Intraovarian steroidogenesis in women with endometriosis undergoing IVF.

RESEARCH QUESTION: Is endometriosis associated with alterations in the intraovarian steroidogenic milieu in women undergoing IVF compared with rigorously matched women without the disease? DESIGN: Prospective cohort study comparing intrafollicular steroid hormone concentrations between women with and without endometriosis undergoing IVF. Eighty-three affected women were recruited and matched 1:1 with controls for age at oocyte retrieval, study period, stimulation regimen and serum anti-Müllerian hormone. Follicular fluid was collected, pooled and stored. Concentrations of 14 steroid hormones were measured using liquid chromatography-tandem mass spectrometry. Subgroup analyses focused on women with ovarian endometriomas and on intra-patient comparisons in cases of unilateral disease. RESULTS: Compared with controls, women with endometriosis showed significantly higher concentrations of 11-deoxycortisol and lower concentrations of aldosterone and progesterone (adjusted P = 0.024 for all). These differences were more pronounced in women with ovarian endometriomas, who also had significantly higher concentrations of corticosterone, dehydroepiandrosterone and testosterone than controls (adjusted P = 0.003, P = 0.011 and P = 0.003, respectively). No significant differences in steroid concentrations were observed between affected and contralateral intact ovaries in women with unilateral endometriomas. CONCLUSIONS: The follicular fluid of women with endometriosis has a distinct hormonal profile compared with that of controls, suggesting alterations in steroidogenesis. Reasons explaining these differences, as well as their clinical relevance, remain unknown and deserve further investigations.