Multi-factorial Analysis of the Follicular Fluid Milieu to explore the discrepant effect of follicular fluid endometrial flushing on outcome of Assisted Reproduction Trial

Document Type : Original Article

Author

Department of Obstetrics & Gynecology, Faculty of Medicine, Benha University 2Department of Clinical Pathology, Faculty of Medicine, Benha University

Abstract

Objectives: To evaluate the effect of endometrial flushing (EF) with
aspirated follicular fluid (FF) on outcome of assisted reproduction
procedure and to explore any possible relationship between FF cytokine
milieu and such outcome.
Study setting : Randomised controlled trial
Patients & Methods: Eighty infertile women were randomly categorized
into: Group EF (n=40) had EF after oocyte retrieval and Control group < br />(n=40) did not have EF. All women were subjected to the standard downregulation regimen followed by controlled ovarian hyper stimulation .
Oocytes were retrieved 34–36 h after hCG administration and aspirated
FF was collected and centrifuged at 600 rpm for 10 min and 5-ml sample
of supernatant was obtained for ELISA estimation of tumor necrosis
factor-α (TNF-α), granulocyte colony-stimulating factor (G-CSF), leptin
and anti-Mullerian Hormone (AMH) levels in both groups. The remaining
amount was used for EF in EF group and was discarded in control group.
Pregnancy was diagnosed by measurement of β-HCG level and confirmed
by transvaginal sonography as clinical pregnancy.
Results: Embryologic data and estimated levels of studied parameters
showed non-significant difference between both groups, despite being in
favor of EF group. Mean FF levels of AMH and G-CSF were significantly
higher and levels of TNF-α were significantly lower in women got clinical
pregnancy (n=24) compared to those had failed trial (n=56). Regression
analysis defined high FF levels of AMH as positive and TNF-α as negative
significant predictors for clinical pregnancy. ROC curve analysis defined
low FF levels of TNF-α as a significant sensitive and high AMH as
significant specific predictors for clinical pregnancy.
Conclusion: Cytokine milieu of FF may affect outcome of IVF/ICSI
procedures in contradictory manner and could explain the discrepant
outcome of endometrial FF flushing. The obtained results may behave the
way for the use of artificial flushing fluids containing anti-TNF-α, AMH
or G-CSF for promotion of implantation and increasing pregnancy rates.

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