The Association between Homocysteine in the Follicular Fluid with Embryo Quality and Pregnancy Rate in Assisted Reproductive Techniques

Abstract

Background: Derangements in the B-vitamin dependent homocysteine pathway are implicated in the pathophysiology of reproductive failures, but the role in fertility has infrequently been studied. Therefore, we measured the concentrations of total homocysteine (tHcy) in follicular fluid of 50 women undergoing IVF or ICSI treatment followed by ET. Aim: Relationships were determined between the total homocysteine in follicular fluid and the number of oocytes, fertilization, embryo quality and the occurrence of biochemical and clinical pregnancy. Method: Fifty infertile female who were meeting the inclusion criteria (the causes of infertility were male factor for 28 cases, ovulatory dysfunction for 6 cases, tubal factor without visible hydrosalpinx for 4 cases and unexplained infertility for 12 cases) were enrolled for this study, at the Assisted Reproduction Technology Unit (ARTU), of Ain Shams University Maternity Hospital. Ovulation induction was performed by using GnRH agonist and gonadotropins. For each patient, homocysteine level in the follicular fluid was measured after the oocyte retrieval. The correlation between the homocysteine concentration in the follicular fluid and the oocyte–embryo quality, pregnancy rates and hormone levels were determined. Results: Mean ± SD Hcy was 9.76±3.02μmol/L and 15.11±3.73μmol/L in pregnant and non-pregnant women, respectively (p<0.001). There were no statistically significant differences between pregnant and non-pregnant women in mean age, duration of infertility, body mass index, the oocyte– embryo quality parameters, and hormone levels. No any correlation was established between tHcy and M2, late M2, and total number of oocytes, number of fertilized oocytes and transferred Embryos, and embryo quality grade. Moreover, the higher the tHcy concentration the follicular fluid, the lower the chance of biochemical pregnancy as demonstrated by the area under curve (AUC) of hcy for prediction of pregnancy failure was 0.922 (p=0.0001, 95% Confidence interval 0.85–0.99). The Threshold level of hcy equals 12.01 μmol/L had a sensitivity of 81.18%, specificity of 99%, positive predictive value of 99% and negative predictive value of 90.68% for prediction of pregnancy failure. Conclusion: These data suggest that a high follicular fluid tHcy concentration is detrimental for the chance of achieving pregnancy. But there was no correlation between follicular fluid hcy levels and oocyte quality and embryo grading. Keywords: Total homocysteine, Assisted Reproduction Technology Unit.