Comparison of Ischemia Modified Albumin Levels in Serum and Follicular Fluid of Infertile Patients with PCOS and without PCOS and the Outcome of IVF Results

Comparison of Ischemia Modified Albumin Levels in Serum and Follicular Fluid of Infertile Patients with PCOS and without PCOS and the Outcome of IVF Results | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Ischemia Modified Albumin Levels in Serum and Follicular Fluid of Infertile Patients with PCOS and without PCOS and the Outcome of IVF Results Neslihan Dursun, Ferruh Acet, Ufuk Atlıhan, Ege Nazan Tavmergen Göker, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5506529/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To compare the ischemia modified albumin (IMA) levels in the serum and follicular fluid of infertile patients with polycystic ovary syndrome (PCOS), and without PCOS, and their IVF outcomes. Material and Method: We conducted a prospective cohort study with patients undergoing IVF treatment at Ege University IVF Center during 2021 and 2023. Blood and follicular fluid samples were collected from a total of 113 infertile women with PCOS (n = 56) and without PCOS (n = 57). The samples were centrifuged and stored at -80 0 C at the Ege University Department of Biochemistry laboratories. The serum and follicular fluid IMA levels of these patients and their IVF outcomes were compared. Results: No statistically significant difference was found between the two groups when compared for mean age, body mass index (BMI) and duration of infertility ( p = 0.075, 0.073 and 0.479 respectively) . The IVF results showed statistically significant differences. Although the number of oocytes retrieved and number of embryos were higher in the PCOS group ( p value < 0.001 and 0.013, respectively ), the recombinant FSH dose used for ovulation induction was lower in PCOS group ( p < 0.001 ) than non-PCOS group. Serum IMA levels in PCOS patients were found to be lower than the control group, but this difference was not statistically significant ( p = 0.16 ). Follicular fluid IMA values were found to be lower in the PCOS group than the control group, while the difference was statistically significant ( p = 0.031 ). Considering the pregnancy results, biochemical pregnancy, clinical pregnancy, and ongoing pregnancy rates in the non-PCOS group was higher than the PCOS group, although the difference was not statistically significant ( p = 0.08, 0.29, 0.18 respectively ). Conclusion: The results of studies comparing serum IMA values of PCOS and non-PCOS cases are conflicting. In our study, we found that the serum and follicular fluid IMA levels in non-PCOS group were higher than the PCOS group. Biochemical, clinical and ongoing pregnancy rates were found higher in the non-PCOS group when compared to the PCOS group. İnfertility polycystic ovary syndrome (PCOS) ischemia-modified albumin (IMA) in vitro fertilization (IVF) intracytoplasmic sperm injection (ICSI) INTRODUCTION PCOS is one of the most common endocrine and metabolic disorder in women of reproductive ages. Although the exact mechanisms leading to the development of PCOS are not fully understood, it is accepted as a multifactorial syndrome [ 1 ]. Various genetic and epigenetic differences, along with environmental factors, contribute to the development of this syndrome [ 2 ]. PCOS presents with symptoms of anovulation and hyperandrogenism, including oligo/amenorrhea (irregular or absent menstrual periods), hirsutism (excessive hair growth), acne, infertility, insulin resistance, and obesity. Long-term complications include an increased risk of cardiovascular disease, type-2 diabetes, hypertension, metabolic syndrome, and endometrial cancer [ 3 ]. The diagnosis of PCOS is based on the demonstration of hyperandrogenism and oligo/anovulation. The treatment of PCOS should be individualized, taking into consideration the patient's specific symptoms [ 4 ]. PCOS leads to infertility through the inhibition of ovulation. It is observed in 25% of infertile women, and it is the most common cause of infertility associated with anovulation. The treatment of infertility in PCOS women ranges from lifestyle changes to medical ovulation induction therapy and in vitro fertilization (IVF) [ 5 ]. Women with PCOS are at a higher risk of pregnancy complications compared to the normal population. PCOS women who conceive have an increased risk of miscarriage, diabetes, hypertension, preeclampsia, and preterm birth [ 6 ]. In acute ischemic conditions, a modified type of albumin called Ischemia-Modified Albumin is formed due to the decreased metal binding capacity in the N-terminal region of albumin [ 7 ]. Studies investigated the changes in albumin's cobalt binding capacity by evaluating cases of acute myocardial ischemia. As a result of these studies, a decrease in cobalt binding in the N-terminal region of serum albumin during myocardial ischemia was detected [ 8 ]. Based on these findings, it has been suggested that IMA levels can serve as an early marker in conditions related to ischemia and oxidative stress, including myocardial infarction, cerebrovascular events, diabetes, kidney failure, hypothyroidism, hyperthyroidism, and PCOS [ 9 , 10 ], and can be used to predict the prognosis of the disease. Subsequently, numerous studies have been conducted in this regard. The aim of this study was to compare ischemia modified albumin (IMA) levels in serum and follicular fluid of infertile patients with and without polycystic ovary syndrome (PCOS) and IVF outcomes. MATERIAL AND METHODS Study Groups This study was designed as a prospective cohort study. The study was initiated after receiving approval from the Ege University Medical Research Ethics Committee with approval number 21-9.1T/30. The study was designed in accordance with the Helsinki Declaration. Informed consent forms were obtained from all patients. Our study included 113 cases who applied to the Ege University Hospital ART Center and were planned for IVF treatment between 2021–2023. According to the 2003 Rotterdam ESHRE/ASRM Criteria, patients diagnosed with PCOS were included in the study group, while others were included in the control group. Patients over the age of 40, diagnosed with endometriosis or endometrioma, having uterine factors (uterine anomaly, leiomyomas, endometrial polyps), using tobacco, having systemic diseases such as diabetes or hypothyroidism, and patients undergoing IVF due to male factor were not included in the study. IVF Procedure All patients received flexible GnRH antagonist protocol for ovarian stimulation. The gonadotropin dosage was determined considering the patient's age, body mass index (BMI), and oocyte reserve. On the 2nd or 3rd day of the cycle, the control group received 150–450 IU of gonadotropin (Gonal F, Merck, Halle, Germany, and/or Merional, IBSA, Switzerland), while the study group received 125–300 IU. For pituitary desensitization 0.25 mg of GnRH antagonist (Cetrotide, Merck, Halle, Germany) was started on the 6th or 7th day of the cycle. During the treatment, follicular development was monitored by transvaginal ultrasound (TVUSG), and when the dominant follicle reached 18 mm, ovulation was triggered by a subcutaneous injection of 250 IU human chorionic gonadotropin (hCG) (Ovitrelle, Merck, Modugno, Italy). Oocyte aspiration was performed 35–36 hours after hCG administration. Following denudation procedures, the mature oocytes (Metaphase II stage) were subjected to intracytoplasmic sperm injection (ICSI) using sperm prepared from the partner through the swim-up method. After ICSI, the oocytes were incubated in culture media, and 10–18 hours later, fertilization was checked under an inverted microscope. The culture media for the embryos were changed, and incubation continued. On the 2nd and 3rd days of development cleavage embryos were checked, and embryo transfer was carried out on the patients, or they were further incubated until the blastocyst stage on the 5th day. The number of embryos transferred was in compliance with the regulations (1 or 2 embryos) and selected from good-quality embryos. For luteal phase support in cases which fresh embryo transfer was performed, vaginal progesterone (Progestan, Koçak Farma) was started at a dosage of 4x200 mg/day on the day of oocyte retrieval. On the 4th day of embryo transfer, patients with E2 levels below 2000 