GnRH antagonist protocol with hCG triggering ameliorates fertilization defect caused by failure of cumulus cell pentraxin-3 expression in unilateral endometriomas

N D Gungor, Gungor ND, O Celik, Celik O, Özgür İlhan Çelik, A Ersahin, Ersahin A, Celik N, N Celik, Nazlı ÇELİK, Kobaner M, Murat Kobaner, M Kobaner, Yardim M, Meltem Yardım, M Yardim, Semih Dalkılıç, Dalkilic S, S Dalkilic, Melil S, Sureyya Melil, S Melil, K Cil, Cil K, Kaan Cil, Celik S, S Celik, Serdar Çelik, Ramazan Fazıl Akkoç, R Akkoc
European review for medical and pharmacological sciences · 2024 · vol. 28(20) , pp. 4461–4468 · doi:10.26355/eurrev_202410_36869 · PMID:39497588 · W4404089242
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

Unilateral endometriomas reduce cumulus cell PTX3 expression, but a GnRH antagonist protocol with hCG trigger ameliorates resultant fertilization defects.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This study examined long pentraxin 3 (PTX3) mRNA expression in cumulus cells isolated from metaphase II oocytes in 12 patients with unilateral endometrioma undergoing controlled ovarian stimulation with a GnRH antagonist protocol and recombinant hCG triggering, comparing the affected ovary to the contralateral disease-free ovary and to external controls with male factor infertility. RT-PCR showed that CC-PTX3 mRNA was significantly lower in the unilateral endometrioma group than in the disease-free ovary and markedly downregulated versus controls, while cumulus morphology was similar across groups. Fertilization rates after ICSI were comparable between the endometrioma group and the contralateral and control groups, leading the authors to conclude that the stimulation protocol ameliorated a fertilization defect associated with failed CC-PTX3 expression; the small sample size and lack of direct functional assays beyond mRNA and fertilization rate are notable limitations. This paper is centrally about endometriosis — it links unilateral endometrioma to reduced cumulus cell PTX3 expression and reports that a GnRH antagonist plus hCG triggering protocol yields similar fertilization outcomes despite this molecular defect.

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Abstract

OBJECTIVE: The aim of the study was to determine the expression pattern of long pentraxin 3 (PTX3) mRNA in cumulus cells (CCs) isolated from metaphase II oocytes of women with unilateral endometrioma undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone antagonist (GnRHa) protocol. PATIENTS AND METHODS: A total of 60 CC samples, 30 from the affected ovary and 30 from the contralateral ovary, were collected from 12 patients with unilateral endometrioma who underwent flexible GnRHa protocol with recombinant human chorionic gonadotropin (rhCG) trigger. Thirty CC samples collected from the left ovary of 12 women with male factor infertility were used as external controls. Long PTX3 mRNA expression in each group was analyzed by real-time polymerase chain reaction (RT-PCR). Relative gene expression (fold-change) was calculated according to the 2-ΔΔCt equation. Fertilization rates after intracytoplasmic sperm injection (ICSI) were recorded for each group. RESULTS: CC-PTX3 mRNA expression in the unilateral endometrioma group was significantly lower than the mRNA expression of the disease-free ovary (0.90±0.01 vs. 0.25±0.02, p<0.01). CC-PTX3 mRNA expression of MII oocytes of the disease-free ovary was found to be similar to the control group (1.02±0.03 vs. 0.90±0.01, p=0.107). A significant 3.6-fold downregulation was observed in the CC-PTX3 mRNA expression of the endometrioma group compared to the CC-PTX3 mRNA expression in the contralateral ovary. CC-PTX3 mRNA expression in the endometrioma group was downregulated 4.08-fold compared to the CC-PTX3 mRNA expression of the control group (1.02±0.03 vs. 0.25±0.02, p<0.001). The cumulus morphologies of the endometrioma group with low CC-PTX3 expression and the groups with normal CC-PTX3 levels were similar. Fertilization rates of the endometrioma group were similar to the contralateral ovary and control groups. CONCLUSIONS: Unilateral endometrioma reduces CC-PTX3 expression but does not affect disease-free ovaries. The GnRHa protocol improved the fertilization rates, suggesting that failed CC-PTX3 expression is an in vivo pathology.
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Objective

The aim of the study was to determine the expression pattern of long pentraxin 3 (PTX3) mRNA in cumulus cells (CCs) isolated from metaphase II oocytes of women with unilateral endometrioma undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone antagonist (GnRHa) protocol. PATIENTS AND METHODS: A total of 60 CC samples, 30 from the affected ovary and 30 from the contralateral ovary, were collected from 12 patients with unilateral endometrioma who underwent flexible GnRHa protocol with recombinant human chorionic gonadotropin (rhCG) trigger. Thirty CC samples collected from the left ovary of 12 women with male factor infertility were used as external controls. Long PTX3 mRNA expression in each group was analyzed by real-time polymerase chain reaction (RT-PCR). Relative gene expression (fold-change) was calculated according to the 2-ΔΔCt equation. Fertilization rates after intracytoplasmic sperm injection (ICSI) were recorded for each group.

Results

CC-PTX3 mRNA expression in the unilateral endometrioma group was significantly lower than the mRNA expression of the disease-free ovary (0.90±0.01 vs. 0.25±0.02, p<0.01). CC-PTX3 mRNA expression of MII oocytes of the disease-free ovary was found to be similar to the control group (1.02±0.03 vs. 0.90±0.01, p=0.107). A significant 3.6-fold downregulation was observed in the CC-PTX3 mRNA expression of the endometrioma group compared to the CC-PTX3 mRNA expression in the contralateral ovary. CC-PTX3 mRNA expression in the endometrioma group was downregulated 4.08-fold compared to the CC-PTX3 mRNA expression of the control group (1.02±0.03 vs. 0.25±0.02, p<0.001). The cumulus morphologies of the endometrioma group with low CC-PTX3 expression and the groups with normal CC-PTX3 levels were similar. Fertilization rates of the endometrioma group were similar to the contralateral ovary and control groups.

Conclusions

Unilateral endometrioma reduces CC-PTX3 expression but does not affect disease-free ovaries. The GnRHa protocol improved the fertilization rates, suggesting that failed CC-PTX3 expression is an in vivo pathology. Free PDF DownloadThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License To cite this article N.D. Gungor, O. Celik, A. Ersahin, N. Celik, M. Kobaner, M. Yardim, S. Dalkilic, S. Melil, K. Cil, S. Celik, R. Akkoc GnRH antagonist protocol with hCG triggering ameliorates fertilization defect caused by failure of cumulus cell pentraxin-3 expression in unilateral endometriomas Eur Rev Med Pharmacol Sci Year: 2024 Vol. 28 - N. 20 Pages: 4461-4468 DOI: 10.26355/eurrev_202410_36869 Publication History Published online: 31 Oct 2024

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Condition tags

endometriosisendometriomainfertility

MeSH descriptors

C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein C-Reactive Protein

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