Abstract
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.
Highlights
Infertility is one of the most frequent health problems in the world, resulting from genetic or pathological diseases, prompting ongoing research and studies in the field of assisted reproductive technology (ART) to find the best treatment options possible (Mongkolchaipak, S [1])
There was a significant difference in Body Mass Index (BMI) (p=0.01) between the two groups with higher BMI in Polycystic Ovarian Syndrome (PCOS) patients, there was no significant difference in mean patients age (p=0.213) between PCOS and non PCOS patients
There were significant differences between the two groups about Antimullerian Hormone (AMH) (p=0.008) and E2 at day of trigger (p=0.012) with higher levels in PCOS group, but there was no significant difference in Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and basal Estradiol (E2) levels between PCOS and non-PCOS groups (p > 0.05)
Summary
Infertility is one of the most frequent health problems in the world, resulting from genetic or pathological diseases, prompting ongoing research and studies in the field of assisted reproductive technology (ART) to find the best treatment options possible (Mongkolchaipak, S [1]). Polycystic Ovarian Syndrome (PCOS) is the most frequent endocrine condition and the predominant cause of female infertility, according to studies conducted around the world (Deshpande and Gupta [3]). In PCOS patient premature granulosa cell luteinization and disruption of the intrafollicular environment are caused by increased ovarian hyperandrogenism and hyperinsulinemia, resulting in poor follicular development and oocyte maturation (Ecklund and Usadi [4]). The IGF system appears to contribute to the reported resistance to follicle-stimulating hormone (FSH) activity and the persistence of an androgen-dominant environment in the arrested follicles in PCOS, a condition characterized by small antral follicle arrest resulting in anovulation (Kwintkiewicz and Giudice [7] , Öztürk, et al [8]). This study is going to assess the correlation between PAPPA levels and oocyte and embryo characteristics in serum and follicular fluid of women undergoing Intracytoplasmic Sperm Injection (ICSI) cycle
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