The impact of serum and follicular fluid secreted frizzled-related protein-5 on ICSI outcome in Iraqi infertile women with different body mass index


  • Hameedah Abdul Hussein Mohsin
  • Hayder A. L. Mossa
  • Mufeeda Ali Jawad



Obesity, BMI, Sfrp5, ICSI, HOMA-IR


Introduction and Aim: Adipose tissue adipokines and cytokines impede oocyte maturation and endometrial epithelial receptivity. Secreted frizzled-related protein 5 (Sfrp5), a novel antagonist adipokine secreted by adipocytes, may have anti-inflammatory and insulin-sensitizing actions, but data is conflicting. This study examined serum and follicular fluid Sfrp5 levels in Iraqi infertile women with varying BMIs undergoing IVF/ICSI, as well as ICSI outcomes.


Materials and Methods: This prospective cross-sectional study comprised 90 infertile females aged 18–45 who underwent IVF/ICSI at the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies Centre in Baghdad, Iraq. Participants received antagonist ovarian hyperstimulation. All individuals' blood fasting sugar, serum fasting insulin, serum, and follicular fluid SFRP5 were tested on oocyte retrieval day. HOMA-IR was computed. Oocyte maturity and embryo morphology were categorized. Serum B-hCG was measured 14 days after embryo transfer.


Results: A notable disparity was observed in the levels of serum and follicular Sfrp5, total oocyte count, mean metaphase II (MII), grade I, and pregnancy rate (p<0.05) among the participants categorized as normal weight, overweight, and obese. A notable disparity was observed in the average germinal vesicles (GV), grade III (GIII) embryos, and HOMA-IR (p < 0.05) among patients with varying body mass index (BMI) values. The study found a positive correlation between the levels of Sfrp5 in both serum and follicular fluid and the total count of oocytes, MII oocytes, grade I embryos, and pregnancy rate. However, there was a negative correlation between Sfrp5 levels and HOMA-IR, with statistical significance at p<0.05.


Conclusion: Increased BMI is associated with lower serum and follicular fluid Sfrp5, reduced total oocyte count, reduced metaphase II oocyte count, more germinal vesicle oocytes, reduced embryo quality and lower pregnancy rate. Serum and follicular fluid Sfrp5 levels are negatively correlated with HOMA-IR but positively associated with ICSI outcome.

Author Biographies

Hameedah Abdul Hussein Mohsin

High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq

Hayder A. L. Mossa

High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq

Mufeeda Ali Jawad

High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq


Savita, S. H., Shantala, S. H., Parwati, P. P., Shivprasad, S. G. A cross sectional study to analyse the correlation of body mass index with skin fold thickness and assessment of effect of training and its duration on agility, flexibility and their correlation among wrestlers. Biomedicine. 2023 Mar 28;43(01):456-461.

Geetha, V. Glycosaminoglycans from fish waste alleviate high fat diet induced obesity via modulating plasma biomarkers and fatty acid profile of obese C57BL/6 mice. Biomedicine. 2023 Feb 26;43(1):72-78.

Begum, T. M., Ramamurthy, V. The modulating effect of ferulic acid on high fat diet induced hyperlipidemia and obesity: A dose response study in male Sprague Dawleyrats. Biomedicine. 2021 Sep 7;41(2):413-420.

Al-yasiry, R. Z., Jwad, M.A., Hasan, M.F., Al Sayigh, H.A. How obesity affects female fertility. Medical Journal of Babylon, 2022;19(2):111-114.

Song, J., Xiang, S., Pang, C., Guo, J., Sun, Z. Metabolomic alternations of follicular fluid of obese women undergoing in-vitro fertilization treatment. Scientific Reports, 2020;10(1): 5968.

Svensson, H., Einarsson, S., Olausson, D., Kluge, L., Bergh, C., Edén, S. et al., Inflammatory and metabolic markers in relation to outcome of in vitro fertilization in a cohort of predominantly overweight and obese women. Scientific Reports, 2022; 12(1):13331.

Ryzhov, J.R., Shpakov, A.O., Tkachenko, N.N., Mahmadalieva, M.R., Kogan, I.Y., Gzgzyan, A.M. The follicular levels of adipokines and their ratio as the prognostic markers of in vitro fertilization outcomes. Gynecological Endocrinology, 2021;37(supp1):31-34.

Inal, Z.O., Inal, H.A., Erdem, S. The effect of serum and follicular fluid secreted frizzled-related protein-5 on in vitro fertilization outcomes in patients with polycystic ovary syndrome. Molecular Biology Reports, 2018; 45(6):2037-2044.

Koutaki, D., Michos, A., Bacopoulou, F., Charmandari, E. The emerging role of Sfrp5 and Wnt5a in the pathogenesis of obesity: implications for a healthy diet and lifestyle. Nutrients, 2021;13(7):2459.

Rydzewska, M., Nikolajuk, A., Matulewicz, N., Stefanowicz, M., Karczewska-Kupczewska, M. Serum secreted frizzled-related protein 5 in relation to insulin sensitivity and its regulation by insulin and free fatty acids. Endocrine, 2021; 74(2):300-307.

