Background: Azoospermia is defined as the lack of sperm in male ejaculate and is suggested to be present in about 1 % of all males and to account for 10-15% of the causes of infertility in men. The development of intracytoplasmic sperm injection (ICSI) as an effective therapy. Embryo grading has gained special attention in published literature regarding its predictive role in pregnancy outcome following ICSI; however, substantial controversy is present that justified the carrying out of the present study. Objective: To study the association between embryo quality and pregnancy rate in women of males with azoospermia. Patients,Materials and Methods: This prospective cohort study included 60 patients with azoospermia, 15 male with obstructive type and 45 males with non-obstructive type.Those patients were randomly selected form the population of infertile couples who regularly visits the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies and from Kamal Al-Samarrai Hospital -Center for Infertility Treatment and IVF. Results Pregnancy was encountered in 7 patients (23.33%). It was not statistically associated with type of azoospermia (P=0.388), also it was not affected by age and serum hormonal level, but highly determined by good quality of embryo. Quality of embryo was graded from 1 to 4. The lower the grade, the better the quality of the embryo was. Quality of embryo was not significantly correlated with type of azoospermia, age and hormonal levels. Conclusions Good quality of embryo is a significant predictor of positive pregnancy outcome in ICSI and the quality of embryo is not affected by age of male patient or type of azoospermia.
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.
Implantation failure and disorders of endometrial receptivity represent an essential cause of infertility; multiple parameters were needed to predict the uterine receptivity understanding that no sole parameter could predict the same. A score was termed as (Uterine Biophysical Profile) could be utilized as a predictor of endometrial receptivity. To evaluate the predictive potential of Uterine biophysical profile of both endometrial receptivity and pregnancy outcome in infertile women undergoing Intrauterine Insemination (IUI). The current cross-sectional study was conducted in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in Al Nahrain University, Baghdad, Iraq from the 1 st of Oct. 2018 till 1 st of May 2019 involving seventy women of infertile couples with the same inclusion and exclusion criteria. Uterine biophysical profile was evaluated using a doppler ultrasound examination and then a score was calculated and correlated to pregnancy outcome. The mean Uterine Artery Pulsatility Index (UAPI) was significantly lower in women with positive pregnancy in comparison to women with negative pregnancy, 2.10±0.19 versus 2.47±0.65, respectively (P=0.032). Moreover, no women with Pulsatility Index (PI) score (0) succeeded to get pregnant and the higher the score, the higher the rate of pregnancy (P=0.006). Furthermore, Spearman correlation showed significant positive correlation between positive pregnancy outcome and UAPI (r=0.365; P= 0.002). The mean total score was significantly higher for pregnant women than in women with negative pregnancy, 18.27±1.33 versus 16.35±2.47, respectively (P= 0.005). The cutoff value was >17 with an acceptable accuracy level of 74.2. The sensitivity of that cutoff vale was 80 % and the specificity was 65.5%. Uterine artery pulsatility index and total uterine biophysical score are the principal predictors of positive pregnancy outcomes in infertile women undergoing IUI.
Fertility is a fundamental function of reproductive health that is under the control of different hormones, cytokines, and growth factors. Transforming growth factor superfamily is a group of cytokines necessary for blastocyst implantation as they regulate endometrial stromal cell proliferation, and promote embryonic adherence to the receptive endometrium. Hyaluronic acid molecule (HA) is a long, unbranched polysaccharide that plays a delicate function in reproduction. Hyaluronic acid regulates gametogenesis, folliculogenesisi, and implantation, thereby was oroposed to improve the rate of successful pregnancy.This study is a prospective clinical trial that includes 80 infertile Iraqi women aged (18-40 years) scheduled for fresh ICSI program. The study sample had been divided into 2 groups based on the type of intervention performed on the day of oocytes retrieval. The Hyaluronic acid group and the control group. For each participant, twice measurement of the serum level of transforming growth factor were done , the first measure was done on day of oocytes retrieval, while the second measure was performed on day of embryo transfer. A comparative statistic was made to examine the effect of hyaluronic acid intrauterine wash on the serum level of transforming growth factor and pregnancy rate.Hyaluronic acid intrauterine wash exerts a significant reduction in transforming growth factor serum level, and a significant improvement in the pregnancy outcome compared to the control group.
