Aromatase inhibitor treatment limits progression of peritoneal endometriosis in baboons  David Langoi, D.V.M., Mary Ellen Pavone, M.D., M.S.C.I., Bilgin Gurates, M.D., Daniel Chai, D.V.M., Asgerally Fazleabas, Ph.D., Serdar E. Bulun, M.D.  Fertility and Sterility  Volume 99, Issue 3, Pages 656-662.e3 (March 2013) DOI: 10.1016/j.fertnstert.2012.11.021 Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Representative laparoscopic photographs with endometriotic lesions (arrows) and histologic samples. (A, B) Placebo group before (A) and after (B) treatment, showing progression of lesion size and change of morphology from subtle to typical blue-black lesion over time. (C, D) Letrozole group before (C) and after (D) treatment, showing lesion diminishing in size after treatment. (E, F) Histology sections of a lesion treated with placebo (E). Active glandular epithelium (g) and stroma (s) are seen. The letrozole-treated lesion (F) shows inactive glands, absence of stroma, sloughing epithelia, and loose connective tissue (C) invasion. Fertility and Sterility 2013 99, 656-662.e3DOI: (10.1016/j.fertnstert.2012.11.021) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Aromatase expression in endometriotic tissue. (A) Representative semiquantitative RT-PCR for aromatase cytochrome P450 expression in endometriotic tissue from six letrozole-treated and six placebo-treated animals. Adipose tissue was used as positive control. Posttreatment expression of aromatase was significantly lower with letrozole compared with placebo (P<.05). (B) Quantitative PCR shows a significantly lower level of lesion aromatase expression with letrozole treatment vs. placebo treatment (P<.05) (units of measure = fluorescence units). Fertility and Sterility 2013 99, 656-662.e3DOI: (10.1016/j.fertnstert.2012.11.021) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 1 Schematic diagram of treatment regimens. Fertility and Sterility 2013 99, 656-662.e3DOI: (10.1016/j.fertnstert.2012.11.021) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 2 (A) Lesion volume before (Pre) and after (Post) treatment with letrozole or placebo. Mean surface volume (cubic millimeters) of peritoneal endometriosis lesions before and after treatment shows a significant decrease in lesion volume with letrozole (*P<.05). A significant increase in lesion volume from baseline was noted in the placebo-treated group (*P<.05). In addition, letrozole significantly decreased lesion volume compared with placebo (*P<.05). (B) Mean ovarian volume before (PRE) and during 6 months (MO) AI treatment in female baboons (n = 10). The mean of the left and right ovarian volume in individual baboons was used to calculate the group mean. There was a statistically significant difference in posttreatment ovarian volume compared with pretreatment ovarian volume (*P=.05). Fertility and Sterility 2013 99, 656-662.e3DOI: (10.1016/j.fertnstert.2012.11.021) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions