Impact of endometrioma on iron levels and oxidative stress in the follicular fluid in women with endometriosis: a cross-sectional study

Monica Peter, Padmanaban Venkatesan, Arun Jose Nellickal, Mahalakshmi C, C Mahalakshmi, Abhilasha Jane Thomas, A.J. Thomas, Madhuri S Balaji, Mithra Balaji, Akula Sindhu Bhargavi, Bhargavi A, Muthukumar K, K. Muthukumar, Christhunesa S Christudass, Aleyamma T Kunjummen, Joe Varghese, Mohan S. Kamath, Mohan Shashikant Kamath
Scientific reports · 2025 · vol. 15(1) , pp. 43416 · doi:10.1038/s41598-025-20319-9 · PMID:41365937 · PMC12690140 · W4417155635
article OA: gold CC0 ⤵ 1 in-corpus citation
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found higher malondialdehyde levels in follicular fluid of infertile women with endometriosis compared to controls, but no differences in iron or IL-6, indicating endometriomas do not worsen oxidative stress or iron levels.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This cross-sectional study compared follicular fluid iron status, oxidative stress, and inflammation in infertile women undergoing ART, recruiting 21 with laparoscopically diagnosed endometriosis (including unilateral/bilateral ovarian endometrioma and non-endometrioma disease) and 14 controls with other infertility etiologies. MDA, a marker of oxidative stress, was significantly higher in the follicular fluid of women with endometriosis versus controls, but iron, transferrin, transferrin saturation, and IL-6 (and NTBI) were not consistently elevated in relation to endometriosis overall; notably, MDA did not increase in the ovary containing an endometrioma compared with the contralateral ovary without endometrioma, and MDA was higher in non-ovarian endometriosis than ovarian endometrioma. IL-6 was higher in women with endometrioma compared with those without endometrioma, yet there were no correlations between MDA and iron or IL-6. The authors acknowledge that their iron measurement approach may have been influenced by blood contamination during follicular fluid aspiration, potentially affecting iron-related results. This paper is centrally about endometriosis — it analyzes whether endometrioma presence in endometriosis changes follicular-fluid iron handling and oxidative stress in ART patients.

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Abstract

The cause of infertility in women with endometriosis remains unclear. Elevated levels of iron in the follicular fluid (FF), potentially leading to oxidative stress, have been reported in endometriosis. In this study, we aimed to compare markers of iron status, oxidative stress, and inflammation in the FF of infertile women with and without endometriosis. Infertile women undergoing assisted reproductive technology (ART) were the subjects of the study. Endometriosis (n = 21) was diagnosed laparoscopically, and the control arm (n = 14) comprised women with tubal factor, male factor, or unexplained infertility. FF collected during oocyte retrieval was used to estimate iron levels, transferrin, interleukin-6 (IL-6), and malondialdehyde (MDA). MDA levels were significantly higher in FF of women with endometriosis compared to controls. Interestingly, the MDA levels did not differ between affected and unaffected ovaries in women with unilateral endometrioma. In fact, MDA levels were significantly higher in the non-ovarian endometriosis compared to those with ovarian endometrioma. Iron, transferrin, and interleukin-6 (IL-6) were not significantly different between controls and those with endometriosis, and there were no correlations between MDA and iron or IL-6. In conclusion, our findings indicate that the presence of endometriomas does not worsen oxidative stress or elevate iron levels in the FF. These results suggest that the decision to surgically remove an endometrioma before ART should be taken based on clinical considerations such as accessibility issues during oocyte retrieval.

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Condition tags

endometriosisendometriomainfertility

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