Research Of PAF In Follicular Fluid In In Vitro Fertilization And Embryo Transfer

Objectives: We examined the level of platelet activating factor (PAF) infollicular fluid and analysised the relationship between it and age, body massindex(BMI), antral follicle count(AFC), sex hormonesd, and the laboratoryParameters in in vitro fertilization embryo transfer(IVF-ET)cycle, in order toevaluate the effect of PAF on fertilization, and embryo development, so as toprovide theoretical evidence to find out a new method of evaluating to thequality of oocytes and embryo potential development.Methods: A total of162patients who first received IVF-ET that includeIVF and intracytoplasmic sperm injection(ICSI)treatment and acceptedembryo transter form July the first,2013to August the thirty-one,2013wereanalyzed. The patients were excluded who had tuberculosis, endometriosis anduterine cavity lesions, nearly three months didn’t use hormonal drugs and therewas no history of spontaneous abortion, couples chromosome was normal,ovarian hyperstimulation syndrome (OHSS)didn’t occurre,etc.They were choosing different treatment program according their differentcinditions: GnRH agonist down-regulation long protocols or Microstimulationprotocols, and choosing IVF or ICSI to fertilization according to the quality ofsemen.48h and72h after ovum pick-up observed embryonic development.The embryo cell number was7to12, the size of blastomere was uniform orslightly uniform and pieces of20%or less after ovum pick-up72h was highquality embryos.In order to analysis the relationship between PAF and age, body massindex(BMI), basal follicle-Stimulating Hormone(bFSH), bFSH/basalluteinizing hormone(bLH), antral follicle count(AFC), the level of estradiol(E2)and progesterone(P) at trigger day, the numbers of oocytes retrieved,162patients with35years old as critical, analysed the difference in the level of PAF in follicular fluid between age≤35year patients and age>35yearspatients; with BMI=25kg/m2as critical, analysed the difference in the level ofPAF in follicular fluid between BMI<25kg/m2patients and BMI≥25kg/m2patients;with bFSH=10IU/L as critical, analysed the difference in the level ofPAF in follicular fluid between bFSH≤10IU/L patients and bFSH>10IU/Lpatients; with bFSH/bLH=2as critical, analysed the difference in thelevel of PAF in follicular fluid between bFSH/bLH≤2patients andbFSH/bLH>2patients; with AFC=7as critical, analysed the difference in thelevel of PAF in follicular fluid between AFC≤7patients and AFC>7patients;with the level of E2at trigger day=1000pg/ml as critical, analysed thedifference in the level of PAF in follicular fluid between the level of E2attrigger day≤1000pg/ml patients and the level of E2at trigger day>1000pg/mlpatients; with the level of P at trigger day=2.6ng/ml as critical, analysed thedifference in the level of PAF in follicular fluid between the level of P attrigger day≤2.6ng/ml patients and the level of P at trigger day>2.6ng/mlpatients; with the number of oocytes retrieved=4as critical, analysed thedifference in the level of PAF in follicular fluid between the number ofoocytes retrieved≤4patients and the number of oocytes retrieved>4patients.68patients who with non-polycystic ovary syndrome(PCOS),age≤35years old, BMI<25kg/m2, AFC>7and application of GnRH agonistdown-regulation long protocols were divided into three groups according tothe level of PAF in follicular fluid:①PAF≤5.9ng/ml group(17cases),②5.9<PAF<11ng/ml group,(34cases)③PAF≥11ng/ml group(17cases), inorder to furthe research on the effect of PAF on the quality of oocyte andembryo development. Analysed the difference in fertilization rate,2PNformation rate, implantation rate, high quality embryo rate and pregnancy rateamong the three groups under the proposition that the basic conditions thatinclude age, infertility duration, BMI and so on and.the Gn days, Gn dosage,the number of oocytes retrieved, the endometrium thickness at embryo transferday and other COS conditions without statistical differences.We examined the level of serum E2, P, LH, FSH and HCG by ECLIA and determined the level of PAF in the first tube follicular fluid which was clear byELISA.Statistical analysis: Statistical analysis was performed using the SPSS13.0software package. The measurement data were expressed as x±s,comparisons between groups were using t test, ANOVA, rank test andx2analysis. Pearson and spearman correlation were used to analysis thecorrelations. A p-value below5%was considered as significant.Results:1The level of PAF in follicular fluid were obviously lower in age>35yearpatients than those in age≤35year patients (P <0.05).2There were no significantly