| Polycystic ovary syndrome（PCOS）is a common gynecological endocrine disease in women of reproductive age,which can lead to hirsutism,acne,anovulation and infertility.Which often shows ovarian polycystic changes under Transvaginal ultrasonography.PCOS is accompanied by metabolic abnormalities such as obesity,insulin resistance and hyperlipidemia.It is a high risk factor of cardiovascular diseases,causing serious harm to women’s health.Homocysteine（Hcy）is closely related to the occurrence of cardiovascular diseases,and is closely related to the disease characteristics of PCOS such as abnormal lipid metabolism,insulin resistance,hyperandrogenemia and abnormal ovulation.The effects of Hcy levels is controversial on oocyte and embryo quality and pregnancy outcomes of women who undergoing in vitro fertilization/intracytoplasmic sperm injection（IVF/ICSI）.Therefore,the purpose of this study is to explore the effect of serum and follicular fluid Hcy levels on the quality of embryos and pregnancy outcome in PCOS patients who underwent IVF/ICSI.Part Ⅰ: Comparison of serum Hcy levels between PCOS patients and controls.Objective: Explore the correlation between elevated Hcy and PCOS prevalence.Methods: The clinical medical records of 668 women who underwent IVF/ICSI assisted pregnancy for the first time in The Reproductive Center of the first hospital of Lanzhou University from January 2020 to July 2021 were retrospectively collected.PCOS group including 246 cases and the control group including 422 cases who were infertility due to female fallopian tubes.First,the baseline data and serum Hcy levels of the two groups of patients were compared.Second,the correlation between age,BMI and serum Hcy level was analyzed.Last,the multivariate binary logistic regression and ROC curve were used to evaluate the influence of serum Hcy on the risk of PCOS.Result:1.Compared with the control group,the serum Hcy level in the PCOS group was significantly increased.The PCOS group was 10.78（8.71-13.60）umol/L while the control group was 9.29（7.75-11.38）umol/L（P<0.001）.BMI,UA,TC,TG,LDL-C were significantly higher than the control group,HDL-C was significantly lower than the control group,the difference was statistically significant（P <0.05）.2.Correlation analysis showed the overall study population（PCOS group+control group）,PCOS group and control group serum Hcy levels had no correlation with age and BMI（P>0.05）.3.Multivariate binary logistic regression analysis showed that high serum Hcy would increase the risk of PCOS [OR=1.080,95% CI（1.042～1.12）],area under curve（AUC）for predicting PCOS was 62.0%;Hcy,TG,UA,BMI and age all had certain predictive value of PCOS.The combined prediction AUC of the indicators was 69.9%,which was higher than the individual prediction.Conclusion: Compared with the control group,the serum Hcy in the PCOS group was significantly increased and independent of age and BMI;Hcy could predict the risk of PCOS,and the combined prediction value of age,BMI,TG and UA was higher.Part Ⅱ: The effect of serum and follicular fluid Hcy levels in PCOS patients on the quality of embryos and pregnancy outcome of IVF/ICSI.Objective: To investigate whether Hcy in serum and follicular fluid affects the quality of embryos and pregnancy outcome during IVF/ICSI.Methods: First,the 246 PCOS patients were divided into high level homocysteine group and normal level homocysteine group.The differences in the quality of embryo between the two groups were compared and the correlation analysis between Hcy level was performed.Then,we collected the follicular fluid of 122 women who underwent IVF/ICSI in The Reproductive Center of the first hospital of Lanzhou University from September 2021 to December 2021,which included 42 cases of PCOS patients and 80 cases of control group（tubal factor infertility）.The Hcy concentration was divided into quartiles,and the correlation between the Hcy concentration and the high quality embryo rate was analyzed in the overall study population（PCOS+control group）,PCOS group and control group.The relationship between the concentration of Hcy in follicular fluid and the rate of high quality embryos was analyzed by univariate logistic regression of generalized additive mixed modeling（GAMM）model and generalized estimating equation（GEE）model.Last,analyzing the influence of serum Hcy level on IVF/ICSI pregnancy outcome.Result:1.Compared with the control group,the number of D3 high-quality embryos,transferable embryos,the oocyte utilization rate and the high quality blastocyst rate in the high level homocysteine group were significantly decreased,the difference was statistically significant（P<0.05）;The number of available embryos,blastocysts formed,available blastocysts,high-quality blastocysts and the rate of oocyte retrieval,MII oocyte,D3 high quality embryos,blastocyst formation,the fertilization rate of 2PN compared with the normal level homocysteine group has a decreasing trend,but the difference is not statistically significant（P>0.05）.Univariate analysis showed that serum Hcy levels in PCOS patients were significantly negatively correlated with the number of D3 high quality embryos,the rate of D3 high quality embryos,high quality blastocysts,the number of transferable embryos and oocyte utilization（P<0.05）.2.There were significant differences in the high quality embryo rate between the overall study population and PCOS patients with different Hcy concentrations in follicular fluid（P<0.05）.The curve fitting analysis using the GAMM model showed that the Hcy concentration in the follicular fluid of the overall study population and PCOS patients had a linear relationship with the high quality embryo rate,and which decreased with the increase of the Hcy concentration in the follicular fluid.Univariate logistic regression analysis using GEE model showed that the increase of Hcy concentration in follicular fluid significantly decreased the rate of high quality embryos（P<0.05）.There was no significant difference in the rate of high quality embryos between groups in the follicular fluid Hcy level of the control group（P>0.05）.It was found that the Hcy concentration in the follicular fluid of the control group had a linear relationship with the high-quality embryo rate,but with the increase of the Hcy concentration the high-quality embryo rate did not change significantly by using GAMM model fitting.The univariate logistic regression analysis of GEE model showed that there was no significant change in the high quality embryo rate of Hcy level in the follicular fluid（P>0.05）.3.There was no significant difference in clinical pregnancy rate,early miscarriage rate and live birth rate between high level homocysteine group and normal level homocysteine group（P>0.05）.Conclusion: High level homocysteine in serum and follicular fluid can reduce the quality of embryos of PCOS patients who underwent IVF/ICSI,but serum level homocysteine not affect pregnancy outcome.The level of Hcy in follicular fluid is not related to embryo quality of tubal factor infertility. |
