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 controoled trial
Patients & Methods: Eighty infertile women were randomly categorized into: Group EF (n=40) had EF after oocyte retrieval and Control group (n=40) did not have EF. All women were subjecte to the standard down-regulation 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.
Keywords: Follicular fluid, endometrial flushing, ICSI outcome, TNF-α, AMH, leptin, G-CSF
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