Determination of Apoptotic Pathways in Ovarian Folicular Fluid of Infertile Patients With Endometrioma in Relation to Follicular Atresia

Yağmur Soykan, Atiye Seda Yar Sağlam, Asiye Uğraş Dikmen, Mehmet Erdem, Ahmet Erdem
American journal of reproductive immunology (New York, N.Y. : 1989) · 2025 · vol. 94(3) , pp. e70164 · doi:10.1111/aji.70164 · PMID:40924865
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study found that endometrioma presence in infertile patients is associated with increased pro-apoptotic and decreased anti-apoptotic gene mRNA expression in follicular fluid.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This study measured mRNA expression in ovarian follicular fluid from infertile patients undergoing IVF with controlled ovarian hyperstimulation, comparing samples from patients with an endometrioma to controls. The authors assessed apoptosis-related genes including CASP3, CASP8, CASP9, BCL-2, BCL2L1, BAX, BAK, and components such as PERFORIN and GRANZYME B, and found that endometrioma presence was associated with higher expression of pro-apoptotic genes and lower expression of anti-apoptotic genes (BCL-2 and BCL2L1). The paper presents these as preliminary findings, with no explicit additional limitations stated in the provided text, and reports associations at the mRNA level rather than functional apoptosis outcomes. This paper is centrally about endometriosis — it specifically analyzes apoptosis-pathway gene expression in follicular fluid of infertile women with endometrioma in relation to follicular atresia.

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Abstract

PROBLEM: Endometriosis is a chronic inflammatory disease that leads to pelvic pain and infertility. Recent studies have indicated that immunological, endocrine, biochemical, and genetic irregularities, along with suboptimal quality of oocytes, embryos, and the endometrial environment, significantly impact infertility associated with endometriosis. Ectopic endometrial cells in endometriosis have the capacity to avoid apoptosis. Therefore, apoptosis has supposed to play a fundamental role in the pathogenesis of endometriosis. This study aimed to investigate the association between the messenger RNA (mRNA) expression levels of apoptosis-related genes-specifically, Caspase 3 (CASP3), Caspase 8 (CASP8), Caspase 9 (CASP9), BCL-2, BCL2L1, BAX, BAK, PERFORIN, and GRANZYME B (GrB)-in follicular fluid (FF) and infertility. METHOD OF STUDY: The mRNA expression levels of the aforementioned genes were analyzed in FF obtained during the oocyte pick-up procedure following controlled ovarian hyperstimulation in patients undergoing in vitro fertilization due to infertility. RESULTS: We found that the presence of endometrioma correlates with altered mRNA expression levels of apoptosis-related genes in FF. Specifically, pro-apoptotic genes exhibited significantly higher expression levels (p < 0.05), while anti-apoptotic genes like BCL-2 and BCL2L1 were significantly lower (p < 0.05) as compared to controls. These results suggest a potential link between these gene expression alterations and infertility. CONCLUSION: This preliminary study provides important insights into the mRNA expression levels of genes involved in apoptosis. The findings may reveal potential therapeutic targets within the apoptosis pathway for the treatment of infertility in women with endometrioma.
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Abstract

Problem Endometriosis is a chronic inflammatory disease that leads to pelvic pain and infertility. Recent studies have indicated that immunological, endocrine, biochemical, and genetic irregularities, along with suboptimal quality of oocytes, embryos, and the endometrial environment, significantly impact infertility associated with endometriosis. Ectopic endometrial cells in endometriosis have the capacity to avoid apoptosis. Therefore, apoptosis has supposed to play a fundamental role in the pathogenesis of endometriosis. This study aimed to investigate the association between the messenger RNA (mRNA) expression levels of apoptosis-related genes—specifically, Caspase 3 (CASP3), Caspase 8 (CASP8), Caspase 9 (CASP9), BCL-2, BCL2L1, BAX, BAK, PERFORIN, and GRANZYME B (GrB)—in follicular fluid (FF) and infertility.

Method

of Study The mRNA expression levels of the aforementioned genes were analyzed in FF obtained during the oocyte pick-up procedure following controlled ovarian hyperstimulation in patients undergoing in vitro fertilization due to infertility.

Results

We found that the presence of endometrioma correlates with altered mRNA expression levels of apoptosis-related genes in FF. Specifically, pro-apoptotic genes exhibited significantly higher expression levels (p < 0.05), while anti-apoptotic genes like BCL-2 and BCL2L1 were significantly lower (p < 0.05) as compared to controls. These results suggest a potential link between these gene expression alterations and infertility.

Conclusion

This preliminary study provides important insights into the mRNA expression levels of genes involved in apoptosis. The findings may reveal potential therapeutic targets within the apoptosis pathway for the treatment of infertility in women with endometrioma. Conflicts of Interest The authors declare no conflicts of interest. Data Availability Statement The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Condition tags

mesh:D004715endometriosisendometriomainfertility

MeSH descriptors

Apoptosis Apoptosis Apoptosis Apoptosis Apoptosis Apoptosis Apoptosis Apoptosis Apoptosis Apoptosis Apoptosis Apoptosis Apoptosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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