Effects of dysregulated glucose metabolism on the occurrence and ART outcome of endometriosis

Effects of dysregulated glucose metabolism on the occurrence and ART outcome of endometriosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of dysregulated glucose metabolism on the occurrence and ART outcome of endometriosis Jian-Peng Chen, Yan-Ye Zhang, Jia-Ni Jin, Yue Ying, Zhi-Min Song, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2750434/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Endometriosis can affect the systemic metabolic indicators, including body mass index, glucose metabolism and lipid metabolism, while the association between metabolic indexes and the occurrence and ART outcome of endometriosis is unclear. We aimed to evaluate the characteristics of systemic metabolic indexes of endometriosis patients with infertility and their effects on pregnancy outcome after ART treatment. Methods: A retrospective cohort study involve 412 endometriosis patients and 1551 controls was conducted. Primary outcome was metabolic indexes, and secondary measures consisted of the influence of metabolic indexes on the number of retrieved oocytes and ART outcomes, as well as the relation between blood glucose and prevalence of GDM. Results: Endometriosis patients had higher INS [6.90(5.10-9.50) vs 6.50(4.80-8.90) μU/mL, P = 0.005]. A prediction model for endometriosis combining the number of previous pregnancies, CA125, fasting blood Glu and INS, had a sensitivity of 73.9%, specificity of 67.8% and area AUC of 0.77. There were no significant differences in ART outcomes and complications. The levels of Glu were associated with GDM both in endometriosis group (aOR 12.95, 95% CI 1.69–99.42; P = 0.014) and in control group (aOR 4.15, 95% CI 1.50–11.53; P = 0.006). Conclusions: Endometriosis patients had abnormal metabolic indexes, in which serum Glu and serum INS are related to the occurrence of endometriosis, the number of retrieved oocytes and the occurrence of GDM. A prediction model based on metabolic indexes was established, representing a promising non-invasive method to predict endometriosis patients with known pregnancy history. Endometriosis Metabolic indicator Number of retrieved oocytes Assisted reproductive technology (ART) outcomes Gestational diabetes mellitus (GDM) Figures Figure 1 Figure 2 Background Endometriosis is defined as the presence of active endometrial tissue outside the uterus, including endometrial glands and stroma, which can cause symptoms such as dysmenorrhea, abnormal menstruation, dyspareunia and infertility [ 1 , 2 ]. The global incidence of endometriosis in women of reproductive age is about 10% and the incidence in infertile women is as high as 50% [ 3 , 4 ]. As a hormone-dependent and chronic disease, endometriosis can also affect the systemic metabolic indicators, including body mass index (BMI), glucose metabolism and lipid metabolism [ 5 , 6 ]. The inflammatory response in endometriosis patients can affect the metabolism of Glu and lipids which may be used as a detection method to assist in the diagnosis of endometriosis [ 7 ]. An increasing number of women with endometriosis use assisted reproductive technology (ART) to achieve pregnancy. But consensus is lacking on the effects of endometriosis on outcome of assisted reproduction. Some studies have found that endometriosis patients had poor ART outcomes due to factors such as decreased oocyte quality and fertilized egg quality, defective corpus luteum function, and poor endometrial receptivity [ 8 ]. Other studies have reported there were no significant difference in ART outcome in endometriosis patients compared with patients with tubular infertility [ 9 , 10 ]. Besides, metabolic indicators may be associated with ART outcome [ 11 ]. While the pathogenesis of endometriosis is closely related to metabolic factors, whether the effect of endometriosis on ART outcome is partly due to abnormal metabolic indicators is still unknown. We retrospectively analyzed the clinical information of endometriosis patients with infertility and infertility patients with only fallopian tube factors, compared the differences in serum metabolic indexes between two groups before receiving assisted reproductive treatment and their effects on the incidence of endometriosis, number of retrieved oocytes, as well as the pregnancy outcome after receiving ART and established a prediction model based on metabolic indexes and pregnancy history to evaluate the possibility of presence of endometriosis. Methods Study Population A retrospective analysis was undertaken to evaluate the characteristics of systemic metabolic indexes in endometriosis patients with infertility and their effects on pregnancy outcome after assisted reproductive treatment. All patients received in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) assisted fertility at the reproductive medicine center of Women’s Hospital, Zhejiang University School of Medicine between February 2019 and December 2020. Inclusion criteria were as follows: age 21–40 years; normal menstrual cycle, non-pregnancy nor lactation; women who had undergone laparoscopic evaluation to confirm the presence of endometriosis were included in the endometriosis group; women with tube factor as the only infertility factor were included in control group. To minimize the potential confounding factors, exclusion criteria were as follows: metabolic disease, gynecological inflammation, chronic infectious diseases, immune diseases, chromosomal or genetic abnormalities, polycystic ovary syndrome (PCOS), potentially malignant or malignant tumors, unexplained infertility or had received any hormone therapy in past six months. In total, 1963 cycles were enrolled from our medical database: 412 with endometriosis and 1551 without endometriosis (Controls group). Available information on the dataset included maternal factors (maternal age, BMI, smoking, drinking, duration of infertility, type of infertility, history of mature, premature, abortion and existence, number of previous pregnancies, and common serum indexes including reproductive hormone, AFC), paternal age, ART procedure (type of ART, total gonadotropin dose and days, number of retrieved oocytes, the stage of fertilized egg and the number of embryos transferred), ART outcomes (clinical pregnancy, live birth, pre-term birth ratio, cesarean section ratio, multiple pregnancies ratio, average birth weight, miscarriages and ectopic pregnancies), pregnancy complications and neonate complications. Ethics This study was approved by the ethical review board of Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China (Ethics Lot number IRB-20200325-R). Outcome Measures Primary outcome was metabolic indexes. Secondary measures consisted of the influence of metabolic indexes on the number of retrieved oocytes and ART outcomes (clinical pregnancy, live birth, multiple pregnancies ratio, average birth weight, miscarriages and ectopic pregnancies), as well as the relavation between blood glucose and gestational diabetes mellitus (GDM). We defined the pregnancy outcomes in our study based on “International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary of ART Terminology, 2009” [12] : 1. Implantation rate: the ratio of the number of gestational sacs to the total number of embryos transferred. 2. Ectopic pregnancy rate: the ratio of the number of Ectopic pregnancy cycles to the total number of transfer cycles. 3. Clinical pregnancy: a pregnancy diagnosed by the detection of β-hCG in serum after 14 days of transplantation, and ultrasonography visualization of one or more gestational sacs after 30–35 days of transplantation (ectopic pregnancy was included). 4. Clinical pregnancy rate: the ratio of the number of clinical pregnancy cycles to the total number of transfer cycles. 5. Miscarriage: clinical pregnancy which was spontaneously terminated in less than 28 weeks. 6. Miscarriage rate: the ratio of the number of miscarriage cycles to the total number of transfer cycles. 7. Delivery rate: the ratio of the number of deliveries that resulted in at least one live born baby to the total number of transfer cycles. 8. Live birth rate: the ratio of the number of live born babies to the total number of live born babies. 9. Preterm birth: delivered after 28 weeks but before 37 weeks. 10. Low birth weight (LBW): birth weight less than 2500 g. Statistical Analyses Statistical analyses were performed with Statistical Package for the Social Sciences software (SPSS version 24.0; IBM). Shapiro-Wilk test was used to assess the normality of the distribution. Normally distributed measurement data were represented by the mean ± standard deviation (x ± SD), while non-normally distributed measurement data were represented by the median (interquartile range). If the data between the two groups was normally distributed and consistent with homogeneity of variance, Student's t test was used to calculate statistical significance; otherwise, Mann-Whitney U nonparametric test was chosen. Rate was shown as number of cases (percentage × 100) or percentage (number of numerator cases/number of denominator cases). Differences between categorical variables were tested using Pearson’s Chi-square test. Both univariable and multivariate logistic regression models were employed to evaluate the influencing factors of endometriosis, and ROC curve was drawn. A multivariate linear regression model was used to analyze the influence of metabolic indexes on the number of retrieved oocytes. Multivariate logistic regression model was chosen to analyze the relationship between blood sugar, INS and GDM. Two-sided P values of less than 0.05 were considered statistically significant. Results Totally, 6890 cycles were assessed for eligibility during February 2019 and December 2020 (Fig. 1 ). We dropped those with age over 40 (n = 180) and missing data on follow-up (n = 4319), as well as those with chromosomal or genetic abnormalities (n = 30), endocrine disease or abnormal liver and kidney function (n = 258), immune disease (n = 16), PCOS (n = 118) and unexplained infertility (n = 6). Finally, 1963 cycles were remained for analyses and divided into two groups, including endometriosis group (n = 412) and control group (n = 1551). Baseline Characteristics In Endometriosis Patients And Controls Baseline characteristics of two study groups were summarized in Table 1 . Significant differences were found for types of infertility ( P < 0.001), history of miscarriage [116(28.2%) vs 928(59.8%), P < 0.001], number of previous pregnancies [0.0(0.0–1.0) vs 0.0(0.0–2.0), P < 0.001] and serum CA125 levels [24.00(15.10–41.20) vs 15.10(11.00-21.60) U/mL, P 0.05, respectively). Table 1 Baseline characteristics of two study groups Characteristics Endometriosis (n = 412) Controls (n = 1551) P value Maternal age (years) 32 (30–35) 33 (30–36) 0.129 BMI (kg/m 2 ) 21.0 (19.5–22.9) 21.3 (19.6–23.3) 0.052 Smoking 0.060 No [n (%)] 409 (99.3) 1518 (97.9) Yes [n (%)] 3 (0.7) 33 (2.1) Drinking NA No [n (%)] 412 (100.0) 1550 (99.9) Yes [n (%)] 0 (0.0) 1 (0.1) Duration of infertility (years) 3.0 (1.5-4.0) 2.8 (1.0–4.0) 0.248 Type of infertility < 0.001 Primary infertility [n (%)] 258 (62.6) 537 (34.6) Secondary infertility [n (%)] 120 (29.1) 838 (54.0) Less than one year [n (%)] 34 (8.3) 176 (11.3) Type of ART 0.437 IVF [n (%)] 337 (79.5) 1195 (77.6) Half ICSI [n (%)] 8 (1.9) 21 (1.4) ICSI [n (%)] 79 (18.6) 323 (21.0) History of preterm delivery [n (%)] 3 (0.7) 21 (1.4) 0.438 History of miscarriage [n (%)] 116 (28.2) 928 (59.8) < 0.001 Number of previous pregnancies (n) 0.0 (0.0–1.0) 0.0 (1.0–2.0) < 0.001 CA125 (U/mL) 24.00 (15.10–41.20) 15.10 (11.00-21.60) < 0.001 Values