Insulin resistance does not affect early embryo development but lowers implantation rate in in vitro maturation-in vitro fertilization-embryo transfer cycle

Objective Although extensive evidence indicates the hyperinsulinemia directly contributes to reproductive dysfunction in polycystic ovarian syndrome (PCOS), influence of insulin resistance (IR) on assisted reproductive technology outcomes is poorly understood. In this study we aimed to evaluate the...

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Published in:Clinical endocrinology (Oxford) 2013-07, Vol.79 (1), p.93-99
Main Authors: Chang, Eun M., Han, Ji E., Seok, Hyun H., Lee, Dong R., Yoon, Tae K., Lee, Woo S.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Birth control
Blood Glucose - metabolism
Body Mass Index
Embryo Implantation - physiology
Embryo Transfer - methods
Embryonic Development - physiology
Endocrinopathies
Female
Fertilization in Vitro - methods
Fundamental and applied biological sciences. Psychology
Gynecology. Andrology. Obstetrics
Homeostasis
Humans
In Vitro Oocyte Maturation Techniques - methods
Insulin - blood
Insulin Resistance - physiology
Logistic Models
Medical sciences
Multivariate Analysis
Polycystic Ovary Syndrome - blood
Polycystic Ovary Syndrome - physiopathology
Pregnancy
Pregnancy Complications - blood
Pregnancy Complications - physiopathology
Pregnancy Outcome
Pregnancy Rate
Prospective Studies
Reproductive Techniques, Assisted
Sterility. Assisted procreation
Vertebrates: endocrinology
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Summary:Objective Although extensive evidence indicates the hyperinsulinemia directly contributes to reproductive dysfunction in polycystic ovarian syndrome (PCOS), influence of insulin resistance (IR) on assisted reproductive technology outcomes is poorly understood. In this study we aimed to evaluate the effects of IR on in vitro maturation‐in vitro fertilization–embryo transfer (IVM‐IVF‐ET) in patients with PCOS. Design Prospective observational study. Patients Women with PCOS (n = 115) commencing IVM. Measurments IR (n = 51) and non‐IR (n = 64) women with PCOS ready to commence an IVM cycle were recruited. IR was diagnosed using the glucose tolerance test (GTT) and homeostasis model assessment (HOMA) index. Patients with an abnormal GTT and/or HOMA index >2·4 were considered IR. Patients underwent 115 cycles of unstimulated hCG‐primed IVM. Results Maturation, fertilization, cleavage rates, the number of good‐quality embryo, and blastocyst formation rates were not significantly different between groups. However, implantation (11·6% vs 28·7%, P = 0·001, respectively), clinical pregnancy (23·5% vs 53·1%, P = 0·002, respectively), and ongoing pregnancy rates (21·6% vs 46·9%. P = 0·006, respectively) were significantly decreased in the IR group. The negative effect of IR on pregnancy outcomes remained after controlling for age, body mass index (BMI) and lipid profiles (OR 4·928, 95% CI 1·735–13·991, P = 0·003). Conclusions Pregnancy rate after IVM is impaired in IR patients with PCOS. Oocyte development and embryo quality are not affected, suggesting that the effects of hyperinsulinemia on endometrial function and implantation process underlie the decreased pregnancy rate.
ISSN:0300-0664
1365-2265
DOI:10.1111/cen.12099