association between the concentration of human … · porto alegre, dezembro de 2014. association...
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Porto Alegre, dezembro de 2014.
ASSOCIATION BETWEEN THE CONCENTRATION OF HUMAN LEUKOCYTE ANTIGENS-G (HLA-G) MEASURED IN
FOLLICULAR FLUID AND EMBRYO QUALITY IN PATIENTS WITH ENDOMETRIOSIS SUBMITTED TO IVF CYCLES
Cunha-Filho JS1, Bezerra G1, Olsen P1, Souza CAB1, Chapon R1, Passos MP1, Goidanich MC1, Genro V2
1UFRGS, Porto Alegre, Brazil, FIPE/HCPA, Porto Alegre, Brazil 2HCPA, Porto Alegre, Brazil
Endometriosis and Infertility
• 20-40% infertility associated endometriosis
• Several mechanisms: oocyte incompetence, LH SNP, ovarian reserve and IVF results
Fertil Steril, 2008; JARG, 2015; BJOG, 2013
BJOG, 2013
Elisa SA, et. al., 1990. Fuzzi B, et al., 2002.
Fanchin R, et al., 2007.
immunomodulation
Gestacional tolerance
PREGNANCY
Endometrial receptivity
S HLA-G Human Reproduction
RBM Online, 2009
sHLA-G and FF
Yonsei Med J 52(6):967-971, 2011
Rationale
• Endometriosis is associated to infertility • Endometriosis is an immunological
disease • Endometriosis is associated to lower IR
after IVF • And about s-HLAG in the FF as a marker
for oocyte competence?
Objective 1. Embryo Score
2. Follicular fluid S-HLAG
Endometriosis x control
73 IVF patients Less than 39y Endometriosis group vs control (tubal/male) sHLA-G were measured by ELISA the in folicullar fluid from these women undergoing ovulation induction for IVF (pool of FF). Embryo quality was classified according to the Graduated Embryo Score (GES) criteria.
Methods
Ethics
! IRB # 572.334
Statistics
! qui-square, t-student or Mann-Whitney-U
! Correlations: Spearman
! Multivariable (logistic regression)
! P < 5%
! Power calculation (sample size): 60 patients
Results
EDT (n=32)
Control (n=41)
P
Age (y) 32.8±2.9 31.5±3.5 0.085 FSH dose (IU)
2483±890 2284±905 0.354
# oocytes 6±0.8 8±0.7 0.037 # embryos 3±0.6 3±0.4 0.540 Mean TE score 71±23 68±28 0.608 # TE 1.6±0.9 1.6±0.6 0.922 Clinical Pregnancy
31% 34% 0.808
S-HLA-G positive
21% 27% 0.626
0
1
2
3
4
5
6
EDT Control
Results sHLA-G
P=0.57
We found a significant association between age and total oocytes (r = -0.31, p = 0.009) and other study variables: anti-Müllerian hormone (AMH) and age (r = -0.38; p = 0.003) and between AMH and total oocytes (r = 0.53; p <0.05)
Logistic regression (forward stepwise model)
# oocytes was associated to EDT (P=0.044) sHLA-G and embryo score were refuted
Results
Patients with endometriosis did not present an altered follicular fluid sHLA-G compared to non endometriosis. Furthermore, It is still controversial use of sHLA-G in FF as a prognostic marker of oocyte/embryo quality.
Conclusion
• ART procedure (ICSI x IVF) • Endometriosis (I-IV) , (peritoneal, ovarian, deep) • FF Pool or single • Culture media • ELISA kit (9 HLA-G types) • Methodology (OD)
Drawbacks