The Relationship Between Follicular Fluid FOXL2 And Ovarian Response And Pregnancy Outcomes In Assisted Reproduction

Background and ObjectiveDuring controlled ovarian stimulation,patient need exogenous gonadotropin to stimulate multifollicular development.However,due to individual difference between patients,the ovaries react differently to gonadotropins.Therefore,it is necessary to reasonable assess the ovarian function and predict the ovarian reactivity,to formulate individualized treatment plans beneficially and reduce the incidence of adverse ovarian reactions.It is beneficial to obtain an appropriate number of high-quality eggs and embryos to achieve an ideal pregnancy outcome.Researchers analyzed that as the amount of Gn dose increased,the live birth rate decreased.Therefore,more and more scholars have advocated clinical programs to reduce the Gn dose while ensuring proper egg retrieval rates.However,there is still a lack of indicators to predict ovarian response directly.By studying the mechanisms affecting ovarian reactivity,it is helpful to improve progestation outcomes and reduce physical and psychological burden on patients.FOXL2 is the earliest marker promoter gene,found in mammalian ovarian development.In humans,the mutation of FOXL2 gene can cause blepharophimosis-ptosis-epicanthus inverus syndrome(BPES).It is an autosomal dominant genetic disease with clinical manifestations o f orbital dysgenesis and premature ovarian failure.Before the sexual differentiation of human embryos,the pre-progenital pheochromocytoma cell line begins to express FOXL2.Until it grow into adults,the ovarian granulosa cells still express FOXL2.It ha s been found that,FOXL2 are secreted by granulosa cells,to regulate the proliferation and differentiation of granlosa cells in an autocrine manner.It plays an important role in the normal development of follicles and maintenance of ovarian function.The aim of this study was to investigate the relationship between follicular fluid FOXL2 and the ovarian response during the ovulation cycle and its association with progestational outcomes.MethodsA total of 231 cycles of infertility patients were selected in our hospital.Selected candidates include infertile patients cause fallopian tube obstruction or male factors treated with in vitro fertilization-embryo transfer for the treatment.Record the following data: age,infertility,weight,Gn dosage,number of oocytes retrieved,number of normal fertilization,number of high-quality embryos,pregnancy outcomes,etc..Collect follicular fluid to detect FOXL2 levels.According to the amount of exogenous gonadotropins dose used during the ovulation cycle,they were divided into 4 groups: group A(<2000 IU);group B(2000-3000 IU);group C(3000 IU-4000 IU);and group D(4000 IU).Compare clinical data between groups and difference s in FOXL2 levels.Based on pregnancy outcome divided the patients into a pregnant group and a non-pregnant group,comparing whether there was a difference in FOXL2 levels between the two groups.ResultsThere was no significant difference in the duration of infertility,body weight,and body mass index between groups A,B,C,and D(P>0.05).There was no significant difference in serum luteinizing hormone and estrogen levels between groups(P> 0.05).The patient's age,serum follicle-stimulating hormone levels were positively correlated with the Gn dosage,and the antral follicle number was inversely proportional to the GN dosage,the difference between the groups was significant(P < 0.05).With the increase of Gn dosage in each group,the number of oocytes retrieved and the rate of high-quality embryos were significantly reduced,and t he difference was statistically significant(P < 0.05).There was no significant difference between normal fertilization rates.The level of FOXL2 in follicular fluid was inversely proportional to the amount of Gn dosage,and there was a linear correlation between them(R =-0.368,P <0.05).The data also showed that FOXL2 levels in follicular fluid were higher in the pregnant group than in the non-pregnant group(P<0.05).ConclusionsBy examining the levels of FOXL2 in mature follicular fluid in patients with superovulation cycles,compared the differences between groups in different ovarian response groups,and find the correlation between FOXL2 and ovarian response.We found that the smaller the Gn dosage in the ovulation cycle,suggest the ovarian response increased,the expression of FO XL2 in the ovaries increase,the number of eggs obtained increase,and further pregnancy outcome improve.