The impact of serum and follicular fluid secreted frizzled-related protein-5 on ICSI outcome in Iraqi infertile women with different body mass index

Introduction and Aim: Adipose tissue adipokines and cytokines impede oocyte maturation and endometrial epithelial receptivity. Secreted frizzled-related protein 5 (Sfrp5), a novel antagonist adipokine secreted by adipocytes, may have anti-inflammatory and insulin-sensitizing actions, but data is conflicting. This study examined serum and follicular fluid Sfrp5 levels in Iraqi infertile women with varying BMIs undergoing IVF/ICSI, as well as ICSI outcomes. Materials and Methods: This prospective cross-sectional study comprised 90 infertile females aged 18–45 who underwent IVF/ICSI at the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies Centre in Baghdad, Iraq. Participants received antagonist ovarian hyperstimulation. All individuals' blood fasting sugar, serum fasting insulin, serum, and follicular fluid SFRP5 were tested on oocyte retrieval day. HOMA-IR was computed. Oocyte maturity and embryo morphology were categorized. Serum B-hCG was measured 14 days after embryo transfer. Results: A notable disparity was observed in the levels of serum and follicular Sfrp5, total oocyte count, mean metaphase II (MII), grade I, and pregnancy rate (p<0.05) among the participants categorized as normal weight, overweight, and obese. A notable disparity was observed in the average germinal vesicles (GV), grade III (GIII) embryos, and HOMA-IR (p < 0.05) among patients with varying body mass index (BMI) values. The study found a positive correlation between the levels of Sfrp5 in both serum and follicular fluid and the total count of oocytes, MII oocytes, grade I embryos, and pregnancy rate. However, there was a negative correlation between Sfrp5 levels and HOMA-IR, with statistical significance at p<0.05. Conclusion: Increased BMI is associated with lower serum and follicular fluid Sfrp5, reduced total oocyte count, reduced metaphase II oocyte count, more germinal vesicle oocytes, reduced embryo quality and lower pregnancy rate. Serum and follicular fluid Sfrp5 levels are negatively correlated with HOMA-IR but positively associated with ICSI outcome.