B-cell lymphoma 6 expression is not associated with live birth in a normal responder in vitro fertilization population

In this case-control study, endometrial biopsies from women with and without live birth were evaluated for presence of B-cell lymphoma 6 (BCL6). BCL6 positivity did not significantly differ between the 2 groups.

VOLUME 117, ISSUE 2, P351-358


Amber M. Klimczak, M.D., Nola S. Herlihy, M.D., Cynthia S. Scott, Brent M. Hanson, M.D., Julia G. Kim, M.D., M.P.H., Shiny Titus, Ph.D., Emre Seli, M.D., Richard Thomas Scott Jr., M.D., H.C.L.D.



To determine whether increased endometrial B-cell lymphoma 6 (BCL6) expression is associated with live birth in a normal responder in vitro fertilization (IVF) population.


Case-control study.


University-affiliated infertility center.


Two groups of women undergoing IVF with preimplantation genetic testing for aneuploidy followed by warmed, single, euploid embryo transfer. Group 1 consisted of women who failed to achieve live birth, and group 2 consisted of women who achieved live birth.



Main Outcome Measure(s)

Endometrial BCL6 expression measured by immunohistochemistry in endometrial tissue samples. Overexpression was defined by mean HSCORE with a cutoff of positivity of >1.4, as previously described in the literature.


Twenty-seven patients who achieved live birth and 23 patients who failed to achieve live birth were included. B-cell lymphoma 6 expression/HSCORE and live birth rate were not associated (Odds ratio [OR], 0.78 [0.24–2.55]). Using a cutoff of >1.4 for positivity, 8 of 23 samples were positive for BCL6 in the no live birth group, whereas 7 of 27 were positive in the live birth group. There was no significant association between BCL6 positivity and live birth (OR, 0.66 [0.19–2.21]).


The proportion of patients with BCL6 positivity did not significantly differ between those who achieved live birth and those who did not. In the population of patients at our center, who compromise of women who respond normally to IVF stimulation, BCL6 overexpression was not associated with IVF success. Physicians implementing BCL6 testing as a diagnostic tool for clinical decision making should counsel patients that results may have limited utility in predicting IVF outcomes in this population.


Go to the profile of Hosam Zaki
6 months ago

This study has the following points of concern:
1- The study excluded cases where BCL6 testing is very much needed such as women with >1 prior failed IVF, history of recurrent pregnancy loss, rather poor ovarian reserve. These are cases that BCL6 testing is suggested to be indicated

2- The result of positive BCL6 may be seen in the presence of inflammatory conditions such as endometriosis or hydrosalpinges (tubal condition). This study (as stated in table 3) has found significant (26.7% vs 2.9%) tubal factor in BCL6 positive cases, which explains the presence of live births in BCL6 positive cases, and that undermines the real value of BCL6 testing as a biological marker for endometriosis and it’s negative effect on live birth rates

3- The study did not look at essential other risk factors that form a crucial part in the diagnosis of endometriosis, such as symptoms (menstrual irregularities, deep dyspareunia, etc.) or ultrasonographic features of endometrioma or adenomyosis. Hence the findings of this study may be strictly applied when BCL6 is used as a screening test