Associations between free fatty acids, cumulus oocyte complex morphology and ovarian function during in vitro fertilization

Objective To determine if follicular free fatty acid (FFA) levels are associated with cumulus oocyte complex (COC) morphology. Design Prospective cohort study. Setting University in vitro fertilization (IVF) practice. Patient(s) A total of 102 women undergoing IVF. Intervention(s) Measurement of FFAs in serum and ovarian follicular fluid. Main Outcome Measure(s) Total and specific follicular and serum FFA levels, correlations between follicular and serum FFAs, and associations between follicular FFA levels and markers of oocyte quality, including COC morphology. Result(s) Predominant follicular fluid and serum FFAs were oleic, palmitic, linoleic, and stearic acids. Correlations between follicular and serum FFA concentrations were weak ( r = 0.252, 0.288, 0.236, 0.309, respectively for specific FFAs; r = 0.212 for total FFAs). A receiver operating characteristic curve determined total follicular FFAs ≥0.232 μmol/mL distinguished women with a lower versus higher percentage of COCs with favorable morphology. Women with elevated follicular FFAs (n = 31) were more likely to have COCs with poor morphology than others (n = 71; OR 3.3, 95% CI1.2–9.2). This relationship held after adjusting for potential confounders, including age, body mass index, endometriosis, and amount of gonadotropin administered (β = 1.2; OR 3.4, 95% CI 1.1–10.4). Conclusion(s) Elevated follicular FFA levels are associated with poor COC morphology. Further work is needed to determine what factors influence follicular FFA levels and if these factors impact fertility.