IU and no OHSS (ovarian hyperstimulation syndrome) criteria received a subcutaneous injection of 250 IU HCG. On the 14th day of transfer, the beta hCG level has been measured. If the beta hCG level is > 50 U/L, it was considered as biochemical pregnancy. The presence of a gestational sac with the fetal cardiac activity in transvaginal ultrasonography (TVUSG) was considered as clinical pregnancy and the pregnancy that have reached 24 weeks based on the last menstrual period was considered ongoing pregnancy. Biochemical analysis For each participant in the study, 2 mL of EDTA blood and follicular fluid samples collected during oocyte retrieval were sent to the Ege University Department of Medical Biochemistry Laboratory of Clinical Biochemistry Science within 30 minutes. Plasma samples were obtained by centrifuging the blood samples at 1000 g for 15 minutes at 2–8°C within the first 30 minutes after blood collection, while the follicular fluid samples were centrifuged at 1000 g for 20 minutes at 2–8°C and separated samples were stored at -80°C in accordance with kit conditions. IMA levels were measured using a competitive enzyme-linked immunosorbent assay (ELISA) kit (CEA825Hu, Wuhan USCN Business Co., Ltd., China). Statistical analysis The number of participants in the study was determined based on statistical calculations to achieve significant results: according to the power analysis conducted in the G Power 3.08 program, 52 patients were required in each group to detect the difference between the two groups with a large effect size (0.8) and a significance level of 0.05. In the statistical analysis phase, frequency tables for categorical variables and descriptive statistics for continuous variables were calculated. The Pearson chi-square test was applied to examine categorical data between groups. The Shapiro-Wilk normality test was used to assess whether continuous variables were normally distributed. Since the data were not normally distributed, the Mann Whitney U test was used for independent groups in both the patient and control groups. The significance level was set at 0.05 for all hypothesis tests. The statistical analysis was performed using IBM SPSS Version 25.0 statistical package program. RESULTS The characteristic features of the patients, serum and follicular fluid IMA levels, and IVF data are presented in Table 1. Statistically significant difference of IMA values were found only in the follicular fluid IMA levels between two groups (p = 0.031) . In the PCOS group, a lower total dose of recombinant FSH was used, while the number of retrieved oocytes and embryos was found to be higher. Out of 57 patients in the control group, no oocytes were obtained from one patient, and fertilization did not occur in seven patients. In the PCOS group, out of 56 cases, one had no fertilization, and embryos could not be obtained. Embryos with grade 1 and grade 2 in cleavage stage and grade AA, AB, BB in blastocyst stage were considered as good-quality embryos. The rate of high-quality embryos was found to be higher in the control group, but this difference was not statistically significant ( p = 0.153, 0.21, cleavages and blasts respectively ). The anti-müllerian hormone (AMH) level in the PCOS group was found to be significantly higher than the control group (p < 0.01). In the IVF cycle outcomes, it is observed that the gonadotropin dose used in the control group was higher, while the number of oocytes and embryos retrieved was lower (p < 0.01, < 0.01, 0.013 respectively). Table-1. Comparison of demographic and clinical data between groups Control group (n = 57) PCOS group (n = 56) p Median-(Min-Max) Age (year) 33-(26–39) 32-(23–39) 0.075 BMI (kg/m 2 ) 24.1-(18-37.8) 25.4-(16-40.8) 0.073 Infertility duration (year) 4-(1–13) 4-(1–11) 0.479 AMH (ng/mL) 1-(0.09–3.6) 4.2-(1.4–15) < 0.01 Serum IMA (mg/mL) 24-(1.2–40.6) 22.05-(1.43–31.4) 0.16 FF-IMA (mg/mL) 24.6-(1.5–46.6) 21.4-(3-41.6) 0.031 IVF data Median-(Min-Max) Total dose of gonadotropins (IU) 2250-(1050–3900) 1400-(325–4750) < 0.01 No. of retrieved oocytes 5-(0–18) 15-(2–41) < 0.01 No. of embryos 1-(0–11) 2-(0–10) 0.013 Oocyte grade n-% M II oocytes rates 77.72% 79.44% M I oocytes rates 21.18% 17.7% Prophase oocytes rates 1.09% 1.5% Embryo grade and quality n-% Cleavage embryo number 37 34 Blast embryo number 12 21 High quality cleavage embryos rates 92.1% 91.1% 0.153 High quality blasts rates 83.3% 76.2% 0.21 *BMI: Body mass index, AMH: anti-müllerian hormone, IMA: ischemia modified albumin, FF: follicular fluid, M: metaphase In this study, patients at high risk for OHSS (Ovarian Hyperstimulation Syndrome) were not subjected to fresh embryo transfer but instead underwent frozen embryo transfer. Among the 49 patients in the control group which obtained embryos, 44 of them (89.8%) received fresh embryo transfers, while 5 of them (10.2%) received frozen embryo transfers. In the PCOS group, out of the 55 patients which obtained embryos, 36 of them (65.5%) received fresh embryo transfers, while 19 of them (32.7%) received frozen embryo transfers. The frequency of frozen embryo transfers was found to be higher the PCOS group when comparing to the control group ( p = 0.0012). The pregnancy outcomes of patients in the study and control groups are shown in Table-2. The rates of beta hCG positivity, clinical pregnancy, and ongoing pregnancy were found to be higher in the control group compared to the study group, but none of these differences were statistically significant ( p = 0.08, 0.293, 0.188, respectively ). Additionally, when comparing all patients, those with positive beta hCG results and those without, there were no significant difference in IMA levels in both serum and follicular fluid ( p = 0.275, 0.571 respectively ). Table-2. Comparison of pregnancy rates between groups Control group n-% PCOS group n-% p Biochemical pregnancy 32–56.1% 26–46.62% 0.08 Clinical pregnancy 28–49.1% 22–39.3% 0.293 Ongoing pregnancy 23–40.4% 16–28.6% 0.188 The patients participating in the study were divided into subgroups based on the embryo transfer day and whether it was a fresh or frozen embryo transfer. Serum and follicular fluid IMA levels and the pregnancy outcomes of this subgroups are shown in Table-3. In contrasts to the overall results obtained from all patient groups, the only group which pregnancy rates were higher in the PCOS group was the 3rd day frozen embryo transfer group (57.1%, 0%). In all other groups, pregnancy rates were higher in the control group. In the PCOS cases, the subgroup that underwent frozen blastocyst transfer, the ongoing pregnancy rate was 50%, while the subgroup with fresh blastocyst transfer, the rate was 28.6%. In PCOS group the ongoing pregnancy rate of patients with transferred 3th day frozen embryo was %57.1, while the rate was %14.8 in patients with 3th day fresh embryo transfers. It is noteworthy that only in the PCOS group, patients who underwent embryo cryopreservation had better pregnancy outcomes compared to those who had fresh embryo transfers. According to Table 3, the follicular fluid IMA level was found to be significantly higher in the control group in cases which 3th day fresh embryo transferred (p = 0.04) . Table-3. Comparison of groups according to transfer type and cycle type Control group (n = 57) PCOS group (n = 56) p Median-(Min-Max) Cleavage (3td day embryos) Fresh cycles Serum IMA (mg/mL) 24-(1.2–40.6) 24-(4-29.1) 0.36 FF IMA (mg/mL) 25.8-(2.2–46.6) 21.7-(3.69–41.6) 0.04 Biochemical pregnancy rate 57.1% 44.4% 0.3 Clinical pregnancy rate 48.6% 29.6% 0.13 Ongoing pregnancy rate 37.1% 14.8% 0.051 Thaw cycles Serum IMA (mg/mL) 29.5-(24.8–34.2) 23.5-(1.43–29.3) 0.14 FF IMA (mg/mL) 31.9-(30.2–33.6) 23.4-(4.56–35.1) 0.14 Biochemical pregnancy rate 0% 57.1% 0.4 Clinical pregnancy rate 0% 57.1% 0.44 Ongoing pregnancy rate 0% 57.1% 0.44 Blastocyst (5th day embryo) Fresh cycles Serum IMA (mg/mL) 6.4-(5-35.4) 5-(4.03–31.4) 1 FF IMA (mg/mL) 8.2-(1.2–31.6) 4.9-(3.03–22.7) 0.57 Biochemical pregnancy rate 100% 42.9% 0.19 Clinical pregnancy rate 75% 42.9% 0.3 Ongoing pregnancy rate 50% 28.6% 0.47 Thaw cycles Serum IMA (mg/mL) 26.9-(3.24–26.7) 17.1-(5.08–30.2) 0.19 FF-IMA (mg/mL) 17.6-(6.42–24.6) 22.6-(6.6–34.2) 0.83 Biochemical pregnancy rate 100% 60% 0.5 Clinical pregnancy rate 100% 60% 0.5 Ongoing pregnancy rate 100% 50% 0.47 * IMA: ischemia modified albumin, FF: