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Clin Exp Reprod Med > Volume 47(3); 2020 > Article
Baek, Jo, Lee, Cho, Shin, Lee, Lee, Cho, and Choi: Vitamin D and endometriosis: Is there a correlation with disease severity?
Thank you for your kind comments. Our research started with an interest in how vitamin D, which is involved in the immune response, affects the pathogenesis of endometriosis. Numerous research reports indicate that endometriosis can occur due to abnormal immune response activity, involving various pathological mechanisms [1,2]. In accordance with your comments, the authors sought to clarify the role of vitamin D as a biomarker for the diagnosis of endometriosis through this study. We also wanted to find evidence regarding whether vitamin D could be used as a treatment for endometriosis.
In our present study, we did not observe any link between endometriosis and vitamin D or vitamin D-binding protein. A reason for this finding may be that there were few cases and the results therefore could not reach statistical significance. In ongoing follow-up studies, the number of cases has been increased to augment the statistical power of the research.
As you said, the revised American Society for Reproductive Medicine (rASRM) classification has the advantages of being easy to use and being the most widely used system, but it has the disadvantage of not reflecting severity, certain locations (such as cul-de-sac lesions), or deep-infiltration lesions [3]. We agree that the Enzian classification is an alternative that addresses the disadvantages of the rASRM classification [4]. In order to apply the Enzian classification, however, the total number of patients would need to be increased. In addition, patient classification requires effort to describe findings in a purely morphological manner.
In accordance with your opinions, follow-up studies are planned with the goals of obtaining meaningful results regarding the role of vitamin D in the pathogenesis of endometriosis and exploring the role of vitamin D as a therapeutic agent.


Conflict of interest

No potential conflict of interest relevant to this article was reported.


1. Christodoulakos G, Augoulea A, Lambrinoudaki I, Sioulas V, Creatsas G. Pathogenesis of endometriosis: the role of defective ‘immunosurveillance’. Eur J Contracept Reprod Health Care 2007;12:194-202.
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2. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004;80(6 Suppl): 1678S-1688S.
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3. Haas D, Shebl O, Shamiyeh A, Oppelt P. The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses. Acta Obstet Gynecol Scand 2013;92:3-7.
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4. Haas D, Oppelt P, Shebl O, Shamiyeh A, Schimetta W, Mayer R. Enzian classification: does it correlate with clinical symptoms and the rASRM score? Acta Obstet Gynecol Scand 2013;92:562-6.
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