Nitric oxide is associated with poor embryo quality and pregnancy outcome in in vitro fertilization cycles

Objective To evaluate the association between follicular and serum nitric oxide (NO) levels and embryo development and outcome in IVF. Design Prospective, case-control study. Setting University hospital, tertiary medical center. Patient(s) Eighteen patients with tubal or peritoneal factor infertility and 18 female partners from couples with male factor infertility underwent controlled ovarian stimulation and IVF/intracytoplasmic sperm injection (ICSI). Intervention(s) Controlled ovarian stimulation and oocyte retrieval followed by IVF/ICSI and embryo culture. Main outcome measure(s) Degree of fragmentation of embryos and pregnancy rate. Result(s) Higher follicular NO levels were associated with advanced fragmentation of embryos. Follicular soluble Fas could not prevent embryo fragmentation. Higher serum NO levels were found among nonpregnant patients with tubal or peritoneal factor infertility. No elevated serum NO levels were found in the female partners from couples with male factor infertility. Conclusion(s) Up-regulation of serum NO is associated with implantation failure in patients with tubal or peritoneal factor infertility.