follicular fluid DISCUSSION In this prospective cohort study, we aimed to compare the levels of IMA in the serum and follicular fluid of infertile patient groups with and without PCOS, and to observe the impact of IMA levels on the IVF outcomes. As a result of the study, we found that the serum and follicular fluid IMA levels were lower, and the pregnancy rates were also lower in the PCOS group when compared to the control group. The IMA level has been suggested as an early marker in conditions related to ischemia and oxidative stress, including myocardial infarction, cerebrovascular events, diabetes, renal failure, hypothyroidism, and hyperthyroidism, and numerous studies have been conducted on its use as a marker and predicting the prognosis of the disease [ 9 , 10 ]. Studies suggest that the most significant advantage of IMA level among ischemia biomarkers is its ability to be detected in the early stages of ischemia [ 11 ]. Although the etiology of PCOS has not been fully elucidated, chronic ischemia and oxidative stress mechanisms play a role in its pathophysiology. Consequently, studies investigating the IMA level in patients with PCOS have been increasingly conducted in recent years. In a study conducted by Reddy et al. in 2018, nine studies investigating serum IMA levels in cases of PCOS were examined, and it was found that the serum IMA levels in the PCOS cases was higher compared to the control group [ 12 ]. There are also studies that did not find a significant difference in serum IMA levels between two groups [ 13 , 15 ]. There is only one study that investigates the IMA level in the follicular fluid in cases of PCOS [ 14 ]. In this study by Dilbaz et al., IMA and TAC levels in the follicular fluid were found to be higher than serum levels. Similarly, in our study, the IMA level in the follicular fluid was higher than the serum levels in both groups. In the study by Dilbaz et al., the IMA value in follicular fluid was higher in the PCOS group compared to the control group, but this difference was not statistically significant. In contrast to this study, in our study, the follicular fluid IMA value was found to be higher in the non-PCOS group, than the PCOS group, and this difference was statistically significant. In our study, the finding of lower IMA values in the PCOS group could be explained by the chronic ischemic process of PCOS, where the reversal of IMA modification occurs due to the involvement of antioxidant mechanisms in PCOS cases, leading to a decrease in both serum and follicular fluid IMA levels. Studies in this regard indicate that albumin modification is a bidirectional and reversible change, and that after the acute phase of myocardial ischemia, IMA rapidly returns to its albumin form [ 16 ]. In patients with cerebral infarction, serum IMA values increase during the acute phase and gradually decrease within a week [ 17 ]. Furthermore, since IMA increases due to acute oxidative stress, the chronic nature of PCOS can also explain the lower values. As the number of studies investigating serum IMA values in ischemic processes increases, it has been understood that IMA levels vary depending on the type of pathological process, the stage of the disease, and the measurement method used [ 11 ]. Numerous studies have demonstrated that reactive oxygen species increase and total antioxidant capacity decreases in the follicular fluid of infertile patients with PCOS compared to infertile patients without PCOS [ 18 ]. However, the impact of this oxidative stress condition on pregnancy outcomes has not been definitively established. In our study, when comparing all patient groups, there was no significant difference in IMA values in both serum and follicular fluid between patients who tested positive and negative for beta hCG after IVF. Chattopadhyay et al. conducted a study where they found that infertile patients with PCOS had higher levels of reactive oxygen radicals in their follicular fluid compared to patients with infertility due to tubal factors. In IVF results, it was shown that the fertilization and clinical pregnancy rates were higher in the tubal factor group, but this difference was not statistically significant[ 19 ]. In our study, both serum and follicular fluid IMA levels were higher in the control group compared to the PCOS group, and pregnancy rates were also higher in the control group. This could be explained by IMA levels not fully reflecting the actual oxidative stress condition or the limited impact of the oxidative load in the follicular environment on pregnancy outcomes. The results of studies comparing pregnancy rates in IVF cycles between PCOS patients and non-PCOS infertile patients are conflicting. In the study conducted by Dilbaz and colleagues, biochemical and clinical pregnancy rates were found to be higher in the PCOS group; however, this difference was not found to be statistically significant [ 14 ]. The previous studies have reported different pregnancy rates in patients with PCOS following IVF cycles. In the study conducted by Muharam and colleagues, biochemical and clinical pregnancy rates were found to be higher in the PCOS group [ 20 ]. In another study comparing the pregnancy rates after IVF cycles in PCOS patients and those with isolated male factor infertility, pregnancy rates were found to be higher in the PCOS group [ 21 ]. Lower pregnancy rates have found in PCOS group by other authors [ 19 ]. In our study, the biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate were found to be higher in the control group compared to the PCOS group, but none of these differences were statistically significant. While IMA levels were found to be higher in the control group in all subgroups, there are some differences in pregnancy outcomes. In our study we found that pregnancy rates in PCOS patients are higher in frozen cycles compared to fresh cycles. Additionally, unlike all other subgroups, the only group where pregnancy rates were higher in the PCOS group is in cases of frozen cleavage embryo transfer. The pregnancy rates were higher when cleavage and blastocyst embryos were cryopreserved and transferred compared to fresh embryo transfer cycles. It is known that cryopreservation leads to a decrease in oxidative stress parameters in embryos. Factors that can impair embryo quality and negatively affect pregnancy outcomes in PCOS patients may be eliminated when embryos are cryopreserved. Even though IMA values may be low in PCOS patients under chronic oxidative stress, the freezing and thawing process is believed to have a positive impact in this regard. There are studies showing that live birth rates in PCOS patients are higher in frozen cycles compared to fresh cycles [ 19 ]. Frozen cycles protect the endometrium from the negative effects of high estrogen levels. CONCLUSION In the literature, there have been studies investigating serum IMA (levels in patients with PCOS however, the results are contradictory. Furthermore, there are very few studies that have investigated IMA levels in the follicular fluid of PCOS patients. Our study, in this regard, is of a nature that will contribute to the literature. It is necessary to conduct numerous studies with a larger number of patients to elucidate the pathophysiology of how PCOS affects infertility, oocyte quality, and leads to IVF (In Vitro Fertilization) failure, and for the successful implementation of infertility treatment in these cases. Declarations CONFLICT OF INTEREST STATEMENT The authors have no conflicts of interest. Author Contribution Author contributions: UA: Data analysis; ND, ET: Project development; FA: Data Collection; Manuscript writing; ND; Manuscript writing; ENTGAll authors reviewed and approved the final version, and no other person made a substantial contribution to the paper. Data Availability The datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request. References Kahsar-Miller MD, Nixon C, Boots LR, Go RC, Azziz R. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertil Steril 2001;75:53–8. https://doi.org/10.1016/S0015-0282(00)01662-9. 