Does Endometriosis Impact the Composition of Follicular Fluid in IL6 and AMH? A Case-Control Study

OBJECTIVE

The aim of this study was to compare follicular liquid levels of IL6 and AMH in women with and without endometriosis and to evaluate their potential impact on ICSI outcomes.

MATERIALS AND METHODS

It is a prospective case-control study conducted on 25 women with proven endometriosis and 50 patients diagnosed with other causes of infertility. All these patients were candidates for ICSI cycles. Their follicular fluid was collected at the time of oocyte retrieval and used to evaluate IL-6 and AMH titers by electro-chemiluminescent immunoassay (Cobas e411-Roche).

RESULTS

The IL-6 levels in follicular fluid were higher in the endometriosis group than in the control group (152.3 vs. 19.9 pg/mL; p = 0.02). The median level for AMH was 2.2 ± 1.88 ng/mL with no statistical difference between the two groups (2.2 vs. 2.7 ng/mL, p = 0.41). No significant correlation between the follicular IL6 and AMH levels was observed.

CONCLUSIONS

The oocyte quality seems to be preserved in patients with endometriosis with the adequate response to ovarian stimulation. High levels of follicular IL6 are in accordance with the inflammatory phenomenon of the disease; however, this increase has no impact on ICSI outcomes.

P-236 Impact of Hyaluronan-enriched embryo transfer medium on the ICSI cycles outcomes

Study question

Does the use of hyaluronan-enriched embryo transfer medium improve the ICSI cycles outcomes?

Summary answer

The pregnancy rate was significantly higher when a hyaluronan-enriched embryo transfer medium was used compared to standard medium.

What is known already

Hyaluronan (HA) is a naturally existing macromolecule in the uterine fluid that seems to increase embryo adhesion.

In fact, the human embryo and uterine endometrium express a receptor for HA in the implantation window, and it is conceivable that HA is involved in the initial phases of blastocyst attachment to the endometrium. Multiple studies demonstrated that the use of HA-enriched transfer medium in women receiving either cleavage-stage embryos or blastocyst improved the outcome of IVF cycle such as the implantation rate and life birth rate compared to the standard transfer medium. However, the effectiveness of this ET medium is controversial.

Study design, size, duration

A descriptive, prospective and randomized study was enrolled in the ART center at Aziza Othmana Hospital in Tunis recruiting patients between January 2021 and June 2021. One hundred and thirty three ICSI cycles with fresh embryo transfer (FET) were included. The embryo transfer medium was either a hyaluronan-enriched one (EmbryoGlue®, Vitrolife) or a standard one (G-2®, Vitrolife).

Participants/materials, setting, methods

ICSI cycles with FET were divided into two groups according to the ET medium. The latter’s choice was made according to the transfer’s day. Two groups were constituted: Group1 including embryo transfers with EmbryoGlue(N = 67) and Group2 including those with G2(N = 66). The pregnancy, the implantation, the miscarriage and the live birth rates were compared between the two groups. The statistical analysis was performed by Chi-square and U tests using SPSS and p < 0.05 was considered as significant.

Main results and the role of chance

Among the 133 transfer cycles included, 67 were performed with EmbryoGlue medium and 66 with G2 medium. The mean female’s age was 35.14 ±4.628 years. Both groups were comparable according to the epidemiologic characteristics (age, ovarian reserve, infertility etiology) and according to the number of embryos transferred. The pregnancy rate was significantly higher when using HA-enriched transfer medium compared with standard medium (31% vs 23%, p = 0.04). However, no statistical differences between Group 1 and Group 2 were found concerning the implantation rate (18.65% vs 15.65 %, p = 0.634), the miscarriage rate (28.57% vs 40%; p = 0.804) and the life birth rate (22.38 % vs 13.64 %, p = 0.189).

Limitations, reasons for caution

The results did not consider the embryo stage transferred (cleavage stage or in blastocyst stage). All transfer cycles were included without taking into account of the transfer cycle rank and the medical history of patients.

Wider implications of the findings

The hyaluronan-enriched embryo transfer medium seems to improve the pregnancy rate and should be used especially for patients with a miscarriage history.

Trial registration number

Not Applicable

Evaluation of ovarian reserve before and after chemotherapy

BACKGROUND

Progress in oncology has improved patient survival. However, cancer chemotherapy can be gonadotoxic and affect their fertility. Recourse to fertility preservation before starting these treatments is therefore necessary in order to allow a better life quality after survival. The aim of this work was to study the impact of chemotherapy on ovarian reserve by AMH measurement.

METHODS

This is a descriptive and longitudinal study from 2015 to 2018 carried out at Aziza Othmana hospital ART center in Tunis on patient aged less than 41 years who were candidates for fertility preservation. Patients included had AMH measurement prior to cancer treatment. We called them back to follow up the AMH level after chemotherapy. The AMH assay was performed by electrochemilumiescence technique. At the end, only 66 patients met the inclusion criteria.

RESULTS

The most frequent pathologies were Hodgkin's lymphoma and breast cancer. The mean age of patients was 26.7 ± 6.8. The most used chemotherapy protocols were BEACOPP, ABVD or the combination of both in lymphoma and FEC + TXT for breast cancer treatment. A significant difference between AMH before and after chemotherapy was found for BEACOPP and FEC + TXT protocols (p < 10 3). The patient's age was correlated with the AMH decrease after chemotherapy (r = 0.577, p < 10 3).

CONCLUSION

Our results showed that the high risk gonadotoxicity protocols were BEACOPP for lymphoma treatment and FEC + TXT for breast cancer treatment. However, studies with a larger sample and more time extended monitoring are necessary for a better gonadotoxicity understanding of the cancer treatments available today.