Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
J Ovarian Res. 2019 Oct 21;12(1):98. doi: 10.1186/s13048-019-0572-7.
Endometriosis patients undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment suffer from lower success rates. The success of IVF-ET is related to the receptivity of the uterus and the quality of embryos, and it is well known a patient's endometriosis does not impair the receptivity. Whether endometrioma should be removed surgically before IVF remains controversial. Studies have shown that endometrioma removal decreases peritoneal inflammation, but little information is available regarding the alteration in the cytokines of follicular fluid. The objective of this study was to examine the impact of endometrioma cystectomy on the outcome of IVF and the levels of intrafollicular inflammatory cytokines and to investigate correlations between cytokine concentrations and IVF outcomes.
A total of 41 women with endometriosis-associated infertility undergoing IVF were recruited; 13 patients (surgery group, S group) had surgery to remove the endometrioma before enrollment, and 28 patients (non-surgery group, NS group) were untreated before IVF. The follicular fluid from a dominant follicle was collected during oocyte retrieval, and the concentrations of sixteen soluble cytokines known to be involved in ovarian function were measured.
Among the soluble molecules examined in this study, chemokines and growth factors and a few are inflammatory cytokines were found in the follicular fluid of patients with endometriosis. In addition, the expression levels of chemokines, growth factors, and most inflammatory cytokines did not differ between the S and NS groups, but interleukin (IL)-18 levels were significantly lower in the NS group. However, the levels of IL-18 in the FF did not correlate with IVF cycle parameters. The implantation and clinical pregnancy rates were similar between the two groups, but the anti-Müllerian hormone (AMH) level was lower in the S group than in the NS group.
These findings suggest that endometrioma surgery may potentially reduce the ovarian reserve and has little impact on the success rate of IVF. Ovarian endometriomas are not associated with cytokine profiles in FF from infertile women, and they are not likely to affect the quality of the oocyte and embryo as a result of an inflammatory mechanism.
患有子宫内膜异位症的接受体外受精-胚胎移植（IVF-ET）治疗的患者成功率较低。IVF-ET 的成功与子宫的接受能力和胚胎的质量有关，众所周知，子宫内膜异位症不会损害接受能力。是否应该在 IVF 之前通过手术切除子宫内膜异位症仍然存在争议。研究表明，切除子宫内膜异位症可减少腹膜炎症，但有关卵泡液中细胞因子变化的信息很少。本研究的目的是检查子宫内膜异位囊肿切除术对 IVF 结局以及卵泡内炎症细胞因子水平的影响，并探讨细胞因子浓度与 IVF 结局之间的相关性。
共招募了 41 名患有子宫内膜异位症相关不孕的接受 IVF 的女性；13 名患者（手术组，S 组）在入组前进行了手术切除子宫内膜异位症，28 名患者（非手术组，NS 组）在 IVF 前未接受治疗。在取卵过程中采集优势卵泡的卵泡液，并测量已知参与卵巢功能的 16 种可溶性细胞因子的浓度。
在所检查的可溶性分子中，在子宫内膜异位症患者的卵泡液中发现了趋化因子和生长因子以及一些炎症细胞因子。此外，S 组和 NS 组之间趋化因子、生长因子和大多数炎症细胞因子的表达水平没有差异，但 NS 组的白细胞介素（IL）-18 水平显着降低。然而，FF 中的 IL-18 水平与 IVF 周期参数无关。两组的着床率和临床妊娠率相似，但 S 组的抗苗勒管激素（AMH）水平低于 NS 组。
这些发现表明，子宫内膜异位囊肿手术可能会降低卵巢储备，对 IVF 的成功率影响不大。卵巢子宫内膜异位症与不孕妇女卵泡液中的细胞因子谱无关，并且不太可能通过炎症机制影响卵子和胚胎的质量。
