Association of follicular fluid advanced glycation end-products with oocyte response and clinical pregnancy in assisted reproduction cycles

Context: Advanced glycation end-products (AGEs) are toxic metabolic end-products of lipids, nucleic acids, and proteins. Their accumulation in the ovaries can alter the follicular microenvironment and affect stimulation response. Aims: We aimed to study the association of AGEs in follicular fluid (FF AGE) with oocyte response and clinical pregnancy in ART-Assisted Reproductive Technology cycles. Settings and Design: This prospective study involved 84 individuals undergoing ART. Methods and Material: FF was collected during oocyte retrieval, and the level of AGEs was measured by enzyme-linked immunosorbent assay. Oocyte response was grouped as below target (<7 MII oocytes) or above target response (≥7 MII). Statistical Analysis Used: The association of FF AGE with the oocyte response and clinical pregnancy rate was analyzed by Mann–Whitney U-test. The strength of association of FF AGE with the outcome variables was analyzed with receiver operating characteristic (ROC) curve. Results: The median FF AGE was 17.6 (8.5) μg/ml. It was significantly higher in the below target than the normal ovarian response group (18.5 [17.8] vs. 16.3 [7.8] μg/ml, P = 0.046). Similarly, it was significantly higher in those who did not conceive (19.9 [7.3] vs. 13.5 [5.9] μg/ml, P < 0.001). The cutoff of FF AGE obtained by ROC curve analysis was 16.5 μg/ml above which there were significantly lower oocyte response and clinical pregnancy. Conclusions: Elevated FF AGE can be a significant negative predictor of clinical pregnancy and ovarian response to stimulation in ART cycles. The FF AGE level above the cutoff value of 16.5 μg/ml was associated with significantly lower oocyte response and clinical pregnancy.