Pregnancy on long term follow up in endometriosis patients with evidence of altered peritoneal fluid oxidative stress status

Abstract

Abstract Objective The aim is to assess whether women with endometriosis, idiopathic infertility, and tubal ligation have different levels of reactive oxygen species (ROS), total antioxidant capacity (TAC), and ROS–TAC score in their peritoneal fluid, and to assess whether the ROS–TAC score is a better predictor of endometriosis and pregnancy than the ROS and TAC scores alone. Materials and methods Peritoneal fluid from 108 women: 60 with endometriosis, 38 with tubal ligation/reanastomosis and 10 with unexplained infertility was obtained. ROS was measured by the chemiluminescence assay using luminol as the probe and TAC was measured using the colorimetric assay. We compared the three groups on their ROS, TAC, and ROS–TAC scores using Kruskal–Wallis test, and compared the ability of ROS, TAC and the ROS–TAC scores to predict endometriosis vs. idiopathic and tubal, and pregnancy using the DeLong non-parametric method of comparing two dependent ROC curves. Results Endometriosis patients had significantly higher ROS values compared with tubal ligation/reanastomosis patients ( P = 0.005). Peritoneal fluid TAC levels were not different across the three groups. Significantly lower ROS–TAC score [indicative of higher oxidative stress (OS)] was observed in endometriosis and unexplained infertility patients compared to tubal ligation/reanastomosis patients (overall P = 0.003). There is no evidence that the ROS–TAC score (AUC = 0.71, 95%; CI = 0.60, 0.81) is significantly better at predicting endometriosis diagnosis than either TAC alone (AUC = 0.73, 95%; CI = 0.63, 0.82) or ROS alone (AUC = 0.73, 95%; CI = 0.63, 0.83). Fifty-four patients with endometriosis attempted to become pregnant. Those that became pregnant (20%, 11/54) had significantly lower levels of ROS values ( P = 0.001), higher levels of TAC ( P = 0.021), and higher ROS–TAC scores ( P = 0.002) than endometriosis patients who did not get pregnant. Conclusion Endometriosis patients with lower peritoneal fluid ROS and higher TAC levels were more likely to get pregnant.