Endometrial receptivity in clomiphene citrate therapy for polycystic ovarian syndrome assessment by serum and endometrial tocopherol and superoxide dismutase as markers

ABSTRACT

Endometrial receptivity is determined by mediators of implantation produced by the endometrium and the embryo. Different markers of this receptivity are studied. Oxidative stress causes endothelial dysfunction thus hypoxia. As one ultrasonic feature of polycystic ovarian syndrome patients treated with clomiphene citrate is thin endometrium and low vascularity we assume that this hypoxia may have a relation to oxidative stress. To investigate the antioxidants, serum and endometrial tocopherol and superoxide dismutase, as possible markers of endometrial receptivity in clomiphene citrate treated polycystic ovarian syndrome patients and their correlation with other markers. A prospective controlled study was carried out in AI-Kadhmyia teaching hospital, AI-Nahrain University for the period, Dec 1[st] 2001- July 31[st] 2002. The study group G-A included 62 polycystic ovarian syndrome patients further sub-divided to G-A 1, 33 patients who ovulated when given clomiphene citrate therapy; G-A2 29 patients on no clomiphene citrate therapy. The control group G-B included 20 women with sub-fertility due to pure male or tubal factor with no polycystic ovarian syndrome. At mid-luteal phase of the cycle determination of serum progesterone, serum and endometrial tocopherol by high performance liquid chromatography and superoxide dismutase by spectrophotometry were performed. Both tocopherol and superoxide dismutase in serum and endometrium were the lowest in patients with untreated polycystic ovarian syndrome. higher in clomiphene citrate polycystic ovarian syndrome and the highest in the control. Highly significant reduction of endometrial tocopherol in both polycystic ovarian syndrome groups in comparison to serum tocopherol [p=0.008 and 0.006] while such serum and endometrial gradient was not present regarding superoxide dismutase [p=0.053 and 0.38]. Other markers of endometrial receptivity, as obesity, serum progesterone, LH and testosterone, had no significant correlation with tocopherol and superoxide dismutase in polycystic ovarian syndrome. Antioxidant level is not related to other markers of endometrial receptivity. So serum as well as endometrial tocopherol and serum but not endometrial superoxide dismutase is suggested to be new biochemical markers of endometrial receptivity. We may suggest clinical trial studies about Vitamin E [alpha-tocopherol] supplement to polycystic ovarian syndrome patients to improve endometrial receptivity and possibly the success rate in reproductive treatment of polycystic ovarian syndrome