Association of Interleukin-33 with Recurrent Pregnancy Loss in Egyptian Women

Background: A successful pregnancy requires a distinct and complex immunological state. Cytokines appear to be critical for the establishment of a tolerogenic environment towards the semi-allogenic foetus during the foeto-maternal interphase, and a shift from a Th1- to a Th2-cytokine profile may be crucial. An imbalance of cytokines can be a significant factor in recurrent pregnancy loss (RPL). Interleukin-33 (IL-33) is a member of the IL- 1 cytokine family, involved in both the innate and adaptive immune responses coordinating immune cell function for a broad range of physiological and pathological processes, including the regulation of pregnancy outcome. Objectives: The aim of this study was to investigate a possible association between IL-33 and RPL in Egyptian women. Methods: The study was conducted on 66 Egyptian females recruited from Ain Shams University Specialized Hospital and 66 matched healthy non-pregnant females of typical childbearing age without a history of RPL. Serum IL-33 was measured in all subjects using a sandwich ELISA technique. Results: Serum IL-33 levels were significantly higher in patients with RPL than in the healthy control group. In addition, in the patient group, there was a positive correlation between serum IL-33 level and both age and number of miscarriages and a negative correlation between serum IL-33 level and the number of deliveries. Conclusion: In Egyptian women, serum levels of IL-33 are associated with RPL, thus IL-33 level could be a predictive biomarker for RPL in early pregnancy.

Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas.

STUDY OBJECTIVE: Because laparoscopic ovarian cystectomy of endometriomas is known to adversely impact patient ovarian reserve, the search for other techniques of surgical management is ongoing. The present study was undertaken to evaluate laparoscopic cyst deroofing as a feasible alternative. STUDY DESIGN: Prospective, randomized clinical trial (Canadian Task Force classification I). SETTING: University maternity hospital. PATIENTS: Women diagnosed with unilateral or bilateral ovarian endometriomas. INTERVENTIONS: Patients were managed with either laparoscopic ovarian cystectomy or cyst deroofing. MEASUREMENTS AND MAIN RESULTS: A total of 122 women with endometriomas were randomized to either laparoscopic cystectomy (group 1) or laparoscopic cyst deroofing (group 2). The primary endpoint was the effect on ovarian reserve based on changes in anti-Müllerian hormone (AMH) values. At 1 month postsurgery, anti-Müllerian hormone values were significantly decreased (p < .001) from preoperative values, from 4.25 ± 0.87 ng/mL to 1.66 ± 1.02 ng/mL in group 1 and from 4.2 ± 1.69 ng/mL to 2.15 ± 1.48 ng/mL in group 2. In addition, antral follicle count and ovarian volume decreased significantly (p < .001) in both groups by 1 month postsurgery. The decreases in these 3 parameters were more significant (p < .001) in group 1 than in group 2. CONCLUSION: Laparoscopic cyst deroofing of endometriomas appears to be a promising alternative to laparoscopic cystectomy, with less postoperative decrease in ovarian reserve; however, the higher rate of endometrioma recurrence warrants future clinical research to determine the optimal surgical management of endometriomas.