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Insulin resistance does not affect early embryo development but lowers implantation rate in in vitro maturation– in vitro fertilization–embryo transfer cycle
Author(s) -
Chang Eun M.,
Han Ji E.,
Seok Hyun H.,
Lee Dong R.,
Yoon Tae K.,
Lee Woo S.
Publication year - 2013
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12099
Subject(s) - embryo , embryo transfer , medicine , endocrinology , in vitro , in vitro fertilisation , andrology , embryogenesis , biology , human fertilization , microbiology and biotechnology , anatomy , genetics
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.