The contribution of subtle oocyte or sperm dysfunction affecting fertilization in endometriosis-associated or unexplained infertility: a controlled comparison with tubal infertility and use of donor spermatozoa

Abstract

This study aims to determine the relative contribution of oocyte and/or sperm dysfunction to the reduction of fertilization rates in vitro in cases of minor endometriosis and prolonged unexplained infertility. The results of in-vitro fertilization (IVF) treatment with ovarian stimulation have been compared between couples with the above conditions and women with tubal infertility (as control for oocyte function) and the use of donor spermatozoa (as control for sperm function). Fertilization and cleavage rates using husband's spermatozoa were significantly reduced in endometriosis couples (56%, n = 194, P < 0.001) and further significantly reduced in couples with unexplained infertility (52%, n = 327, P < 0.001) compared with tubal infertility (60%, n = 509). Using donor spermatozoa the rates were the same as using husband's spermatozoa in tubal infertility (61%, n = 27) or endometriosis (55%, n = 21) but significantly though only partly improved with unexplained infertility (57%, n = 60, P < 0.02). In unexplained infertility, a significantly increased proportion of couples experienced complete failure of fertilization and cleavage in a cycle (5-6% versus 2-3%). However, complete failure was not usually repetitive, and the affected couples did not account for the overall reduction in fertilization and cleavage rates, which remained significantly lower in the rest of the unexplained and endometriosis groups. Implantation and pregnancy rates appeared similar in all groups. The benefit of IVF treatment in cases of minor endometriosis and prolonged unexplained infertility is due to superabundance of oocytes obtained by stimulation. The reduction in natural fertility associated with endometriosis appears to be at least partly due to a reduced fertilizing ability of the oocyte. In unexplained infertility, there is distinct impairment due to otherwise unsuspected sperm dysfunction but probably also oocyte dysfunction.

The role of the Hoxa10/HOXA10 gene in the etiology of endometriosis and its related infertility: a review

“…It is cyclically expressed in the adult endometrium in response to steroid hormones, regulating endometrial receptivity during the nidation window [15]. Several studies have suggested an impairment of implantation in patients with endometriosis, but the mechanisms underlying it are not well understood [16][17][18]. In accordance with HOXA10's role in implantation, it was found that women with endometriosis have altered expression of HOXA10 in the eutopic endometrium, which could account for the defective implantation observed in these women [19].…”

Conventional IVF versus ICSI in sibling oocytes from couples with endometriosis and normozoospermic semen

“…Several studies reported a reduced fertilization rate with IVF in women with endometriosis [2,[8][9][10][11][12][13][14]. Pal et al (1998) reported a significant reduction in fertilization rates in stage III and IV of endometriosis compared with stage I and II.…”

Proteasomes and Proteasome Activator 200 kDa (PA200) Accumulate on Chromatin in Response to Ionizing Radiation

“…Clear mechanisms causing the endometriosis-associated infertility have not been firmly established. Infertility in women with endometriosis may be associated with subtle, explicit or multifaceted abnormalities [1][2][3][4][5][6][7][8]. Anomalies have been identified in the ovary such as reduced rates of follicular growth, functional capacity of the preovulatory follicle, and early luteal function [1,2,4,5]; in gametes and embryos, including reduced rates of fertilization and defects in embryo development [1,6,[8][9][10]; and in endometrial function [7,11].…”