肥胖型PCOS患者卵泡液中同型半胱氨酸浓度对胚胎质量的影响

Effect of homocysteine concentration in follicular fluid on embryonic quality in obese PCOS patient

目的探讨肥胖型多囊卵巢综合征(PCOS)患者卵泡液中同型半胱氨酸(Hcy)浓度对胚胎质量的影响。方法选取2021年1月至2022年7月于运城市中心医院生殖医学科行体外受精助孕的137例PCOS患者为研究对象,将体质量指数(BMI)≥25 kg/m^(2)的患者纳入肥胖型PCOS组(n=76),BMI<25 kg/m^(2)的患者纳入非肥胖型PCOS组(n=61)。所有患者均采用拮抗剂方案促排卵,取卵前1日收集患者空腹静脉血清,取卵日留取第1管无血液和其他污染的卵泡液,采用酶联免疫吸附试验法检测两组患者卵泡液及血清中Hcy含量。比较两组患者的基础资料、获卵数、胚胎发育情况、卵泡液及血清Hcy水平;又根据卵泡液Hcy水平不同进行亚组分析,比较不同Hcy水平各组的胚胎发育情况。结果肥胖型PCOS组BMI、不孕年限均显著高于非肥胖型PCOS组,基础E2水平显著低于非肥胖型PCOS组(P<0.05);肥胖型PCOS组受精率、优质胚胎率均显著低于非肥胖型PCOS组(P<0.05)。肥胖型PCOS组患者卵泡液中Hcy水平显著高于同组患者血清中Hcy水平(P<0.05),亦显著高于非肥胖型PCOS组卵泡液中Hcy水平(P<0.05),而非肥胖型PCOS组患者卵泡液Hcy水平与同组患者血清Hcy水平无显著性差异(P>0.05)。又根据卵泡液Hcy水平不同利用四分位数将两组PCOS患者分别分为高、中、低3个浓度组。非肥胖型PCOS患者高浓度组优质胚胎数、优质胚胎率均显著低于中、低浓度组(P<0.05);肥胖型PCOS患者高浓度组的受精数、受精率、2PN数均显著低于中浓度组(P<0.05),高浓度组的2PN率、优质胚胎数、优质胚胎率均显著低于中、低浓度组(P<0.05)。结论对肥胖型和非肥胖型PCOS患者来说,卵泡液适宜的Hcy浓度不同,但卵泡液高浓度Hcy都对其胚胎质量有负面影响。

Objective:To study the effect of homocysteine(Hcy)concentration in follicular fluid on embryo quality in obese patients with polycystic ovary syndrome(PCOS).Methods:The PCOS patients who underwent IVF-ET assisted pregnancy treatment at Reproductive Medicine Department of Yuncheng Central Hospital from January 2021to July 2022were selected as the study objects.Patients with body mass index(BMI)≥25kg/m^(2) were included in the obese PCOS group(n=76),while patients with BMI<25kg/m^(2) were included in the non-obese PCOS group(n=61).All patients were treated with GnRH antagonist protocol to induce ovulation.One day before oocyte retrieval,fasting venous serum was collected from the patients.On the day of oocyte retrieval,the first tube of follicular fluid without blood or other contamination was retained.The Hcy contents in follicular fluid and serum of the two groups were measured using enzyme-linked immunosorbent assay.The basic information,number of oocytes retrieved,embryonic development,Hcy levels of follicular fluid and serum were compared between the two groups.Subgroup analysis was conducted based on different Hcy levels in follicular fluid to compare the embryonic development of each group with different Hcy levels.Results:The BMI and infertile years in the obese PCOS group were significantly higher than those in the non-obese PCOS group,and the basal E2level was significantly lower than that in the non-obese PCOS group(P<0.05).The fertilization rate and high-quality embryo rate in the obese PCOS group were significantly lower than those in the non-obese PCOS group(P<0.05).The Hcy concentration of follicular fluid was significantly higher than that in serum Hcy in obese PCOS group,and also significantly higher than that of follicular fluid in non-obese PCOS patients(P<0.05).The Hcy concentration of follicular fluid was close to the serum Hcy concentration in non-obese PCOS group(P>0.05).PCOS patients of the two groups were divided into high,medium and low Hcy concentration groups using quartiles based on different Hcy levels of follicular fluid.The number and rate of high-quality embryos in the high Hcy concentration group were significantly lower than those in the medium and low Hcy concentration groups in non-obese PCOS patients(P<0.05).The fertilization number,fertilization rate,and 2PN number in the high Hcy concentration group were significantly lower than those in the medium concentration group in obese PCOS patients(P<0.05).The 2PN rate,number and rate of high-quality embryo in the high Hcy concentrationﾄ・・ﾛgroup were significantly lower than those in the medium and low Hcy concentration groups(P<0.05).Conclusions:For obese and non-obese PCOS patients,the appropriate concentration of Hcy in follicular fluid varies,but high Hcy concentration in follicular fluid has a negative impact on their embryonic quality.