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Oxidative stress and male infertility: from research bench to clinical practice. ClevelandclinicOrg n.d.;23. Chen Y hui, Wang Q, Zhang Y nan, Han X, Li D han, Zhang C lian. Cumulative live birth and surplus embryo incidence after frozen-thaw cycles in PCOS: how many oocytes do we need? J Assist Reprod Genet 2017;34:1153–9. https://doi.org/10.1007/S10815-017-0959-6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5506529","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":381994508,"identity":"f610be19-bca8-4305-ad0b-169a26b89630","order_by":0,"name":"Neslihan Dursun","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Neslihan","middleName":"","lastName":"Dursun","suffix":""},{"id":381994509,"identity":"6741421d-0c95-47b8-a8c7-178c82e1da8b","order_by":1,"name":"Ferruh Acet","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ferruh","middleName":"","lastName":"Acet","suffix":""},{"id":381994510,"identity":"a1f24ba4-ae59-4520-80c6-b3e89deb0f9b","order_by":2,"name":"Ufuk Atlıhan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYDAC5sMNDAw2DAb8IE5CATFa2BKBWtIYDCQbQFoMSNFicADEI0YLfxtjAzNPwmFj4/OrEz88MGCQ5xc7gF+LxDGIFjOzG283SwAdZjhzdgJ+LQbyjQ3MvD8O25jdOLsBpCXB4DYhLWwQW2yMZ5zd/IMkLWYG/L3biLMF5JeDcxLSjSVu8G6zSDCQIOwX/jbmgw/eJFgb9vef3XzzR4WNPL80AS0gcABiH1ilBGHlSPYdIEX1KBgFo2AUjCQAAKPUQVo5TgZUAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Ufuk","middleName":"","lastName":"Atlıhan","suffix":""},{"id":381994511,"identity":"98062689-5134-4438-a334-1e949b40bd1b","order_by":3,"name":"Ege Nazan Tavmergen Göker","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ege","middleName":"Nazan Tavmergen","lastName":"Göker","suffix":""},{"id":381994512,"identity":"532b5b82-5fac-4799-9dcb-443d10ce0796","order_by":4,"name":"Erol Tavmergen","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Erol","middleName":"","lastName":"Tavmergen","suffix":""}],"badges":[],"createdAt":"2024-11-22 18:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5506529/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5506529/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69802182,"identity":"849abd0b-e49f-4250-8352-96cf1d567fde","added_by":"auto","created_at":"2024-11-25 11:18:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":464713,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5506529/v1/b3f88cd2-9d4a-458b-92ba-e5952dd475e4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Ischemia Modified Albumin Levels in Serum and Follicular Fluid of Infertile Patients with PCOS and without PCOS and the Outcome of IVF Results","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePCOS is one of the most common endocrine and metabolic disorder in women of reproductive ages. Although the exact mechanisms leading to the development of PCOS are not fully understood, it is accepted as a multifactorial syndrome [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Various genetic and epigenetic differences, along with environmental factors, contribute to the development of this syndrome [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. PCOS presents with symptoms of anovulation and hyperandrogenism, including oligo/amenorrhea (irregular or absent menstrual periods), hirsutism (excessive hair growth), acne, infertility, insulin resistance, and obesity. Long-term complications include an increased risk of cardiovascular disease, type-2 diabetes, hypertension, metabolic syndrome, and endometrial cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The diagnosis of PCOS is based on the demonstration of hyperandrogenism and oligo/anovulation. The treatment of PCOS should be individualized, taking into consideration the patient's specific symptoms [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. PCOS leads to infertility through the inhibition of ovulation. It is observed in 25% of infertile women, and it is the most common cause of infertility associated with anovulation. The treatment of infertility in PCOS women ranges from lifestyle changes to medical ovulation induction therapy and in vitro fertilization (IVF) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Women with PCOS are at a higher risk of pregnancy complications compared to the normal population. PCOS women who conceive have an increased risk of miscarriage, diabetes, hypertension, preeclampsia, and preterm birth [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In acute ischemic conditions, a modified type of albumin called Ischemia-Modified Albumin is formed due to the decreased metal binding capacity in the N-terminal region of albumin [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Studies investigated the changes in albumin's cobalt binding capacity by evaluating cases of acute myocardial ischemia. As a result of these studies, a decrease in cobalt binding in the N-terminal region of serum albumin during myocardial ischemia was detected [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Based on these findings, it has been suggested that IMA levels can serve as an early marker in conditions related to ischemia and oxidative stress, including myocardial infarction, cerebrovascular events, diabetes, kidney failure, hypothyroidism, hyperthyroidism, and PCOS [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and can be used to predict the prognosis of the disease. Subsequently, numerous studies have been conducted in this regard. The aim of this study was to compare ischemia modified albumin (IMA) levels in serum and follicular fluid of infertile patients with and without polycystic ovary syndrome (PCOS) and IVF outcomes.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Groups\u003c/h2\u003e \u003cp\u003eThis study was designed as a prospective cohort study. The study was initiated after receiving approval from the Ege University Medical Research Ethics Committee with approval number 21-9.1T/30. The study was designed in accordance with the Helsinki Declaration. Informed consent forms were obtained from all patients. Our study included 113 cases who applied to the Ege University Hospital ART Center and were planned for IVF treatment between 2021\u0026ndash;2023. According to the 2003 Rotterdam ESHRE/ASRM Criteria, patients diagnosed with PCOS were included in the study group, while others were included in the control group. Patients over the age of 40, diagnosed with endometriosis or endometrioma, having uterine factors (uterine anomaly, leiomyomas, endometrial polyps), using tobacco, having systemic diseases such as diabetes or hypothyroidism, and patients undergoing IVF due to male factor were not included in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eIVF Procedure\u003c/h3\u003e\n\u003cp\u003eAll patients received flexible GnRH antagonist protocol for ovarian stimulation. The gonadotropin dosage was determined considering the patient's age, body mass index (BMI), and oocyte reserve. On the 2nd or 3rd day of the cycle, the control group received 150\u0026ndash;450 IU of gonadotropin (Gonal F, Merck, Halle, Germany, and/or Merional, IBSA, Switzerland), while the study group received 125\u0026ndash;300 IU. For pituitary desensitization 0.25 mg of GnRH antagonist (Cetrotide, Merck, Halle, Germany) was started on the 6th or 7th day of the cycle. During the treatment, follicular development was monitored by transvaginal ultrasound (TVUSG), and when the dominant follicle reached 18 mm, ovulation was triggered by a subcutaneous injection of 250 IU human chorionic gonadotropin (hCG) (Ovitrelle, Merck, Modugno, Italy). Oocyte aspiration was performed 35\u0026ndash;36 hours after hCG administration. Following denudation procedures, the mature oocytes (Metaphase II stage) were subjected to intracytoplasmic sperm injection (ICSI) using sperm prepared from the partner through the swim-up method. After ICSI, the oocytes were incubated in culture media, and 10\u0026ndash;18 hours later, fertilization was checked under an inverted microscope. The culture media for the embryos were changed, and incubation continued. On the 2nd and 3rd days of development cleavage embryos were checked, and embryo transfer was carried out on the patients, or they were further incubated until the blastocyst stage on the 5th day. The number of embryos transferred was in compliance with the regulations (1 or 2 embryos) and selected from good-quality embryos. For luteal phase support in cases which fresh embryo transfer was performed, vaginal progesterone (Progestan, Ko\u0026ccedil;ak Farma) was started at a dosage of 4x200 mg/day on the day of oocyte retrieval. On the 4th day of embryo transfer, patients with E2 levels below 2000 IU and no OHSS (ovarian hyperstimulation syndrome) criteria received a subcutaneous injection of 250 IU HCG. On the 14th day of transfer, the beta hCG level has been measured. If the beta hCG level is \u0026gt;\u0026thinsp;50 U/L, it was considered as biochemical pregnancy. The presence of a gestational sac with the fetal cardiac activity in transvaginal ultrasonography (TVUSG) was considered as clinical pregnancy and the pregnancy that have reached 24 weeks based on the last menstrual period was considered ongoing pregnancy.