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RESULTS: The serum a-klotho level during the follicular phase of preimplantation for non-pregnant women was 557.07+ 208.28 pg/ml (mean+ SD). Furthermore, the serum a-klotho levels during the follicular phase of preimplantation decreased due to aging (p< 0.001), whereas the maturation rates of human oocytes (p= 0.0002) and the fertilization rates (p< 0.001) improved in association with increased serum a-klotho levels during the follicular phase of preimplantation. Moreover, clinical pregnancy rates could be improved by increasing the serum a-klotho levels during the follicular phase of preimplantation (p< 0.001). On the other hand, multivariate analysis showed that the clinical pregnancy rates were influenced by serum a-klotho levels (p= 0.01), maturation rates of human oocytes (p< 0.001) and fertilization rates (P= 0.001) regardless of the patient’s age (p= 0.44), estradiol levels (p= 0.39) or BMI (p= 0.32). Furthermore, the cut-off value of more than 630 pg/ml for the serum a-klotho levels during the follicular phase of preimplantation for clinical pregnancy resulted in a sensitivity of 97%(95% confidence interval: 85%-99%), a specificity of 93%(95% confidence interval: 76%-98%), a positive predictive value of 93%(95% confidence interval: 77%-98%), and a negative predictive value of 92%(95% confidence interval: 76%-98%).

CONCLUSIONS: Serum a-klotho levels during the follicular phase of preimplantation are a simple biomarker for evaluating the aging or quality of human oocytes and clinical pregnancy rates.