Follicular Fluid Cell-Free DNA as a Non-Invasive Biomarker of Pregnancy Outcome in IVF/ICSI Cycles: Influence of Follicle Size, Age, and BMI in a Nigerian Cohort

Background: Cell-free DNA (cfDNA) in follicular fluid has emerged as a potential non-invasive biomarker of oocyte quality and implantation success in assisted reproductive technologies (ART). However, limited data exist regarding its clinical utility in African populations undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
Objectives: This study aimed to evaluate the association between follicular fluid cfDNA concentration, follicle size, and pregnancy outcomes in infertile women undergoing IVF/ICSI in Nigeria, and to assess the influence of age and body mass index (BMI).
Methods: A prospective observational study that was conducted at the IVF Centre, National Hospital Abuja. The study involved 105 infertile women aged 20-40 years. Follicular fluid samples were collected from follicles and categorized into < 16 mm, 16 – 20 mm, and >20 mm groups. cfDNA concentrations were measured using fluorometric assays. Patients were monitored for clinical pregnancy, and comparisons were made using independent t-test with significance set at p ≤ 0.05.
Results: Women with positive pregnancy outcomes had significantly lower cfDNA levels across all follicle size groups. In the 16 – 20 mm category, cfDNA was 68.9 ± 9.7 ng/mL in the pregnant group versus 92.5 ± 11.1 ng/mL in the non-pregnant group (p = 0.001). Similar patterns were observed in the < 16 mm (p = 0.012) and >20 mm (p = 0.005) categories. Pregnant women also had slightly lower BMI and were younger across all groups.
Conclusion: High follicular fluid cfDNA is associated with poor pregnancy outcomes in IVF/ICSI. cfDNA may serve as a non-invasive biomarker of oocyte quality and ART success in Nigerian women.