are expressed as mean ± standard deviation, median (interquartile range) or number (%). BMI body mass index, ART assisted reproductive technology, IVF in vitro fertilization, ICSI intracytoplasmic sperm injection Metabolic Indexes In Endometriosis Patients And Controls As shown in Table 2 , there were no statistically differences in basal serum levels of estradiol (E 2 ) and progesterone (P), Glu, triglycerides (TG), total protein (TP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, urea nitrogen, uric acid and homocysteine (HCY) between the two groups ( P > 0.05, respectively). While we found significantly lower serum basal testosterone (T) [0.50(0.00-0.80) vs 0.60(0.00-0.90) nmol/L, P = 0.005], higher serum INS [6.90(5.10–9.50) vs 6.50(4.80–8.90) µU/mL, P = 0.005], TC [4.35(3.92–4.80) vs 4.27(3.81–4.77) mmol/L, P = 0.036], HDL-C [1.36(1.19–1.57) vs 1.32(1.14–1.52) mmol/L, P = 0.005] and LDL-C [2.63(2.17–3.01) vs 2.54(2.12–2.94) mmol/L, P = 0.043] in endometriosis group compared with controls. Table 2 Metabolic indexes, ovarian function and ART outcomes of two study groups Characteristics Endometriosis (n = 412) Controls (n = 1551) P value Basal E 2 (pmol/L) 114.65 (67.97-156.58) 110.70 (67.70-153.60) 0.405 Basal P (nmol/L) 1.14 (0.75–1.55) 1.12 (0.76–1.50) 0.644 Basal T (nmol/L) 0.50 (0.00-0.80) 0.60 (0.00-0.90) 0.005 Glu (mmol/L) 5.01 (4.79–5.27) 5.04 (4.80–5.31) 0.134 INS (µU/mL) 6.90 (5.10–9.50) 6.50 (4.80–8.90) 0.005 TG (mmol/L) 0.92 (0.71–1.19) 0.92 (0.69–1.27) 0.435 TC (mmol/L) 4.35 (3.92–4.80) 4.27 (3.81–4.77) 0.036 HDL-C (mmol/L) 1.36 (1.19–1.57) 1.32 (1.14–1.52) 0.005 LDL-C (mmol/L) 2.63 (2.17–3.01) 2.54 (2.12–2.94) 0.043 TP (g/L) 71.97 ± 4.49 72.20 ± 4.77 0.318 ALT (U/L) 13.00 (10.00–17.00) 13.00 (10.00–18.00) 0.178 AST (U/L) 17.00 (15.00–20.00) 18.00 (15.00–20.00) 0.068 Creatinine (µmoI/L) 56.00 (50.00-62.60) 55.10 (49.00–62.00) 0.202 Urea nitrogen (mmol/L) 3.78 (3.21–4.48) 3.76 (3.18–4.51) 0.621 Uric acid (µmoI/L) 266.00 (234.25–303.00) 270.00 (231.00-312.00) 0.277 HCY (nmol/L) 9.70 (8.50–10.80) 9.80 (8.50–11.10) 0.281 AMH (ng/mL) 2.02 (1.06–3.49) 2.53 (1.48–4.07) < 0.001 AFC (n) 8.00 (5.00–11.00) 10.00 (7.00–12.00) < 0.001 Basal FSH (IU/L) 6.74 (5.26–8.35) 6.32 (4.81–7.87) < 0.001 Basal LH (IU/L) 4.19 ± 2.40 4.60 ± 2.66 0.031 Gn dosage (IU) 2025.00 (1575.00-2700.00) 2025.00 (1575.00-2475.00) 0.664 Gn days (day) 9.00 (8.00–12.00) 9.00 (8.00–11.00) 0.058 Number of retrieved oocytes (n) 7.00 (4.00–11.00) 9.00 (5.00–14.00) < 0.001 Fertilization rate [%] 64.3 (2158/3357) 64.0 (9714/15172) 0.778 Cleavage rate [%] 23.7 (512/2158) 24.1 (2338/9714) 0.736 Number of transferable embryos (n) 0.76 ± 0.93 0.77 ± 0.93 0.776 Number of high-quality embryos (n) 0.57 ± 0.82 0.60 ± 0.83 0.402 High-quality embryos rate [%] 12.1 (232/1912) 11.1 (936/8435) 0.196 Number of embryos transferred (n) 1.81 ± 0.39 1.78 ± 0.41 0.389 Implantation rate [%] 38.7 (122/315) 36.0 (429/1191) 0.375 Ectopic pregnancy rate [%] 2.3 (4/174) 1.5 (10/669) 0.684 Clinical pregnancy rate [%] 51.7 (90/174) 49.5 (331/669) 0.597 Miscarriage rate [%] 6.9 (12/174) 5.7 (38/669) 0.606 Delivery rate [%] 45.4 (79/174) 43.8 (293/669) 0.606 Live birth rate [%] 54.0 (94/174) 54.0 (361/669) 0.988 Values are expressed as mean ± standard deviation, median (interquartile range) or number (%). E 2 estradiol, P progesterone, T testosterone, Glu glucose, INS insulin, TG triglycerides, TC total cholesterol, HDL-C high density lipoprotein cholesterol, LDL-C low density lipoprotein cholesterol, TP total protein, ALT alanine aminotransferase, AST aspartate aminotransferase, HCY homocysteine, AMH Anti-Müllerian hormone, AFC antral follicle counting, FSH follicle stimulating hormone, LH luteinizing hormone, Gn gonadotropin Prediction Of Endometriosis By Metabolic Indexes After adjusting for potential confounders, number of previous pregnancies [adjusted odds ratio (aOR) 0.51, 95% confidence interval (CI) 0.43–0.62; P < 0.001], serum CA125 levels (aOR 1.02, 95% CI 1.01–1.03; P < 0.001), serum Glu (aOR 0.74, 95% CI 0.56–0.97; P = 0.027) and serum INS (aOR 1.03, 95% CI 1.01–1.04; P = 0.002) were found to be significantly associated with endometriosis (Table 3 ). Besides, compared with subjects with primary infertility, those with secondary infertility suffered from decreased incidence of endometriosis (aOR 0.70, 95% CI 0.50–0.97; P = 0.030). The aORs and their 95% confidence intervals (CI) were extracted and a forest plot graphic was built [ 13 ]. Table 3 Odd ratios for endometriosis in these patients Crude OR (95% CI) P value Adjusted OR (95% CI) P value Maternal age (years) 0.99 (0.96–1.01) 0.298 Removed Smoking No [n (%)] Reference Reference Yes [n (%)] 2.96 (0.90–9.71) 0.073 1.93 (0.48–7.74) 0.352 Number of previous pregnancies (n) 0.46 (0.40–0.53) < 0.001 0.51 (0.43–0.62) < 0.001 Type of infertility Primary infertility [n (%)] Reference Reference Secondary infertility [n (%)] 0.40 (0.27–0.60) < 0.001 0.70 (0.50–0.97) 0.030 Less than one year [n (%)] 0.30 (0.23–0.38) < 0.001 1.07 (0.66–1.72) 0.793 CA125 (U/mL) 1.02 (1.02–1.03) < 0.001 1.02 (1.01–1.03) < 0.001 AST (U/L) 1.00 (0.98–1.01) 0.589 Removed BMI (kg/m 2 ) 0.96 (0.92-1.00) 0.058 0.99 (0.94–1.04) 0.676 Glu (mmol/L) 0.74 (0.58–0.94) 0.014 0.74 (0.56–0.97) 0.027 INS (µU/mL) 1.02 (1.00-1.03) 0.010 1.03 (1.01–1.04) 0.002 TG (mmol/L) 0.88 (0.72–1.08) 0.213 Removed TC (mmol/L) 1.16 (1.01–1.33) 0.031 0.95 (0.72–1.25) 0.706 HDL-C (mmol/L) 1.63 (1.14–2.35) 0.008 1.54 (0.94–2.54) 0.088 LDL-C (mmol/L) 1.16 (0.99–1.35) 0.065 1.26 (0.96–1.72) 0.137 Basal E 2 (pmol/L) 1.00 (1.00–1.00) 0.894 Removed Basal P (nmol/L) 1.03 (0.97–1.09) 0.356 Removed Basal T (nmol/L) 0.98 (0.90–1.06) 0.595 Removed OR odd ratio, AST aspartate aminotransferase, BMI body mass index, Glu glucose, INS insulin, TG triglycerides, TC total cholesterol, HDL-C high density lipoprotein cholesterol, LDL-C low density lipoprotein cholesterol, E 2 estradiol, P progesterone, T testosterone Furthermore, we performed AUC and receiver operator control curves (ROC analysis) to assess whether the statistically different factors found in Table 1 could be used as indicators to predict the occurrence of endometriosis [ 13 ](Fig. 2 ). Results showed Glu and INS had a sensitivity of 39.9% and 41.3%, specificity of 66.5% and 67.5%, AUC of 0.52 and 0.55, respectively. When combining previous pregnancies, serum CA125, serum Glu and INS, the mode had a sensitivity of 73.9%, specificity of 67.8% and AUC of 0.77. The Effect Of Altered Metabolic Indexes On The Number Of Retrieved Oocytes In Endometriosis As shown in Table 2 , there were statistically significant differences in AMH [2.02(1.06–3.49) vs 2.53(1.48–4.07) ng/mL, P < 0.001], AFC [8.00(5.00–11.00) vs 10.00(7.00–12.00), P < 0.001], FSH [6.74(5.26–8.35) vs 6.32(4.81–7.87) IU/L, P < 0.001] and LH [(4.19 ± 2.40 vs 4.60 ± 2.66 IU/L, P = 0.031)] between endometriosis group and control group. Furthermore, the number of retrieved oocytes in endometriosis patients was significantly lower than that in control group [7.00(4.00–11.00) vs 9.00(5.00–14.00), P < 0.001], without differences in gonadotropin (Gn) dosage and Gn days. Given that the number of retrieved oocytes was closely related to ART outcomes of endometriosis patients, we explored whether alterations in serum Glu and INS played a role in the numbers of retrieved oocytes in endometriosis, we conducted multi-factor linear regression analysis. As shown in Table 4 , the number of retrieved oocytes was positively correlated with INS [0.07(0.00-0.14), P = 0.048] in endometriosis group. In control group, the number of retrieved oocytes was negatively correlated with Glu [-0.80(-1.48 - -0.12), P = 0.021]. Table 4 Multivariate logistic regression predictors of the number of retrieved oocytes Endometriosis (n = 412) Controls (n = 1551) β(95% CI) P value β(95% CI) P value Maternal age (years) -0.52 (-0.68 - -0.31) < 0.001 -0.57 (-0.64 - -0.49) < 0.001 CA125 (U/mL) 0.00 (-0.01–0.00) 0.201 -0.01 (-0.02–0.01) 0.314 Number of previous pregnancies (n) 0.95 (0.26–1.64) 0.007 0.25 (0.02–0.47) 0.032 BMI (kg/m 2 ) 0.00 (-0.23–0.154) 0.984 0.01 (-0.11–0.14) 0.833 Basal E 2 (pmol/L) 0.00 (0.00–0.00) 0.212 -0.00 (0.00–0.00) 0.120 Basal P (nmol/L) -0.18 (-0.43–0.07) 0.161 -0.16 (-0.20–0.17) 0.864 Basal T (nmol/L) 0.99 (0.37–1.60) 0.002 0.16 (-0.04–0.36) 0.122 TG (mmol/L) -0.29 (-1.24–0.67) 0.552 -0.06 (-0.63–0.51) 0.835 TC (mmol/L) 1.70 (0.38–3.03) 0.012 0.88 (0.10–1.67) 0.028 HDL-C (mmol/L) -0.83 (-3.18–1.52) 0.490 -0.78 (-2.14–0.58) 0.260 LDL-C (mmol/L) -1.75 (-3.19 - -0.31) 0.018 -0.59 (-1.43 - -0.25) 0.168 Glu (mmol/L) 0.19 (-0.90–1.28) 0.734 -0.80 (-1.48 - -0.12) 0.021 INS (µU/mL) 0.07 (0.00–0.14) 0.048 -0.03 (-0.08–0.02) 0.264 BMI body mass index, E 2 estradiol, P progesterone, T testosterone, TG triglycerides, TC total cholesterol, HDL-C high density lipoprotein cholesterol, LDL-C low density lipoprotein cholesterol, Glu glucose, INS insulin Comparisons Of Art Outcomes In Endometriosis Patients And Controls We further compared ART outcomes in two groups (Table 2 ). There were no statistically significant differences in fertilization rate, cleavage rate, number of transferable embryos, number of high-quality embryos, high-quality embryos rate, number of embryos transferred, implantation rate, clinical pregnancy rate, miscarriage rate, ectopic pregnancy rate, delivery rate and live birth rate between the study groups ( P > 0.05, respectively). Neonatal Outcomes And Complications In Two Groups Neonate outcomes in two groups were illustrated in Supplementary Table 2[ 13 ]. There were no statistically significant differences in gestational week, manner of childbirth, rate of twins as well as gender and weight of both single and twin babies. As shown in Supplementary Table 3[ 13 ], no significant difference was found in incidences of pregnancy complications (GDM, gestational hypertension, intra-hepatic cholestasis of pregnancy, placenta previa, placental abruption, premature rupture of membranes, umbilical cord around neck, postpartum hemorrhage, infection and hypothyroidism) or neonatal complications (neonatal respiratory distress syndrome, hypoglycemia, jaundice and infection) between endometriosis group and control group. We further explored effects of serum Glu and INS on incidence of GDM in both groups (Table 5 ), and found serum Glu [(aOR 12.95, 95% CI 1.69–99.42; P = 0.014) were significantly associated with incidence of GDM in both groups (aOR 4.15, 95% CI 1.50–11.53; P = 0.006). Table 5 Effects of Glu and INS on GDM of two study groups N (-/+) GDM (%) Crude OR (95% CI) P value Adjusted OR (95% CI) P value Glu (mmol/L) Endometriosis 66/13 16.5 7.90 (1.23–50.80) 0.027 12.95 (1.69–99.42) 0.014 Controls 264/29 9.9 3.27 (1.28–8.39) 0.013 4.15 (1.50-11.53) 0.006 INS (µU/ml) Endometriosis 66/13 16.5 1.00 (0.93–1.07) 0.973 1.01 (0.94–1.08) 0.822 Controls 264/29 9.9 0.98 (0.89–1.08) 0.687 0.99 (0.90–1.09) 0.819 GDM gestational diabetes mellitus, OR odd ratio, Glu glucose, INS insulin Discussion Metabolomics represents a useful diagnostic tool for the study of metabolic changes during a different physiological or pathological status. Clinically, endometriosis patients have abnormal metabolic manifestations, including abnormal clinical features and metabolic indexes. Recently, metabolic approach has emerged as a possible non-invasive diagnostic tool in women with or without endometriosis [ 14 – 19 ]. Our previous study showed that most metabolites important for glucolipid metabolism were up-regulated in FF of endometriosis patients [ 20 ]. Those data suggested dysregulated circulating metabolic molecules might play an important role in endometriosis development. We further explored whether relevant serum