Successful implantation needs a receptive endometrium, a functional and normal embryo at the stage of blastocyst developmental and a synchronized dialogue between embryonic tissues and maternal tissues. The current study was planned and conducted to investigate the potential role of vaginal pessary of hyaluronic acid on intracytoplasmic sperm injection (ICSI) outcome. This study included 63 infertile women (32 women as study group receiving hyaluronic acid and 31 control group) who were subjected to ovulation induction programs with gonadotropin releasing hormone (GnRH) antagonist protocols for in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) procedures. Blood samples were taken by Vacutainer tubes and centrifuged according to the manufacturer’s instructions for the preparation of serum samples. Serum samples for Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) were obtained from each patient when the basal hormonal status was determined. The second time point is when the samples were obtained on the day of ova pickup, after that the G1 embryos will be transferred inside the uterine cavity. Then performance of endometrial receptivity parameters or patterns evaluation and patients were followed up to do pregnancy test after14 days after embryo transfer. On the day of human chorionic gonadotropin (hCG), there was no significant difference in mean serum Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) between hyaluronic acid group and reference group, respectively (p = 0.824). There was no significant difference in mean follicular fluid Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) between the hyaluronic acid group and reference group, 0.92 ±0.36 pg/ml versus 0.82 ±0.22 pg/ml, respectively (p = 0.223). Treatment with the hyaluronic acid resulted in non-significant increase in serum and follicular fluid Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1), and this increment is not related to Lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) improvement in local blood endometrial blood flow as reflected by reduction in resistive index and pulsatility index with eventual improvement in pregnancy outcome.
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.
E ndometrial thickness (ET) is one of the best predictors of implantation rate and pregnancy success rate because endometrial growth depends on hormones. Estrogen regulates the proliferative phase, endometrial proliferation induced by estrogen after menstruation is largely dependent on blood flow to the basal endometrium that produces progesterone receptors which are required for progesterone-regulated endometrial growth in the secretory process. To compare the effect of estradiol valerate vs. sildenafil citrate on endometrial receptivity and subsequent pregnancy outcome in unexplained infertility patients receiving letrozole for ovulation induction. Herein, 21 patients with unexplained infertility underwent ovulation induction by letrozole (2.5 mg). Patients were divided into 2 groups; group A (10 patients) were given sildenafil tablets vaginally (25 mg) four times daily and group B (11 patients) were treated with estradiol valerate tablet 2 mg/12 hours. Patients were evaluated by transvaginal ultrasonography (TVS) to determine endometrial thickness, pattern, size, and the number of the dominant follicles, serum assessment of Vascular Endothelial Growth Factor (VEGF) level at trigger day, and chemical pregnancy outcome 14 days later. Results showed that the endometrial thickness, patterns of the endometrium, VEGF, size of the dominant follicle at the trigger day, and pregnancy rates were not significantly different between the two groups. However, the difference in the number of the dominant follicles at trigger day was statistically significant which is more in the sildenafil treated group. The present study confirmed the findings of both Sildenafil and E 2 valerate to boost endometrial receptivity and pregnancy rate.
