Evaluation of follicular fluid inflammatory response in patients with unilateral ovarian endometriosis and its impact in vitro fertilization

Abstract

Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterine cavity, which mainly affects women during the reproductive period. Dysmenorrhea, deep dyspareunia, chronic pelvic pain, and infertility are the main symptoms associated with endometriosis. Several factors can affect fertility in the presence of endometriosis, among them, the presence of elevated levels of inflammatory cytokines in the follicular fluid, has recently been reported in the scientific literature as an important factor related to infertility in patients with ovary endometriosis. Understanding the inflammatory microenvironment caused by ovarian endometriosis lead pieces and possibly new treatments, which could improve the quality of life of infertile patients with endometriosis, as well as increase the success rates of assisted reproduction treatment in patients with ovarian endometriosis. The aim of this study will be evaluate the protein expression of 50 inflammatory markers in follicular fluid from infertile women with endometriosis and compared with the follicular fluid from control patients. It will be included 63 patients divided into three groups: 21 patients presenting unilateral ovarian endometriosis (group I), 21 donor eggs patients (group II) and 21 patients who had male infertility diagnosed (group III). Protein expression of inflammatory markers in follicular fluid will be evaluate using the Luminex ® platform and the cellular component by flow cytometry technique. Of the 50 cytokines evaluated in a pilot study (N = 22) performed at the Center for Reproductive Medicine Brigham and Women's Hospital / Harvard Medical School (Boston, USA) and the Massachusetts Institute of Technology (MIT) - Center for Gynepathology Research (Cambridge - USA), eleven of them (MCP-1, IL-6, IL-8, CFGF-beta, GCSF, MP1beta, IL1-beta, IL-4, TNF-alpha, IL-15, IL2-RA) were found significantly increased in follicular fluid from the ovary with endometriosis in relation to ovarian follicular fluid obtained without endometriosis. Other cytokines, such as ICAM-1, VCAM-1, were found significantly decreased in the ovary with endometriosis when compared to the ovary without endometriosis (Group I). The same significance was observed when compared to group II and III. These preliminaries results are encouraging and were used to perform the sample size calculation. For the completion of the entire project, sixty-three patients will be required. The study will be held in collaboration with the Department of Obstetrics and Gynecology - FMUSP, Laboratory of Human Reproduction (Invida) of Sírio Libanês Hospital and LIM-60 (HCFMUSP). (AU)