Effect of Anti-Zona Antibodies in Follicular Fluid and Serum on ICSI Outcomes For Explained and Unexplained Groups


Objective: This study aims to determine the presence of blood serum and follicular anti-zona pellucid antibody in two groups of sub-fertile women (explained and unexplained), to evaluate the influence of these autoantibodies on ICSI treatment outcomes and to interpret these findings according to the cause of subfertility treatment outcome. Methods and Materials: This prospective cohort study included 45 sub-fertile women who are divided into subgroups; that are the explained and unexplained groups. All females underwent 45 IVF-ICSI cycles after a certain ovarian stimulation protocol, 45 reached the egg retrieval stage and 44 was reaching embryo transfer stage, at the Fertility center in AL-Najaf Al-Ashraf city from October 2015 to November 2016. Women had undergone thorough assessments (clinical history and full examination) and frequent ultrasonography with basal hormonal level in cycle day two and hematological assessment for AZA, hormonal assessments (E2), two days before retrieval. Also on the day of oocyte retrieval, follicular fluid was centrifuged and freeze for assessing AZA later. After 2 weeks, serum assessed for HCG to detect biochemical pregnancy. Results: The study found that the age mean and range of the studied groups were (29.71±6.62) (18-45year); the BMI mean was (27.70±4.05) Kg/m2, ranged between (19 -35.7); and duration of infertility in years (8.40±4.16), ranged between (2-18) years, and a large percent of them had a history of primary subfertility (86.7%). Regarding the cause of subfertility, a high percent of the studied groups of unexplained cause with a percentage (40%). Regarding ICSI outcome, the pregnancy rate was 28.89%. In women with unexplained cause, pregnancy rate was (33.30%) followed by women with explained cause which was (25.90%). Pregnant women had better ICSI parameters than non-pregnant one. Basal hormonal levels were within normal range, also peak E2 show normal value, but E2 at CD2 was of higher significance in an unexplained type or group. Follicular and serum AZA was higher in women with unexplained cause than in women with explained cause but of no significant difference. Furthermore, peak mean of Follicular AZA in women with unexplained infertility was (10.29 IU/L), followed by ovulatory cause. Pregnancy rate in women with high AZA decreased, and it affect ICSI outcome in general. Regarding FF –AZA, higher follicular fluid values were in unexplained cause. Also, positive non-significant correlation between E2 and follicle count with serum AZA was observed. Finally, there were some correlations between blood serum AZA, FF AZA and ICSI outcome and other parameters. Conclusion: We conclude from this study that multiple factors affect ICSI outcome, and may be used as markers of fecundity for counseling IVF/ICSI candidates to elevate success rate and decrease the cancellation cycles. Women with unexplained subfertility must firstly be checked for presence of AZA and treated before beginning ICSI cycle to increase conception rate. Minimal immune activation as detected by serum and follicular AZA may help in success rate of ICSI outcome.