Prospective evaluation of mid-luteal endometrial BCL6/SIRT and correlation with outcomes of euploid frozen embryo transfer: a prospective cohort study.

PURPOSE: To study whether mid-luteal endometrial B-cell lymphoma 6 (BCL6) or sirtuin-1 (SIRT1) immunostaining in an ovarian stimulation (fresh) in vitro fertilization (IVF) cycle was predictive of risk for endometriosis. Additionally, to evaluate for association with future euploid frozen embryo transfer (FET) pregnancy outcomes. METHODS: Prospective, blinded observational cohort study in an academic fertility center. Patients pursuing IVF with euploid FET within 1 year who met inclusion criteria for one of three groups: (G1) surgically confirmed endometriosis (n = 10), (G2) unexplained infertility or recurrent pregnancy loss (n = 42), or (G3) controls without identifiable female infertility (n = 24). BCL6 and SIRT1 immunostaining was quantified in endometrial samples obtained 5-7 days after oocyte retrieval (HSCORE > 1.4 considered positive). Euploid FET in a subsequent cycle was blinded to BCL6/SIRT1 assessment. Demographic and pregnancy outcomes for each group were correlated with BCL6/SIRT1 levels. RESULTS: There was high BCL6 positivity with a significant interaction among groups (G1: 80%, G2: 97.6%, G3: 100%; p = 0.044), but pairwise comparisons did not demonstrate a difference between individual groups. Median BCL6 levels by H-SCORE were similarly high in all groups [median (inter-quartile range); G1: 3.7 (3.45, 4.0), G2: 3.8 (3.6, 3.8), G3: 3.8 (3.4, 4.0); p = 0.95]. Median SIRT1 levels also did not differ between groups. Pregnancy outcomes following FET were comparable between groups (live birth rate G1: 57.1%, G2: 62.1%, G3: 54.5%; p = 0.68). BCL6 levels were inversely correlated with serum progesterone level on the day of endometrial biopsy (τ =  - 0.223, p = 0.01). Correlation analysis of pregnancy outcomes for all patients included in the study revealed no difference between BCL6 or SIRT1 levels for patients who did or did not experience a live birth. CONCLUSION: Endometrial BCL6 and SIRT1 levels collected in a fresh ovarian stimulation cycle did not correlate with endometriosis diagnosis nor pregnancy outcomes. BCL6 levels were inversely correlated with serum progesterone levels. CLINICAL TRIAL ID: NCT0410712.

Duke Scholars

Author Steven L Young Obstetrics and Gynecology, Reproductive Endocrinology & Infe ...