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.
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 : 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.
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.
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.
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.
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 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.
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.
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.
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.