metabolic indexes were involved in endometriosis development via a retrospective study including 412 endometriosis patients and 1551 control patients in the present study and found endometriosis patients present with higher serum levels of INS, TC, HDL-C, LDL-C and lower serum level of basal T. By logistic regression analyses we developed a model combining the number of previous pregnancies, serum levels of CA125, Glu and INS to predict the occurrence of endometriosis. The mode had a sensitivity of 73.9%, specificity of 67.8% and AUC of 0.77, however, further research is needed to explore the underlying mechanisms. Glucose Metabolism And Endometriosis Marianna S has confirmed that endometriosis patients had lower glucose level and higher INS level in FF [ 21 ]. Higher INS level in FF of endometriosis patients might be related to lower glucose level. Our study not only confirmed the higher INS level in endometriosis patients at serum level for the first time, but also found that serum Glu might be a protective factor for endometriosis and INS might be a risk factor. It is generally believed that glucose metabolism in endometriosis patients is increased, which explains the possible cause of low glucose in endometriosis patients [ 22 ]. Mitochondrial breathing might be impaired because of high glucose metabolism, leading to the accumulation of oxygen free radicals in the body and aggravating the occurrence and development of endometriosis. INS maintains the stability of serum Glu levels by promoting the body's intake of glucose, increasing glycogen synthesis and inhibiting gluconeogenesis and glycogen decomposition [ 23 ]. Therefore, INS within a certain range may have a benign effect on improving the ovarian function of endometriosis patients, explaining the number of retrieved oocytes is positively correlated with INS in endometriosis patients, as shown in our study. Lipid Or Steroid Metabolism And Endometriosis In terms of lipid metabolism, Mu F found endometriosis patients were more susceptible to hypercholesterolemia and hypertension, which was most obvious among women younger than 40 years old [ 24 ]. Melo also reported that endometriosis patients had higher levels of TG, TC and LDL-C [ 7 ], consistent with our findings. While the mechanisms underlying dysregulated lipid metabolism and development of endometriosis is still unclear. On the other hand, many epidemiological studies reported that endometriosis women might have a lower BMI [ 25 , 26 ]. But other studies found that women with a normal BMI were also likely to experience endometriosis [ 27 , 28 ]. In our study, we found no difference in BMI between two groups. The diagnosis of endometriosis in our study was confirmed by laparoscopic examination, while the diagnosis of endometriosis in most previous population-based studies was just described by patients. We assume that different populations and different mode of diagnosis might also cause bias to the study results. Therefore, the association of BMI and endometriosis has yet to be confirmed. As to steroid hormone metabolism, previous studies have found lower levels of T in endometriosis lesions [ 29 , 30 ], and we further confirmed lower serum basal level of T in endometriosis patients and found the basal serum T is positively correlated with the number of retrieved oocytes in endometriosis patients (Table 3 ). It is generally known that the imbalance of T synthesis can lead to endometrial disease and impaired endometrial function [ 31 ], and Selak V found that Danazol (17α-ethynyl testosterone) could reduce the size of endometriotic lesions [ 32 ]. Therefore, we speculated a relatively high T might be beneficial for alleviating endometriosis related symptoms, thereby improving ovarian function and increasing the number of oocytes in endometriosis patients. Metabolism Dysregulation And Art Outcomes Of Endometriosis The incidence of infertility in endometriosis patients was higher than that of the general population, as reported by previous studies [ 33 , 34 ] and also by the present study. We found the ovarian reserve and responsiveness of endometriosis patients were significantly lower, manifested by lower AMH, lower AFC, higher basal FSH, lower basal LH, and a significantly decreased number of retrieved oocytes. The impact of endometriosis on ovarian function is mainly reflected in two aspects [ 35 ]: endometriosis damages the ovary and affects ovarian function through physical compression, inflammation and blood supply; previous surgical treatment of endometriosis may also cause certain damage to the ovary. Currently, ART is the most effective treatment for endometriosis related infertility. It is still no consensus on whether there is difference in ART outcome in infertility patients with or without endometriosis [ 4 , 36 , 37 ]. Several studies reported no difference in live-birth rates in subsequent IVF cycles in endometriosis patients versus tubal factor [ 37 , 38 ]. Another study described lower pregnancy and live-birth rates in patients with endometrioma [ 7 ]. In our study, we found no significant difference in ART outcomes in endometriosis patients compared with the control group, although they had worse ovarian reserve and responsiveness. Similarly, several studies examining the basic morphology of oocytes and embryo development in endometriosis patients or controls have not found any differences in the two groups [ 39 – 41 ]. We thought the quality of the retrieved oocytes by ART in endometriosis were not much different from that of the control group and endometriosis lesion alone is unlikely to be the major contributory cause to worse reproductive outcomes, at least in the context of IVF/ICSI. We also explored whether the dysregulated metabolic indexes had effects on the number of retrieved oocytes, ART outcome and the incidence of pregnancy complications in endometriosis patients. Interestingly, our results showed that serum levels of Glu were significantly associated with incidence of GDM both in endometriosis group and in control group, suggesting that the higher the blood glucose level before pregnancy, the greater the incidence of GDM during pregnancy, which might shed light on preventing the occurrence of GDM in clinical work. However, we found no significant difference in the incidence of GDM between the two groups (16.5% vs 9.9%, P = 0.102), and the sample size needs to be expanded for further research. Strengths And Limitations Some main strengths of this study deserve to be mentioned. We excluded patients without a definitive diagnosis of endometriosis by laparoscopy. Moreover, logistic regression analysis might have further lessened the impact of the confounders, in which we matched age, CA125, types of infertility and other baseline characteristics to protect our data from other confounders. As for limitations, endometriosis patients included in this study had a history of endometriosis-related surgery, but the control group did not. Some studies believed that surgery could improve female fertility conditions [ 1 ], while other studies thought surgery might cause damage to the ovaries [ 42 ]. Secondly, we could not perform subgroup analyses according to disease stages in retrospective study, because endometriosis was heterogeneous, and the severity of endometriosis might directly affect ART outcomes [ 38 ]. Thirdly, some basal characteristics of the two groups differed and we could not fully exclude the influence of confounders. Finally, our study was conducted in a single reproductive medical center with standardized laboratory techniques and ART protocols, and multi-center based randomized controlled trials are suggested in the future study. Conclusion We found endometriosis patients had abnormal metabolic indexes, in which serum Glu and serum INS are related to the occurrence of endometriosis, the number of retrieved oocytes and the occurrence of GDM. We also established a prediction model based on metabolic indexes to evaluate the possibility of presence of endometriosis, which might represent a promising non-invasive method to predict endometriosis patients with known pregnancy history, but further study is warranted to verify. Our findings suggest clinicians pay more attention to serum Glu before pregnancy, which was relevant with occurrence of GDM. In conclusion, the present study shed light on the effects of dysregulated glucose metabolism on the occurrence and ART outcome of endometriosis, while the underlying mechanisms is jet to be clarified. Abbreviations AFC antral follicle counting, ALT alanine aminotransferase, AMH Anti-Müllerian hormone, ART assisted reproductive technology, AST aspartate aminotransferase, BMI body mass index, E2 estradiol, FSH follicle stimulating hormone, GDM gestational diabetes mellitus, Glu glucose, Gn gonadotropin, HDL-C high density lipoprotein cholesterol, HCY homocysteine, ICSI intracytoplasmic sperm injection, INS insulin, IVF in vitro fertilization, LDL-C low density lipoprotein cholesterol, LH luteinizing hormone, OR odd ratio, P progesterone, T testosterone, TC total cholesterol, TG triglycerides, TP total protein. Declarations Conflict of interest The authors declare no conflicts of interest. Authors’ Contribution DZ, JYL: conception and design of the study. JPC, YYZ, JNJ: data collection. YY, ZMS, MXT, XHY, HNT: follow-up of enrolled subjects. JPC, YYZ, FDN, YYY, JL: analysis and interpretation of data. JPC and YYZ drafted the article, and DZ revised it critically. All authors reviewed the manuscript and approved the version to be published. Acknowledgements The authors would like to thank Saijun Sun for the collection of original data, and all participants involved in this study. Funding This work was supported by the National Key Research and Development Program of China (2021YFC2700601), the National Natural Science Foundation of China (No. 81974224, 82001537), the Key Research and Development Program of Zhejiang Province (2021C03098), and Zhejiang Provincial Clinical Research Center for Child Health. Data Availability The dataset supporting the conclusions of this article is available in the [Harvard Dataverse] repository, [unique persistent identifier and hyperlink to dataset in https://doi.org/10.7910/DVN/THVJUU]. 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Senapati S, Sammel MD, Morse C, Barnhart KT: Impact of endometriosis on in vitro fertilization outcomes: an evaluation of the Society for Assisted Reproductive Technologies Database . Fertility and sterility 2016, 106 (1):164-171.e161. Tanbo T, Fedorcsak P: Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options . Acta obstetricia et gynecologica Scandinavica 2017, 96 (6):659-667. Opøien HK, Fedorcsak P, Omland AK, Abyholm T, Bjercke S, Ertzeid G, Oldereid N, Mellembakken JR, Tanbo T: In vitro fertilization is a successful treatment in endometriosis-associated infertility . Fertility and sterility 2012, 97 (4):912-918. Reinblatt SL, Ishai L, Shehata F, Son WY, Tulandi T, Almog B: Effects of ovarian endometrioma on embryo quality . Fertility and sterility 2011, 95 (8):2700-2702. Sanchez AM, Pagliardini L, Cermisoni GC, Privitera L, Makieva S, Alteri A, Corti L, Rabellotti E, Candiani M, Viganò P: Does Endometriosis Influence the Embryo Quality and/or Development? Insights from a Large Retrospective Matched Cohort Study . Diagnostics (Basel, Switzerland) 2020, 10 (2). Demirel C, Bastu E, Aydogdu S, Donmez E, Benli H, Tuysuz G, Keskin G, Buyru F: The Presence of Endometrioma Does Not Impair Time-Lapse Morphokinetic Parameters and Quality of Embryos: A Study On Sibling Oocytes . Reproductive sciences (Thousand Oaks, Calif) 2016, 23 (8):1053-1057. Brink Laursen J, Schroll JB, Macklon KT, Rudnicki M: Surgery versus conservative management of endometriomas in subfertile women. A systematic review . Acta obstetricia et gynecologica Scandinavica 2017, 96 (6):727-735. Additional Declarations No competing interests reported. Supplementary Files Supplementaryfigure1.tif Supplementary figure 1Forest plot of metabolic index in predicting endometriosis. OR odd ratio, HDL-C high density lipoprotein cholesterol, INS insulin, TC total cholesterol, Gluglucose. Supplementarytable1.docx Table S1: Sensitivity and specificity of potential biomarkers for diagnosis of endometriosis Supplementarytable2.docx Table S2: Neonate outcomes of two study groups Supplementarytable3.docx Table S3: Pregnancy complications and neonate complications of two study groups Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2750434","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":187673866,"identity":"20725939-3775-4d38-9860-8100fbb92f03","order_by":0,"name":"Jian-Peng Chen","email":"","orcid":"","institution":"Women's Hospital, School of Medicine, Zhejiang University","correspondingAuthor":false,"prefix":"","firstName":"Jian-Peng","middleName":"","lastName":"Chen","suffix":""},{"id":187673867,"identity":"d97ffbc4-0bcd-4361-9dbe-e25f78675a52","order_by":1,"name":"Yan-Ye Zhang","email":"","orcid":"","institution":"Women's Hospital, School of 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syndrome.