Cover
Vol. 11 No. 1 (2021)

Published: June 30, 2021

Pages: 65-79

Research Article

The Effect of L-Carnitine on Oocyte Maturity in Women with Polycystic Ovarian Syndrome Undergoing ICSI

Abstract

Due to malfunction of the hypothalamus-pituitary-ovary axis and probable dysregulation of ovarian activities, ovary has a large number of small follicles but no developed follicles. L-Carnitine is a tiny, water-soluble chemical that plays a critical role in fat metabolism. It is required for appropriate mitochondrial fatty acid oxidation and acyl-CoA ester excretion, as well as affecting ATP levels. The current study was aiming at evaluating the protective effect of L-Carnitine (LC) against deleterious substances present in serum of patients with PCOS, which may affect the oocyte maturation. 60 infertile women diagnosed with polycystic ovarian syndrome have been enrolled in this study and enter their Intracytoplasmic Sperm Injection (ICSI) cycle; they were informed about the study and signed a written informed consent. They were grouped into treatment group (n=30) who were treated with L-Carnitine® tablet for two months and placebo group (n=30). All enrolled women underwent flexible antagonist protocol for ICSI. Significant increase in mean mature metaphase II (MII) oocyte count in study group than placebo group, oocyte maturity rate was significantly higher in study group in comparison with placebo group. In addition, mean fertilized (2PN) oocyte count was increased significantly in study group in comparison with placebo group. Mean fertilization rate was significantly higher in study group in comparison with placebo group. Treatment with of patients with polycystic ovary syndrome of L-Carnitine resulted better oocyte quality and the improvement in oocyte quality is reflected by mature MII oocytes, maturity rate and fertilized rate with eventual improvement in embryo quality.

References

  1. Carmina E, Rosato F, Janni A, Rizzo M. Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyper androgenism J Clin Endocrinol Metab. 2006; 91: 2-6.
  2. Glintborg D, Andersen M. An update on the pathogenesis inflammation, and metabolism in hirsutism and polycystic ovary syndrome. Gynecol Endocrinol 2010; 26: 281-296. Doi: 10.3109/09513590903247873
  3. Yin J, Gao Z, He Q, Zhou D, Guo Z, Ye J. Role of hypoxia in obesity induced disorders of glucose and lipid metabolism in adipose tissue. Am J Physiol Endocrinol Metab 2009; Feb. 296: 333-342. Doi: 10.1152/ajpendo.90760.2008.
  4. Song W.-J. · Shi X. · Zhang J. · Chen L. · Fu S.-X. · Ding Y.-L.Akt-mTOR Signaling Mediates Abnormalities in the Proliferation and Apoptosis of Ovarian Granulosa Cells in Patients with Polycystic Ovary Syndrome.Gynecol Obstet Invest 2018; Jul. 83:124–132. Doi: 10.1159/000464351
  5. Maciel GA, Baracat EC, Benda JA, Markham SM, Hensinger K, Chang RJ, Erickson GF. Stockpiling of transitional and classic primary follicles in ovaries of women with polycystic ovary syndrome. J Zuhrah, et al. http://doi.org/10.28969/IJEIR.v11.i1.r5.21 Clin Endocrinol Metab 2004; Nov. 89: 5321-5327. Doi: 10.1210/jc.2004-0643.
  6. Steiber A, Kerner J, Hoppel CL. Carnitine: a nutritional, biosynthetic, and functional perspective. Mol Aspects Med. 2004. Dec. 25(5-6):455-73. Doi: 10.1016/j.mam.2004.06.006.
  7. Zhang X, Wu XQ, Lu S. Deficit of mitochondria-derived ATP during oxidative stress impairs mouse MII oocyte spindles. Cell Res 2006; Sep.16:841–50. Doi: 10.1038/sj.cr.7310095.
  8. Raheem FA, Mossa HAL, Abdulhamed WA. Altamimi LR. Assessment of Oxidative Stress Changes in Serum and Follicular Fluid in Relevance to GnRH Rival Protocol in Iraqi Infertile Ladies Undergoing ICSI. Ejmed 2019;1(5):1-5. Doi.org/10.24018/ejmed.
  9. Ludwig M, Finas DF, al-Hasani S, Diedrich K, Ortmann O. Oocyte quality and treatment outcome in intracytoplasmic sperm injection cycles of polycystic ovarian syndrome patients. Hum Reprod. 1999 Feb;14(2):354-8.
  10. Alzaidi, Z., Yildiz, Ş.M., Saatçi, Ç. et al. The effect of cytokine leukemia-inhibitory factor (LIF) and interleukin-11 (IL-11) gene expression on the primary infertility related to polycystic ovary syndrome, Tubal factor, and Unexplained infertility in Turkish women. Egypt J Med Hum Genet 22, 85 (2021). https://doi.org/10.1186/s43042-021-00201-9
  11. Sheida A, Davar R, Tabibnejad N, Eftekhar M. The effect of adding LCarnitine to the GnRH- antagonist protocol on assisted reproductive technology outcome in women with polycystic ovarian syndrome: a randomized clinical trial. Gynecol Endocrinol. 2021 Feb 1:1-5. Doi:10.1080/09513590.2021.1878135
  12. Ismail AM, Hamed AH, Saso S, Thabet HH. A. A randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2014 Sep; 180:148-52. Epub 2014 Jun 23. PMID: 25015747. Doi: 10.1016/j.ejogrb.2014.06.008. Zuhrah, et al. http://doi.org/10.28969/IJEIR.v11.i1.r5.21