Obesity induces metabolic dysfunctions in bodily systems and is a significant health challenge. Excessive adipose tissue accumulation encompasses dynamic, endocrine, and biologically active processes. The fundamental pathogenic mechanism of obesity is chronic low-grade inflammation exacerbated by pro-inflammatory biomarkers such as free fatty acids, lipopolysaccharides, adipokines, and cytokines. The rising prevalence of obesity over the past forty years has led to an increase in associated comorbidities, including polycystic ovarian syndrome (PCOS). To clarify the impact of increasing body mass index (BMI) in PCOS and non PCOS on the ICSI outcomes of 143 infertile Iraqi females, dividing them into two main groups: PCOS and non PCOS and each group into normal weight and overweight/obese group. Group 1= normal BMI PCOS, group 2= overweight/ obese PCOS, group 3= normal BMI non PCOS, group 4= overweight/obese non PCOS. Significant differences in ICSI outcomes were observed in the PCOS groups compared to the non-PCOS groups concerning the total number of harvested, MI, MII oocytes, GV, abnormal and fertilised oocytes, total and D3 grade I embryos alongside higher number of arrested and transplanted embryos. There are numerically higher number of D3 grade II and III embryos, morula and blastocyst with no significant difference seen. The rates of maturation and fertilisation exhibited no significant disparities. The biochemical pregnancy rate was higher in group 2 compared to group 1, and in group 4 compared to group 3, with a statistically significant difference. A higher BMI among younger PCOS individuals may be associated with better pregnancy outcomes.
Activin is a member of the transforming growth factor-beta superfamily and is a polypeptide growth factor. Activin regulates follicle growth, gonadotropin responsiveness, steroidogenesis, oocyte maturation, ovulation, and corpus luteum function in the ovary via a local autocrine/paracrine effect. Activin measurement A level in serum and follicular fluid during the preovulatory stage in PCOS women undergoing an IVF/ICSI cycle to predict fertilization capacity earlier Fifty infertile couples, 25 with PCOS and 25 without PCOS, who attended Al Nahrain University in Baghdad, Iraq's High Institute of Infertility Diagnosis and Assisted Reproductive Technologies. The females that participated were between the ages of 18 and 40. On the day of oocyte retrieval, the level of Activin A in serum and follicular fluid was measured. Activin A levels in PCOS women's serum (activin A=1274 77.9) and follicular fluid (activin A =1038 50.3) compared to non-PCOS women's serum (activin A=453 25.74) and follicular fluid (Activin A=450 23.73). The study shows no correlation between activin A hormone with oocytes characteristics and fertilization rate in PCOS women with a significant increase of activin A hormone in the serum and FF of PCOS women compared to non PCOS women. Activin A level can predict a diagnosis of PCOS in addition to positive predictive pregnancy but not indicator of fertilization capacity in PCOS women.
Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Polycystic ovary syndrome signs and symptoms often begin soon after menarche. In some cases, PCOS develops later during the reproductive years, for instance, in response to substantial weight gain. The PCOS produces symptoms in about 5-10% of women of reproductive age(12-45 years) and it is one of the leading causes of female subfertility.Women with PCOS suffer not only from subfertility, but also from a high rate of early pregnancy loss. About 30-50% of clinically confirmed early pregnancy loss are associated with PCOS.In addition to early pregnancy loss, women with PCOS have increased risk of recurrent miscarriage ,which defined as 3 or more consecutive pregnancy loss before 20 week. Metformin hydrochloride, an insulin sensitizing agent, has been shown to have encouraging effects on several aspect of PCOS like insulin sensitivity, plasma glucose concentration & lipid profile.It is found that using Metformin during pregnancy in women with PCOS may reduce the pregnancy loss and also reduce the risk of gestational diabetes,intrauterine growth retardation(IUGR) & preterm labor. Aim of study: To evaluate the role of Metformin in women with recurrent miscarriage & its effect on other pregnancy complications in women with PCOS. Patients, Materials & Methods: A prospective study done at gynecology outpatient clinic of AL-Batool Teaching Hospital in Baquba-Diyala -Iraq, from September 2012 to September 2016. A total of 100 cases were studied, all have aconfirmed diagnosis of PCOS depending on the following criteria:1)Oligo or amenorrhea (8 or fewer cycles per a year) , 2) signs of hyperandrogenism 3)ultrasound features of PCOS.All should have history of 3 or more recurrent first trimester miscarriage & they were invistigated for other causes of recurrent miscarriage. All cases were followed before getting pregnant and received Metformin for enhancing fertility & when they become pregnant, they were divided into two groups: the 1st group stopped using Metformin once they get pregnant while the 2nd group continued to use Metformin in a dose of 500-1000mg per day throughout pregnancy .Both groups are followed to determine pregnancy outcome. Results: Patients who continued to receive Metformin during pregnancy had better pregnancy outcome regarding early pregnancy loss and recurrent miscarriage, gestational diabetes development, IUGR & preterm labor. Conclusions: Metformin use during pregnancy improve pregnancy outcome in patients with polycystic ovary syndrome.