\u003c/p\u003e","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2750434/v1/bf4e6041bdbf1b5b75d7d1a1.png"},{"id":35118635,"identity":"9cc5fdf6-3645-483c-bf65-6e86c4a09109","added_by":"auto","created_at":"2023-03-31 18:59:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":177161,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNomogram for the prediction of endometriosis.\u003c/strong\u003e ROC curves were produced using each potential biomarker and for the combination of them. ROC receiver operator control curve,\u003cem\u003e \u003c/em\u003eGlu glucose, INS insulin.\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2750434/v1/fdb1f025908a0fd6898691da.png"},{"id":36292252,"identity":"b71b15b7-7dac-4820-baa8-94469f26b990","added_by":"auto","created_at":"2023-04-25 19:14:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1672885,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2750434/v1/abaa951a-151e-49e9-8bc6-7061e234c1b7.pdf"},{"id":35118636,"identity":"247b961d-3c0e-4356-9b09-559b4038a3e0","added_by":"auto","created_at":"2023-03-31 18:59:10","extension":"tif","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":8783704,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary figure 1Forest plot of metabolic index in predicting endometriosis. \u003c/strong\u003eOR odd ratio, HDL-C high density lipoprotein cholesterol, INS insulin, TC total cholesterol, Gluglucose.\u003c/p\u003e","description":"","filename":"Supplementaryfigure1.tif","url":"https://assets-eu.researchsquare.com/files/rs-2750434/v1/cf550aac87b7912dc368860c.tif"},{"id":35118631,"identity":"e0f99c23-a237-4fd6-b633-66d82327b649","added_by":"auto","created_at":"2023-03-31 18:59:09","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15972,"visible":true,"origin":"","legend":"\u003cp\u003eTable S1: Sensitivity and specificity of potential biomarkers for diagnosis of endometriosis\u003c/p\u003e","description":"","filename":"Supplementarytable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-2750434/v1/29760f4eff7783d87f5c1e4a.docx"},{"id":35119163,"identity":"f69ada13-5802-4c06-b476-bc25131a7fe7","added_by":"auto","created_at":"2023-03-31 19:07:09","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":16395,"visible":true,"origin":"","legend":"\u003cp\u003eTable S2: Neonate outcomes of two study groups\u003c/p\u003e","description":"","filename":"Supplementarytable2.docx","url":"https://assets-eu.researchsquare.com/files/rs-2750434/v1/9748fd7529b8b01865450fa9.docx"},{"id":35118632,"identity":"debcb343-c53b-4fc2-9ab4-0583430e3c92","added_by":"auto","created_at":"2023-03-31 18:59:09","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":16646,"visible":true,"origin":"","legend":"\u003cp\u003eTable S3: Pregnancy complications and neonate complications of two study groups\u003c/p\u003e","description":"","filename":"Supplementarytable3.docx","url":"https://assets-eu.researchsquare.com/files/rs-2750434/v1/d49557fbed98f6bb5fe55f28.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of dysregulated glucose metabolism on the occurrence and ART outcome of endometriosis","fulltext":[{"header":"Background","content":"\u003cp\u003eEndometriosis is defined as the presence of active endometrial tissue outside the uterus, including endometrial glands and stroma, which can cause symptoms such as dysmenorrhea, abnormal menstruation, dyspareunia and infertility [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The global incidence of endometriosis in women of reproductive age is about 10% and the incidence in infertile women is as high as 50% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. As a hormone-dependent and chronic disease, endometriosis can also affect the systemic metabolic indicators, including body mass index (BMI), glucose metabolism and lipid metabolism [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The inflammatory response in endometriosis patients can affect the metabolism of Glu and lipids which may be used as a detection method to assist in the diagnosis of endometriosis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn increasing number of women with endometriosis use assisted reproductive technology (ART) to achieve pregnancy. But consensus is lacking on the effects of endometriosis on outcome of assisted reproduction. Some studies have found that endometriosis patients had poor ART outcomes due to factors such as decreased oocyte quality and fertilized egg quality, defective corpus luteum function, and poor endometrial receptivity [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Other studies have reported there were no significant difference in ART outcome in endometriosis patients compared with patients with tubular infertility [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Besides, metabolic indicators may be associated with ART outcome [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. While the pathogenesis of endometriosis is closely related to metabolic factors, whether the effect of endometriosis on ART outcome is partly due to abnormal metabolic indicators is still unknown.\u003c/p\u003e \u003cp\u003eWe retrospectively analyzed the clinical information of endometriosis patients with infertility and infertility patients with only fallopian tube factors, compared the differences in serum metabolic indexes between two groups before receiving assisted reproductive treatment and their effects on the incidence of endometriosis, number of retrieved oocytes, as well as the pregnancy outcome after receiving ART and established a prediction model based on metabolic indexes and pregnancy history to evaluate the possibility of presence of endometriosis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective analysis was undertaken to evaluate the characteristics of systemic metabolic indexes in endometriosis patients with infertility and their effects on pregnancy outcome after assisted reproductive treatment. All patients received in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) assisted fertility at the reproductive medicine center of Women\u0026rsquo;s Hospital, Zhejiang University School of Medicine between February 2019 and December 2020. Inclusion criteria were as follows: age 21\u0026ndash;40 years; normal menstrual cycle, non-pregnancy nor lactation; women who had undergone laparoscopic evaluation to confirm the presence of endometriosis were included in the endometriosis group; women with tube factor as the only infertility factor were included in control group.\u003c/p\u003e\n\u003cp\u003eTo minimize the potential confounding factors, exclusion criteria were as follows: metabolic disease, gynecological inflammation, chronic infectious diseases, immune diseases, chromosomal or genetic abnormalities, polycystic ovary syndrome (PCOS), potentially malignant or malignant tumors, unexplained infertility or had received any hormone therapy in past six months.\u003c/p\u003e\n\u003cp\u003eIn total, 1963 cycles were enrolled from our medical database: 412 with endometriosis and 1551 without endometriosis (Controls group). Available information on the dataset included maternal factors (maternal age, BMI, smoking, drinking, duration of infertility, type of infertility, history of mature, premature, abortion and existence, number of previous pregnancies, and common serum indexes including reproductive hormone, AFC), paternal age, ART procedure (type of ART, total gonadotropin dose and days, number of retrieved oocytes, the stage of fertilized egg and the number of embryos transferred), ART outcomes (clinical pregnancy, live birth, pre-term birth ratio, cesarean section ratio, multiple pregnancies ratio, average birth weight, miscarriages and ectopic pregnancies), pregnancy complications and neonate complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethical review board of Women\u0026rsquo;s Hospital, Zhejiang University School of Medicine, Hangzhou, China (Ethics Lot number IRB-20200325-R).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary outcome was metabolic indexes. Secondary measures consisted of the influence of metabolic indexes on the number of retrieved oocytes and ART outcomes (clinical pregnancy, live birth, multiple pregnancies ratio, average birth weight, miscarriages and ectopic pregnancies), as well as the relavation between blood glucose and\u0026nbsp;gestational diabetes mellitus\u0026nbsp;(GDM).\u003c/p\u003e\n\u003cp\u003eWe defined the pregnancy outcomes in our study based on \u0026ldquo;International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary of ART Terminology, 2009\u0026rdquo;\u0026nbsp;[12]\u0026nbsp;:\u003c/p\u003e\n\u003cp\u003e1. Implantation rate: the ratio of the number of gestational sacs to the total number of embryos transferred.\u003c/p\u003e\n\u003cp\u003e2. Ectopic pregnancy rate: the ratio of the number of Ectopic pregnancy cycles to the total number of transfer cycles.\u003c/p\u003e\n\u003cp\u003e3. Clinical pregnancy: a pregnancy diagnosed by the detection of \u0026beta;-hCG in serum after 14 days of transplantation, and ultrasonography visualization of one or more gestational sacs after 30\u0026ndash;35 days of transplantation (ectopic pregnancy was included).\u003c/p\u003e\n\u003cp\u003e4. Clinical pregnancy rate: the ratio of the number of clinical pregnancy cycles to the total number of transfer cycles.\u003c/p\u003e\n\u003cp\u003e5. Miscarriage: clinical pregnancy which was spontaneously terminated in less than 28 weeks.\u003c/p\u003e\n\u003cp\u003e6. Miscarriage rate: the ratio of the number of miscarriage cycles to the total number of transfer cycles.\u003c/p\u003e\n\u003cp\u003e7. Delivery rate: the ratio of the number of deliveries that resulted in at least one live born baby to the total number of transfer cycles.\u003c/p\u003e\n\u003cp\u003e8. Live birth rate: the ratio of the number of live born babies to the total number of live born babies.\u003c/p\u003e\n\u003cp\u003e9. Preterm birth: delivered after 28 weeks but before 37 weeks.\u003c/p\u003e\n\u003cp\u003e10. Low birth weight (LBW): birth weight less than 2500 g.