\u003c/p\u003e\n\u003ch3\u003eBiochemical analysis\u003c/h3\u003e\n\u003cp\u003eFor each participant in the study, 2 mL of EDTA blood and follicular fluid samples collected during oocyte retrieval were sent to the Ege University Department of Medical Biochemistry Laboratory of Clinical Biochemistry Science within 30 minutes. Plasma samples were obtained by centrifuging the blood samples at 1000 g for 15 minutes at 2\u0026ndash;8\u0026deg;C within the first 30 minutes after blood collection, while the follicular fluid samples were centrifuged at 1000 g for 20 minutes at 2\u0026ndash;8\u0026deg;C and separated samples were stored at -80\u0026deg;C in accordance with kit conditions. IMA levels were measured using a competitive enzyme-linked immunosorbent assay (ELISA) kit (CEA825Hu, Wuhan USCN Business Co., Ltd., China).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe number of participants in the study was determined based on statistical calculations to achieve significant results: according to the power analysis conducted in the G Power 3.08 program, 52 patients were required in each group to detect the difference between the two groups with a large effect size (0.8) and a significance level of 0.05. In the statistical analysis phase, frequency tables for categorical variables and descriptive statistics for continuous variables were calculated. The Pearson chi-square test was applied to examine categorical data between groups. The Shapiro-Wilk normality test was used to assess whether continuous variables were normally distributed. Since the data were not normally distributed, the Mann Whitney U test was used for independent groups in both the patient and control groups. The significance level was set at 0.05 for all hypothesis tests. The statistical analysis was performed using IBM SPSS Version 25.0 statistical package program.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe characteristic features of the patients, serum and follicular fluid IMA levels, and IVF data are presented in Table\u0026nbsp;1. Statistically significant difference of IMA values were found only in the follicular fluid IMA levels between two groups \u003cem\u003e(p\u0026thinsp;=\u0026thinsp;0.031)\u003c/em\u003e. In the PCOS group, a lower total dose of recombinant FSH was used, while the number of retrieved oocytes and embryos was found to be higher. Out of 57 patients in the control group, no oocytes were obtained from one patient, and fertilization did not occur in seven patients. In the PCOS group, out of 56 cases, one had no fertilization, and embryos could not be obtained. Embryos with grade 1 and grade 2 in cleavage stage and grade AA, AB, BB in blastocyst stage were considered as good-quality embryos. The rate of high-quality embryos was found to be higher in the control group, but this difference was not statistically significant (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.153, 0.21, cleavages and blasts respectively\u003c/em\u003e). The anti-m\u0026uuml;llerian hormone (AMH) level in the PCOS group was found to be significantly higher than the control group \u003cem\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/em\u003e In the IVF cycle outcomes, it is observed that the gonadotropin dose used in the control group was higher, while the number of oocytes and embryos retrieved was lower \u003cem\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, \u0026lt;\u0026thinsp;0.01, 0.013 respectively).\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable-1.\u003c/b\u003e Comparison of demographic and clinical data between groups\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCOS group (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMedian-(Min-Max)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33-(26\u0026ndash;39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32-(23\u0026ndash;39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.075\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.1-(18-37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.4-(16-40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.073\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfertility duration (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4-(1\u0026ndash;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4-(1\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.479\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-(0.09\u0026ndash;3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2-(1.4\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum IMA\u003c/p\u003e \u003cp\u003e(mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24-(1.2\u0026ndash;40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.05-(1.43\u0026ndash;31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.16\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFF-IMA (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.6-(1.5\u0026ndash;46.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.4-(3-41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIVF data\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian-(Min-Max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal dose of gonadotropins (IU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2250-(1050\u0026ndash;3900)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1400-(325\u0026ndash;4750)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of retrieved oocytes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5-(0\u0026ndash;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15-(2\u0026ndash;41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of embryos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-(0\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2-(0\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOocyte grade\u003c/b\u003e\u003c/p\u003e \u003cp\u003en-%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM II oocytes rates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77.72%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM I oocytes rates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProphase oocytes rates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.09%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEmbryo grade and quality\u003c/b\u003e\u003c/p\u003e \u003cp\u003en-%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleavage embryo number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlast embryo number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh quality cleavage embryos rates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.153\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh quality blasts rates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*BMI: Body mass index, AMH: anti-m\u0026uuml;llerian hormone, IMA: ischemia modified albumin, FF: follicular fluid, M: metaphase\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn this study, patients at high risk for OHSS (Ovarian Hyperstimulation Syndrome) were not subjected to fresh embryo transfer but instead underwent frozen embryo transfer. Among the 49 patients in the control group which obtained embryos, 44 of them (89.8%) received fresh embryo transfers, while 5 of them (10.2%) received frozen embryo transfers. In the PCOS group, out of the 55 patients which obtained embryos, 36 of them (65.5%) received fresh embryo transfers, while 19 of them (32.7%) received frozen embryo transfers. The frequency of frozen embryo transfers was found to be higher the PCOS group when comparing to the control group (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.0012).