Homocysteine excess

 

Measurement and its clinical significances The issue of estimating plasma homocysteine in cases of recurrent early pregnancy  loss and or unexplained subfertility ? The cost of such estimation is high.

HCy is gaining importance almost in every branch of medicine but problem is ints restoration to normal level. The question which remains unanswered is what % of Hhcy are remains uncorrected, in Indian scenario inspite of adequate replacement by active F Acid, B-6 and even Vit B12? In such cases genetic predisposition is there to yield persistent H.Hcy(Hyperhomocytenaemia) .

 

 

Q.A) Any member have ever ordered for plasma homocysteine level in their practice  in  cases of

1)  Otherwise unexplained subfertility or

 2) In long standing PCOS with documented hyperlipidaemia and or   hyperandrgenaemia with an idea to prevent CVS risk??

I learnt that a fair number men and women with prevailing HHcyst may not improve due to some other enzymatic error . Is that true? - Unfortunately supplementation by F acid does not guarantee that one’s  H level will be normalized . - What harm on reproductive pathway  or  Repro performance??? What damage on Blood vessels?? Ill  effects of hyper homocyteine (H.Hcy)  No 1:- Elevated Hcy may impair implantation by interfering with endometrial blood flow and vascular integrity, and has been documented to increase the probability of early pregnancy loss.

ill effects No  2:- Both impaired implantation and increased rates of miscarriage are more frequent in PCOS, even after controlling for ovulatory abnormalities, increased LH, and hyperandrogenism, which might be due in part to elevated Hcy in these patients. Many have therefore rightly  suggested that  that the vascular–endothelial aspect of insulin‐resistant PCOS—which is part caused by the factor of hyperhomocysteinemia—has important diagnostic and treatment implications, and warrants further clinical and laboratory investigation. Moreover,, actively treating elevated homocysteine in these patients could increase implantation and decrease pregnancy loss. Prospective studies could address the practical implications of our findings in terms of improved treatment success