Background: HYPERHOMOCYSTEINEMIA (hhcy) has been considered as a risk factor for several obstetrical complications such as early pregnancy loss, pre-eclampsia and IUGR. Recently its association with infertility has been underscored in IVF failures; however limited information is available about the relationship of hhcy and subfertility.   Objective: To find out the association between unexplained subfertility and hhcy in Pakistani women. Materials and methods: This observational study was conducted in Department of Obstetrics and Gynaecology, Liaquat University Hospital Hyderabad from 1st April 2008 to 31st March 2009. Study group consisted of all those women who were subfertile for more then one year, have body mass index less than 25, regular menstrual cycle, normal pelvic examination findings and no past history of pelvic inflammatory disease. Exclusion criteria was male factor subfertility, endocrine and ovulatory dysfunction and tubal blockage. Evaluation was done by semen analysis, pelvic ultrasound scan, hystero-salpingography and hormonal assays. Fasting serum levels of homocysteine were determined using a fluorescence polarization immunoassay. Results: In total, 61 subjects were enrolled in the study including 49 subfertile women and 12 healthy women. Among subfertile women, 39 (80%) were suffering from primary subfertility while 10 (20%) were complaining of secondary subfertility. Majority of the subjects were young, house wives and residents of Hyderabad city. Mean serum fasting homocysteine levels were significantly higher in women suffering from unexplained subfertility as compared to controls (12.8+5.1 versus 9.7+1.7, p-value= 0.04). Conclusion: HYPERHOMOCYSTEINEMIA was observed in women suffering from unexplained subfertility. However large scale clinical studies are required to confirm the association.

Objectives: This study was to determine the total homocysteine (tHcy) level, and to evaluate its role as a risk factor of atherosclerosis in renal transplant recipients (RTRs). Material and Methods: Clinical data and blood chemistries, fasting total homocysteine (tHcy), folic acid, vitamin B12, blood urea nitrogen, creatinine, fasting blood sugar and total cholesterol were assessed in 60 RTRs (26 woman and 34 men). Atherosclerosis was defined by clinical presentations of CAD or carotid intima-media thickness (IMT) by ultrasound. Results: Plasma tHcy level in RTRs was significantly higher than that in controls (18.48±6.8 µmol/lit vs. 9.02±0.7 μmol/lit, p<0.0001). Plasma folate concentration in trial group was significantly lower than that in controls (6.01±4.5 ng/ml vs. 9.5±2.9 ng/ml, p<0.0001) and mean IMT in trial group was significantly higher than that in controls (0.84±0.17 mm vs. 0.55±0.05 mm, p<0.0001). By univariate analysis, was observed that aging (p<0.001), longer hemodialysis duration (p<0.005) and higher plasma tHcy level (p<0.01) correlated with atherosclerosis. There was also correlation between plasma tHcy level and IMT and atherosclerosis in RTRs.Conclusions: IMT is a useful marker of atherosclerosis in RTRs and given the results of this investigation, it seems that folate deficiency was a major cause of high tHcy plasma level in these patients and aging and hemodialysis duration before kidney transplant play a major role in increased IMT in these patients. It seems that HYPERHOMOCYSTEINEMIA besides the other mentioned factors, can increase and facilitate the atherosclerosis process in the RTRs.

Recently multiple studies have shown that elevated homocysteine levels may be associated with ophthalmic vascular disease. To investigate the role of high plasma levels of homocysteine in the patients with retinal vein occlusion, 21 patients with retinal vein occlusion (RVO) and 20 age and sex matched controls without RVO were included in this retrospective case–control study. Information regarding sex, age, blood pressure, history of diabetes, history of glaucoma were obtained from all participants. Plasma level of homocysteine was measured by high plasma liquid chromatography. Mean plasma total homocysteine level was significantly higher in patients than controls (14.17 ± 9.91 versus 8.97 ± 3.10 μmol/L, P < 0.031). HYPERHOMOCYSTEINEMIA was present in 5 of the 21 patients (25%) but only one control had elevated plasma homocysteine (5%). HYPERHOMOCYSTEINEMIA is highly associated with retinal vein occlusion; therefore, its measurement may be useful in the management of these patients.