\u003c/em\u003e The pregnancy outcomes of patients in the study and control groups are shown in Table-2. The rates of beta hCG positivity, clinical pregnancy, and ongoing pregnancy were found to be higher in the control group compared to the study group, but none of these differences were statistically significant (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.08, 0.293, 0.188, respectively\u003c/em\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, when comparing all patients, those with positive beta hCG results and those without, there were no significant difference in IMA levels in both serum and follicular fluid (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.275, 0.571 respectively\u003c/em\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable-2.\u003c/b\u003e Comparison of pregnancy rates between groups\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003en-%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCOS group\u003c/p\u003e \u003cp\u003en-%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiochemical pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u0026ndash;56.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u0026ndash;46.62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.08\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u0026ndash;49.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u0026ndash;39.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.293\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOngoing pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u0026ndash;40.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u0026ndash;28.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.188\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe patients participating in the study were divided into subgroups based on the embryo transfer day and whether it was a fresh or frozen embryo transfer. Serum and follicular fluid IMA levels and the pregnancy outcomes of this subgroups are shown in Table-3. In contrasts to the overall results obtained from all patient groups, the only group which pregnancy rates were higher in the PCOS group was the 3rd day frozen embryo transfer group (57.1%, 0%). In all other groups, pregnancy rates were higher in the control group. In the PCOS cases, the subgroup that underwent frozen blastocyst transfer, the ongoing pregnancy rate was 50%, while the subgroup with fresh blastocyst transfer, the rate was 28.6%. In PCOS group the ongoing pregnancy rate of patients with transferred 3th day frozen embryo was %57.1, while the rate was %14.8 in patients with 3th day fresh embryo transfers. It is noteworthy that only in the PCOS group, patients who underwent embryo cryopreservation had better pregnancy outcomes compared to those who had fresh embryo transfers. According to Table\u0026nbsp;3, the follicular fluid IMA level was found to be significantly higher in the control group in cases which 3th day fresh embryo transferred \u003cem\u003e(p\u0026thinsp;=\u0026thinsp;0.04)\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable-3. Comparison of groups according to transfer type and cycle type\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePCOS group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMedian-(Min-Max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eCleavage\u003c/p\u003e \u003cp\u003e(3td day embryos)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eFresh cycles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSerum IMA (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24-(1.2\u0026ndash;40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24-(4-29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.36\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFF IMA (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.8-(2.2\u0026ndash;46.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.7-(3.69\u0026ndash;41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBiochemical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.3\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.13\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOngoing pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.051\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eThaw cycles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSerum IMA (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.5-(24.8\u0026ndash;34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.5-(1.43\u0026ndash;29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.14\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFF IMA (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.9-(30.2\u0026ndash;33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.4-(4.56\u0026ndash;35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.14\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBiochemical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.4\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.44\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOngoing pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.44\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eBlastocyst\u003c/p\u003e \u003cp\u003e(5th day embryo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eFresh cycles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSerum IMA (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.4-(5-35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5-(4.03\u0026ndash;31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFF IMA (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.2-(1.2\u0026ndash;31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.9-(3.03\u0026ndash;22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.57\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBiochemical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.19\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.3\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOngoing pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.47\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eThaw cycles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSerum IMA (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.9-(3.24\u0026ndash;26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.1-(5.08\u0026ndash;30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.19\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFF-IMA (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6-(6.42\u0026ndash;24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.6-(6.6\u0026ndash;34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.83\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBiochemical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.5\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.5\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOngoing pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.47\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003e*\u003c/b\u003eIMA: ischemia modified albumin, FF: follicular fluid\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this prospective cohort study, we aimed to compare the levels of IMA in the serum and follicular fluid of infertile patient groups with and without PCOS, and to observe the impact of IMA levels on the IVF outcomes. As a result of the study, we found that the serum and follicular fluid IMA levels were lower, and the pregnancy rates were also lower in the PCOS group when compared to the control group.