Study question

研究问题

Does presence of endometriosis adversely affect oocyte morphology? Evaluation of a large number of oocytes obtained from endometriosis patients, 27204 oocytes

子宫内膜异位症是否对卵母细胞的形态有不良影响？一项大样本量评估，包括了子宫内膜异位症患者的 27204 个卵母细胞。

Summary answer

摘要

In the presence of endometriosis, oocyte morphology is not impaired. The rate of reaching blastocyst and fertiilization rate, also pregnancy outcomes are not affected negatively.

子宫内膜异位症不会损害卵母细胞形态。对囊胚率、受精率、妊娠结局都不会产生不良影响。

What is known already

目前已知的情况

Although there are hypothesis, theories that altered steroidogenesis and folliculogenesis, higher oxidative stress, reactive oxygen species, altered cell cycle progression, inflammation and angiogenesis in the follicular environment exposes oocytes to a hostile inflammatory environment and alters oocyte quality. There has been much debate and conflicting evidence as to whether the poorer IVF outcomes in women with endometriosis is related to altered oocyte quality. There is some evidence to suggest that impaired oocyte morphology in women with endometriosis may have an adverse impact on fertilization rate, however, most studies have shown that there is no difference in pregnancy outcomes following IVF.

虽然有一些假说和理论认为，卵泡周围类固醇激素和卵泡生成、氧化应激、活性氧的增加、细胞周期的变化、炎症和血管生成等因素，共同营造了一个不利于卵母细胞的炎性环境，从而影响了卵母细胞的质量。子宫内膜异位症患者IVF结局不良是否与卵泡质量相关还有争议，且证据相互矛盾。有证据表明，子宫内膜异位症患者的卵母细胞形态受损可能会影响受精率，然而，大多数研究表明，体外受精后的妊娠结局并无差异。

Study design, size, duration

研究设计、规模和持续时间

This retrospective, single center study evaluated 29130 ART cycles from August 2011 to March 2023,based on data obtained from Istanbul Memorial Hospital,ART and Reproductive Genetics Center.Study group included endometriosis patients(n = 4602 cycles, 27204 oocytes) and control group included non-endometriosis patients(n = 24528 cycles, 178774 oocytes).We analyzed demographic and cycle characteristics, oocyte morphology in ART cycles between the two groups.Futhermore, we compared pregnancy outcomes in frozen-thawed embryo transfer(FET) cycles (total number:11116 FET cycles; endometriosis group:2255 cycles,non-endometriosis group:8861 cycles).

这是一项单中心回顾性研究，评估了伊斯坦布尔纪念医院人工辅助生育和生殖中心2011年8月至2023年3月期间的29130个ART周期。研究组为子宫内膜异位症患者（4602 个周期，27204 个卵母细胞），对照组为非子宫内膜异位症患者（24528 个周期，178774 个卵细胞）。分析了两组人口统计学资料、周期特征和ART周期卵母细胞的形态。此外，我们还比较了冻胚移植周期（FET）周期的妊娠结局（共11116个FET周期，子宫内膜异位症组：2255 个周期，非子宫内膜异位症组：8861 个周期）。

Participants/materials, setting, methods

参与者/材料、环境、方法

Patients diagnosed with endometrioma by ultrasound, diagnosed with endometriosis by laparoscopy or patients who underwent endometrioma surgery or adenomyosis detected on ultrasound were included in the study (endometriosis) group. In the control group, the patients without endometriosis were included.

Mann Whitney U test and Pearson Chi-square test used. Cliff's Delta effect size (????) for non-parametric tests and Phi effect size (p) for categorical data were reported.

