International Journal of Clinical Obstetrics and Gynaecology

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder causing anovulatory infertility. Chronic Oxidative Stress (OS) is implicated in PCOS pathogenesis and may negatively impact Assisted Reproductive Technology (ART) outcomes. Ischemia-modified albumin (IMA) is a sensitive biomarker reflecting systemic and local oxidative/ischemic conditions. Evaluating IMA simultaneously in serum and Follicular Fluid (FF) provides complementary insights into systemic versus local ovarian redox status.
Aim: This comparative prospective cohort study aimed to investigate and compare the levels of IMA in the serum and FF of infertile women with and without PCOS undergoing in vitro fertilization (IVF), and to examine the relationship between IMA levels and IVF outcomes.
Methods: A total of 50 infertile women scheduled for IVF were included: 25 diagnosed with PCOS (Rotterdam criteria) and 25 non-PCOS controls. Patients with significant metabolic comorbidities were excluded. Controlled ovarian stimulation was performed using a flexible GnRH antagonist protocol. Serum and FF IMA concentrations were measured using a competitive ELISA kit. Key outcomes assessed included ovarian response (gonadotropin dose, oocyte yield), embryological competence (MII rate, high-quality embryos), and pregnancy rates (biochemical, clinical, ongoing).
Results: Baseline characteristics were homogenous across groups, except for Anti-Müllerian Hormone (AMH), which was markedly higher in the PCOS group (median 4.2 vs 1.0 ng/mL, p<0.01). The study found no statistically significant difference in serum IMA levels between PCOS and control groups (P=0.16). In contrast, follicular fluid IMA concentrations were significantly lower in PCOS patients compared to controls (median 21.4 vs 24.6 ng/mL, P=0.031). Regarding ovarian response, the PCOS group had a significantly lower total gonadotropin dose and yielded significantly higher numbers of retrieved oocytes and embryos. However, oocyte maturity (MII rates) and high-quality embryo percentages were statistically equivalent between the groups. Pregnancy outcomes (biochemical, clinical, ongoing rates) were numerically lower in the PCOS group but did not reach statistical significance. Furthermore, IMA levels (in both serum and FF) did not show a statistically significant correlation with overall pregnancy rates. Follicular fluid IMA did exhibit a negative correlation with BMI and AMH within the PCOS cohort.
Conclusion: Serum IMA levels did not differ significantly between PCOS and non-PCOS women, while follicular fluid IMA levels were significantly lower in PCOS patients. This suggests an altered local oxidative homeostasis in the PCOS follicular microenvironment, potentially due to strong compensatory antioxidant mechanisms. Despite this biochemical variation, IMA levels were not found to be a strong standalone biomarker for predicting oocyte maturity, embryo quality, or IVF success in well-selected PCOS patients utilizing antagonist stimulation protocols. These findings reinforce the complexity of oxidative profiles in PCOS and suggest that local redox balance may be preserved sufficiently to maintain reproductive performance under controlled stimulation.