Prediction of the efficiency of surgical treatment for infertility in women with minor forms of genital endometriosis - from theory to practice

Objective. To identify immunological criteria for predicting the onset of spontaneous pregnancy after laparoscopy in women of active reproductive age with infertility and minor forms of genital endometriosis. Subjects and methods. Peripheral venous blood samples were examined in 264 women of active reproductive age with infertility and minor forms of genital endometriosis. The levels of B-lymphocytes (CD20+), B1 cells (CD20+CD5+), CD86+ neutrophils, and IL-1P+ monocytes were measured by flow cytometry and the content of sRAGE was determined by ELISA. Results. The women who got pregnant within a year after laparoscopy had differences in immunological parameters from those who did not. Pregnancy occurred in women who showed decreased values of CD20+, CD20+CD5+ lymphocytes, and CD86+ neutrophils and increased levels of IL-lfi+ monocytes in the blood, while patients who had high blood serum sRAGE levels prior to treatment failed to get pregnant within one year after laparoscopy. ROC analysis of immunological parameters in order to use the latter in the future for predicting pregnancy after surgical treatment established that parameters, such as the peripheral blood levels of CD20+ lymphocytes and sR AGE had a low predictive value and sensitivity. W hereas the indicators of B-l lymphocyte (CD20+CD5+), IL-ip+ monocyte, and CD86+ neutrophils levels were highly sensitive and specific; these indicators may suggest that humoral immunity is stimulated, and there are systemic inflammatory reactions and phagocyte hyperactivation. These processes can determine the mechanisms of the development of infertility in minor forms of genital endometriosis. Conclusion. Thus, the triad of indicators: the levels of B-l lymphocytes, IL-1fi+ monocytes, and CD86+ neutrophils are pathogenetically significant predictors of the efficiency of surgical treatment for infertility in patients of active reproductive age with minor forms of genital endometriosis at the preoperative stage.

endometriosis, infertility, B1-lymphocytes, IL-1β monocytes, CD86 neutrophils