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed with Statistical Package for the Social Sciences software (SPSS version 24.0; IBM). Shapiro-Wilk test was used to assess the normality of the distribution. Normally distributed measurement data were represented by the mean \u0026plusmn; standard deviation (x \u0026plusmn; SD), while non-normally distributed measurement data were represented by the median (interquartile range). If the data between the two groups was normally distributed and consistent with homogeneity of variance, Student\u0026apos;s t test was used to calculate statistical significance; otherwise, Mann-Whitney U nonparametric test was chosen. Rate was shown as number of cases (percentage \u0026times; 100) or percentage (number of numerator cases/number of denominator cases). Differences between categorical variables were tested using Pearson\u0026rsquo;s Chi-square test. Both univariable and multivariate logistic regression models were employed to evaluate the influencing factors of endometriosis, and ROC curve was drawn. A multivariate linear regression model was used to analyze the influence of metabolic indexes on the number of retrieved oocytes. Multivariate logistic regression model was chosen to analyze the relationship between blood sugar, INS and GDM. Two-sided \u003cem\u003eP\u003c/em\u003e values of less than 0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTotally, 6890 cycles were assessed for eligibility during February 2019 and December 2020 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). We dropped those with age over 40 (n\u0026thinsp;=\u0026thinsp;180) and missing data on follow-up (n\u0026thinsp;=\u0026thinsp;4319), as well as those with chromosomal or genetic abnormalities (n\u0026thinsp;=\u0026thinsp;30), endocrine disease or abnormal liver and kidney function (n\u0026thinsp;=\u0026thinsp;258), immune disease (n\u0026thinsp;=\u0026thinsp;16), PCOS (n\u0026thinsp;=\u0026thinsp;118) and unexplained infertility (n\u0026thinsp;=\u0026thinsp;6). Finally, 1963 cycles were remained for analyses and divided into two groups, including endometriosis group (n\u0026thinsp;=\u0026thinsp;412) and control group (n\u0026thinsp;=\u0026thinsp;1551).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eBaseline Characteristics In Endometriosis Patients And Controls\u003c/h3\u003e\n\u003cp\u003eBaseline characteristics of two study groups were summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Significant differences were found for types of infertility (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), history of miscarriage [116(28.2%) vs 928(59.8%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001], number of previous pregnancies [0.0(0.0\u0026ndash;1.0) vs 0.0(0.0\u0026ndash;2.0), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001] and serum CA125 levels [24.00(15.10\u0026ndash;41.20) vs 15.10(11.00-21.60) U/mL, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001]. Nevertheless, there were no differences in age, BMI, smoking, drinking, duration of infertility, type of ART and history of preterm delivery between two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of two study groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;412)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1551)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (30\u0026ndash;35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (30\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.0 (19.5\u0026ndash;22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.3 (19.6\u0026ndash;23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e409 (99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1518 (97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e412 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1550 (99.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of infertility (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0 (1.5-4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8 (1.0\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of infertility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary infertility [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e258 (62.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e537 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary infertility [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e838 (54.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than one year [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVF [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e337 (79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1195 (77.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHalf ICSI [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICSI [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e323 (21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of preterm delivery [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of miscarriage [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e928 (59.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of previous pregnancies (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0 (0.0\u0026ndash;1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0 (1.0\u0026ndash;2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA125 (U/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.00 (15.10\u0026ndash;41.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.10 (11.00-21.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (interquartile range) or number (%).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eART\u003c/em\u003e assisted reproductive technology, \u003cem\u003eIVF\u003c/em\u003e in vitro fertilization, \u003cem\u003eICSI\u003c/em\u003e intracytoplasmic sperm injection\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eMetabolic Indexes In Endometriosis Patients And Controls\u003c/h3\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, there were no statistically differences in basal serum levels of estradiol (E\u003csub\u003e2\u003c/sub\u003e) and progesterone (P), Glu, triglycerides (TG), total protein (TP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, urea nitrogen, uric acid and homocysteine (HCY) between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, respectively). While we found significantly lower serum basal testosterone (T) [0.50(0.00-0.80) vs 0.60(0.00-0.90) nmol/L, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005], higher serum INS [6.90(5.10\u0026ndash;9.50) vs 6.50(4.80\u0026ndash;8.90) \u0026micro;U/mL, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005], TC [4.35(3.92\u0026ndash;4.80) vs 4.27(3.81\u0026ndash;4.77) mmol/L, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036], HDL-C [1.36(1.19\u0026ndash;1.57) vs 1.32(1.14\u0026ndash;1.52) mmol/L, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005] and LDL-C [2.63(2.17\u0026ndash;3.01) vs 2.54(2.12\u0026ndash;2.94) mmol/L, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.043] in endometriosis group compared with controls.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMetabolic indexes, ovarian function and ART outcomes of two study groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;412)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1551)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal E\u003csub\u003e2\u003c/sub\u003e (pmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114.65 (67.97-156.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110.70 (67.70-153.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal P (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.14 (0.75\u0026ndash;1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.12 (0.76\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal T (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.50 (0.00-0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.60 (0.00-0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlu (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.01 (4.79\u0026ndash;5.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.04 (4.80\u0026ndash;5.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINS (\u0026micro;U/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.90 (5.10\u0026ndash;9.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.50 (4.80\u0026ndash;8.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.92 (0.71\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92 (0.69\u0026ndash;1.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.35 (3.92\u0026ndash;4.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.27 (3.81\u0026ndash;4.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL-C (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.36 (1.19\u0026ndash;1.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.32 (1.14\u0026ndash;1.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL-C (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.63 (2.17\u0026ndash;3.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.54 (2.12\u0026ndash;2.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTP (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.00 (10.00\u0026ndash;17.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.00 (10.00\u0026ndash;18.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.00 (15.00\u0026ndash;20.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.00 (15.00\u0026ndash;20.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (\u0026micro;moI/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.00 (50.00-62.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.10 (49.00\u0026ndash;62.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrea nitrogen (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.78 (3.21\u0026ndash;4.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.76 (3.18\u0026ndash;4.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUric acid (\u0026micro;moI/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e266.00 (234.25\u0026ndash;303.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e270.00 (231.00-312.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.277\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCY (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.70 (8.50\u0026ndash;10.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.80 (8.50\u0026ndash;11.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.02 (1.06\u0026ndash;3.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.53 (1.48\u0026ndash;4.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFC (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.00 (5.00\u0026ndash;11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.00 (7.00\u0026ndash;12.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal FSH (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.74 (5.26\u0026ndash;8.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.32 (4.81\u0026ndash;7.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal LH (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGn dosage (IU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2025.00 (1575.00-2700.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2025.00 (1575.00-2475.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGn days (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.00 (8.00\u0026ndash;12.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.00 (8.00\u0026ndash;11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of retrieved oocytes (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.00 (4.00\u0026ndash;11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.00 (5.00\u0026ndash;14.