CA125 is a glycoprotein mucins (MUC16) tumor marker, used in screening, ovarian and endometrial malignancies and in monitoring therapy, early recurrences, and prognosis of these cancers. Hormonal induction for ovulation can elevate the risk of ovarian cancers so CA125 may be used for screening in PCOS as an unsafe group and the way of treatment may need to be changed in these patients. Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal disturbed diseases that can affect females in reproductive life. It has both metabolic and fertility impacts that can be seen in the reproductive period and post-menopausal life. To study the correlation between PCOS and CA125 level in relation to body weight in non-cancerous patients. 60 women were selected with age 18-42-year-old forty of them were diagnosed with PCOS according to Rotterdam criteria. They were divided into two groups according to BMI G1 was more than 25 kg/m 2 (overweight and obese) G2 was less than 25 kg/m 2 (normal) and the G3 was 20 healthy non-PCOS BMI less than 25 kg/m 2 . Blood samples were taken in the early follicular phase for assessing luteinizing hormone (LH), follicular stimulating hormone (FSH) and, free testosterone (FT) hormone. Other blood samples were taken at the late follicular phase to measure CA125 levels using Enzyme-Linked Immune Sorbent Assay (ELISA). PCOS G2 were significantly higher in the concentration of CA125 than PCOS G1 (p< 0.05), but there was no significant difference in CA125 level in groups when there is no significant difference in body mass index (BMI) between PCOS G1 and G2. P>0.05. The negative relation between CA125 concentration and weight. The tumor marker CA125 efficacy is decreased in obese women. Furthermore, PCOS not causes an increase in CA125 in the non-cancerous patient.
Background: Polycystic ovarian syndrome (PCOS) is the most common cause of hyperandrogenism anovulatory infertility; it affects 5-10% female reproductive age. The present study aims to investigate the total prostate specific antigen levels, total serum testosterone, FSH and LH in women with PCOS and compare the results with control group of normal fertile females of corresponding age group on Iraqis PCOS patients. Materials and Methods: Seventy patients with PCOS diagnosed depending on three criteria: Menstrual history: Oligomenorrhea, Ultrasound reveals polycystic ovaries and Biomedical and/ or clinical hyperandrogenism. Twenty normal fertile females who serve as control group in this study. Blood samples were aspirated from all individuals from 2-4 day of menstrual cycle to measure total prostate specific antigen(PSA), total testosterone and FSH, LH. Results: Patients with PCOS and controls differed significantly in PSA, Total serum testosterone (p<0.05). Patients with PCOS and controls have highly significant difference in LH level, the mean was (7.88±1.83 vs 3.90±0.73) respectively highly significant difference in LH/FSH ratio and BMI parameters (p<0.001). No significant differences were found in FSH (p>0.05). Positive correlation between PSA and testosterone, PSA and BMI. Conclusion: Total serum prostate specific antigen levels are higher in patient with PCOS. Total testosterone levels are higher in patient with PCOS. Serum PSA measurement might be marker of hyperandrogenism in females suffering from PCOS.
Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders among females in reproductive age. Women with PCOS have several cardiovascular disease risk factors. Hyperinsulinemia and insulin resistance (IR) which is a known key factor in the development of type 2 diabetes (T2DM) may associate PCOS. Homocysteine, a sulfur-containing amino acid, is toxic to vascular endothelium, leads to early atherosclerosis. PCOS said to be associated with high plasma homocysteine. Objective: To determine the correlation between insulin resistance and homocysteine in PCOS patients. Methods: Patients diagnosed as PCO according to Androgen Excess and PCOS Society/2009 criteria were grouped into two groups: those with BMI less than 30kg/m2 and those with BMI 30kg/m2 and more. Blood was drawn for biochemical and hormonal assay. Information tabulated, means and percentages used, and the results were analyzed. Results: Homocysteine levels were significantly higher (P value < 0.05) in PCOS group (12.28±1.89 µmol/l) as compared to control (9.51±1.92 µmol/l).HOMA-IR was significantly higher (P value < 0.05) in PCOS (4.15±2.54) as compared to control (1.69±0.54) .There was no correlation between IR and homocysteine within PCOS group. Conclusions: Polycystic ovarian patients have higher levels of homocysteine and IR compared to control but there is no correlation between IR and homocysteine within PCOS group.
Background: Polycystic ovarian syndrome (PCOS) constitutes the most common endocrinopathy of women of reproductive age. Women with PCOS manifest hyperandrogenemia, hyperinsulinemia, and hypothalamic-pituitary-ovarian axis aberrations. Objective: The objective of the present study was to find the prevalence and the presenting features of PCO patients and associated manifestations in relation to biochemical and anthropometric parameters in adult obese women attending obesity research and therapy unit. Methods: Patients diagnosed as PCOS according to Androgen Excess and PCOS Society/2009 criteria were grouped into two groups: those with BMI less than 30kg/m2 and those with BMI 30kg/m2 and more. Blood was drawn for biochemical and hormonal assay. Information tabulated, means and percentages used, and the results were analyzed. Results: The number of adult females 20-40 years of age attending Obesity research and therapy unit (ORTU) during February 2013 to February 2014 was 756, (14.3%) of them had PCOS, (65%) were diagnosed during examination. (94.4%) had menstrual disturbances, (63.8%) had hirsutism and (91.7%) had PCOS ultrasound findings. Mean BMI of the patients with PCOS was 33.62 (SD 4.21). Mean LH exceeded mean FSH in patients with PCOS and it was more evident with increasing BMI where it was doubled in those with BMI more than 30 kg/m2. LH/FSH ratio for BMI above 30 was 2.1, and although testosterone level was elevated showed no statistical relation to BMI. The fasting glucose level, cholesterol and triglycerides levels showed the same pattern of elevation that with increasing BMI. Conclusions: The prevalence of PCOS in females (20-40y) attending ORTU was 14%, of them 65% were undiagnosed before, 63% had hirsutism, 94% had menstrual disturbances and 90% had ultrasonic features of polycystic ovary. These findings suggest the need to stress on diagnosing PCOS in adult female during management of obesity.