\u003c/p\u003e \u003cp\u003eThe IMA level has been suggested as an early marker in conditions related to ischemia and oxidative stress, including myocardial infarction, cerebrovascular events, diabetes, renal failure, hypothyroidism, and hyperthyroidism, and numerous studies have been conducted on its use as a marker and predicting the prognosis of the disease [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Studies suggest that the most significant advantage of IMA level among ischemia biomarkers is its ability to be detected in the early stages of ischemia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Although the etiology of PCOS has not been fully elucidated, chronic ischemia and oxidative stress mechanisms play a role in its pathophysiology. Consequently, studies investigating the IMA level in patients with PCOS have been increasingly conducted in recent years. In a study conducted by Reddy et al. in 2018, nine studies investigating serum IMA levels in cases of PCOS were examined, and it was found that the serum IMA levels in the PCOS cases was higher compared to the control group [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. There are also studies that did not find a significant difference in serum IMA levels between two groups [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. There is only one study that investigates the IMA level in the follicular fluid in cases of PCOS [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In this study by Dilbaz et al., IMA and TAC levels in the follicular fluid were found to be higher than serum levels. Similarly, in our study, the IMA level in the follicular fluid was higher than the serum levels in both groups. In the study by Dilbaz et al., the IMA value in follicular fluid was higher in the PCOS group compared to the control group, but this difference was not statistically significant. In contrast to this study, in our study, the follicular fluid IMA value was found to be higher in the non-PCOS group, than the PCOS group, and this difference was statistically significant. In our study, the finding of lower IMA values in the PCOS group could be explained by the chronic ischemic process of PCOS, where the reversal of IMA modification occurs due to the involvement of antioxidant mechanisms in PCOS cases, leading to a decrease in both serum and follicular fluid IMA levels. Studies in this regard indicate that albumin modification is a bidirectional and reversible change, and that after the acute phase of myocardial ischemia, IMA rapidly returns to its albumin form [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In patients with cerebral infarction, serum IMA values increase during the acute phase and gradually decrease within a week [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Furthermore, since IMA increases due to acute oxidative stress, the chronic nature of PCOS can also explain the lower values. As the number of studies investigating serum IMA values in ischemic processes increases, it has been understood that IMA levels vary depending on the type of pathological process, the stage of the disease, and the measurement method used [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Numerous studies have demonstrated that reactive oxygen species increase and total antioxidant capacity decreases in the follicular fluid of infertile patients with PCOS compared to infertile patients without PCOS [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, the impact of this oxidative stress condition on pregnancy outcomes has not been definitively established. In our study, when comparing all patient groups, there was no significant difference in IMA values in both serum and follicular fluid between patients who tested positive and negative for beta hCG after IVF. Chattopadhyay et al. conducted a study where they found that infertile patients with PCOS had higher levels of reactive oxygen radicals in their follicular fluid compared to patients with infertility due to tubal factors. In IVF results, it was shown that the fertilization and clinical pregnancy rates were higher in the tubal factor group, but this difference was not statistically significant[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our study, both serum and follicular fluid IMA levels were higher in the control group compared to the PCOS group, and pregnancy rates were also higher in the control group. This could be explained by IMA levels not fully reflecting the actual oxidative stress condition or the limited impact of the oxidative load in the follicular environment on pregnancy outcomes. The results of studies comparing pregnancy rates in IVF cycles between PCOS patients and non-PCOS infertile patients are conflicting. In the study conducted by Dilbaz and colleagues, biochemical and clinical pregnancy rates were found to be higher in the PCOS group; however, this difference was not found to be statistically significant [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The previous studies have reported different pregnancy rates in patients with PCOS following IVF cycles. In the study conducted by Muharam and colleagues, biochemical and clinical pregnancy rates were found to be higher in the PCOS group [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In another study comparing the pregnancy rates after IVF cycles in PCOS patients and those with isolated male factor infertility, pregnancy rates were found to be higher in the PCOS group [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Lower pregnancy rates have found in PCOS group by other authors [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our study, the biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate were found to be higher in the control group compared to the PCOS group, but none of these differences were statistically significant. While IMA levels were found to be higher in the control group in all subgroups, there are some differences in pregnancy outcomes. In our study we found that pregnancy rates in PCOS patients are higher in frozen cycles compared to fresh cycles. Additionally, unlike all other subgroups, the only group where pregnancy rates were higher in the PCOS group is in cases of frozen cleavage embryo transfer. The pregnancy rates were higher when cleavage and blastocyst embryos were cryopreserved and transferred compared to fresh embryo transfer cycles. It is known that cryopreservation leads to a decrease in oxidative stress parameters in embryos. Factors that can impair embryo quality and negatively affect pregnancy outcomes in PCOS patients may be eliminated when embryos are cryopreserved. Even though IMA values may be low in PCOS patients under chronic oxidative stress, the freezing and thawing process is believed to have a positive impact in this regard. There are studies showing that live birth rates in PCOS patients are higher in frozen cycles compared to fresh cycles [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Frozen cycles protect the endometrium from the negative effects of high estrogen levels.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn the literature, there have been studies investigating serum IMA (levels in patients with PCOS however, the results are contradictory. Furthermore, there are very few studies that have investigated IMA levels in the follicular fluid of PCOS patients. Our study, in this regard, is of a nature that will contribute to the literature. It is necessary to conduct numerous studies with a larger number of patients to elucidate the pathophysiology of how PCOS affects infertility, oocyte quality, and leads to IVF (In Vitro Fertilization) failure, and for the successful implementation of infertility treatment in these cases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCONFLICT OF INTEREST STATEMENT\u003c/h2\u003e \u003cp\u003eThe authors have no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor contributions: UA: Data analysis; ND, ET: Project development; FA: Data Collection; Manuscript writing; ND; Manuscript writing; ENTGAll authors reviewed and approved the final version, and no other person made a substantial contribution to the paper.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKahsar-Miller MD, Nixon C, Boots LR, Go RC, Azziz R. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertil Steril 2001;75:53\u0026ndash;8. https://doi.org/10.1016/S0015-0282(00)01662-9.\u003c/li\u003e\n \u003cli\u003eKılı\u0026ccedil; D, G\u0026uuml;ler T, Alataş Derya Kılı\u0026ccedil; E, \u0026Uuml;ye Pamukkale \u0026Uuml;niversitesi Tıp Fak\u0026uuml;ltesi Kadın Hastalıkları ve Doğum Anabilim Dalı \u0026Ouml;, Pamukkale \u0026Uuml;niversitesi Tıp Fak\u0026uuml;ltesi Kadın Hastalıkları ve Doğum Anabilim Dalı D, Alataş E, et al. 2018 Uluslarası kanıta dayalı Polikistik Over Sendromu değerlendirme ve y\u0026ouml;netim rehberi doğrultusunda uzun d\u0026ouml;nem risklerin y\u0026ouml;netimi. Pamukkale Medical Journal 2020;13:453\u0026ndash;61. https://doi.org/10.31362/PATD.641770.\u003c/li\u003e\n \u003cli\u003eCho LW, Atkin SL. Cardiovascular risk in women with polycystic ovary syndrome. Minerva Endocrinol. 2007 Dec;32(4):263-73. PMID: 18091663.\u003c/li\u003e\n \u003cli\u003eLegro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-92. doi: 10.1210/jc.2013-2350. Epub 2013 Oct 22. Erratum in: J Clin Endocrinol Metab. 2021 May 13;106(6):e2462. doi: 10.1210/clinem/dgab248. PMID: 24151290; PMCID: PMC5399492.