Association of Ovarian Steroids in Follicular Fluid with Pregnancy Rates in Patients with or without Polycystic Ovary during in vitro Fertilization

The point of this consideration is to examine the possible influence of progesterone (P4), estradiol (E2), and testosterone (T) concentrations in follicular fluid (FF) on fertilization, implantation, and biochemical pregnancy rates in patients with polycystic ovary (PCO) and normal women during in vitro fertilization (IVF) treatment. 30 normal-ovulatory women between 24-42 years old and 26 women with the PCO, between 21-37 years old under assisted reproductive therapy were recruited from two university hospital IVF centers during this study. The fluid from more than one preovulatory follicle was obtained on the day of ovulation for hormone measurement using the Elisa method. Association between the mentioned steroid levels and fertilization, implantation, and biochemical pregnancy rates were assessed by using spearman, Mann-Whitney, and regression tests. Among the assessed outcomes, in the PCO group, the FF, E2, and T levels appeared to have a noteworthy reverse relationship with fertilization rate (P= 0.050). In both groups, intrafollicular levels of the E2/T ratio correlated positively with implantation rate (P=0.024 in control vs. P= 0.009 in PCO) and biochemical pregnancy (P= 0.020 in control vs. P= 0.012 in PCO). Furthermore, intrafollicular E2/P4 levels showed a positive relationship with both implantation (P= 0.047) and biochemical pregnancy (P= 0.050) rates in the control group. Our results for the first time suggest that high intrafollicular levels of E2 and T may influence reduced fertilization rate. The E2/T ratio would be a good predictor of successful implantation and pregnancy rates regardless of infertility causes. Moreover, the E2/P4 ratio could be a valuable prescient marker for implantation and biochemical pregnancy rates in normal-ovulatory women. Beyond the mentioned results, the underlying pathological processes, and pathways, including hyperandrogenism and interruptions in the hypothalamic-pituitary-ovarian (HPO) axis could be the potent concepts in polycystic ovary syndrome (PCOS) etiology and an alteration in genetic variants of SHBGs and catalytic enzymes responsible in steroidogenesis pathways. Furthermore, possible correlations between the mentioned steroid hormones and the functions of genes related to gonadotropins and steroid hormones in the pathophysiological pathways involved in PCOS were explored.