Background: Polycystic ovary syndrome (PCOS) is the most common cause of hyperandrogenism anovulatory infertility; it affects 510-% of females in the reproductive age. PCOS is a risk disease; it has an association with gynecological malignancy. Objectives: To determine whether Cancer Antigen 125 (CA125) and Cancer Antigen 153-(CA153-) levels are increased in PCOS and possibility of CA125 and CA153- to be used as a diagnostic marker of PCOS. Methods: Seventyfemales with PCOS diagnosed depending on threecriteria: Menstrualhistoryofoligomenorrhea ultrasound examinations revealed polycystic ovaries and biochemical hyperandrogenism. Twenty normal fertile females serve as control group. Blood samples were obtained from all individuals from 2nd-4th day of menstrual cycle to measure levels of FSH, LH and testosterone.Second blood samples were collected from the same patients during late follicular phase to measure CA153- and CA125( by ELISA). Results: Females with PCOS and controls differed significantly(p< 0.05) in total serum testosterone (p). Females with PCOS and controls have highly significant difference (p < 0.001) in LH mean level (7.881.83+ vs 3.900.73+) respectivelyand, highly significant difference (p < 0.001) in LH/FSH ratio and BMI parameters. No significant differences (p > 0.05) were found in FSH, CA125 and CA153- between PCOS patients and the controls.There were positive correlation between testosterone and CA125.Negative correlation between testosterone and CA153- serum values. Conclusion: There were no changes in the serum levels of CA125andCA153- in PCOS patient at the age of reproduction and those cancer antigens could not be used as diagnostic markers for polycystic ovarian syndrome.
Background: Leptin, a key hormone in energy homeostasis and neuroendocrine function, has a permissive role in the pathogenesis of reproductive dysfunction. Objective: To assess the role of serum leptin in women with PCOS and to evaluate leptin and insulin levels in PCOS women before and after treatment with metformin. Materials and Methods: Sixty women of reproductive age (18- 38years) were allocated to four groups: 15 obese women with PCOS (BMI >30 kg/m2), 15 obese controls, 15 non-obese women with PCOS (BMI 18 -30 kg/m2), and 15 non-obese controls. Serum leptin and insulin levels were measured and compared between case and control subjects also comparison done pretreatment and after treatment with metformin. Results: There was a significant increase in leptin in nonobese PCOS compared to non-obese control (5.64±1.43), (P value=0.0032), insulin level was significantly higher in PCOS group (15.87±6.65) than control (5.47±1.68), (P value<0.001). There was significant decrease in BMI, leptin and insulin levels after 12 month of metformin treatment in obese and non-obese PCOS subjects. Conclusion: Leptin level increased remarkably with increasing body weight and it is higher in non-obese PCOS women in comparison with non-obese healthy women.
Polycystic ovarian syndrome (PCOS) is a group of clinically distinct endocrine conditions. Insulin resistance-related proteins are involved in PCOS pathogenesis. Irisin is a new myokine that functions similarly to adipokines. Irisin has been linked to insulin resistance and metabolic syndrome. There have been conflicting findings regarding irisin levels and their connection to hormonal and metabolic alterations in PCOS .This study aimed to compare the levels of irisin in follicular fluid and serum between women with PCOS and healthy women and correlate them with oocyte and embryo quality in women undergoing the ICSI cycle .Ninety infertile Iraqi women were enrolled, 46 women with PCOS and 44 weight-matched non-PCOS controls, in whom ICSI was done for them and evaluated the level of follicular fluid, serum Irisin, and insulin level with measure of Homeostasis Model of Assessment-Insulin Resistance (HOMA-IR) and correlate them to with oocyte and embryo quality. HOMA-IR, FF, and serum irisin levels in PCOS considerably increased. (P ≤ 0.01). In addition, there was a significant negative correlation between Irisin levels in follicular fluid and serum with MII oocyte, oocyte maturity rate, and grade 1 embryo. The serum, follicular fluid Irisin, and HOMA-IR were significantly higher in PCOS than in control cases, which may cause a reduction in oocyte maturation, embryo quality, and pregnancy outcome.