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFertilization rate [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.3 (2158/3357)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.0 (9714/15172)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.778\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleavage rate [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.7 (512/2158)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.1 (2338/9714)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.736\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of transferable embryos (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of high-quality embryos (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh-quality embryos rate [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.1 (232/1912)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.1 (936/8435)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of embryos transferred (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImplantation rate [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.7 (122/315)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.0 (429/1191)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEctopic pregnancy rate [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3 (4/174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5 (10/669)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical pregnancy rate [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.7 (90/174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.5 (331/669)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiscarriage rate [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.9 (12/174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.7 (38/669)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.606\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelivery rate [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.4 (79/174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.8 (293/669)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.606\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLive birth rate [%]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.0 (94/174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.0 (361/669)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (interquartile range) or number (%).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eE\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e estradiol, \u003cem\u003eP\u003c/em\u003e progesterone, \u003cem\u003eT\u003c/em\u003e testosterone, \u003cem\u003eGlu\u003c/em\u003e glucose, \u003cem\u003eINS\u003c/em\u003e insulin, \u003cem\u003eTG\u003c/em\u003e triglycerides, \u003cem\u003eTC\u003c/em\u003e total cholesterol, \u003cem\u003eHDL-C\u003c/em\u003e high density lipoprotein cholesterol, \u003cem\u003eLDL-C\u003c/em\u003e low density lipoprotein cholesterol, \u003cem\u003eTP\u003c/em\u003e total protein, \u003cem\u003eALT\u003c/em\u003e alanine aminotransferase, \u003cem\u003eAST\u003c/em\u003e aspartate aminotransferase, \u003cem\u003eHCY\u003c/em\u003e homocysteine, \u003cem\u003eAMH\u003c/em\u003e Anti-M\u0026uuml;llerian hormone, \u003cem\u003eAFC\u003c/em\u003e antral follicle counting, \u003cem\u003eFSH\u003c/em\u003e follicle stimulating hormone, \u003cem\u003eLH\u003c/em\u003e luteinizing hormone, \u003cem\u003eGn\u003c/em\u003e gonadotropin\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003ePrediction Of Endometriosis By Metabolic Indexes\u003c/h3\u003e\n\u003cp\u003eAfter adjusting for potential confounders, number of previous pregnancies [adjusted odds ratio (aOR) 0.51, 95% confidence interval (CI) 0.43\u0026ndash;0.62; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001], serum CA125 levels (aOR 1.02, 95% CI 1.01\u0026ndash;1.03; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), serum Glu (aOR 0.74, 95% CI 0.56\u0026ndash;0.97; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027) and serum INS (aOR 1.03, 95% CI 1.01\u0026ndash;1.04; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) were found to be significantly associated with endometriosis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Besides, compared with subjects with primary infertility, those with secondary infertility suffered from decreased incidence of endometriosis (aOR 0.70, 95% CI 0.50\u0026ndash;0.97; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030). The aORs and their 95% confidence intervals (CI) were extracted and a forest plot graphic was built [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOdd ratios for endometriosis in these patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.99 (0.96\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRemoved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.96 (0.90\u0026ndash;9.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.93 (0.48\u0026ndash;7.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of previous pregnancies (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.46 (0.40\u0026ndash;0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.51 (0.43\u0026ndash;0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of infertility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary infertility [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary infertility [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.40 (0.27\u0026ndash;0.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.70 (0.50\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than one year [n (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.30 (0.23\u0026ndash;0.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.07 (0.66\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA125 (U/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02 (1.02\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02 (1.01\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.98\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRemoved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96 (0.92-1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99 (0.94\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlu (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.74 (0.58\u0026ndash;0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.74 (0.56\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINS (\u0026micro;U/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02 (1.00-1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.03 (1.01\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88 (0.72\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRemoved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.16 (1.01\u0026ndash;1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95 (0.72\u0026ndash;1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL-C (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.63 (1.14\u0026ndash;2.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.54 (0.94\u0026ndash;2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL-C (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.16 (0.99\u0026ndash;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.26 (0.96\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal E\u003csub\u003e2\u003c/sub\u003e (pmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (1.00\u0026ndash;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRemoved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal P (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.03 (0.97\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRemoved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal T (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98 (0.90\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRemoved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eOR\u003c/em\u003e odd ratio, \u003cem\u003eAST\u003c/em\u003e aspartate aminotransferase, \u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eGlu\u003c/em\u003e glucose, \u003cem\u003eINS\u003c/em\u003e insulin, \u003cem\u003eTG\u003c/em\u003e triglycerides, \u003cem\u003eTC\u003c/em\u003e total cholesterol, \u003cem\u003eHDL-C\u003c/em\u003e high density lipoprotein cholesterol, \u003cem\u003eLDL-C\u003c/em\u003e low density lipoprotein cholesterol, \u003cem\u003eE\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e estradiol, \u003cem\u003eP\u003c/em\u003e progesterone, \u003cem\u003eT\u003c/em\u003e testosterone\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFurthermore, we performed AUC and receiver operator control curves (ROC analysis) to assess whether the statistically different factors found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e could be used as indicators to predict the occurrence of endometriosis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e](Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Results showed Glu and INS had a sensitivity of 39.9% and 41.3%, specificity of 66.5% and 67.5%, AUC of 0.52 and 0.55, respectively. When combining previous pregnancies, serum CA125, serum Glu and INS, the mode had a sensitivity of 73.9%, specificity of 67.8% and AUC of 0.77.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eThe Effect Of Altered Metabolic Indexes On The Number Of Retrieved Oocytes In Endometriosis\u003c/h3\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, there were statistically significant differences in AMH [2.02(1.06\u0026ndash;3.49) vs 2.53(1.48\u0026ndash;4.07) ng/mL, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001], AFC [8.00(5.00\u0026ndash;11.00) vs 10.00(7.00\u0026ndash;12.00), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001], FSH [6.74(5.26\u0026ndash;8.35) vs 6.32(4.81\u0026ndash;7.87) IU/L, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001] and LH [(4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40 vs 4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66 IU/L, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031)] between endometriosis group and control group. Furthermore, the number of retrieved oocytes in endometriosis patients was significantly lower than that in control group [7.00(4.00\u0026ndash;11.00) vs 9.00(5.00\u0026ndash;14.00), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001], without differences in gonadotropin (Gn) dosage and Gn days.\u003c/p\u003e \u003cp\u003eGiven that the number of retrieved oocytes was closely related to ART outcomes of endometriosis patients, we explored whether alterations in serum Glu and INS played a role in the numbers of retrieved oocytes in endometriosis, we conducted multi-factor linear regression analysis. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the number of retrieved oocytes was positively correlated with INS [0.07(0.00-0.14), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048] in endometriosis group. In control group, the number of retrieved oocytes was negatively correlated with Glu [-0.80(-1.48 - -0.12), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression predictors of the number of retrieved oocytes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEndometriosis (n\u0026thinsp;=\u0026thinsp;412)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eControls (n\u0026thinsp;=\u0026thinsp;1551)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.52 (-0.68 - -0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.57 (-0.64 - -0.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA125 (U/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00 (-0.01\u0026ndash;0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.01 (-0.02\u0026ndash;0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of previous pregnancies (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.26\u0026ndash;1.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.25 (0.02\u0026ndash;0.