The ovarian reserve as target of insulin/IGF and ROS in metabolic disorder-dependent ovarian dysfunctions

It is known for a long time that metabolic disorders can cause ovarian dysfunctions and affect a woman’s fertility either by direct targeting follicular cells and/or the oocytes or by indirect interference with the pituitary-hypothalamic axis, resulting in dysfunctional oogenesis. Such disorders may also influence the efficiency of the embryo implantation and the quality of the embryo with permanent effects on the fertility and health of the offspring. Thanks to the expanding knowledge on the molecular mechanisms governing oogenesis and folliculogenesis in mammals, we are beginning to understand how such disorders can negatively affect this process and consequently fertility in women. In the present review, we point out and discuss how the disturbance of insulin/IGF-dependent signalling and increased reactive oxygen species (ROS) level in the ovary typically associated to metabolic disorders such as type II diabetes and obesity can dysregulate the dynamics of the ovarian reserve and/or impair the survival and competence of the oocytes. Lay summary In women, a progressive decline and depletion of the primary ovary reserve, which represents the reserve of immature eggs, are a challenging condition in the field of reproductive medicine. This decline, occurring physiological with age, is the main determinant of the age at the onset of menopause. Concomitant with the reduction in their number, the quality of the eggs also decreases with age. Metabolic disorders such as diabetes and obesity can cause ovarian dysfunctions and affect a woman’s fertility mainly by direct targeting the egg stockpile or by indirect interference with the production of reproductive hormones. Here, we report up-to-date data and discuss results about how disturbance of insulin-dependent signalling and increased oxidative stress in the ovary, usually associated to metabolic disorders, can dysregulate the dynamics of the primary ovary reserve and/or impair the survival and quality of the eggs.

Intra-Cavitary Fluid Resulted From Caesarean Section But Not Isthmocele Compromised Clinical Pregnancy After IVF/ICSI Treatment

The aim of this study was to explore whether the presence of intra-cavitary fluid (ICF) influences the pregnancy outcomes of patients with caesarean section (CS) in embryo transfer cycles. A total of 8494 transferred cycles of 4924 women were enrolled in this retrospective study and separated into three subgroups by previous delivery method and the presence of intra-cavity fluid, a caesarean group with ICF (CS-ICF, n=649), a caesarean group without ICF (CS-noICF, n=3207) and the remaining 4638 cycles without ICF were included in the vaginal delivered group (VD, n=4638). Baseline characteristics and clinical outcome were compared. Propensity score matching (PSM) was conducted to adjust confounding factors between groups. Patients in the CS-ICF group were of younger age (36.49±4.19 vs 37.34±4.25, 37.32±4.86, P<0.001), had better ovary reserve and had more blastocyst transferred compared with the CS-noICF and VD groups. However, cycles in the CS-ICF group achieved unsatisfactory clinical pregnancy outcomes. PSM analysis for comparability, differences in clinical outcomes still existed. The clinical pregnancy rate was significantly lower in the CS-ICF group than in the CS-noICF group (35.1% vs 41.7% for CS-noICF group, 48.1% for VD group, P<0.001). Subgroup analysis of fresh embryo transferred cycles, the differences in clinical outcomes disappeared after PSM analysis, while the clinical pregnancy rate was still lowest among the three matched group of FET cycles (36.4% vs 50.3% for VD group, P<0.001). The presence of intra-cavitary fluid (ICF), but not necessarily the isthmocele, significantly compromises the clinical pregnancy rate in patients with previous CS undergoing IVF/ICSI treatment.

P–314 Serum Stem Cell Factor as a predictor of top quality blasotcysts formation in women with endometriosis

Study question To evaluate the correlation between the serum level of stem cell factor (s-SCF) during the stimulation and results of embryo culture. Summary answer The serum SCF concentration at the stimulation stage may be a potential predictor of IVF outcome in endometriosis patients. What is known already Stem cell factor (SCF) is a pleiotropic cytokine that affects the target cells via the c-kit receptor, a tyrosine kinase receptor. Recent evidence indicates that SCF and c-kit may play a role in regulation and growth of ovarian follicular function. It is unclear whether endometriosis primarily affects in vitro fertilization outcomes via oocyte quality. SCF is produced during the human follicular phase, immediately before the ovulatory phase, and may play an important role in folliculogenesis and in the mechanism of ovulation. It may reflect a successful stimulation with ample follicle maturation. Study design, size, duration This was a prospective case-control study and consisted four group of patients: 10 with endometriosis, 24 PCOs, 20 with normal (AMH 1.2–4.0 ng/ml) and 11 with lower (AMH&lt;1.2 ng/ml) ovary reserve who were undergoing IVF treatment with the assessment of serum SCF concentration between August 2019 and March 2020 at INVICTA Fertility Centre, Poland. The age of the patients ranged from 22 to 42 years (median 34 years). Participants/materials, setting, methods s-SCF was measured in duplicate by enzyme-linked immunosorbent assay (ELISA) kit in 195 serum samples collected during ovarian stimulation on days 1 and 8 and on the day of oocyte retrieval. We analysed correlation between s-SCF level and formation of top quality (TQ) blastocysts on day 5 formation in the study groups. Main results and the role of chance We have compared mean level of s-SCF within each group dividing the patients into two subgroups – those with at least one TQ blastocyst (TQ) on day 5 vs. those with no TQ blastocysts (no-TQ). There were no significant differences in mean s-SCF level on day 1 of stimulation between no-TQ and TQ patients in PCOs, normal and lower ovary reserve groups (41.1 pg/ml vs. 40.9 pg/ml; 34.8 pg/ml vs. 38.9 pg/ml and 32.3pg/ml vs. 28.7 pg/ml respectively). The mean level of s-SCF in endometriosis patients was higher in case of no-TQ compared to the TQ subgroup and were 41.1 pg/ml and 29.1 pg/ml respectively. Also no significant differences were also observed in the mean level of s-SCF in the no-TQ and TQ subgroups on the 8 day of stimulation and pick-up in PCOs, normal and lower ovary reserve patients. However, again in the case of endometriosis patients, the mean level of s-SCF was significantly lower on the 8 day of stimulation (28.1 pg/ml vs. 49.1 pg/ml; p &lt; 0.05) and pick-up day (33.4 pg/ml vs. 50.4 pg/ml; p &lt; 0.005) in samples from patients who had at least one TQ blastocysts on day 5 of culture. Limitations, reasons for caution More data are required to confirm the corelation of s-SCF level and presence of top quality blastocysts in patients with endometriosis. Wider implications of the findings: Our study suggests that the level of serum SCF during ovarian stimulation in patients with endometriosis of less 30 pg/ml may potentially be a predictor for the chance of obtaining at least one top quality blastocyst on day 5 and thus a chance to successful treatment. Trial registration number Not applicable