Despite developments in assisted reproductive technology, there is immaterial progress in the implantation and pregnancy rates. Intrauterine infusion (IUIF) of autologous platelet-rich plasma (PRP) might renew implantation rates through its paracrine properties by progression cytokines and growth factors which favor implantation. Here we determine whether the IUIF of autologous PRP had a role in pregnancy outcome through its outcome on epidermal growth factor and endometrial thickness. An overall of 43 patients where prospectively randomly dispersed into two groups subjected to a superovulation program using Letrozole® tablet orally 2.5 mg twice daily 12 hours apart from day 2 for 5 days for one cycle. 20 women were considered as control receiving the conventional intrauterine insemination (IUI) management while 23 of them were given PRP by IUIF on the day of human chorionic gonadotrophin injection. The IUI was done for both groups 36-48 hours after confirming ovulation. The blood samples were collected from both groups on the day of IUI for the valuation of epidermal growth factor and an ultrasound was done on the day of human chorionic gonadotrophin injection and day of IUI for assessment of endometrial thickness. The mean endometrial thickness in the PRP group at the day of IUI was significantly thicker than that of the control group and the difference in percentage change of endometrial thickness between PRP group and controls significantly higher in PRP group. The mean epidermal growth factor and the pregnancy rate were significantly superior in the PRP group than that of controls. In conclusion, autologous PRP IUIF was well-tolerated and resulted in a significant expansion in endometrial thickness, epidermal growth factor Level and, subsequent pregnancy rate in an infertile woman undergoing IUI.
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.
The association between the two hormones (progesterone and Activin A) in infertile women on the day of ova pick up and their relationship with pregnancy status in assisted reproductive programs are both poorly understood. To determine the correlation of progesterone and activin A on the day of ova pick up with pregnancy status of women undergoing IVF/ICSI cycle. The study was conducted on 80 infertile couples. The serum at day of ova pick up was collected. Serum progesterone and activin A analysis were done for all samples for activin A. Out of eighty infertile females twenty-five became pregnant (Pregnancy rate = 31%). Serum progesterone levels at days of oocytes pick up was significantly higher in pregnant females than non-pregnant (9.22 ± 0.54 vs. 4.47 ± 0.44; p < 0.001). There was a significantly higher serum activin levels at day of oocytes pick up in pregnant women compared to non-pregnant (2.19 ± 0.04 vs. 1.52 ± 0.04; p < 0.001). The cut-off value of serum progesterone at day of oocytes picks up was > 7.5 ng/ml and the cut-off value of serum activin A at day of oocytes pick up was > 1.85 ng/ml. Pregnant women had higher levels of the hormone progesterone and Activin A than non-pregnant women, which is significantly correlated. This result can be utilized to predicate the pregnancy status early in IVF Centers.
Background: The effects of taking oral contraceptive pills that contain steroid hormones (estrogen and progesterone) during pregnancy on some aspects of fetus and newborn have been previously reviewed. Objectives: The objectives of this study are to detect the effect of using different doses of progestin and estrogen (contraceptive pills OCPs) by pregnant female mice on the gonadal development of their male fetuses, and on their pregnancy outcome. Materials and Methods: Ninety female mice were divided equally into three major groups: two experimental (G1 and G2) and control group according to the level of the dose. Administration of OCPs (either 0.034 or 0.068 mg/kg b. wt. /d dissolved with 0.1ml distilled water) orally once a day, were started at the first day of gestation and continued till day 14 for the experimental groups G1 and G2 respectively. When the female in each experimental and control groups reach day 17 of gestation, 15 animals of each group were sacrificed, whereas the other 15 animals were left to be sacrificed at birth time. Weight and numbers of fetuses were recorded, in addition, histological study for their testes were done. Results: The statistical analysis showed a highly significant (P<0.01) decrease in weights and numbers of fetuses (males and females), and highly significant decrease ( (P<0.01) in the testes diameter of fetuses belonged to mothers treated with normal and double dose of OCPs at day 17 and at birth time. In addition, fetuses belongs to G2 mothers revealed testicular undescending to its normal position and remained adjacent to the kidneys at the upper part of the abdominal cavity in comparison with control group. Conclusion: Administration of steroid hormones orally to pregnant female mice for 14 days causes a highly significant decrease in the weight and number of fetuses at day 17 and at birth time and cause negative effect on the diameter of the fetal testes. The OCPs can inhibit at its high dose, the descending of the testes to its normal location at the pelvic cavity and then to the inguinal canal.