研究（子宫内膜异位症）组为超声诊断的子宫腺肌瘤、腹腔镜诊断的子宫内膜异位症、子宫腺肌瘤手术治疗或超声发现的子宫腺肌症的患者。对照组为非子宫内膜异位症的患者。

采用 Mann Whitney U 检验和 Pearson Chi-square 检验。非参数检验采用克利夫德尔塔（Cliff’s Delta）效应量，分类数据采用 Phi 效应量 (p)报告。

Main results and the role of chance

主要结果和偶然性的作用

The sample was very large, so the statistical results were given in terms of effect size, not only p value calculated. Female age was similar. Female body mass index, number of previous cycles, duration of infertility, AMH, total gonadotropin dosage used, duration of ovarian stimulation, estradiol level on trigger day, number of aspirated oocytes, mature and fertilized oocytes, maturation and fertilization rate, rate of blastulation, rate of usable blastocyst (top and good quality), number of embryos transferred, blastocyst stage embryo transfer cycles were statistically different between the two groups (p < 0.001). However when the effect size examined, all variables were found to have a negligible association by Cliff's Delta or Phi effect size calculations. Oocytes obtained from endometriosis patients had statistically significantly higher severe central granulation, large perivitellin space, thick zona, polar body defect abnormalities compared to non-endometriosis patients (p < 0.001), Phi effect size showed negligible association for all variables.

In endometriosis group compared to non endometriosis group; biochemical pregnancy (68.9% vs 72.2%, p:0.002, Phi:0.030), clinical pregnancy (61.5% vs 64.5%, p:0.007, Phi:0.025), total pregnancy loss (22% vs 24.4%, p:0.05, Phi:0.022) were statistically higher, but Phi effect sizes were negligible. Live birth were similar (52.5% vs 53.2 P:0.56) between the two groups.

由于样本量巨大，统计结果以p值和效应量表示。女性年龄相似。女性体质指数、既往周期数、不孕持续时间、AMH、促性腺激素总用量、卵巢刺激持续时间、雌二醇水平、卵巢刺激持续时间、触发日的雌二醇水平、抽取的卵母细胞数量、成熟度和受精卵数、卵母细胞数、成熟卵母细胞数和受精卵数、成熟率和受精率、胚胎着床率、可用胚胎着床率、受精率、成熟率和受精率。囊胚形成率、可用囊胚率（优质和极优质）、移植胚胎数、囊胚期、胚胎大小、胚胎质量、移植胚胎数、胚胎质量、移植胚胎数、胚胎移植数量、囊胚期胚胎移植周期两组间均存在统计学差异（P < 0.001）。然而，在检查效应量时，发现通过Cliff’s Delta或Phi效应量计算，所有变量间的关联性都微乎其微。子宫内膜异位症患者的卵母细胞，中心颗粒化严重、卵周间隙增大、透明带增厚及极体缺陷等异常，较非子宫内膜异位症患者显著增多（P<0.001），而 Phi效应量显示所有变量间的相关性可忽略不计。

与非子宫内膜异位症组相比，子宫内膜异位症组的生化妊娠率（68.9% vs 72.2%，P:0.002，Phi:0.030）、临床妊娠率（61.5% vs 64.5%，P:0.002，Phi:0.025）、总妊娠丢失率（22% vs 24.4%，P:0.05、Phi:0.022）更高，但 Phi 效应量微不足道。两组的活产率相似（52.5% vs 53.2%，P:0.56）。

Limitations, reasons for caution

局限性，需谨慎的原因

The principal limitation of the study is retrospective design of the analysis. But the strength of the study is that included 27204 oocytes from endometriosis patients.

主要局限性在于本研究设计为回顾性分析。优势在于纳入了来自子宫内膜异位症患者的 27204 个卵母细胞。

Wider implications of the findings

研究结果的广泛影响

To our knowledge, this study includes the largest case group that investigates the endometriosis and oocyte morphology. The results show that endometriosis does not have a negative impact on oocyte morphology. Additionally, it has been shown that the presence of endometriosis does not have a negative effect on pregnancy outcomes.

据我们所知，本研究纳入了迄今为止研究子宫内膜异位症和卵母细胞形态学的最大病例数。结果表明，子宫内膜异位症不会影响卵母细胞形态。也不影响妊娠结局。

参考文献：

I N B Duzguner, Y Sahin, H Yelke, Y Kumtepe, S Kahraman, O-148 Does presence of endometriosis adversely affect oocyte morphology? Evaluation of a large number of oocytes obtained from endometriosis patients, 27204 oocytes, Human Reproduction, Volume 39, Issue Supplement_1, July 2024, deae108.167, https://doi.org/10.1093/humrep/deae108.167

Tags： 内异症对卵母细胞形态的影响评估：27204个卵母细胞的分析