Study On Serum And Follicular Fluid Levels Of Insulin-Like Growth Factor-Ⅱand Insulin-Like Growth Factor Binding Protein-3 In Patients With Polycystic Ovary Syndrome Undergoing In Vitro Fertilization

Objective: To investigate serum and human follicular fluid (hFF) insulin-like growth factor-Ⅱ (IGF-Ⅱ) and insulin-like growth factor binding protein-3 (IGFBP-3) behavior in superstimulated cycles in normally ovulating women and in patients with polycystic ovary syndrome(PCOS),and the relationship between PCOS and IGF-Ⅱ and/or IGFBP-3. Methods: Fifty-six patients with normal ovulation and fallopian tubal and/or male factor infertility and eighteen patients with PCOS undergoing IVF-ET were chosen as the research subjects. The former was designated the normol control group. The IVF program used Goserelin suppression followed by sequential FSH-HP in the subsequent cycle. After follicular development, hCG administration was followed 32-36 hours later by oocyte retrieval. Samples of serum was collected before use of FSH-HP at the third day and before pick-up oocyte. FF samples were aspirated at oocyte collection after FSH-HP stimulation in the same menstrual cycle. Serum and FF levels of IGF-II,IGFBP-3 and E2 were assayed and analyzed with the use of RIA,IRMA and EIA (Magnetic Solid Phase) respectively.Results: ① The both of controls and patients with PCOS showed significant increases in serum levels of E2 in response to FSH-HP stimulation. Serum E2 levels at the third day and at the pick up oocyte day in control group were 14±5pg/ml and1842±675pg/ml, respectively(P<0.01). Accordingly, PCOS group were 15±7pg/ml and 2282±709pg/ml, respectively(P<0.01). Serum and FF (follicular fluid) E2 levels at the operation day in the control group(10142±6893pg/ml) were lower than those in the PCOS group(12833±7176pg/ml)(P<0.05). ② Before FSH-HP stimulation, serum IGF-Ⅱ levels were similar in the controls(0.27±0.08ng/ml) and patients with PCOS( 0.27±0.05ng/ml)(P>0.05). After FSH-HP stimulation, serum IGF-Ⅱ levels in the control group(0.32±0.06ng/ml) were significantly increased(P<0.01), but not in the PCOS group(P>0.05),and serum IGF-Ⅱ levels in the PCOS group were significantly lower than those in the control group at the same time(P<0.01). At the pick up phase, FF levels of IGF-II in the control group(0.47±0.06ng/ml)were not only significantly higher than those of serum at the same time(P<0.01),but also than FF levels of IGF-II in the PCOS group(0.31±0.05ng/ml)(P<0.01). ③ Basal serum IGFBP-3 concentrations before ovarian hyperstimulation were similar in the controls(3350±611ng/ml) and patients with PCOS(3091±721ng/ml)(P>0.05). After FSH-HP stimulation,serum IGFBP-3 levels in controls(2509±560ng/ml)were strongly reduced, but not significantly in patients with PCOS(2775±731ng/ml). However, after stimulating , serum IGFBP-3 concentrations in the patients with PCOS were significantly higher than those in the nomally ovulating women(P<0.01). At the pick up oocyte day , FF IGFBP-3 values of the PCOS group (2762±438ng/ml)were significantly higher than those in the control group(2049±678ng/ml)(P<0.01). ④ A negative correlation,although significant only in control FF,was found between IGF-Ⅱ and IGFBP-3 levels(n=56, r=-0.679,P<0.01).Conclusion (s):(1) After FSH-HP stimulation, serum and FF IGF-Ⅱlevels in patients with PCOS were significantly lower than those in the controls. At the pick up phase, serum and FF IGFBP-3 values in the PCOS group were strongly higher than those in the control group. Both serum and FF IGF-Ⅱ and/or IGFBP-3 levels in PCOS were significantly different from those in controls, confirming a possible role ofan IGF system imbalance in the development of this disease.