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

• Published in: Journal of assisted reproduction and genetics 2019-03, Vol.36 (3), p.483-490
• Main Authors: Likes, Creighton E., Cooper, Leah J., Efird, Jessica, Forstein, David A., Miller, Paul B., Savaris, Ricardo, Lessey, Bruce A.
• Format: Article
• Language: English
• Subjects: Abortion, Spontaneous - genetics; Abortion, Spontaneous - physiopathology; Acetic acid; Adult; Assisted Reproduction Technologies; Bcl-6 protein; Biopsy; Embryo Implantation - genetics; Embryo Transfer; Endometriosis; Endometriosis - drug therapy; Endometriosis - genetics; Endometriosis - physiopathology; Endometriosis - surgery; Endometrium; Endometrium - drug effects; Endometrium - physiopathology; Female; Gene Expression Regulation, Developmental - drug effects; Gonadotropin-releasing hormone; Gonadotropin-Releasing Hormone - genetics; Gynecology; Human Genetics; Humans; Implantation; Infertility; Laparoscopy; Live Birth; Medicine; Medicine & Public Health; Miscarriage; Ovulation Induction - methods; Pregnancy; Pregnancy Rate; Proto-Oncogene Proteins c-bcl-6 - genetics; Reproductive Medicine; Reproductive Techniques, Assisted - trends; Reproductive technology
• ISSN: 1058-0468; 1573-7330
• DOI: 10.1007/s10815-018-1388-x

Purpose 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. Methods 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. Results 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. Conclusions 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.