Pregnancy-Associated Plasma Protein (PAPP-A) is a zinc metalloproteinase in the insulin growth factor system (IGFs) produced by the syncytiotrophoplast region of the placenta. It plays a critical function in the cleavage of IGFBP4. In the ovary IGFs, it regulates follicular and oocyte maturation, and steroidogenesis. While in polycystic ovarian syndrome (PCOS) Hyperinsulinemia and hyperandrogenemia it causes follicular environment changes and early ovulation resulting in lower oocyte and embryo quality in patients and this will decrease the success of pregnancy in women enrolled in the ICSI cycle. The present study aimed to assess the relationship of PAPP-A levels in serum and follicular fluid in women with PCOS and non-PCOS with oocyte and embryo quality in women undergoing ICSI cycle. 45 infertile Iraqi women were enrolled. Women with PCOS had to meet at least two of the three criteria set by the Rotterdam ESHRE/ASRMS criteria, the age of the included women ranged between 20-45 years. In non-PCOS patients, PAPP-A has higher level in serum and follicular fluid but without a statistically significant difference matching with PCOS group. In addition, there was no significant correlation between PAPP-A levels in serum and follicular fluid with oocytes and embryo characteristics. However, PAPP-A levels are higher in serum and follicular fluid in women with positive pregnancy but without significant differences. PAPP-A had no correlation with oocyte and embryo quality.
Background: Elevated serum concentrations of testosterone is common in women with polycystic ovary syndrome (PCOS)but it'srelationto body mass in dex(BMI), isstillunknown. Objective: The present study was conducted to investigate the relationship between testosterone level and body massindexin womenwith polycysticovary syndrome. Methods: A total of eighty PCOS women with average age 27.6±0.7 and BMI 31.9±0.5 were compared with twenty-two healthy women considered as a control group (age 28.2±1.1, BMI 28.8±1.0). Patients and controls were grouped according to (BMI: Lean, overweight and obese. Allwomen in both groups were subjected to the following investigations: evaluation of luteinizing hormone (LH), follicle stimulating hormone (FSH.), prolactin (PRL), testosterone levels and ultrasonography. Results: The serum levels of LH, LH/FSH and testosterone were significantly higher (P< 0.05) in PCOS compared to control women,while in FSH and PRL the difference was non significant. Obese women with PCOS also had a significantly higher (P<0.05) mean level of testosterone (1.33±0.28ng/ml) compared to lean and overweight patients (0.53±0.17, 0.61±0.08 ng/ml respectively). Uitrasound examination was performed in the ovulatory phase during (12-14) days of the cycle in both PCOS patients and controls, and all women with PCOS with evidence of polycystic ovaries on ultrasonography. Conclusion: Testosterone levelwas significantly elevated in obesecompared to overweightand lean women with PCOS.The role of weight reduction is more beneficial in the management of PCOS and improvementoftestosteronelevel.
Background: Polycystic ovary syndrome (PCOS) is the most common and prevalent endocrinopathy in women, and the most common cause of anovulatory infertility. An altered lipid profile is common in polycystic ovary syndrome (PCOS) and is usually characterized by increased total cholesterol, triglycerides, low-density lipoproteins and very low density lipoprotein levels with low high-density lipoprotein. PCOS is associated with a higher frequency of cardiovascular disease because of dyslipidemia. Which are potent markers for cardiovascular risk factors. Metformin, is a widely used antihyperglycemic agent. It decreases insulin resistance and reduces hyperglycemia through a reduction of the hepatic glucose production. Objectives: Determine the beneficial effect of metformin in PCOS patients in reducing lipid profile and subsequently reduction in cardiovascular disease. Method: Measurements and analysis levels of total cholesterol, triglycerides, low-density lipoproteins, very low density lipoprotein and high-density lipoprotein were samples collected at the Institute of embryo research and infertility treatment, Al-Nahrain University. PCOS patients were recruited at the consultant clinic Patients: forty three women with PCOS were studied. Anthropometric data, lipid profile, were evaluated, before oral metformin (500mg/twice daily) treatment and after three months of use. Results: Patients with PCOS after oral metformin treatment, revealed a significant lowering serum concentrations of total cholesterol, triglyceride, low-density lipoproteins and very low density lipoprotein and elevated high-density lipoprotein compared to before treatment. Conclusions: dyslipidemia is common finding in PCOS women, in this study we found that the use of oral metformin tablets 500mg/twice daily for three months will correct lipid profile level (cholesterol, triglyceride, LDL, VLDL and HDL) which is considered as cardiovascular risk factors and this lead to reduce risk of cardiovascular diseases.
Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder with symptoms and diverse clinical manifestations. Obesity, a common comorbidity in PCOS, may exacerbate and lead to varied hormonal and inflammatory profiles. This study aimed to compare serum DHEAS, TNF-α, and IL-10 levels between obese and non-obese women with PCOS, providing insights into the intricate interplay between obesity, hormonal imbalances, and inflammation in this condition and offering potential pathways for enhancing fertility treatment outcomes in this challenging patient population. In this cross-sectional study, the data was analyzed from sixty -five women diagnosed with PCOS, categorized into two groups based on their Body Mass Index (BMI): Thirty-eight were non-obese (BMI < 30) and twenty-seven obese women (BMI ≥ 30). Serum samples were collected to measure DHEAS, TNF-α, and IL-10 levels using the ELIZA kit. These measures were then compared between the two groups to ascertain any significant differences. The study found significantly higher serum DHEAS levels in non-obese PCOS patients compared to their obese counterparts (p = 0.01). However, no significant difference was observed in serum TNF-α and IL-10 levels between the two groups (TNF-α p = 0.58; IL-10 p = 0.13). Serum DHEAS were significantly higher in non-obese compared to their obese counterparts’ women with PCOS. In contrast, no significant variance was found regarding S.TNF-α and S.IL-10 between the two groups
Background: Polycystic ovary syndrome is the most common, yet complex, endocrine disorder with principal features of anovulation, amenorrhea, ovulation-related infertility, polycystic ovaries, and obesity. Number of metabolic aberrations is now well recognized as a growing public health problem in PCOS as glucose intolerance, hyperinsulinemia and dyslipidemia. Objective: To investigate and analyze the anthropometric, hormonal profile and metabolic abnormalities of obese and non-obese women with this disorder. Materials and Methods: Sixty-five healthy Iraqi women serves as the control group and eighty-four infertile women divided into two subgroups depending on the BMI (< and ≥30 kg/m2) were studied. BMI, waist to hip ratio and waist to thigh ratio were measured. Serum levels of luteinizing hormone, follicle stimulating hormone, estradiol, testosterone, fasting blood glucose, and oral glucose tolerance test, and total lipid profile were measured. Results: BMI, waist/hip, waist/thigh ratio were significantly higher in PCOS than control women. Lower FSH level, higher LH and E2 levels, LH/FSH ratio, and lower E2/testosterone ratio was found in obese and non-obese PCOS. Higher blood sugar level, high cholesterol, triglyceride, LDL, VLDL and lower HDL levels in PCOS compared to control women. Conclusion: Obesity is a common finding of women with PCOS, but it is not part of the diagnostic criteria. Women with PCOS usually have the so-called centralobesity (Visceral adiposity), and therefore tend to have an increased waist-hip ratio (WHR) and waist to thigh ratio, regardless of the weight factor (i.e., in obese and non-obese). PCOS patients exhibited abnormal hormonal status and biochemical indices also regardless of obesity.
Resistin and follistatin levels have been found to be high in polycystic ovarian syndrome (PCOS) patients, that play role in pathophysiology of PCOS and pregnancy status of women having ICSI cycle. This study aimed to determine the relationship between the hormone levels and pregnancy outcome in PCOS and non-PCOS women undergoing intracytoplasmic sperm injection (ICSI) program. The study was done at Higher Institute for Infertility Diagnosis and Assisted Reproductive Technologies from 2022 to 2023. Eighty infertile women participating in the IVF/ICSI treatment. They were split to control (40 non-polycystic ovarian syndrome-PCOS women) and 40 women for PCOS group. They were subdividing to subgroups’ according to body max index (BMI; normal and overweight / obese). ELISA method was used to measure hormone level at day 2 and follicular fluid and serum at day of ova pick up. About 38.8% of study participants were got pregnant. Means of serum resistin and follistatin in day 2 and OPU were significantly higher in patients with PCOS and normal BMI level while follistatin at day 2 and in follicular fluid (FF) were significantly higher in participants who got pregnant. Follistatin level at day 2 > 9.89 ng/ml and in FF > 15.06 ng/ml and might be as a predictor for occurrence of pregnancy after ICSI. The cutoff point of follistatin level in the serum at day two and in FF at the day OPU was found to be a predictor of pregnancy following ICSI, while no correlation was found between resistin and pregnancy outcome.
Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility and is associated with an increased risk of premature luteinizing hormone (LH) surges during controlled ovarian stimulation. Progestin-primed ovarian stimulation (PPOS) using Medroxyprogesterone Acetate (MPA) has emerged as a convenient alternative to conventional gonadotropin-releasing hormone (GnRH) antagonist protocols. This study aimed to compare the effects of MPA-based PPOS and GnRH antagonist protocols on oocyte yield, maturation, fertilization, and embryo quality in women with PCOS undergoing ICSI . This prospective, randomized, open-label controlled clinical trial included 108 women with PCOS undergoing ICSI at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq, between 2023 and 2024. Participants were allocated to an MPA-based PPOS group (n=49) or a flexible GnRH antagonist group (n=59). Oocyte yield, metaphase II (MII) oocytes, fertilization rate, embryo quality, ovarian sensitivity index (OSI), gonadotropin consumption, stimulation duration, and LH profiles were evaluated.No significant differences were observed in baseline characteristics or hormonal profiles between groups. The MPA group showed a numerically higher number of retrieved oocytes (20.65 ± 7.50 vs. 13.39 ± 4.41; p=0.083) and MII oocytes (15.10 ± 5.20 vs. 11.24 ± 4.12; p=0.09), although these differences were not statistically significant. Fertilization rates were comparable between groups (72.4 ± 10.6% vs. 71.2 ± 11.3%; p=0.68), as were embryo quality, OSI, gonadotropin consumption, and stimulation duration. Both protocols effectively suppressed premature LH surges without premature ovulation or cycle cancellation. MPA-based PPOS appears to be an effective and practical alternative to GnRH antagonist protocols for PCOS patients undergoing ICSI, providing comparable fertilization and embryological outcomes with effective LH suppression. Its oral administration and potential cost advantages may be particularly valuable in resource- limited ART settings.
Background : With the rapid evolution of assisted reproductive technologies, more and more studies are concerned about the possible influential factors on the success rates of these procedures, with the efforts are now mainly directed toward defining these factors in a trial to increase these rates. Of these factors, inflammation is considered among the most remarkable and is in the focus of the updated studies. However, most of these studies are evaluating the role of inflammation in patients with polycystic ovarian syndrome(PCOS) , while the impact of this inflammation in insulin resistant non PCOS patients is underesti mated and not well evaluated . Objectives: This study is a trial to elucidate the importance of one of the inflam matory mediators , Tumor Necrosis Factor-alpha (TNF – α) , in insulin resistant patients undergoing IVF ( ICSI ) cycles . Patients and Methods: A group of 27non-PCOS infertile patients were select ed for this clinical randomized prospective study from patients attending the high institute for infertility diagnosis and assisted reproductive technologies / Al-Nahrain University and subjected to intra-cytoplasmic sperm injection (ICSI) procedure. BMI was measured for all patients and they were classified according to WHO classification into 3 groups : Acceptable , overweight and obese . Fast ing plasma level of glucose and insulin was investigated and insulin resistance index (HOMA) was calculated. Serum TNF-α has been measured using ELISA and the relation with insulin resistance was investigated. Finally, the pregnancy rate, as a primary reproductive endpoint was compared according to TNF -a and insulin resistance levels between different study subjects. Results: Of the 27 infertile patients , 17(63 %) were non obese and 10 (37%) were obese , 15(55.5%) were having HOMA index < 1.6 and 12 (44.5 %) were having HOMA index ≥ 1.6 . BMI was found to be positively correlated with high er HOMA index ( P = 0.01 and R= 0.4 in spearman correlation). Investigating the relation between TNF-α with BMI revealed that TNF-α levels are increasing with the increment in BMI, However , the difference in the mean TNF-α between the three BMI groups failed to achieve statistical significance (P=0.1). In contrast to that, when stratifying for HOMA index , TNF-α was significantly correlated with it ( spearman correlation R= 0.4 , P=0.01 ) , and patients with HOMA index ≥1.6 were found to have higher levels of TNF-α ( P = 0.03) and to be more obese ( P=0.02 ) than those with HOMA index <1.6.