\u003c/li\u003e\n \u003cli\u003eHull MG, Glazener CM, Kelly NJ, Conway DI, Foster PA, Hinton RA, Coulson C, Lambert PA, Watt EM, Desai KM. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed). 1985 Dec 14;291(6510):1693-7. doi: 10.1136/bmj.291.6510.1693. PMID: 3935248; PMCID: PMC1418755.\u003c/li\u003e\n \u003cli\u003eRees DA, Jenkins-Jones S, Morgan CL. Contemporary Reproductive Outcomes for Patients With Polycystic Ovary Syndrome: A Retrospective Observational Study. J Clin Endocrinol Metab 2016;101:1664\u0026ndash;72. https://doi.org/10.1210/JC.2015-2682.\u003c/li\u003e\n \u003cli\u003eLippi G, Montagnana M, Guidi GC. Albumin cobalt binding and ischemia modified albumin generation: an endogenous response to ischemia? Int J Cardiol 2006;108:410\u0026ndash;1. https://doi.org/10.1016/J.IJCARD.2005.03.040.\u003c/li\u003e\n \u003cli\u003eBar-Or D, Lau E, Winkler J V. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia-a preliminary report. J Emerg Med 2000;19:311\u0026ndash;5. https://doi.org/10.1016/S0736-4679(00)00255-9.\u003c/li\u003e\n \u003cli\u003eBhagavan N V., Lai EM, Rios PA, Yang J, Ortega-Lopez AM, Shinoda H, et al. Evaluation of human serum albumin cobalt binding assay for the assessment of myocardial ischemia and myocardial infarction. Clin Chem 2003;49:581\u0026ndash;5. https://doi.org/10.1373/49.4.581.\u003c/li\u003e\n \u003cli\u003eCollinson PO, Gaze DC. Ischaemia-modified albumin: clinical utility and pitfalls in measurement. J Clin Pathol 2008;61:1025\u0026ndash;8. https://doi.org/10.1136/JCP.2007.053363.\u003c/li\u003e\n \u003cli\u003eShevtsova A, Gordiienko I, Tkachenko V, Ushakova G. Ischemia-Modified Albumin: Origins and Clinical Implications. Dis Markers 2021;2021. https://doi.org/10.1155/2021/9945424.\u003c/li\u003e\n \u003cli\u003eSeshadri Reddy V, Bukke S, Munikumar M. Elevated levels of the circulatory ischemia-modified albumin in patients with polycystic ovary syndrome: a meta-analysis. Gynecol Endocrinol 2018;34:868\u0026ndash;74. https://doi.org/10.1080/09513590.2018.1462318.\u003c/li\u003e\n \u003cli\u003eCakir E, Ozbek M, Ozkaya E, Colak N, Cakal E, Sayki M, et al. Oxidative stress markers are not valuable markers in lean and early age of polycystic ovary syndrome patients. J Endocrinol Invest 2011;34:e178\u0026ndash;82. https://doi.org/10.3275/7352.\u003c/li\u003e\n \u003cli\u003eDilbaz B, Demirtas S. The ımpact of follicular fluid ıschemia-modified albumin levels on ICSI outcomes ın PCOS patients Gamze Sinem Caglar Ufuk \u0026Uuml;niversitesi 2017. https://doi.org/10.15761/JPR.1000104.\u003c/li\u003e\n \u003cli\u003eOzturk M, Keskin U, Ozturk O, Ulubay M, Alanbay İ, Aydin A, et al. Are serum gamma-glutamyl transferase, high-sensitivity C-reactive protein, and ischaemia-modified albumin useful in diagnosing PCOS? Http://DxDoiOrg/101080/0144361520161174827 2016;36:929\u0026ndash;34. https://doi.org/10.1080/01443615.2016.1174827.\u003c/li\u003e\n \u003cli\u003eSinha MK, Vazquez JM, Calvino R, Gaze DC, Collinson PO, Kaski JC. Effects of balloon occlusion during percutaneous coronary intervention on circulating Ischemia Modified Albumin and transmyocardial lactate extraction. Heart 2006;92:1852. https://doi.org/10.1136/HRT.2005.078089.\u003c/li\u003e\n \u003cli\u003eMenon B, Ramalingam K, Krishna V. Study of Ischemia Modified Albumin as a Biomarker in Acute Ischaemic Stroke. Ann Neurosci 2018;25:187\u0026ndash;90. https://doi.org/10.1159/000488188.\u003c/li\u003e\n \u003cli\u003eSeyfettinoğlu S, Şahin G, Akdoğan A, Nazan E, G\u0026ouml;ker T, Ak\u0026ccedil;ay Y, et al. Role of total antioxidant capacity and oxidative stress in fertilization and embryo selection in the IVF cycle. Cukurova Medical Journal 2021;46:1694\u0026ndash;702. https://doi.org/10.17826/CUMJ.979955.\u003c/li\u003e\n \u003cli\u003eChattopadhayay R, Ganesh A, Samanta J, Jana SK, Chakravarty BN, Chaudhury K. Effect of follicular fluid oxidative stress on meiotic spindle formation in infertile women with polycystic ovarian syndrome. Gynecol Obstet Invest 2010;69:197\u0026ndash;202. https://doi.org/10.1159/000270900.\u003c/li\u003e\n \u003cli\u003eMuharam R, Prasetyo YD, Prabowo KA, Putri YI, Maidarti M, Hestiantoro A. IVF outcome with a high level of AMH: a focus on PCOS versus non-PCOS. BMC Womens Health 2022;22. https://doi.org/10.1186/S12905-022-01756-4.\u003c/li\u003e\n \u003cli\u003eSaleh R, andrology AH-J of, 2002 undefined. Oxidative stress and male infertility: from research bench to clinical practice. ClevelandclinicOrg n.d.;23.\u003c/li\u003e\n \u003cli\u003eChen Y hui, Wang Q, Zhang Y nan, Han X, Li D han, Zhang C lian. Cumulative live birth and surplus embryo incidence after frozen-thaw cycles in PCOS: how many oocytes do we need? J Assist Reprod Genet 2017;34:1153\u0026ndash;9. https://doi.org/10.1007/S10815-017-0959-6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"İnfertility, polycystic ovary syndrome (PCOS), ischemia-modified albumin (IMA), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI)","lastPublishedDoi":"10.21203/rs.3.rs-5506529/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5506529/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo compare the ischemia modified albumin (IMA) levels in the serum and follicular fluid of infertile patients with polycystic ovary syndrome (PCOS), and without PCOS, and their IVF outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and Method:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a prospective cohort study with patients undergoing IVF treatment at Ege University IVF Center during 2021 and 2023. Blood and follicular fluid samples were collected from a total of 113 infertile women with PCOS (n = 56) and without PCOS (n = 57). The samples were centrifuged and stored at -80 \u003csup\u003e0\u003c/sup\u003eC at the Ege University Department of Biochemistry laboratories. The serum and follicular fluid IMA levels of these patients and their IVF outcomes were compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo statistically significant difference was found between the two groups when compared for mean age, body mass index (BMI) and duration of infertility (\u003cem\u003ep = 0.075, 0.073 and 0.479 respectively)\u003c/em\u003e. The IVF results showed statistically significant differences. Although the number of oocytes retrieved and number of embryos were higher in the PCOS group (\u003cem\u003ep value \u0026lt; 0.001 and 0.013, respectively\u003c/em\u003e), the recombinant FSH dose used for ovulation induction was lower in PCOS group (\u003cem\u003ep \u0026lt; 0.001\u003c/em\u003e) than non-PCOS group. Serum IMA levels in PCOS patients were found to be lower than the control group, but this difference was not statistically significant (\u003cem\u003ep = 0.16\u003c/em\u003e). Follicular fluid IMA values were found to be lower in the PCOS group than the control group, while the difference was statistically significant (\u003cem\u003ep = 0.031\u003c/em\u003e). Considering the pregnancy results, biochemical pregnancy, clinical pregnancy, and ongoing pregnancy rates in the non-PCOS group was higher than the PCOS group, although the difference was not statistically significant (\u003cem\u003ep = 0.08, 0.29, 0.18 respectively\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of studies comparing serum IMA values of PCOS and non-PCOS cases are conflicting. In our study, we found that the serum and follicular fluid IMA levels in non-PCOS group were higher than the PCOS group. Biochemical, clinical and ongoing pregnancy rates were found higher in the non-PCOS group when compared to the PCOS group.\u003c/p\u003e","manuscriptTitle":"Comparison of Ischemia Modified Albumin Levels in Serum and Follicular Fluid of Infertile Patients with PCOS and without PCOS and the Outcome of IVF Results","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-25 11:02:51","doi":"10.21203/rs.3.rs-5506529/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f24eaa63-c257-4ce1-9842-ee8a3f05746c","owner":[],"postedDate":"November 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-25T11:02:53+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-25 11:02:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5506529","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5506529","identity":"rs-5506529","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}