Dados do Trabalho

Title

MYO-INOSITOL IN FOLLICULAR FLUID – OOCYTE QUALITY AND FERTILIZATION RATE IN PATIENTS UNDERGOING IN VITRO FERTILIZATION/INTRACYTOPLASMIC SPERM INJECTION (IVF/ICSI).

Objective

To evaluate a possible correlation between Myo-inositol (MI) in follicular fluid (FF) and the quality of recovered oocytes/fertilization rates in patients undergoing IVF/ICSI as the follicular microenvironment is an important determinant of oocyte development. MI is an isomer of a C6 alcohol that belongs to the vitamin B complex group. Previous studies support the notion that it is involved in the regulation of the release of Ca2+, related to gamete development including oocyte maturation. The growth and development of oocytes requires communication between the granulosa cells and the FF. Thus, changes in this environment can negatively impact oocyte maturation and reproductive potential.

Methods

Prospective study carried out from June 2018 to April 2019, including 35 infertile women aged between 30 and 40 years, using MI for at least 8 weeks, undergoing IVF/ICSI. At the time of oocyte puncture, the FF of the first ≥ 18 mm follicle with oocyte recovered was separated to determine the MI concentration (spectrophotometric analysis). All patients received similar stimulus protocol, namely deltafollitropin or menotropin (Rekovelle® or Menopur®, Ferring Pharmaceuticals) in an individualized SC-dose. Clinical decision led to a GnRH-antagonist (Cetrorelix acetate, Cetrotide®, Merck) 0,25 mg/d initiated in a flexible schedule (one follicle ≥14 mm) continued throughout the stimulation period or Dydrogesterone 10mg 8/8 hours (Duphaston®, Abbott) from the beginning of stimulation until the day after the trigger. Oocyte retrieval took place 36 hours after trigging.
Four generalized linear models were run to test the impact of MI on the following variables: number of metaphase II (MII) oocytes, fertilization rate, recovered oocytes and follicles ≥ 15 mm on the hCG-day. The analyzes were controlled by AMH, age, BMI, and AFC, using SPSS Windows version 23 software.

Results

No relationships were identified between MI and the variables follicles ≥ 15 mm, number of oocytes retrieved and fertilization rate while in model 1, both the general Chi-square and the variable Inositol demonstrated predictive value for the number of recovered MII (Table1). Interestingly, the analysis of coefficient B shows an increase of 0.03 points in MII for each increase of 1 point in Inositol.
Table (annexed)
Limitations. To compensate weakness of the sample size, resampling procedures (bootstrapping) were implemented to produce greater reliability of the results and present a confidence interval (CI) of 99% for Exp B3.

References.
Chiu, TTY et al. Follicular fluid and Serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality. Hum Reprod, v. 17, n. 6, p. 1591-1596, 2002.

Novielli, C et al. Effects of ά-lipoic acid and myo-inositol supplementation on the oocyte environment of infertile obese women: a preliminary study. Reprod Biology, v. 20, n. 4, p. 541-546, 2020.

Haukoos, JS; Lewis, RJ. Advanced Statistics: Bootstrapping Confidence Intervals for Statistics with ‘‘Difficult’’ Distributions. Acad Emerg Med, v. 12, n. 4, p. 360-365, 2005.

Conclusion

Myo-inositol in follicular fluid correlated with better metaphase II oocyte rates.

Keywords

Myo-Inositol; Follicular fluid; Metaphase II oocytes; In vitro fertilization.

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