Discussion
inflammation, endometriosis-associated infertility, PCOS, endometriosis
LATE PREGNANCY, ENDOMETRIOSIS, INFLAMMATION, UNEXPLAINED INFERTILITY, PATHOPHYSIOLOGY
Since OS and inflammation are interrelated and involved in the pathophysiology of endometriosis-associated infertility, in a randomized, triple-blind, placebo-controlled clinical trial on 50 infertile endometriosis patients candidate for ART, we investigated the antioxidative, anti-inflammatory, and fertility-enhancing effects of AST supplementation. We indicated that a 12-week supplementation with 6 mg/day of AST could effectively alleviate OS and inflammation and enhance ART outcomes.This trial showed that women using AST for 12 weeks achieved significantly higher serum levels of TAC and SOD. Serum MDA was also decreased significantly following antioxidant treatment. At the same time, the concentration of CAT remained unchanged after AST administration. However, no significant changes were detected in the CAT levels. This is consistent with published RCTs performed in Korea (A statistically significant decrease was observed in the FF TNF-α and IL-6 levels between the AST and the placebo group. However, dietary AST did not affect OS markers in the FF of endometriosis patients. Although AST supplementation led to a higher TAC level, it was not statistically significant. A previous study on PCOS patients undergoing ART (Significantly lower serum levels of IL-1β and TNF-α, but no considerable changes in serum IL-6, were observed following the intervention. In an RCT by Park et al. (2010) (Endometrial explants potentially expose the developing follicle, the oocyte, sperm, and embryos to high levels of ROS generated by inflammation. The damage to gametes and embryos can be prevented by antioxidant supplementation (Correlation analysis showed that serum IL-1β correlated negatively with fertilization rate. Nevertheless, increased IL-1β concentrations have been previously reported to be beneficial as high IL-1β in patients presenting male or unexplained infertility correlated with higher fertilization, implantation, and pregnancy rates (To the best of our knowledge, this is the first randomized, triple-blind, placebo-controlled clinical trial evaluating the effect of AST supplementation on OS markers, inflammatory cytokines, and ART outcomes in infertile endometriosis patients. Furthermore, a homogenous study population from the whole country undergoing uniform treatment practices was included. It is important to note, however, that our study had some limitations. Our study only includes patients undergoing assisted reproduction, so the results may not be generalizable to the entire endometriosis patient population. A larger sample size is required to analyze pregnancy outcomes. Besides, time constraints prevented us from evaluating late pregnancy outcomes, including live birth rate, the most relevant standard of success in ART. In addition, our analysis was limited to frozen ICSI cycles without assessing pregnancy outcomes in fresh cycles.