The homocysteine pathway in human subfertility
Abstract
Subfertility, defined as at least one year of unprotected intercourse with the same partner \\nwithout conception, affects ten to fifteen percent of couples in the western world. Depending \\non the duration of the subfertility, a female factor is the dominant cause of subfertility \\nin around 50%, a male factor in 20-26% and the cause is unexplained in 25-30%. In \\nmost couples, subfertility is of multifactorial origin and should therefore be considered \\nas a complex disease. Whereas genetic causes are difficult to modulate, environmental \\nand lifestyle factors implicated in reproduction are potentially amendable to curative or \\npreventive measures. Worldwide, an increasing number of couples are treated by assisted \\nreproductive technology (ART) to achieve pregnancy. Currently, the chance of achieving \\na clinical pregnancy is around 28-31% per started in vitro fertilization (IVF) cycle with \\nor without intracytoplasmic sperm injection (ICSI) in the Netherlands. The advantage of \\nthe introduction of IVF and ICSI treatment is that it gives access to and information about \\nthe direct environment of the gametes and early developing embryo. On the other hand, \\nIVF and ICSI treatment is introducing an artifactual endocrinologic milieu which may affect \\nthe quality of the embryo. Whether concentrations of nutrients and enzymes change due \\nto ovarian hyperstimulation is unclear, but it has already been demonstrated that different \\novarian stimulation…
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