Evaluation of serum and follicular fluid progranulin in relevance to BMI, oocyte, and embryo quality in Iraqi women with polycystic ovary syndrome undergoing intracytoplasmic sperm injection

Abstract

Introduction and aim. Polycystic ovarian syndrome (PCOS) is a common endocrine-metabolic disease often associated with obesity, persistent low-grade inflammation, and suboptimal results of assisted reproductive technology (ART). The aim was to evaluate the relevance of serum and follicular progranulin (PGRN) levels in relation to intracytoplasmic sperm injection outcomes among normal and overweight/obese body mass index (BMI) women with PCOS. Material and methods. This prospective comparative study included women diagnosed with PCOS undergoing intracytoplasmic sperm injection (ICSI) between the first of October 2024 and the first of April 2025. Baseline serum markers were measured on cycle days 2‒3. Participants were categorized as having a normal BMI, group 1 (n=30), or being overweight/obese, group 2 (n=37). Fasting serum and follicular fluid progranulin (PGRN) levels were assessed on oocyte retrieval day. Results. Women with normal BMI were younger and had significantly lower BMI and shorter infertility duration compared with overweight/obese women (p≤0.05). No statistically significant differences were observed between BMI groups in the number of retrieved oocytes, MII oocytes, fertilized oocytes, embryo grades, blastocysts, or biochemical pregnancy rate (p>0.05). Numerically, normal-BMI women showed slightly higher retrieved and MII oocyte counts, whereas overweight/obese women demonstrated higher numbers of fertilized oocytes, total embryos, grade I embryos, blastocysts, and biochemical pregnancy rates; however, these differences did not reach statistical significance. Serum and follicular fluid PGRN levels were comparable between groups (p>0.05), with only limited correlations observed between follicular fluid PGRN and total oocyte count. Conclusion. Serum and follicular fluid PGRN levels were comparable across BMI categories in women with PCOS undergoing ICSI. Although numerical variations in oocyte and embryo parameters were observed between BMI groups, most differences were not statistically significant. The findings suggest that follicular fluid PGRN may be associated with certain ovarian response parameters; however, its independent clinical relevance in predicting ART outcomes remains uncertain. Larger studies incorporating clinical pregnancy and live birth outcomes are required to clarify the potential role of follicular fluid PGRN in PCOS-related infertility.