difference in the level of PAF in follicularfluid between BMI<25kg/m2patients and BMI≥25kg/m2patients (P>0.05).3There were no significantly difference in the level of PAF in follicularfluid between bFSH>10IU/L patients and bFSH≤10IU/L patients (P>0.05).4The level of PAF in follicular fluid were lower in FSH/LH≥2patientsthan those in FSH/LH<2patients,but without significantly differenc (P>0.05).5There were no significantly difference in the level of PAF in follicularfluid between AFC>7patients and AFC≤7patients (P>0.05).6The level of PAF in follicular fluid were lower in the level of E2attrigger day≤1000pg/ml patients than those in the level of E2at triggerday>1000pg/ml, but without significantly differenc (P>0.05).7There were no significantly difference in the level of PAF in follicularfluid between the level of P at trigger day≤2.6ng/ml patients and the level ofE2at trigger day>2.6ng/ml patients (P>0.05).8There were no significantly difference in the level of PAF in follicularfluid between the number of oocytes retrieved≤4patients and the number ofoocytes retrieved>4patients (P>0.05).9The correlation between PAF and age, BMI, bFSH, bFSH/bLH, AFC,the level of E2and P at trigger day, the number of oocytes retrieved:there wassignificant negatively correlation between the level of PAF in follicular fluidand age(r=-0.197,P<0.05); But there was no significantly correlation between the level of PAF in follicular fluid with BMI(r=0.006,P<0.05),bFSH(r=0.097,P<0.05), bFSH/bLH(r=0.039,P<0.05), AFC(r=0.098,P<0.05),the level of E2at trigger day(r=-0.101,P<0.05), the level of P at triggerday(r=0.066,P<0.05), the number of oocytes retrieved(r=0.015,P>0.05).Butthere was diffrent correlation between the level of PAF in follicular fluid andthe level of E2at trigger day with the level of E2at trigger day=1000pg/ml ascritical.When the level of E2at trigger day≤1000pg/ml, there was significantpositively correlation between the level of PAF in follicular fluid with thelevel of E2(r=0.567,P<0.05); but there was significant negatively correlationbetween the level of PAF in follicular fluid with E2when the level of E2was at>1000pg/ml(r=-0.242,P<0.05).1068patients were divided into three groups according to the level ofPAF in follicular fluid:①PAF≤5.9ng/ml group,②5.9<PAF<11ng/ml group,③PAF≥11ng/ml group, under the proposition that the basic conditions thatinclude age, infertility duration, BMI and so on and the Gn days, Gn dosage,the number of oocytes retrieved, the endometrium thickness at embryo transferday and other COS conditions without statistical differences, the fertilizationrate and implantation rate as the level of PAF rise, but without significantlydifference among the three groups (P>0.05).11There were significantly difference in2PN formation rate among thethree groups,2PN formation rate was highest in PAF≥11ng/ml group that was71.16%and was higher than those in PAF≤5.9ng/ml group that was59.81%(P<0.05), but without significantly difference between5.9<PAF<11ng/ml group and PAF≥11ng/ml group,5.9<PAF<11ng/ml groupand PAF≤5.9ng/ml group was no significantly difference too(P>0.05).12There were significantly difference in high quality embryo rate amongthe three groups, it was highest in PAF≥11ng/ml group that was64.96%(P<0.05). and was higher than those in PAF≤5.9ng/ml group that was46.09%(P<0.05),and also higher than those in5.9<PAF<11ng/ml group thatwas50.63%(P<0.05),but but without significantly difference between5.9<PAF<11ng/ml group and PAF≤5.9ng/ml group(P>0.05). 13There were significantly difference in pregnancy rate among the threegroups, which was highest in PAF≥11ng/ml group that was70.59%and washigher than those in PAF≤5.9ng/ml group that was23.53%(P<0.05), butwithout significantly difference between5.9<PAF<11ng/ml group andPAF≥11ng/ml group(P>0.05),5.9<PAF<11ng/ml group and PAF≤5.9ng/mlgroup was no significantly difference too(P>0.05).Conclusion:PAF could promote the follicular development. The level of PAF infollicular fluid was affected with Age, and it related to Ovarian reservefunction, which in OPU day of normal ovarian function of patients was higher.The level of serum E2at trigger day had different influence on PAF level infollicular fluid, PAF could not only promote the E2secretion of granular celland high level of serum E2could induce the level of PAF. The level of PAF infollicular fluid could be used as a norm to predict pregnancy outcome and anew method to evaluate the quality of oocyte and the potential ofembryogenesis. That prompted we should control degree of COS in IVFprocess, thus reducing the level of E2and the number of oocytes retrieved, soas to improve the outcome of IVF.