title: IVF outcomes are associated with biomarkers of the homocysteine pathway in monofollicular fluid.
abstract: BACKGROUND
  Maternal hyperhomocysteinemia is detrimental for reproduction, but the effects on embryo quality are unknown. The aim of this study was to investigate whether biomarkers of the homocysteine pathway are associated with in vitro fertilization (IVF) outcome.
  
  
  METHODS
  In a prospective study, we investigated biomarkers of the homocysteine pathway for associations with embryo quality and biochemical pregnancy in women undergoing IVF or intracytoplasmic sperm injection treatment (n = 181). In the treatment cycle, blood and monofollicular fluid samples were collected for determination of folate, cobalamin and total homocysteine (tHcy) concentrations.
  
  
  RESULTS
  Of all the women in the study, 67% used folic acid supplements. In blood, a significant correlation was established between high cobalamin and better embryo quality [standardized adjusted regression coefficient: -0.17, 95% confidence interval (CI): -0.30, -0.01]. In monofollicular fluid of non-supplemented women, high cobalamin correlated with better embryo quality (estimate: -0.87; 95% CI: -1.68, -0.06), whereas high tHcy resulted in poor embryo quality (estimate: 1.01; 95% CI: 0.08, 1.95). However, in monofollicular fluid of supplemented women, high tHcy correlated with better embryo quality (estimate: -0.58; 95% CI: -1.12, -0.04). In the total group, a 2-fold increase of monofollicular fluid folate corresponded with a 3.3 times higher chance (95% CI: 1.09, 9.71) of achieving pregnancy.
  
  
  CONCLUSIONS
  An optimal homocysteine pathway in follicular fluid is associated with a better embryo quality and chance of pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jolanda C
authors.initials: JC
authors.lastname: Boxmeer
authors.forename: Nick S
authors.initials: NS
authors.lastname: Macklon
authors.forename: Jan
authors.initials: J
authors.lastname: Lindemans
authors.forename: Nicole G M
authors.initials: NG
authors.lastname: Beckers
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: Joop S E
authors.initials: JS
authors.lastname: Laven
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: Régine P M
authors.initials: RP
authors.lastname: Steegers-Theunissen
mesh_terms: D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D005260:Female; D005307:Fertilization in Vitro; D005492:Folic Acid / Q000097:blood / Q000378:metabolism; D015571:Follicular Fluid / Q000378:metabolism*; D006710:Homocysteine / Q000097:blood* / Q000378:metabolism; D006801:Humans; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic; D014805:Vitamin B 12 / Q000097:blood / Q000378:metabolism
chemical_list: D015415:Biomarkers; D006710:Homocysteine; D005492:Folic Acid; D014805:Vitamin B 12