Oxidative stress in the field of reproduction has been extensively considered in association with sperm properties and male infertility; in any case, the effect of oxidative stress in association with oocyte trademark got less thought than that of sperms. The goal of the study is to understand the possible association among serum and follicular oxidative markers in infertile women and oocyte characteristics and pregnancy result in ICSI cycles. The present case-control study included 57 infertile women undergoing ICSI that was done in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies at Al-Nahrain University. The assessment started in April 2018 and connected with March 2019. Mean metaphase II oocyte count of all women was 5.70±3.87, that of pregnant women was 6.90±3.68 and that of non-pregnant women was 4.46±3.73; there was a basic qualification in mean metaphase II oocyte check among pregnant and non-pregnant women (P = 0.016); being higher in pregnant women. The mean abnormal oocyte count of all women was 0.63±1.26, that of pregnant women was 0.28±0.45 and that of non-pregnant women was 1.00±1.68. Oxidative stress markers inside and out affected clinical pregnancy result (P < 0.05) and appear to impact clinical pregnancy bring about women undergoing ICSI due to its effect of oocyte characteristics.
Luteinizing hormone (LH) plays vital role for optimal follicular growth, maturation and is responsible for inducing ovulation, various protocols in ICSI cycles used to prevent the premature surge of luteinizing hormone. Currently, flexible GnRH antagonist protocols appears to be mostly used protocols. individualization of controlled ovarian hyper stimulation (COS) needs better timing of antagonist administration, assessing variation in LH levels during COS helps in determining appropriate initiation of inhibition .This prospective comparative observational analysis was made on one hundred twenty females with infertility who were undergoing ICSI flexible antagonist protocol at the “High Institute for Infertility Diagnosis and Assisted Reproductive Technologies/Al-Nahrain University” from October 2020 to April 2022, primary infertility was the with higher percentage (78.3%) than the secondary type. However; the main cause of infertility among the participant was male type (36.7%) fallowed by the combined one (20.8%). A highly significant difference was present in LH levels at all time points, with level decreasing from 4.99 ± 1.90 at baseline to 4.82± 2.15 at antagonist starting day to 1.63± 0.87 at trigger day and p value was > 0.001, no statistical difference in LH levels regarding the three time points between patients who get pregnant and non-pregnant women with pregnant patients having higher baseline lower antagonist starting day, and higher trigger LH levels 5.16 ± 1.87, 4.30 ± 1.72, 4.30 ± 1.72 respectively. Difference in LH level between cycle day 2 and the day of antagonist starting according to starting day of antagonist reveals that the basal LH values declined significantly (p= <0.001) until cycle day 7 of stimulation after which the basal LH start to increase and also with a high significant difference (negative values mean that the level decrease in comparison to the base line level).The comparable LH level in the current study reveals that earlier initiation of antagonist may serve no purpose and it is advisable to include the measurement of LH level to the criteria of antagonist initiation for better individualization and better outcome and to avoid un necessary earlier start of antagonist.
