CHARACTERISTICS OF FOLLICULAR FLUID MORPHOLOGY AND LEVELS OF MATRIX METALLOPROTEINASE-1 AND ITS INHIBITOR-1 IN PATIENTS WITH POLYCYSTIC OVARIES IN ASSISTED REPRODUCTIVE TECHNOLOGY

Abstract

Assisted reproductive technologies in patients with polycystic ovary syndrome (PCOS) is an effective way to realize reproductive function with a global pregnancy rate of 25–30 %. The purpose of the study is to establish the correlation between the levels of matrix metalloproteinase-1 (MMP-1) and its inhibitor-1 (TIMP-1) with follicular fluid morphology in PCOS patients undergoing assisted reproductive technology. Materials and Methods. The authors examined 26 PCOS patients aged 24–40. All patients were diagnosed with primary and secondary infertility lasting from 1 to 10 years. A comparative analysis of patients was carried out depending on the presence (n=12) or absence (n=14) of concomitant pathology, a history of endometrial hyperplasia. Clinical, anamnestic, instrumental and laboratory methods were used for analysis. Concentrations of MMP-1 and TIMP-1 in follicular fluid was determined by quantitative solid-phase ELISA. Follicular fluid morphology was studied according to wedge-shaped dehydration method. Statistica 10.0 wasnused for statistical data processing. Results. TIMP-1 level in PCOS patients was 2550±57.8 ng/ml, in PCOS patients with endometrial hyperplasia – 2694.4±87.8 ng/ml (p<0.01). At the same time, the average MMP-1 level was low – 1.5±0.1 ng/ml. In PCOS patients, the 3rd (reactive) type of facies and markers indicating impaired blood supply were detected in the follicular fluid. In PCOS patients with endometrial hyperplasia, the 4th (chaotic) type of facies and markers indicating impaired elasticity, vascular sclerosis, and vasospasm was observed. It was found that the higher the TIMP-1 level, the more markers indicating destructive changes in the vessels of ovarian tissue (r=0.7) and the lower the chances of getting pregnant in assisted reproducrtive technology programs. Conclusions. In PCOS patients over 32 years of age, infertility duration of more than 4 years, having endometrial hyperplasia and surgical interventions in the past medical history (tubectomies for sactohydrosalpinx), TIMP-1 level significantly (p<0.05) increases (≥2694 ng/ml) in the follicular fluid. Moreover, markers indicating destructive changes (vascular sclerosis, vasospasm and endothelial dysfunction) are identified. Thus, the chances of getting pregnant in assisted reproducrtive technology programs become lower.