O-26: Association of Follicular Fluid Endocrine Changes with Oocyte Morphology and Quality in PCOS Patients Undergoing Metformin and N-Acetylcysteine Treatment

Background: Polycystic ovary syndrome (PCOS) is a common cause of infertility often responsive to treatment with oral ovulation induction agents. PCOS patients are typically characterized by producing an increased number of oocytes that they are often of poor quality, leading to lower fertilization, cleavage and implantation rates. Recently data involve functional associations between endocrine/paracrine irregularities, metabolic dysfunction and changes in the intrafollicular microenvironment during folliculogenesis, follicle maturation in women with PCOS. In the present study, we have evaluated association of follicular fluid(FF) endocrine changes with oocyte morphology and Quality in PCOS Patients undergoing Metformin and N-acetylcysteine treatment. Materials and Methods: A prospective randomized, placebo controlled experimental study was conducted in the IVF/ICSI Unit of infertility treatment center of the Qom. Total 80 cases between the age of 25 and 35 years of polycystic ovarian syndrome were selected for the study, 20 cases in each group were treated for six weeks with Metformin (500 mg three times daily), with N-acetyl cysteine (600 mg three times daily), with Nacetyl cysteine plus Metformin and with Placebo (Group Control). Before oocyte aspiration, follicular fluid was sampled and carefully collected from the first aspiration follicle of each ovary. The endocrine and hormonal parameters evaluated that including levels of fasting insulin, LH, E2, DHEA-S, TT, AMH, leptin and MDA in follicular fluid in each of the four patients groups. Results: After treatment levels of follicular fluid leptin were significantly differences in the treatment groups compared with placebo group, and only levels of follicular fluid insulin and LH were significantly differences in the MET and NAC group compared with placebo group. Data showed that rates of immature oocytes, fertilization and embryo quality between exprimental groups were statistically significant differences. There were 47.4% of the MII oocytes that had abnormality in Placebo group, while there were 24.5, 34.9 and 39.7% of the MII oocytes that had abnormality in groups NAC, MET and MET+NAC groups, respectively. Also, there were significant correlation between of oocytes retrieved, oocyte quality and maturity, fertilization rate, embryo quality with endocrine variables of follicular fluid in PCOS patients. Conclusion: In the present study, we suggest metformin and NAC promoted endocrine and hormonal levels, improvement of oocyte maturation and quality and ovulation of women with PCOS. Taking its lack of adverse effects into consideration, NAC can be regarded as an appropriate substitute for insulin- reducing medications in the treatment of PCOS patients.