Infertility is prevalent among couples in our community, and a considerable number of cases of infertility are caused by tubal factors. The hysterosalpingography (HSG) technique is one of the most important tools for determining the patency status of the tubes. Nevertheless, this method has certain drawbacks that can be addressed with a less invasive alternative, such as hysterosalpingo-contrast sonography (HyCoSy) and hysterosalpingo- foam sonography (HyFoSy) .By enrolling subfertile patients undergoing hysterosalpingo- foam sonography (HyFoSy) or hysterosalpingo-contrast sonography (HyCoSy) procedures and subsequently undergoing intrauterine insemination (IUI), this study sought to evaluate the pregnancy rate in a large single center prospectively . Between January 2024 and January 2025, 100 women who underwent IUI as a therapy modality for infertility at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in Kadhimiya city, Baghdad, were involved in this randomized controlled research. Those who underwent hysterosalpingo-contrast sonography with foam (HyFoSy) or HSG evaluation of the fallopian tube were included. The main results were a biochemical pregnancy test (blood test) and clinical pregnancy verified by ultrasonography at 6–8 weeks gestation . When comparing the HyFoSy and HyCoSy groups, the mean serum levels of estradiol, FSH, LH, prolactin, TSH, and testosterone did not differ significantly (p > 0.05). Differences in the mean length of infertility, the mean ova size, the mean ova count, the average endometrial width (ET), the average number of antral follicles (AFC), and the forms of infertility (p > 0.05). Sixty-eight percent of the HyFoSy group and forty percent of the HyCoSy group experienced successful pregnancies, with a significant difference (p = 0.005) . These results imply that HyFoSy might be better than HyCoSy when tubal evaluation is required before IUI, assuming they are validated in bigger multi-center trials. Future studies should investigate long-term results, such as live birth rates, and include a control group (IUI without prior tubal evaluation).
Intrauterine insemination has an important role in the treatment of infertile couples. Usage of vaginal misoprostol therapy at the time of intrauterine insemination has been investigated, and its tolerability and effects on clinical pregnancy rates still questionable. To assess the effectiveness of vaginal misoprostol on some demographic characteristics and hormones level with a success rate of Intrauterine Insemination. the period of collection of patients extended from Sep. 2018 until May 2019. Eighty-one infertile couples who attended Al Nahrain University, High Institute for Diagnostic Infertility and Assisted Reproductive Technologies, and private fertility clinics were enrolled through this study. Divided into two groups, the next group received 100 µg vaginal misoprostol immediately after completion of the IUI procedure, while the control group was subjected to ordinary IUI procedure without adjunctive therapy. The mean of demographic data of body mass index, age, and duration of infertility was statistically insignificant in control, Misoprostol post-intrauterine insemination. The percentage of pregnancy rate in the control group 5.0% and it 19.5% in the Misoprostol post-intrauterine insemination group. Moreover, there are significant differences in pregnancy rates among all study groups. According to this study, there is no significant result of pregnancy occurrences correlated with, female age, male age, and body mass index, duration of infertility or type of infertility, hormone levels. Misoprostol use after intrauterine insemination has a positive impact on pregnancy outcome in the control group 5.0% and it 19.5% in Misoprostol post-intrauterine insemination group. Smaller doses (100 µg) of misoprostol can decrease side effects without affecting the outcome.
Reactive oxygen species (ROS) are believed to play an important role in the function of the male and female reproductive system, as well as in embryonic development. If the balance between production and elimination of ROS is disturbed, pathogenic consequences would happen. Reactive oxygen species can sometimes exert damaging effects when overabundant, oxidative stress is hypothesized to have a negative impact on, for example, folliculogenesis, embryo development, oocyte maturation, oocyte fertilization, endometriosis, polycystic ovary syndrome and unexplained infertility .8-Hydroxy2-desoxy guanosine (8‐OHdG) is a sensitive indicator of DNA damage as a result of oxidative stress. The study aim was to evaluate follicular fluid levels of 8-Hydroxy2-desoxy guanosine in patients undergoing Intracytoplasmic Sperm Injection (ICSI) and compared the results between both pregnant and non-pregnant patients . One hundred and twenty-seven women included in this study, they underwent controlled ovarian hyper stimulation, program followed by ova pick up, at that time follicular fluid were obtained and freezes till the time of analysis for reactive oxygen species (ROS), patient injected oocyte was cultured in CO2 incubator, then embryo grading, embryo transfer, pregnancy rate and reactive oxygen species level were determined. Follicular fluid 8-OHdG was significantly lower in pregnant females (p < 0.001), 8-OHdG had negative correlations with grade 1 and grade 2 embryos and negative correlation with total blastocyst count. Follicular fluid levels of 8-OHdG provides sensitive tool to predict positive pregnancy outcome in women undergoing ICSI.
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.
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.