FOS and Other Genes Linked to Oxidative Stress Are Upregulated in Women Suffering from Endometriosis and Might Negatively Impact the Oocyte Developmental Competence During ICSI

Purpose: We aim to elucidate the impact of endometriomas on oocyte developmental competence and identify genetic alterations that may influence ICSI success rates in women of different ages. Methods: In this retrospective study, two groups of patients have been analyzed: 108 women with a history of severe endometriosis (stages III and IV), who underwent OPU and ICSI after endometriosis surgery, and a control group, built out of 108 women with no endometriosis history. The Turku Endometriosis Database was used for differential gene expression analysis. Results: The number of aspirated oocytes (endometrioma group: 2.75 ± 0.32 vs. control 10.32 ± 0.54) was significantly (p < 0.0001) lower in patients with endometrioma excision, and the number of generated blastocysts was significantly (p < 0.0001) lower when compared to patients without endometriosis (endometrioma group: 1.09 ± 0.13 vs. control group: 3.76 ± 0.23). Additionally, AMH levels were significantly lower (p < 0.001) in the endometriosis-affected group below the age of 35 years (1.65 ± 0.15) than in the unaffected control group (2.99 ± 0.27) within the same age group. The mRNA expression of the following genes related to oxidative stress was significantly (p < 0.05) upregulated in the endometriosis group compared with healthy controls: DES, P2RX1, FOS, SRF, RASD2, SLITRK3, and TEAD3. Gene Ontology and pathway enrichment analyses demonstrated a significant (p < 0.0001) enrichment of oxidative stress–associated biological processes and signaling pathways, including responses to reactive oxygen species and hypoxia, HIF-1, MAPK, PI3K–Akt, NF-κB, and apoptotic signaling, supporting oxidative stress as a central molecular mechanism underlying the observed transcriptomic alterations. Conclusions: In conclusion, this retrospective study provides a holistic perspective on the impact of endometrioma and its oxidative stress effect on oocyte developmental rates and ICSI outcomes across different age groups.