Endometrial BCL6 testing for the prediction of in vitro fertilization outcomes: a cohort study

Abstract

Objective: To evaluate endometrial BCL6 expression as a prognostic biomarker for IVF outcome in women with unexplained infertility (UI) before ET.

Design: Prospective cohort study.

Setting: University-associated infertility clinic.

Patient(s): Women with UI for >1 year.

Intervention(s): We studied women with UI who underwent testing for endometrial BCL6, in an LH-timed midluteal phase biopsy and completed an IVF cycle and ET.

Main outcome measure(s): Clinical pregnancy rate (PR) and live birth rate per transfer was compared for women positive or negative for BCL6 expression. An abnormal BCL6 result was defined by an histologic score (>1.4).

Result(s): Women with normal and abnormal BCL6 and those who conceived or not had similar characteristics. Women with low levels of BCL6 expression had a significantly higher clinical PR (11/17; 64.7%; 95% confidence interval [CI] 41.3-82.6) compared with women with abnormal (high) BCL6 expression (9/52; 17.3%; 95% CI 9.3-30.8). These results yield a relative risk of 0.267 (95% CI 0.13-0.53; P=.0004) for those with normal BCL6 expression, an absolute benefit of 47.4% (95% CI 22.5-72.0). Live birth rate was also significantly higher in women with low BCL6 expression (10/17; 58.8%; 95% CI 36.0-78.4) compared with women with abnormal BCL6 expression (6/52; 11.5%; 95% CI 5.4-23.0). The relative risk was 0.19 (95% CI 0.08-0.45; P=.0002), yielding an absolute benefit of 47.3% (95% CI 21.8-67.8).

Conclusion(s): Aberrant BCL6 expression (histologic score, >1.4) was strongly associated with poor reproductive outcomes in IVF cycles in women with UI.

Keywords: BCL6; Endometrium; IVF; pregnancy; prognosis.

Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Flow diagram of the study

Figure 2

Expression patterns of BCL6 in A: Normal, in phase endometrium; inset: Lymph node (positive control). B: Endometrium from IVF failure patient with endometriosis. Bars represent 50μm. C: Percentage of pregnant women (bars represent 95% confidence interval) according to BCL6 expression: normal (≤1.4 HSCORE) or abnormal (overexpressed) of BCL6 (> 1.4 HSCORE).