Intraovarian steroidogenesis in women with endometriosis undergoing IVF

Is endometriosis associated with alterations in the intraovarian steroidogenic milieu in women undergoing IVF compared with rigorously matched women without the disease?

Prospective cohort study comparing intrafollicular steroid hormone concentrations between women with and without endometriosis undergoing IVF. Eighty-three affected women were recruited and matched 1:1 with controls for age at oocyte retrieval, study period, stimulation regimen and serum anti-Müllerian hormone. Follicular fluid was collected, pooled and stored. Concentrations of 14 steroid hormones were measured using liquid chromatography-tandem mass spectrometry. Subgroup analyses focused on women with ovarian endometriomas and on intra-patient comparisons in cases of unilateral disease.

Compared with controls, women with endometriosis showed significantly higher concentrations of 11-deoxycortisol and lower concentrations of aldosterone and progesterone (adjusted P = 0.024 for all). These differences were more pronounced in women with ovarian endometriomas, who also had significantly higher concentrations of corticosterone, dehydroepiandrosterone and testosterone than controls (adjusted P = 0.003, P = 0.011 and P = 0.003, respectively). No significant differences in steroid concentrations were observed between affected and contralateral intact ovaries in women with unilateral endometriomas.

The follicular fluid of women with endometriosis has a distinct hormonal profile compared with that of controls, suggesting alterations in steroidogenesis. Reasons explaining these differences, as well as their clinical relevance, remain unknown and deserve further investigations.