| Objective:We aimed to investigate the influence of mild-moderate overian endometriosis(OEM)surgery or not on the ovarian reserve function and the outcome of in vitro fertilization and embryo transfer(IVF-ET).And we determined the content of iron and ferritin in follicular fluid in patients with OEM to investigate the influence of iron overload in follicular fluid on the outcome of IVF-ET.Methods:A total of 335 patients of infertility due to unilateral OEM were analyzed from January 2016 to August 2019 in the Department of Reproductive Medicine,Affiliated hospital of Qingdao university.The patients were divided into the operation group(n=144)and the OEM group(n=191)according to whether they underwent laparoscopic cystectomy before IVF-ET.At the same time,276 patients of infertility due to simple fallopian tube factors were included as control group(n=276).The differences of basic clinical data,unilateral ovarian reserve and pregnancy outcomes among three groups were analyzed.The effect of different ovulation-promoting schemes and IVF-ET outcomes between the operation and OEM groups were compared,and the factors that may affect the number of retrieved oocytes were analyzed by multiple linear regression analysis.During ovarian puncture,a total of 90 follicular fluid samples which were neither contaminated with blood nor in insufficient amount were collected(30 from the healthy side and affected side in the OEM group respectively,and 30 from the control group,all of whom used antagonist regimen to promote ovulation).The content of iron and ferritin in follicular fluid were measured and the effect on the outcome of IVF was analyzed.Results:(1)The levels of basal follicle stimulating hormone(FSH),CA125 and the dosage of gonadotropin(Gn)in control group were significantly lower than those in operation group and OEM group.The fertilization rate and high-quality embryonic rate in the operation group were significantly lower than those in the OEM group and the control group(t=3.527～5.004,χ~2=3.939～14.689,P<0.05).With regard to the antral follicle count,the serum estradiol level(E2)before ovarian puncture,the average number of retrieved oocytes,the number of transplantable embryos and the number of high-quality embryos,the control group was the highest among the three groups,with the operation group the lowest;the differences among the three groups were statistically significant(t=2.682～9.140,P<0.05).The differences in the blastocyst formation rate and the outcome of fresh embryo transfer among three groups didn’t reach statistical significance(χ~2=0.016～1.836,P>0.05).(2)The antral follicle count and retrieved oocyte number were significantly higher in the unaffected side than those in the affected side in patients in the operation group and the OEM group(t=3.014～4.335,P<0.05).And the antral follicle count and retrieved oocyte number in the affected side of the OEM group were significantly higher than those in the operation side of the operation group(t=2.3321、3.453,P<0.05).(3)In operation group and OEM group,the total dosage and use duration of Gn used in antagonist regimens were significantly lower than those in the ultra-long regimens(t=3.533～5.928,P<0.05).There was no significant differences in the retrieved oocyte number,high-quality embryonic rate and the clinical pregnancy rate of fresh embryos(t=0.237～0.717,χ~2=0.000～1.757,P>0.05).The fertility rate of the ultra-long regimens was significantly higher than that of the antagonist regimens in the OEM group(χ~2=7.287～28.400,P<0.05).(4)Multiple linear regression analysis indicated that,patients’age,E2 levels before ovarian puncture,antral follicle count,and levels of basal FSH,all affected the average number of retrieved oocytes in OEM group(t=-4.340～7.743,P<0.05).The size of OEM had no significant effect on the average number of retrieved oocytes(t=-0.537,P>0.05).In operation group,the average number of retrieved oocytes was related to the E2 levels before ovarian puncture and the antral follicle count(t=7.932、3.329,P<0.05).(5)The concentration of iron and ferritin in the affecetd side of patients in the OEM group was significantly higher than that in unaffected side and that in the control group(t=3.737～6.306,P<0.05).The concentration of ferritin was significantly and positively correlated with the concentration of iron(r=0.536,P<0.05).Conclusion:(1)The mild-moderate OEM would interfere with the ovarian reserve and ovarian reactivity to gonadotropin,leading to a lower oocyte count and poorer oocyte quality in IVF-ET cycles.(2)Laparoscopic ovarian cystectomy couldn’t significantly improve the IVF-ET outcomes in patients with mild-moderate OEM,but rather increased the risk of reduced ovarian reserve function.(3)For OEM patients,ultra-long regimen could significantly improve the fertilization rate,and antagonist regimens could reduce the total dosage and use duration of gonadotropin and obtain similar pregnancy outcomes as that in the ultra-long regimen.(4)Ovarian reserve function was the main factor affecting the IVF-ET outcomes for infertile patients with mild-moderate OEM.A comprehensive assessment of the patient’s age and ovarian reserve function is needed to measure the value of surgery before IVF-ET.(5)OEM could cause iron overload in the ovarian follicle fluid,which may damage the oocytes quality by aggravating oxidative stress in the microenvironment of the follicle.The increase of ferritin is a protective response to iron overload,however,the specific mechanisms need further work. |
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