The ımpact of follicular fluid ıschemia-modified albumin levels on ICSI outcomes ın PCOS patients

Abstract

Aim: Serum and follicular fluid ischemia-modified albumin levels and total antioxidant capacity were evaluated in patients with polycystic ovary syndrome applied ICSI-ET to clarify the association between these markers and IVF outcome parameters. Methods:In this prospective controlled clinical trial, the study group consisted of PCOS cases (n=30) undergoing ICSI-ET cycles. The control group consisted normogonadotropic female partners of male factor infertility (n=30). The controlled ovarian hyperstimulation was performed by long protocol down regulation and recombinant FSH stimulation. Aspirated follicular fluid from the first retrieved follicle were analyzed for TAC and IMA levels. Oocyte quality, fertilization rate, embryo quality and final pregnancy outcomes were assessed.Results: No statistically significant difference was found between the groups when compared for mean age, body mass index and cycle outcome parameters (p>0.05). FF IMA levels were found positively correlated with embryo grading (r=0.328; p=0.03). The sensitivity, specificity, positive and negative predictive values of the best cutoff value of FF IMA (1.475 ABSU) for the prediction of grade 1 embryo development were 75%, 72%, 73% and 60%, respectively (AUC:0.765;CI 95%:0,606-0,924; p=0.017). In PCOS cases with TAC ≤1.299 mmol/L compared with TAC >1.299 mmol/L, number of metaphase II oocytes, fertilization rates, embryo grading and FF IMA levels were found significantly different (p<0.05). Conclusions:The levels of IMA and TAC in FF were higher than serum levels which inturn indicates a greater degree of oxidative stress in follicular microenvironment compared to systemic circulation. Although oxidative stres in FF of PCOS cases was found similar to non-PCOS cases when detected by IMA, a significant positive correlation between FF IMA levels and embryo grade may indicates the role of augmented oxidative stress in infertility.