Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression

  • Creighton E. Likes
  • Leah J. Cooper
  • Jessica Efird
  • David A. Forstein
  • Paul B. Miller
  • Ricardo Savaris
  • Bruce A. LesseyEmail author
Assisted Reproduction Technologies



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.


Endometrium 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).

Supplementary material

10815_2018_1388_MOESM1_ESM.docx (161 kb)
Supplemental Figure 1 (DOCX 160 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyGreenville Health SystemGreenvilleUSA
  2. 2.Obstetrics and GynecologyUniversity of South Carolina SOM-GreenvilleGreenvilleUSA
  3. 3.Departamento de Ginecologia e ObstetríciaUniversidade Federal do Rio Grande do SulPorto AlegreBrazil

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