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Endometrioma, the follicular fluid inflammatory network and its association with oocyte and embryo characteristics

  • Author Footnotes
    # Joint first authors.
    Jennifer Yland
    Correspondence
    Corresponding author.
    Footnotes
    # Joint first authors.
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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  • Author Footnotes
    # Joint first authors.
    Luiz Fernando Pina Carvalho
    Footnotes
    # Joint first authors.
    Affiliations
    Department of Obstetrics and Gynecology, São Paulo University, Butanta, São Paulo, Brazil

    Baby Center, Center for Reproductive Medicine, R. Joaquim Floriano, São Paulo, 04534-002, Brazil
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  • Michael Beste
    Affiliations
    Novartis Institutes for BioMedical Research, 250 Massachusetts Avenue, Cambridge MA, 02139, USA
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  • Amelia Bailey
    Affiliations
    Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Vanderbilt University School of Medicine, 1161 21st Avenue S, Nashville TN 37232, USA

    Fertility Associates of Memphis, 80 Humphreys Center, Memphis TN, 38120, USA
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  • Cassandra Thomas
    Affiliations
    Center for Infertility and Reproductive Surgery, Brigham and Womenʼs Hospital and Harvard Medical School, 75 Francis St, Boston MA, 02115, USA
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  • Mauricio S. Abrão
    Affiliations
    Department of Obstetrics and Gynecology, São Paulo University, Butanta, São Paulo, Brazil

    Center for Gynepathology Research, Department of Biological Engineering, Massachusetts Institute of Technology, 21 Ames St, Cambridge TN, 02142, USA
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  • Catherine Racowsky
    Affiliations
    Center for Infertility and Reproductive Surgery, Brigham and Womenʼs Hospital and Harvard Medical School, 75 Francis St, Boston MA, 02115, USA
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  • Linda Griffith
    Affiliations
    Center for Gynepathology Research, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge MA, USA
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  • Stacey A. Missmer
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Boston Center for Endometriosis, Boston Childrenʼs and Brigham and Womenʼs Hospitals, Boston MA, USA

    Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, 400 Monroe Avenue NW, Grand Rapids MI, 49503, USA
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  • Author Footnotes
    # Joint first authors.
Published:December 23, 2019DOI:https://doi.org/10.1016/j.rbmo.2019.12.005

      Abstract

      Research question

      What is the association between endometrioma-affected ovaries, their follicular fluid inflammatory microenvironment, and ovary-specific oocyte and embryo yield and quality?

      Design

      Exposure-matched prospective cohort study conducted at a university-affiliated infertility clinic. Thirty-four women presenting for oocyte retrieval were enrolled between 2012 and 2013: women with unilateral endometrioma and no other observed peritoneal or deep lesions (n = 10) and women with no signs or symptoms of endometriosis (n = 24). Follicular fluid was aspirated at the time of oocyte retrieval. Samples from each ovary were analysed using a 27-plex immunoassay panel. The associations were evaluated by ovary-specific endometrioma exposure status (affected, unaffected, unexposed) with cytokine levels, oocyte yield and embryo quality.

      Results

      Levels of interleukin (IL)-8 and monocyte chemoattractant protein-1 were higher in fluid obtained from endometrioma-affected ovaries compared with the unexposed ovaries from women without endometriosis, with intermediate levels observed in the contralateral unaffected ovaries. More modest differences were observed for IL-1β and IL-6. The affected ovaries of women with endometriosis yielded fewer oocytes (mean ± SD = 4.6 ± 2.3) compared with both the unaffected (6.0 ± 3.8) and unexposed (7.9 ± 5.6) ovaries. After adjusting for potential confounders and variables generated in a cytokine principal components analysis, oocyte yield remained slightly lower for the endometrioma-affected ovaries compared with unexposed ovaries. No informative differences among ovary groups for embryo quality parameters were observed.

      Conclusions

      The results suggest that the inflammatory milieu of ovarian endometriosis is strongly localized and has a more modestly systemic effect. The effect of endometriomas on infertility, however, cannot be entirely explained by increased inflammation.

      KEYWORDS

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      Biography

      Jennifer Yland, MSc, is a doctoral student in epidemiology at the Boston University School of Public Health, and a research assistant at the Harvard TH Chan School of Public Health. Her research is focused on endometriosis, predictors of infertility, and the effect of preconception and prenatal exposures on birth outcomes.
      Key message
      In this study, we compared ovary-specific cytokine levels in follicular fluid and oocyte and embryo yield and quality between women with unilateral endometrioma and women with no evidence of endometriosis. Our results suggest that the inflammatory milieu of ovarian endometriosis is strongly localized and has a more modestly systemic effect.