Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression
To evaluate the effect of medical or surgical treatment prior to embryo transfer in women with elevated endometrial BCL6 expression and suspected endometriosis in a prospective, cohort study design at a university-associated infertility clinic.
All subjects had at least 1 year of unexplained infertility (UI) and each prospectively underwent endometrial biopsy and immunostaining for the oncogene BCL6, prior to embryo transfer during an assisted reproductive technology (ART) cycle. To be included, subjects had to have an abnormal BCL6 result, defined by elevated HSCORE ≥ 1.4. Women that were pre-treated with laparoscopy or medical suppression with GnRH agonist (depot leuprolide acetate; Lupron®, Abbvie, Inc., Chicago, IL) for 2 months were compared to a group that went untreated (controls). Endpoints included implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR), and as well as cycle characteristics. Miscarriage rate were also compared between treatment and control group.
Women in each group had similar characteristics. Those treated by medical suppression and those undergoing laparoscopy for endometriosis had a significantly higher LBR, (5/10; 50%; 95%CI 23.7 to 76.3%) and (11/21; 52.4%; 95%CI 32.4 to 71.7), respectively, compared to controls (4/54; 7.4%; 95%CI 2.9 to 17.6). An absolute benefit of 44.2% (16/31; 95%CI 24.6 to 61.2) and a number need to treat of 3 for those that received treatment (medical suppression and laparoscopy), compared to no treatment. Miscarriages were significantly more common in the control group.
Women with suspected endometriosis and aberrant endometrial BCL6 expression have worse reproductive outcomes following embryo transfer, including a high miscarriage rate, poor IR, and low LBR and CPR compared to cycles pre-treated with medical and surgical management.
KeywordsEndometrium BCL6 Prognosis IVF Pregnancy, endometriosis, miscarriage
This study was supported by NICHD/NIH R01 HD067721 Grant 99999.003035/2015-08 (BAL) and by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior: CAPES/PROAP (RFS).
Compliance with ethical standards
The Institutional Review Board approval was obtained from the Committee for the Protection of Human Subjects (GHS #00013885).
- 8.Zullo F, Spagnolo E, Saccone G, Acunzo M, Xodo S, Ceccaroni M, et al. Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertil Steril 2017;108:667–72.e5.Google Scholar
- 9.National Summary Report [Internet] [cited 2017 Jul 21];Available from: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?reportingYear=2014.
- 17.World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen. 2010.Google Scholar
- 27.Fox C, Morin S, Jeong J-W, Scott RT Jr, Lessey BA. Local and systemic factors and implantation: what is the evidence? Fertil Steril 2016;105:873–884.Google Scholar
- 32.Website [Internet] . [cited 2018 Apr 19]. Available from: National Summary Report [Internet][cited 2017 Jul 21];Available from: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?reportingYear=2014.Google Scholar
- 35.Siristatidis CS, Gibreel A, Basios G, Maheshwari A, Bhattacharya S. Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in assisted reproduction. Cochrane Database Syst Rev 2015;CD006919.Google Scholar
- 37.van Hoogenhuijze NE, Torrance HL, Mol F, Laven JSE, Scheenjes E, Traas MAF, et al. Endometrial scratching in women with implantation failure after a first IVF/ICSI cycle; does it lead to a higher live birth rate? The SCRaTCH study: a randomized controlled trial (NTR 5342). BMC Womens Health. 2017;17:47.CrossRefGoogle Scholar