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00 (-0.23\u0026ndash;0.154)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01 (-0.11\u0026ndash;0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal E\u003csub\u003e2\u003c/sub\u003e (pmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.00 (0.00\u0026ndash;0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal P (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.18 (-0.43\u0026ndash;0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.16 (-0.20\u0026ndash;0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal T (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.99 (0.37\u0026ndash;1.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16 (-0.04\u0026ndash;0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.29 (-1.24\u0026ndash;0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.06 (-0.63\u0026ndash;0.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.70 (0.38\u0026ndash;3.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88 (0.10\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL-C (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.83 (-3.18\u0026ndash;1.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.78 (-2.14\u0026ndash;0.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL-C (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.75 (-3.19 - -0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.59 (-1.43 - -0.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlu (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.19 (-0.90\u0026ndash;1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.80 (-1.48 - -0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINS (\u0026micro;U/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.07 (0.00\u0026ndash;0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.03 (-0.08\u0026ndash;0.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eE\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e estradiol, \u003cem\u003eP\u003c/em\u003e progesterone, \u003cem\u003eT\u003c/em\u003e testosterone, \u003cem\u003eTG\u003c/em\u003e triglycerides, \u003cem\u003eTC\u003c/em\u003e total cholesterol, \u003cem\u003eHDL-C\u003c/em\u003e high density lipoprotein cholesterol, \u003cem\u003eLDL-C\u003c/em\u003e low density lipoprotein cholesterol, \u003cem\u003eGlu\u003c/em\u003e glucose, \u003cem\u003eINS\u003c/em\u003e insulin\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eComparisons Of Art Outcomes In Endometriosis Patients And Controls\u003c/h3\u003e\n\u003cp\u003eWe further compared ART outcomes in two groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There were no statistically significant differences in fertilization rate, cleavage rate, number of transferable embryos, number of high-quality embryos, high-quality embryos rate, number of embryos transferred, implantation rate, clinical pregnancy rate, miscarriage rate, ectopic pregnancy rate, delivery rate and live birth rate between the study groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, respectively).\u003c/p\u003e\n\u003ch3\u003eNeonatal Outcomes And Complications In Two Groups\u003c/h3\u003e\n\u003cp\u003eNeonate outcomes in two groups were illustrated in Supplementary Table\u0026nbsp;2[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. There were no statistically significant differences in gestational week, manner of childbirth, rate of twins as well as gender and weight of both single and twin babies. As shown in Supplementary Table\u0026nbsp;3[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], no significant difference was found in incidences of pregnancy complications (GDM, gestational hypertension, intra-hepatic cholestasis of pregnancy, placenta previa, placental abruption, premature rupture of membranes, umbilical cord around neck, postpartum hemorrhage, infection and hypothyroidism) or neonatal complications (neonatal respiratory distress syndrome, hypoglycemia, jaundice and infection) between endometriosis group and control group.\u003c/p\u003e \u003cp\u003eWe further explored effects of serum Glu and INS on incidence of GDM in both groups (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), and found serum Glu [(aOR 12.95, 95% CI 1.69\u0026ndash;99.42; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014) were significantly associated with incidence of GDM in both groups (aOR 4.15, 95% CI 1.50\u0026ndash;11.53; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects of Glu and INS on GDM of two study groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (-/+)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGDM (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlu (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometriosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.90 (1.23\u0026ndash;50.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12.95 (1.69\u0026ndash;99.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e264/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.27 (1.28\u0026ndash;8.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.15 (1.50-11.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINS (\u0026micro;U/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometriosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00 (0.93\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.01 (0.94\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e264/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98 (0.89\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.99 (0.90\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.819\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eGDM\u003c/em\u003e gestational diabetes mellitus, \u003cem\u003eOR\u003c/em\u003e odd ratio, \u003cem\u003eGlu\u003c/em\u003e glucose, \u003cem\u003eINS\u003c/em\u003e insulin\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMetabolomics represents a useful diagnostic tool for the study of metabolic changes during a different physiological or pathological status. Clinically, endometriosis patients have abnormal metabolic manifestations, including abnormal clinical features and metabolic indexes. Recently, metabolic approach has emerged as a possible non-invasive diagnostic tool in women with or without endometriosis [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Our previous study showed that most metabolites important for glucolipid metabolism were up-regulated in FF of endometriosis patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Those data suggested dysregulated circulating metabolic molecules might play an important role in endometriosis development. We further explored whether relevant serum metabolic indexes were involved in endometriosis development via a retrospective study including 412 endometriosis patients and 1551 control patients in the present study and found endometriosis patients present with higher serum levels of INS, TC, HDL-C, LDL-C and lower serum level of basal T. By logistic regression analyses we developed a model combining the number of previous pregnancies, serum levels of CA125, Glu and INS to predict the occurrence of endometriosis. The mode had a sensitivity of 73.9%, specificity of 67.8% and AUC of 0.77, however, further research is needed to explore the underlying mechanisms.\u003c/p\u003e\n\u003ch3\u003eGlucose Metabolism And Endometriosis\u003c/h3\u003e\n\u003cp\u003eMarianna S has confirmed that endometriosis patients had lower glucose level and higher INS level in FF [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Higher INS level in FF of endometriosis patients might be related to lower glucose level. Our study not only confirmed the higher INS level in endometriosis patients at serum level for the first time, but also found that serum Glu might be a protective factor for endometriosis and INS might be a risk factor. It is generally believed that glucose metabolism in endometriosis patients is increased, which explains the possible cause of low glucose in endometriosis patients [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Mitochondrial breathing might be impaired because of high glucose metabolism, leading to the accumulation of oxygen free radicals in the body and aggravating the occurrence and development of endometriosis. INS maintains the stability of serum Glu levels by promoting the body's intake of glucose, increasing glycogen synthesis and inhibiting gluconeogenesis and glycogen decomposition [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Therefore, INS within a certain range may have a benign effect on improving the ovarian function of endometriosis patients, explaining the number of retrieved oocytes is positively correlated with INS in endometriosis patients, as shown in our study.\u003c/p\u003e\n\u003ch3\u003eLipid Or Steroid Metabolism And Endometriosis\u003c/h3\u003e\n\u003cp\u003eIn terms of lipid metabolism, Mu F found endometriosis patients were more susceptible to hypercholesterolemia and hypertension, which was most obvious among women younger than 40 years old [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Melo also reported that endometriosis patients had higher levels of TG, TC and LDL-C [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], consistent with our findings. While the mechanisms underlying dysregulated lipid metabolism and development of endometriosis is still unclear. On the other hand, many epidemiological studies reported that endometriosis women might have a lower BMI [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. But other studies found that women with a normal BMI were also likely to experience endometriosis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In our study, we found no difference in BMI between two groups. The diagnosis of endometriosis in our study was confirmed by laparoscopic examination, while the diagnosis of endometriosis in most previous population-based studies was just described by patients. We assume that different populations and different mode of diagnosis might also cause bias to the study results. Therefore, the association of BMI and endometriosis has yet to be confirmed.\u003c/p\u003e \u003cp\u003eAs to steroid hormone metabolism, previous studies have found lower levels of T in endometriosis lesions [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and we further confirmed lower serum basal level of T in endometriosis patients and found the basal serum T is positively correlated with the number of retrieved oocytes in endometriosis patients (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). It is generally known that the imbalance of T synthesis can lead to endometrial disease and impaired endometrial function [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and Selak V found that Danazol (17α-ethynyl testosterone) could reduce the size of endometriotic lesions [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Therefore, we speculated a relatively high T might be beneficial for alleviating endometriosis related symptoms, thereby improving ovarian function and increasing the number of oocytes in endometriosis patients.