Cell-free DNA in Human Follicular Microenvironment: New Prognostic Biomarker to Predict in vitro Fertilization Outcomes.
Cell-free DNA (cfDNA) fragments, detected in blood and in other biological fluids, are released from apoptotic and/or necrotic cells. CfDNA is currently used as biomarker for the detection of many diseases such as some cancers and gynecological and obstetrics disorders. In this study, we investigated if cfDNA levels in follicular fluid (FF) samples from in vitro fertilization (IVF) patients, could be related to their ovarian reserve status, controlled ovarian stimulation (COS) protocols and IVF outcomes. Therefore, 117 FF samples were collected from women (n = 117) undergoing IVF/Intra-cytoplasmic sperm injection (ICSI) procedure and cfDNA concentration was quantified by ALU-quantitative PCR. We found that cfDNA level was significantly higher in FF samples from patients with ovarian reserve disorders (low functional ovarian reserve or polycystic ovary syndrome) than from patients with normal ovarian reserve (2.7 ± 2.7 ng/μl versus 1.7 ± 2.3 ng/μl, respectively, p = 0.03). Likewise, FF cfDNA levels were significant more elevated in women who received long ovarian stimulation (> 10 days) or high total dose of gonadotropins (≥ 3000 IU/l) than in women who received short stimulation duration (7-10 days) or total dose of gonadotropins < 3000 IU/l (2.4 ± 2.8 ng/μl versus 1.5 ± 1.9 ng/μl, p = 0.008; 2.2 ± 2.3 ng/μl versus 1.5 ± 2.1 ng/μl, p = 0.01, respectively). Finally, FF cfDNA level was an independent and significant predictive factor for pregnancy outcome (adjusted odds ratio = 0.69 [0.5; 0.96], p = 0.03). In multivariate analysis, the Receiving Operator Curve (ROC) analysis showed that the performance of FF cfDNA in predicting clinical pregnancy reached 0.73 [0.66-0.87] with 88% specificity and 60% sensitivity. CfDNA might constitute a promising biomarker of follicular micro-environment quality which could be used to predict IVF prognosis and to enhance female infertility management.
CHU Montpellier, INSERM U1203, Saint-Eloi Hospital, Institute of Regenerative Medicine and Biotherapy, Montpellier, France.
Sabine
S
Traver
CHU Montpellier, INSERM U1203, Saint-Eloi Hospital, Institute of Regenerative Medicine and Biotherapy, Montpellier, France; Montpellier 1 University, UFR of Medicine, Montpellier, France; ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.
Elodie
E
Scalici
Montpellier 1 University, UFR of Medicine, Montpellier, France; ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.
Tiffany
T
Mullet
UMR 1049, DIM, CHRU, Montpellier, France.
Nicolas
N
Molinari
ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.
Claire
C
Vincens
ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.
Tal
T
Anahory
CHU Montpellier, INSERM U1203, Saint-Eloi Hospital, Institute of Regenerative Medicine and Biotherapy, Montpellier, France; Montpellier 1 University, UFR of Medicine, Montpellier, France; ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.
Samir
S
Hamamah
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D002474:Cell-Free System / Q000737:chemistry; D004247:DNA / Q000032:analysis*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D015571:Follicular Fluid / Q000737:chemistry*; D006801:Humans; D007247:Infertility, Female / Q000378:metabolism / Q000628:therapy; D065851:Ovarian Reserve; D010062:Ovulation Induction / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000378:metabolism; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic; D055815:Young Adult
D015415:Biomarkers; D004247:DNA