To assess the predictive value of different clinical, laboratory, and ultrasound parameters in Letrozole when used as an ovulation induction in anovulatory infertile PCOS women. The current study was done in the secondary-referral infertility clinic in AL-Yarmouk teaching hospital, and Al-Mustansiriyah medical college. Sixty-seven anovulatory infertile women with the polycystic ovarian syndrome. Letrozole was given orally on day 2 or 3 of the menstrual cycle for five days and repeated for three consecutive cycles. The primary outcome measures were to evaluate the response rate in the form of successful ovulation and clinical pregnancy. The ovulation rate was (64.2%), with clomiphene naïve vs. previous clomiphene use; it was 87.5%, 51.2% respectively, while pregnancy rate was (32.8%), 41.6% with clomiphene naïve vs. 27.9% with previous clomiphene use. Clinical (age, BMI, Waist circumference, cycle length and days between cycle, infertility period and type, previous reproductive outcome, androgen symptom and m-FG score), laboratory (E 2 , FSH, LH, testosterone, FAI, FBS, fasting insulin, HOMA – IR, and AMH) and ultrasound (mean ovarian volume, mean AFC and antral follicular diameter) parameters were founded to affect ovulation and pregnancy in different extent. After putting all variables in a scoring system, it was found that if the patients had > 26 points for the score, it's more likely that the woman becomes pregnant. A predictive pregnancy score was developed from basic clinical, laboratory, and ultrasound parameters. It may help the clinician to individualized ovulation induction protocol in PCOS women; however, external validation of this system is recommended in a more extensive prospective study.
Background: The effects of Lead and other essential metal like zinc and copper on the reproductive system have been previously reviewed. Objective: Our goal in this study was to estimate the levels of Lead, Zinc and Copper in patients with polycystic ovary syndrome and to confirm the effect of such metals on the female reproductive system at environmental exposure. Materials and Method: Fifty two women in their reproductive age (20-40) years old, which had been diagnosed as PCOS. Venous blood sample were taken from each patient and control, blood lead, zinc and copper were determined by atomic absorption spectrophotometer. Hormone assay were determined by ELISA (Enzyme Linked Immune Sorbet Assay) technique. Results: This study showed a significant increase of blood lead and serum zinc, copper (p<0.01), in addition to testosterone, lutenizing hormone, LH/FSH ratio and body mass index (BMI) (p<0.05) in patients with polycystic ovary syndrome when compared with control. Conclusions: On the basis of the observations of the present study, it can conclude that the increased levels of Lead as a result of the exposure to this metal may be a risk factor for the development of polycystic ovary syndrome in women and has adverse effects on female endocrine and reproductive function.
During the process of embryo development, endometrial receptivity is very important for the successful implantation of blastocysts. This research investigated the influence of endometrial thickness on the day of oocyte retrieval and fresh embryo transfer on pregnancy outcomes in Iraqi women who are undergoing intracytoplasmic sperm injection (ICSI). Women from Iraq are taking part in this investigation. Participating in in vitro fertilization (IVF) cycles with the use of ICSI was a group of 44 women who were diagnosed with polycystic ovarian syndrome (PCOS) and had unexplained infertility. During the phases of oocyte retrieval and embryo transfer, there were significant differences seen between the two groups (p-values of 0.003 and 0.049), respectively. There was a total of 44 individuals, and 31 of them had negative pregnancy test results. The remaining 13 persons had positive findings. These results illustrate the importance of endometrial thickness in influencing the effectiveness of assisted reproductive technologies in achieving pregnancies.
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.