cryopreservation." Studies in English and French that delve into FP techniques, success factors, and risks were included. Several fertility preservation techniques are available, but oocyte cryopreservation following ovarian stimulation is the most common and effective option for women affected by endometriosis. Success rates depend on factors such as age and prior surgical history. Surgery for ovarian endometriomas may reduce ovarian reserve, underscoring the importance of considering fertility preservation before surgery. All of ovarian stimulation protocols can be used and may not increase the risk of disease progression or recurrence however the use of an antagonist protocol with GnRH agonist triggering could be particularly beneficial in this context, as it may help reduce pain and minimize the risk of ovarian hyperstimulation syndrome. The number of cryopreserved oocytes is directly correlated with pregnancy success. Multiple stimulation cycles can be performed to obtain a sufficient number of oocytes, increasing the chances of achieving a successful live birth in case of reuse. FP should be routinely discussed with women with endometriosis, particularly those who may undergo surgery, however, its implementation is not systematic and should be considered on a case-by-case basis. Further research is essential to tailor FP strategies for women with endometriosis optimizing both clinical outcomes and cost-effectiveness.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Endometriosis is a frequent chronic estrogen-dependent condition that can significantly impair fertility and reduce the quality of life in affected individuals. Women with endometriosis face a 30-50% risk of infertility. Multifactorial factors such as peritoneal inflammation, altered ovarian reserve, impaired tubal function and modified endometrial receptivity have been proposed to contribute to infertility. Endometriosis has been highlighted as a condition that may require a fertility preservation to safeguard reproductive potential. This review aims to provide a comprehensive update on fertility preservation for women with endometriosis. A comprehensive literature search was conducted using PubMed, focusing on peer-reviewed studies. Key words included “endometriosis,” “fertility preservation,” “oocytes,” and “cryopreservation.” Studies in English and French that delve into FP techniques, success factors, and risks were included. Several fertility preservation techniques are available, but oocyte cryopreservation following ovarian stimulation is the most common and effective option for women affected by endometriosis. Success rates depend on factors such as age and prior surgical history. Surgery for ovarian endometriomas may reduce ovarian reserve, underscoring the importance of considering fertility preservation before surgery. All of ovarian stimulation protocols can be used and may not increase the risk of disease progression or recurrence however the use of an antagonist protocol with GnRH agonist triggering could be particularly beneficial in this context, as it may help reduce pain and minimize the risk of ovarian hyperstimulation syndrome. The number of cryopreserved oocytes is directly correlated with pregnancy success. Multiple stimulation cycles can be performed to obtain a sufficient number of oocytes, increasing the chances of achieving a successful live birth in case of reuse. FP should be routinely discussed with women with endometriosis, particularly those who may undergo surgery, however, its implementation is not systematic and should be considered on a case-by-case basis. Further research is essential to tailor FP strategies for women with endometriosis optimizing both clinical outcomes and cost-effectiveness.
