CAUSE OF INFERTILITY

Endometrioma affects fertility parameters but not embryo quality

Endometrioma affects fertility parameters but not embryo quality

Researchers sought to investigate the effects of endometrioma and the impact of bilaterality on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes.

A Turkish study has found that that presence of endometrioma in patients with endometriosis negatively impacts fertility parameters, but has no effect on embryo quality, clinical pregnancy rates (PR), or live birth rates (LBR).

The study in the Journal of Gynecology Obstetrics and Human Reproduction also concluded bilaterality does not influence any fertility parameters or pregnancy rates.

Done retrospectively, the researchers sought to investigate the effects of endometrioma and the impact of bilaterality on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes.

A total of 159 women who underwent IVF/CSI cycles at Zekai Tahir Burak Women’s Health Education and Research Hospital in Ankara, Turkey, between March 2015 and March 2018, were recruited for the study.

Patients were divided into two groups: the study group (n = 73) of infertile women with either unilateral or bilateral ovarian endometrioma with any IVF indication; and the control group (n = 86) without endometrioma.

Basal follicle-stimulating hormone (FSH) levels and total gonadotropin doses used during ovarian stimulation were significantly higher and antral follicle count (AFC) was significantly lower in the study group compared to the control group.

But the differences in these variables between the unilateral (n = 43) and the bilateral (n = 30) endometrioma group were non-significant.

Anti-Müllerian hormone (AMH) levels for unilateral and bilateral endometrioma were also comparable: 1.4 ng/ML and 1.23 ng/mL, respectively.

However, the number of endometriomas > 4 cm was significantly higher in the bilateral than in the unilateral group.

The study also found that the number of dominant follicles at trigger day and total oocyte retrieved were significantly higher in the control group than in the study group. But when compared between the unilateral and the bilateral endometrioma group, these differences were insignificant.

Still, the number of metaphase II (MII) oocytes was significantly higher in the control group compared to the unilateral group, whereas the difference was non-significant between the control group and the bilateral group.

For all procedures, sperm was obtained via ejaculation, and there were no cycles cancelled in the control group. However, in the study group, 12 cycles were cancelled because fertilized embryos could not be procured: 6 cycles each from the unilateral and bilateral group.

There were also four patients in the study group with no dominant follicle development, two each from the unilateral and bilateral group.

In addition, there were eight total fertilization failures, four each from the two groups.

Given the higher cancelling rates, the prognosis for patients with endometrioma seems to be worse than in patients without endometrioma,” wrote the authors.

On the other hand, the number of embryos achieved and blastocysts obtained were similar between the three groups (no laterality, unilateral and bilateral), as were rates of pregnancy, live birth, and early pregnancy loss.

There was also no statistically significant difference between the control and the unilateral groups for all grades of embryo.

However, the number of grade 2 embryos was significantly lower in the bilateral group compared to the control group. But for blastocyst and grade 1 embryo numbers, the bilateral group had comparable findings to the other two groups.

Based on our results, we speculate that bilaterality doesn’t exert additional damage on ovarian reserve more than unilateral endometrioma does,” wrote the authors.

Read more: https://www.sciencedirect.com/science/article/abs/pii/S2468784720301835

Scientists identify the reason endometriosis causes infertility

Scientists identify the reason endometriosis causes infertility

By I Soussis MD

Deficiency of a protein in the womb has been identified as the reason why endometriosis causes infertility, according to a new study published in Science Translational Medicine.

American and South Korean researchers investigated the link between endometriosis and infertility. In endometriosis, womb-lining tissue grows outside of the uterus, often on the ovaries and fallopian tubes. This can lead to chronic pain and is associated with infertility, but the mechanism has been unclear.

Around ten percent of women have endometriosis and up to 50 percent of endometriosis patients have infertility”, said lead author Dr Jae-Wook.

The scientists compared endometrial tissue from 21 women with endometriosis and infertility with samples from healthy women.

They observed that levels of a protein called histone deacetylase 3 (HDAC3) in the lining of the uterus of women with endometriosis were lower compared to healthy women. Previously developed animal models of endometriosis in mice and baboons supported this finding.

The team then developed mice unable to produce HDAC3 in uterine cells, all of which were infertile. Dr Jeong and his colleagues were able to show that HDAC3 is necessary for embryo to implant in the womb. Follow-up experiments with human endometrial cells cultured in vitro showed that HDAC3 is a crucial part of the changes that occur in the uterus, in preparation for and during pregnancy.

This study could help endometriosis patients and their doctors select more effective treatments and enable a better understanding of female infertility.

My opinion

Finally, the enigma of endometriosis starts to unravel. This is a significant study that shows for the first time that the levels of HDAC3 are crucial for the development of fertile endometrium. This line of research may lead to new treatments for endometriosis caused infertility.

It may also help in cases of recurrent implantation failure in IVF patients without endometriosis.

Read more:

http://stm.sciencemag.org/content/11/474/eaaf7533

https://www.bionews.org.uk/page_140740

Image credit

https://www.theguardian.com/society/2019/jan/09/endometriosis-study-50-50-infertility-risk-women

 

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