Anti zona pellucida antibodies in follicular fluid and outcome of ICSI

Objective: To assess the correlation of the presence of AZA in the follicular fluids (FFs) of women who underwent ICSI, and etiology of infertility as well as multiple puncture of ovaries, and also the relation of presence of AZA with the results of ICSI, as the main outcome, to realize if ICSI can bypass the possible effect of AZA on reproduction.
Materials and Methods:In this prospective one year study, follicular fluids were evaluated from 96 infertile women, who referred to Avesina clinic for ICSI, including (19-40 years old, 31.5±5.1), that based on the etiology of infertility, 80 women were recognized with explained infertility whereas 16 were recognized with unexplained infertility. All FFs were evaluated by ELISA test.
Results:Twenty of samples (20.8%) were AZA positive. In patients with unexplained infertility, AZA antibody in follicular fluid, was significantly higher than the group with proven etiology of infertility (P value =0.001). Additionally in 20.4 % of patients, who had been punctured previously, AZA was detected in their FFs which are statistically similar to the patients who were punctured for the first time. In this regard, there were no significant correlation between the presence of AZA and the number of oocytes, embryos, fertilization rate and clinical pregnancy rates in patients who underwent ICSI.
Conclusions: The high incidence of AZA in infertile women, especially the ones with unexplained infertility has to be considered .The relation between the presence of AZA and repeated puncture of ovaries is still debatable. The clinical significance of AZA in follicular fluid in the outcome of in- vitro fertilization was suggested in some studies. Correlation between fertilization rate of AZA and the number of oocytes and positive AZA still remains controversial. However, it seems that microinjection could bypass the possible effects of AZA on fertilization, the number of embryos and clinical pregnancies. Determinations of AZA are highly recommended in evaluation of infertile couples especially in patients with unexplained infertility for making appropriate decision regarding the need for ICSI.

Keywords
Anti-zona antibody (AZA), unexplained infertility, Follicular fluid, Repeated IVF attempt, ICSI.