Determination of Apoptotic Pathways in Ovarian Folicular Fluid of Infertile Patients With Endometrioma in Relation to Follicular Atresia.

Problem: Endometriosis is a chronic inflammatory disease that leads to pelvic pain and infertility. Recent studies have indicated that immunological, endocrine, biochemical, and genetic irregularities, along with suboptimal quality of oocytes, embryos, and the endometrial environment, significantly impact infertility associated with endometriosis. Ectopic endometrial cells in endometriosis have the capacity to avoid apoptosis. Therefore, apoptosis has supposed to play a fundamental role in the pathogenesis of endometriosis. This study aimed to investigate the association between the messenger RNA (mRNA) expression levels of apoptosis-related genes-specifically, Caspase 3 (CASP3), Caspase 8 (CASP8), Caspase 9 (CASP9), BCL-2, BCL2L1, BAX, BAK, PERFORIN, and GRANZYME B (GrB)-in follicular fluid (FF) and infertility.

Method Of Study: The mRNA expression levels of the aforementioned genes were analyzed in FF obtained during the oocyte pick-up procedure following controlled ovarian hyperstimulation in patients undergoing in vitro fertilization due to infertility.

Results: We found that the presence of endometrioma correlates with altered mRNA expression levels of apoptosis-related genes in FF. Specifically, pro-apoptotic genes exhibited significantly higher expression levels (p < 0.05), while anti-apoptotic genes like BCL-2 and BCL2L1 were significantly lower (p < 0.05) as compared to controls. These results suggest a potential link between these gene expression alterations and infertility.

Conclusion: This preliminary study provides important insights into the mRNA expression levels of genes involved in apoptosis. The findings may reveal potential therapeutic targets within the apoptosis pathway for the treatment of infertility in women with endometrioma.