Magaton, I.M., Helmer, A., Eisenhut, M., Roumet, M., Stute, P., Von Wolff, M. Oocyte maturity, oocyte fertilization and cleavage-stage embryo morphology are better in natural compared with high-dose gonadotropin stimulated IVF cycles. Reproductive Biomedicine online, 2023; 46(4):705-712.

Zhang, Y., Li, Z., Ren, B., Wu, W., Liu, Y., Wang, X., et al., Diagnostic value of a single beta-hCG test in predicting reproductive outcomes in women undergoing cleavage embryo transfer: a retrospective analysis from a single center. Reproductive Health, 2022; 19(1):1-9.

Demir, S., Celik, B.A. Ability of metabolic score for insulin resistance to detect insulin resistance: Metabolic score for insulin resistance. Chronicles of Precision Medical Researchers, 2022; 3(3):187-192.

Elnashar, A.M. Update on obesity and assisted reproductive technology. Middle East Fertility Society Journal, 2023; 28(1): 1-5.

He, X., Ma, H. Correlation between circulating levels of secreted frizzled-related protein 5 and type 2 diabetic patients and subjects with impaired-glucose regulation. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2020; 13:1243-1250.

Relling, I., Akcay, G., Fangmann, D., Knappe, C., Schulte, D.M., Hartmann, K., et al., Role of wnt5a in metabolic inflammation in humans. The Journal of Clinical Endocrinology and Metabolism. 2018; 103(11): 4253-4264.

Yang, R., Li, Q., Zhou, Z., Qian, W., Zhang, J., Wu, Z., et al., Changes in the prevalence of polycystic ovary syndrome in China over the past decade. The Lancet Regional Health-Western Pacific. 2022; 25: 100494.

Akoumianakis, I., Polkinghorne, M., Antoniades, C. Non-canonical WNT signaling in cardiovascular disease: mechanisms and therapeutic implications. Nature Reviews Cardiology. 2022; 1-15.

Dornelles, V.C., Hentschke, M.R., Badalotti, M., Teloken, I.B., Trindade, V.D., Cunegatto, B., et al., The impact of body mass index on laboratory, clinical outcomes, and treatment costs in assisted reproduction: a retrospective cohort study. BMC Women's Health. 2022; 22(1):1-8.

Zhou, H., Zhang, D., Luo, Z., Yang, A., Cui, N., Hao, G., et al., between body mass index and reproductive outcome in women with polycystic ovary syndrome receiving IVF/ICSI-ET. BioMed Research International, 2020.6434080

Bahgat, N.A. Relation between maternal body mass index and laboratory outcome in normal responder young patients undergoing intracytoplasmic sperm injection cycles. Int J Reprod Contracept Obstet Gynecol. 2022; 11(10):2600-2604.

Hu, D., Huang, B., Xiong, M., Yao, J., Yang, S., Wu, R., et al., Impact of elevated body mass index on cumulative live birth rate and obstetric safety in women undergoing assisted reproductive technology. Scientific Reports. 2022;12(1): 18858.

Broughton, D.E., Moley, K.H. Obesity and female infertility: potential mediators of obesity's impact. Fertility and Sterility. 2017;07(4): 840-847.

Abedini, A., Zamberlan, G., Boerboom, D., Price, C.A. Non-canonical WNT5A is a potential regulator of granulosa cell function in cattle. Molecular and Cellular Endocrinology, 2015; 403:.39-45.

Liu, X., Shi, S., Sun, J., He, Y., Zhang, Z., Xing, J., et al., The influence of male and female overweight/obesity on IVF outcomes: a cohort study based on registration in Western China. Reproductive Health, 2023; 20(1): 1-10.

Garcia-Ferreyra, J., Carpio, J., Zambrano, M., Valdivieso-Mejia, P., Valdivieso-Rivera, P. Overweight, and obesity significantly reduce pregnancy, implantation, and live birth rates in women undergoing in vitro fertilization procedures. JBRA Assisted Reproduction, 2021; 25(3): 394.

Keefe, D. L. Telomeres and genomic instability during early development. European Journal of Medical Genetics, 2020; 63(2):103638.

Emre S, Karacan M, Ozcan T. The effect of obesity on reproductive outcomes in ICSI/ET cycles. Zeynep Kamil Med J, 2023; 54(1):28–31.

Atzmon, Y., Shoshan-Karchovsky, E., Michaeli, M., Aslih, N., Shrem, G., Ellenbogen, A., et al., Obesity results with smaller oocyte in vitro fertilization/intracytoplasmic sperm injection cycles-a prospective study. Journal of Assisted Reproduction and Genetics, 2017; 34: 1145-1151.




How to Cite

Abdul Hussein Mohsin H, A. L. Mossa H, Ali Jawad M. The impact of serum and follicular fluid secreted frizzled-related protein-5 on ICSI outcome in Iraqi infertile women with different body mass index. Biomedicine [Internet]. 2023 Aug. 30 [cited 2023 Oct. 4];43(4):1239-46. Available from:



Original Research Articles

Plum Analytics