ABSTRACT
Background and objective: Leptin facilitates onset of puberty by impact on hypothalamic Kisspeptin, gonadotropin releasing hormone, follicle stimulating and luteinizing hormone. The link of peripheral Leptin-Kisspeptin in regulating the ovarian and endometrial tissue in relation to adiposity is unknown. Therefore, we wanted to identify Kisspeptin-Leptin association with body mass index [BMI] and success of assisted reproductive treatments [ART] in infertile females
Methods: A cross sectional study was carried from August 2015 till May 2017 after receiving ethical approval at Australian Concept Infertility Medical Centre, and Aga Khan University. The study group comprised of females with an age range of 25-37 year who had duration of unexplained infertility for more than two years. They were grouped as; underweight [<18 kg/m2], normal weight [18-22.9 kg/m2], overweight 23-24.99 kg/m2 and obese [>25 kg/m2]. Kisspeptin and Leptin levels were measured by enzyme linked immune sorbent assay before down regulation of ovaries and initiation of treatment protocol of ART.Failure of procedure was detected by beta human chorionic gonadotropin <25mIU/ml [non-pregnant] whereas females with levels >25mIU/ml and cardiac activity on trans-vaginal scan were declared pregnant
Results: Highest Kisspeptin and Leptin levels were seen in normal weight group [374.80 +/- 185.08ng/L; 12.78 +/- 6.8 pg/ml] respectively, yet the highest number of clinical pregnancy was observed in overweight group [42%].A strong correlation of Kisspeptin with Leptin [r=0.794, p=0.001] was observed in the overweight females
Conclusion: Leptin-Kisspeptin-fertility link is expressed by maximum number of clinical pregnancies in the female group that showed strongest relationship between serum Leptin and Kisspeptin levels, irrespective of their BMI
ABSTRACT
Background: Kisspeptin [KP] is a neuropeptide that causes the release of the gonadotropin releasing hormone, which controls hypothalamo pituitary ovarian axis and exerts a number of peripheral effects on reproductive organs. The primary objective of this study was to compare baseline KP levels in females with different types of infertility and identify possible correlations with risk of failure to conceive, preclinical abortion and pregnancy after intracytoplasmic sperm injection [ICSI]
Materials and Methods: A longitudinal cohort study was carried out from August 2014 until May 2015 by recruiting 124 female patients undergoing ICSI, after obtaining ethical approval from the Australian Concept Infertility Medical Center. Cause of infertility due to male, female and unexplained factors was at a frequency of 32 [24%], 33 [31%] and 59 [45%] among the individuals respectively. KP levels were measured by ELISA assay before the initiation of the ICSI treatment protocol. Outcome of ICSI was categorized into three groups of non-pregnant with beta-human chorionic gonadotropin [beta-hCG]<5-25 mIU/ml, preclinical abortion with beta-hCG>25 mIU/ml and no cardiac activity, and clinical pregnancy declared upon confirmation of cardiac activity. Results based on cause of infertility and outcome groups were analyzed by one-way ANOVA
Results: Females with unexplained infertility had significantly lower levels of KP when compared with those with male factor infertility [176.69 +/- 5.03 vs. 397.6 +/- 58.2, P=0.001]. Clinical pregnancy was observed in 28 [23%] females of which 17 [71%] had a female cause of infertility. In the non-pregnant group of 66 [53%] females, common cause of infertility was unexplained 56[85%]. A weak positive correlation of KP levels with fertilized oocytes and endometrial thickness was observed [P=0.04 and 0.01 respectively]
Conclusion: Deficiency of KP in females with unexplained infertility was associated with reduced chances of implantation after ICSI