Follicular Fluid Endothelial Inflammatory and Coagulation Markers in Good and Poor Responders to Controlled Ovarian Hyperstimulation for ICSI Procedures
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- Category: Vol. 77, March 2009
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Follicular Fluid Endothelial Inflammatory and Coagulation Markers in Good and Poor Responders to Controlled Ovarian Hyperstimulation for ICSI Procedures,TAREK M.S. EL-AZIZI, AHMAD AWAD ALLAH and GAMAL ELEWA
Abstract
Background: Granulosa cells have endothelial like function and can produce many proteins charactetritic to endothelial activity. Evaluation of these protein products allows under-standing of the microfollicular environment to be reflected on better safe management for controlled hperstimulation for poor and good responders during artificial reproductive tech-niques.
Objectives: To compare levels of markers of inflammation and endothelial dysfunction (C-reactive protein, CRP and von Willebrand factor antigen, vWF) and the poor response to induction of ovulation during controlled ovarian hyperstimu-lation (COH) for ICSI procedures.
Patients and Methods: 78 infertile patients were assigned for ICSI (intracytoplasmic sperm injection) procedure. The patients were divided according to their resoponse into group A (poor responders) who have yielded only five or less follicles of 18mm or more in size, and group B who have adequate response to controlled ovarian hyper stimulation. The follicular fluid from the two groups was tested for markers of inflam-mation; C-reactive protein (CRP) and marker of endothelial damage; vonWillibrand Factor (vWF).
Results: The main cause of infertility in poor responders is ovulatory (polycystic ovary syndrome). The body mass index and age is higher significantly in the poor responders. Both markers studied have higher level in the follicular fluid from the poor responders than normally responding patients (but statistically significant only for CRP). The levels of the two markers have a positive correlation to the body mass index which is significantly higher in the non responders.
Conclusion: The granulose cells have endothelial like activity and produces many proteins that have effect on the microenvironment of the growing follicles. CRP and vWF are markers for inflammation and endothelial stress which are produced in follicular fluid of the poor responders to controlled hyper stimulation in amounts more than the normally responding ones. Further studies are needed to deeply under-stand the value of proteins produced by granulosa cells for efficacy and safety of ovulation induction during artificial reproductive techniques.