\u003c/p\u003e\n\u003ch3\u003eMetabolism Dysregulation And Art Outcomes Of Endometriosis\u003c/h3\u003e\n\u003cp\u003eThe incidence of infertility in endometriosis patients was higher than that of the general population, as reported by previous studies [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and also by the present study. We found the ovarian reserve and responsiveness of endometriosis patients were significantly lower, manifested by lower AMH, lower AFC, higher basal FSH, lower basal LH, and a significantly decreased number of retrieved oocytes. The impact of endometriosis on ovarian function is mainly reflected in two aspects [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]: endometriosis damages the ovary and affects ovarian function through physical compression, inflammation and blood supply; previous surgical treatment of endometriosis may also cause certain damage to the ovary. Currently, ART is the most effective treatment for endometriosis related infertility. It is still no consensus on whether there is difference in ART outcome in infertility patients with or without endometriosis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Several studies reported no difference in live-birth rates in subsequent IVF cycles in endometriosis patients versus tubal factor [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Another study described lower pregnancy and live-birth rates in patients with endometrioma [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In our study, we found no significant difference in ART outcomes in endometriosis patients compared with the control group, although they had worse ovarian reserve and responsiveness. Similarly, several studies examining the basic morphology of oocytes and embryo development in endometriosis patients or controls have not found any differences in the two groups [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. We thought the quality of the retrieved oocytes by ART in endometriosis were not much different from that of the control group and endometriosis lesion alone is unlikely to be the major contributory cause to worse reproductive outcomes, at least in the context of IVF/ICSI.\u003c/p\u003e \u003cp\u003eWe also explored whether the dysregulated metabolic indexes had effects on the number of retrieved oocytes, ART outcome and the incidence of pregnancy complications in endometriosis patients. Interestingly, our results showed that serum levels of Glu were significantly associated with incidence of GDM both in endometriosis group and in control group, suggesting that the higher the blood glucose level before pregnancy, the greater the incidence of GDM during pregnancy, which might shed light on preventing the occurrence of GDM in clinical work. However, we found no significant difference in the incidence of GDM between the two groups (16.5% vs 9.9%, P\u0026thinsp;=\u0026thinsp;0.102), and the sample size needs to be expanded for further research.\u003c/p\u003e\n\u003ch3\u003eStrengths And Limitations\u003c/h3\u003e\n\u003cp\u003eSome main strengths of this study deserve to be mentioned. We excluded patients without a definitive diagnosis of endometriosis by laparoscopy. Moreover, logistic regression analysis might have further lessened the impact of the confounders, in which we matched age, CA125, types of infertility and other baseline characteristics to protect our data from other confounders. As for limitations, endometriosis patients included in this study had a history of endometriosis-related surgery, but the control group did not. Some studies believed that surgery could improve female fertility conditions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], while other studies thought surgery might cause damage to the ovaries [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Secondly, we could not perform subgroup analyses according to disease stages in retrospective study, because endometriosis was heterogeneous, and the severity of endometriosis might directly affect ART outcomes [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Thirdly, some basal characteristics of the two groups differed and we could not fully exclude the influence of confounders. Finally, our study was conducted in a single reproductive medical center with standardized laboratory techniques and ART protocols, and multi-center based randomized controlled trials are suggested in the future study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe found endometriosis patients had abnormal metabolic indexes, in which serum Glu and serum INS are related to the occurrence of endometriosis, the number of retrieved oocytes and the occurrence of GDM. We also established a prediction model based on metabolic indexes to evaluate the possibility of presence of endometriosis, which might represent a promising non-invasive method to predict endometriosis patients with known pregnancy history, but further study is warranted to verify. Our findings suggest clinicians pay more attention to serum Glu before pregnancy, which was relevant with occurrence of GDM. In conclusion, the present study shed light on the effects of dysregulated glucose metabolism on the occurrence and ART outcome of endometriosis, while the underlying mechanisms is jet to be clarified.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cem\u003eAFC\u003c/em\u003e antral follicle counting,\u003cem\u003e\u0026nbsp;ALT\u0026nbsp;\u003c/em\u003ealanine aminotransferase, \u003cem\u003eAMH\u003c/em\u003e Anti-M\u0026uuml;llerian hormone, \u003cem\u003eART\u003c/em\u003e assisted reproductive technology, \u003cem\u003eAST\u003c/em\u003e aspartate aminotransferase, \u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eE2\u003c/em\u003e estradiol, \u003cem\u003eFSH\u003c/em\u003e follicle stimulating hormone, \u003cem\u003eGDM\u003c/em\u003e gestational diabetes mellitus, \u003cem\u003eGlu\u003c/em\u003e glucose, \u003cem\u003eGn\u003c/em\u003e gonadotropin, \u003cem\u003eHDL-C\u003c/em\u003e high density lipoprotein cholesterol, \u003cem\u003eHCY\u003c/em\u003e homocysteine, \u003cem\u003eICSI\u003c/em\u003e intracytoplasmic sperm injection, \u003cem\u003eINS\u003c/em\u003e insulin, \u003cem\u003eIVF\u003c/em\u003e in vitro fertilization, \u003cem\u003eLDL-C\u003c/em\u003e low density lipoprotein cholesterol, \u003cem\u003eLH\u003c/em\u003e luteinizing hormone, \u003cem\u003eOR\u003c/em\u003e odd ratio, \u003cem\u003eP\u003c/em\u003e progesterone, \u003cem\u003eT\u003c/em\u003e testosterone, \u003cem\u003eTC\u003c/em\u003e total cholesterol, \u003cem\u003eTG\u003c/em\u003e triglycerides,\u003cem\u003e\u0026nbsp;TP\u003c/em\u003e total protein.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDZ, JYL: conception and design of the study. JPC, YYZ, JNJ: data collection. YY, ZMS, MXT, XHY, HNT: follow-up of enrolled subjects. JPC, YYZ, FDN, YYY, JL: analysis and interpretation of data. JPC and YYZ drafted the article, and DZ revised it critically. All authors reviewed the manuscript and approved the version to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Saijun Sun for the collection of original data, and all participants involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Key Research and Development Program of China (2021YFC2700601), the National Natural Science Foundation of China (No. 81974224, 82001537), the Key Research and Development Program of Zhejiang Province (2021C03098), and Zhejiang Provincial Clinical Research Center for Child Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset supporting the conclusions of this article is available in the [Harvard Dataverse] repository, [unique persistent identifier and hyperlink to dataset in https://doi.org/10.7910/DVN/THVJUU].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYounis JS, Shapso N, Fleming R, Ben-Shlomo I, Izhaki I: \u003cstrong\u003eImpact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: a systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eHuman reproduction update \u003c/em\u003e2019, \u003cstrong\u003e25\u003c/strong\u003e(3):375-391.\u003c/li\u003e\n\u003cli\u003eMontgomery GW, Giudice LC: \u003cstrong\u003eNew Lessons about Endometriosis - Somatic Mutations and Disease Heterogeneity\u003c/strong\u003e. \u003cem\u003eThe New England journal of medicine \u003c/em\u003e2017, \u003cstrong\u003e376\u003c/strong\u003e(19):1881-1882.\u003c/li\u003e\n\u003cli\u003eShafrir AL, Farland LV, Shah DK, Harris HR, Kvaskoff M, Zondervan K, Missmer SA: \u003cstrong\u003eRisk for and consequences of endometriosis: A critical epidemiologic review\u003c/strong\u003e. 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Insights from a Large Retrospective Matched Cohort Study\u003c/strong\u003e. \u003cem\u003eDiagnostics (Basel, Switzerland) \u003c/em\u003e2020, \u003cstrong\u003e10\u003c/strong\u003e(2).\u003c/li\u003e\n\u003cli\u003eDemirel C, Bastu E, Aydogdu S, Donmez E, Benli H, Tuysuz G, Keskin G, Buyru F: \u003cstrong\u003eThe Presence of Endometrioma Does Not Impair Time-Lapse Morphokinetic Parameters and Quality of Embryos: A Study On Sibling Oocytes\u003c/strong\u003e. \u003cem\u003eReproductive sciences (Thousand Oaks, Calif) \u003c/em\u003e2016, \u003cstrong\u003e23\u003c/strong\u003e(8):1053-1057.\u003c/li\u003e\n\u003cli\u003eBrink Laursen J, Schroll JB, Macklon KT, Rudnicki M: \u003cstrong\u003eSurgery versus conservative management of endometriomas in subfertile women. A systematic review\u003c/strong\u003e. \u003cem\u003eActa obstetricia et gynecologica Scandinavica \u003c/em\u003e2017, \u003cstrong\u003e96\u003c/strong\u003e(6):727-735.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometriosis, Metabolic indicator, Number of retrieved oocytes, Assisted reproductive technology (ART) outcomes, Gestational diabetes mellitus (GDM)","lastPublishedDoi":"10.21203/rs.3.rs-2750434/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2750434/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEndometriosis can affect the systemic metabolic indicators, including body mass index, glucose metabolism and lipid metabolism, while the association between metabolic indexes and the occurrence and ART outcome of endometriosis is unclear. We aimed to evaluate the characteristics of systemic metabolic indexes of endometriosis patients with infertility and their effects on pregnancy outcome after ART treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eA retrospective cohort study involve 412 endometriosis patients and 1551 controls was conducted. Primary outcome was metabolic indexes, and secondary measures consisted of the influence of metabolic indexes on the number of retrieved oocytes and ART outcomes, as well as the relation between blood glucose and prevalence of GDM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eEndometriosis patients had higher INS [6.90(5.10-9.50) vs 6.50(4.80-8.90) μU/mL, P = 0.005]. A prediction model for endometriosis combining the number of previous pregnancies, CA125, fasting blood Glu and INS, had a sensitivity of 73.9%, specificity of 67.8% and area AUC of 0.77. There were no significant differences in ART outcomes and complications. The levels of Glu were associated with GDM both in endometriosis group (aOR 12.95, 95% CI 1.69–99.42; P = 0.014) and in control group (aOR 4.15, 95% CI 1.50–11.53; P = 0.006).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Endometriosis patients had abnormal metabolic indexes, in which serum Glu and serum INS are related to the occurrence of endometriosis, the number of retrieved oocytes and the occurrence of GDM. A prediction model based on metabolic indexes was established, representing a promising non-invasive method to predict endometriosis patients with known pregnancy history.\u003c/p\u003e","manuscriptTitle":"Effects of dysregulated glucose metabolism on the occurrence and ART outcome of endometriosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-31 18:59:04","doi":"10.21203/rs.3.rs-2750434/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"036feb58-848e-40a0-a1fc-edfd31adf176","owner":[],"postedDate":"March 31st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-06-15T05:14:12+00:00","versionOfRecord":[],"versionCreatedAt":"2023-03-31 18:59:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2750434","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2750434","identity":"rs-2750434","version":["v1"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}