Objectives
Elevated proinflammatory advanced glycation end-products (AGEs) and their receptors (RAGE) in obesity may change ovarian microenvironment and cause ovarian dysfunction. Recently, follicular fluid soluble receptors for RAGE (sRAGE) have been used as a potential ovarian reserve indicator. The effect of AGE-RAGE system and oxidative products on PCOS (polycystic ovary syndrome) patients undergoing IVF treatment has not been evaluated in the literature yet. Thus, this study aimed to compare the levels of AGEs, sRAGE, CML (carboxymethyllysine), TOS (total oxidant status), TAS (total antioxidant status) and OSI (oxidative stress index) in serum and follicular fluid of PCOS and controls other than PCOS patients undergoing IVF treatment.
Materials-Methods
In this prospective study, 80 patients, including 40 PCOS and 40 controls, aged 20-40 years undergoing IVF treatment were compared. Both groups were divided into two subgroups: BMI 18-25 and BMI>30. Primary outcome was AGE, RAGE, CML, TAS, TOS and OSI levels in serum and follicular fluid collected on the day of OPU (oocyte pick-up). Secondary outcome was oxidative state parameters in PCOS group of patients with or without clinical pregnancy. Data were statistically analyzed using SPSS 26.0.
Results
Median follicular fluid TOS levels were significantly lower in PCOS group [1,36 μmol H2O2 Eq/L] compared to control group [4,68 μmol H2O2 Eq/L] (p=0.02). Mean follicular fluid TAS levels were higher in PCOS group (1,37±1,6 mmol trolox Eq/L) than control group (0.91±0,4 mmol trolox Eq/L) (p=0.035). Also mean follicular fluid TAS levels of PCOS patients with clinical pregnancy after IVF was higher than PCOS patients without pregnancy (p=0.036). Median follicular fluid OSI value in PCOS group was significantly lower than control group (p=0.021). Mean serum TAS levels were statistically higher in PCOS group (1,86±0,51 mmol trolox Eq/L) compared to control group (1,61±0,23 mmol trolox Eq/L)(p=0.007). There was no significant difference in serum and follicular fluid sRAGE, AGE, and CML levels between PCOS and control groups. Any of the AGE-RAGE and oxidative state parameters studied were correlated to oocyte and embryologic parameters in PCOS and control groups (data not shown).
Conclusion
High follicular fluid TAS and low follicular fluid TOS levels and low follicular OSI values in PCOS patients (particularly in pregnant patients) may be a clue for an oxidative protective defense mechanism. Besides, higher levels of antioxidants in follicular fluid might be associated with favorable pregnancy outcomes. According to our results, the AGE-RAGE system is not thought to be a factor related to obesity in PCOS patients. More research is needed to clarify the relationship of the AGE-RAGE system with PCOS and obesity.
