Abstract
ObjectiveTo relate serum and follicular fluid (FF) kisspeptin and estradiol levels in different stages of stimulation during Intracytoplasmic Sperm Injection (ICSI) with oocyte maturity and endometrial thickness among unexplained infertile females.MethodsThis cross-sectional study was carried out at the Australian Concept Infertility Medical Centre from March 2017 till March 2018. Fifty unexplained infertile females, booked for ICSI, were included in the study. Serum kisspeptin and estradiol were estimated by Enzyme-Linked Immunosorbent Assay in all four stages; 1: follicular stimulation, 2: ovulation induction, 3: oocyte pickup, and 4: embryo transfer. FF was aspirated during oocyte retrieval (stage 3) for the analysis of KP and estradiol. Pregnancy outcomes were categorized as non-pregnant, preclinical abortion, and clinical pregnancy.ResultsThe age of the study subjects was 32.04 ± 2.29 (Mean±SD) years, with mean BMI of 28.51 ± 4.15 (Mean±SD) kg/m2. Mean serum kisspeptin and estradiol levels increased in all subjects as the stimulation proceeded stages 1–3; however, the mean dropped after retrieval of the oocytes (stage 4). Out of 27 female subjects who completed the cycle, 17 remained non-pregnant, 4 had preclinical abortion, and 6 acquired clinical pregnancy. The FF kisspeptin concentration was significantly higher than serum concentrations and positively correlated with serum and FF estradiol concentrations. FF-kisspeptin correlated with serum kisspeptin in Stage 3 (r = 0.930, p<0.001), maturity of oocyte (r = 0.511, p = 0.006) and endometrial thickness (r = 0.522, p = 0.005). Kisspeptin in stage 3 was also found to correlate with endometrial thickness (r = 0.527, p = 0.005) and with estradiol (r = 0.624, p = 0.001) independently.ConclusionIncrease in serum and FF-kisspeptin and estradiol levels from stages 1 to 3, resulted in an optimum endometrial thickness, probability of fertilization of oocytes and chances of clinical pregnancy in Assisted Reproductive Techniques /ICSI cycles of unexplained infertile females.
Highlights
Mean serum kisspeptin and estradiol levels increased in all subjects as the stimulation proceeded stages 1–3; the mean dropped after retrieval of the oocytes
follicular fluid (FF)-kisspeptin correlated with serum kisspeptin in Stage 3 (r = 0.930, p
Regulation of fertility by hypothalamo-pituitary-ovarian (HPO) axis involves the pulsatile release of Gonadotropin-Releasing Hormone (GnRH) from the hypothalamus, stimulating the release of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) from the anterior pituitary that in turn acts on the ovaries to control gametogenesis [1]
Summary
Regulation of fertility by hypothalamo-pituitary-ovarian (HPO) axis involves the pulsatile release of Gonadotropin-Releasing Hormone (GnRH) from the hypothalamus, stimulating the release of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) from the anterior pituitary that in turn acts on the ovaries to control gametogenesis [1]. Kisspeptin (KP) is a neuropeptide that acts via a G-protein coupled receptor and has been found to be the upstream regulator of GnRH release. It plays important roles in female reproduction such as the onset of puberty, ovulation, implantation, placentation and metabolic regulation of fertility [1,2,3]. Estrogen released by the ovaries acts through its receptors present on KP secreting neurons and, in turn, contributes as the negative feedback on KP secretion [6]
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