Insulin Resistance Adversely Affect IVF Outcomes in Lean Women Without PCOS

Wang, Haoyu; Zhang, Yu; Fang, Xuhui; Kwak‐Kim, Joanne; Wu, Li

doi:10.3389/fendo.2021.734638

Cited by 24 publications

(23 citation statements)

References 37 publications

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Section: Discussionmentioning

confidence: 98%

“…Other reports, however, dispute these results (17,30,31). Wang et al failed to find significant differences in pregnancy outcomes, including pregnancy rate, clinical pregnancy loss rate, and cumulative live birth rate, between IR and non-IR group (17). Among non-PCOS participants, no associations were found between hyperinsulinemia and IR and clinical pregnancy, live birth, and miscarriage (31).…”

Section: Discussionmentioning

confidence: 98%

“…In women with HOMA-IR greater than 4.5, the odds ratio (OR) is eight times that of those with HOMA-IR of 4.5 or less (16). Moreover, other studies reported negative associations between IR and oocyte-embryo quality in the ART scenarios (17,18).…”

Section: Introductionmentioning

confidence: 99%

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Homeostatic Model Assessment for Insulin Resistance Is Associated With Late Miscarriage in Non-Dyslipidemic Women Undergoing Fresh IVF/ICSI Embryo Transfer

Yang

Zhang

et al. 2022

Front. Endocrinol.

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ObjectiveTo evaluate the associations between homeostatic model assessment for insulin resistance (HOMA-IR) and pregnancy outcomes in non-dyslipidemic infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).Materials and MethodsThis is a retrospective study involving 3,615 non-dyslipidemic infertile women who attend to the Reproductive Medicine Center of Xiangya Hospital, Central South University (CSU) between January 2014 and October 2021. Eligible participants were divided into three groups according to the quartiles of HOMA-IR: Group 1 (HOMA-IR <1.46), Group 2 (1.46 to <2.71) and Group 3 (HOMA-IR ≥2.71). Baseline data, clinical characteristics during the assisted reproductive technology (ART) procedure, pregnancy, and neonatal outcomes were compared among the three groups. Subgroup analysis based on presence or absence of the polycystic ovary syndrome (PCOS) status was also performed to analyze the effects of HOMA-IR among non-PCOS populations.ResultsThe late miscarriage rate and percentage of macrosomia increased with the HOMA-IR group (for late miscarriage rate: 2.23% vs. 3.04% vs. 7.35%, P<0.001; for macrosomia: 0.21% vs. 1.70% vs. 3.23%, P=0.002). Increased HOMA-IR (HOMA-IR≥2.71) was positively associated with late miscarriage (crude OR 3.50, 95% CI 1.64-7.47, P=0.001; adjusted OR 3.56, 95% CI 1.56-8.15, P=0.003). In the subgroup analysis, there were 3,165 participants in the non-PCOS group and 450 were assigned to the PCOS group. Late miscarriage rate increased with the HOMA-IR group among non-PCOS populations (2.20% vs. 3.03% vs. 7.67%, P<0.001). Late miscarriage rate of PCOS women were comparable among the three HOMA-IR groups (2.50% vs. 3.06% vs. 5.71%, P=0.634). Among non-PCOS women, increased HOMA-IR (HOMA-IR≥2.71) was positively associated with late miscarriage (crude OR 3.71, 95% CI 1.66-8.30, P=0.001; adjusted OR 3.82, 95% CI 1.59-9.17, P=0.003).ConclusionsLate miscarriage rate and prevalence of macrosomia increased with the HOMA-IR index. Preconception HOMA-IR is an independent risk factor for late miscarriage in normolipidemic women undergoing IVF/ICSI-ET. Controlling insulin resistance before ART might prevent the occurrence of late miscarriage and macrosomia.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

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Homeostatic Model Assessment for Insulin Resistance Is Associated With Late Miscarriage in Non-Dyslipidemic Women Undergoing Fresh IVF/ICSI Embryo Transfer

Yang

Zhang

et al. 2022

Front. Endocrinol.

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“…On the other hand, they adversely affects the functions and environment of the endometrium and are responsible for disturbances in embryo implantation ( 180 ). In addition, hyperinsulinemia disturbs the intra-follicular microenvironment during folliculogenesis, decreases the fertilization rate and the potential for embryonic development during natural ovarian stimulation cycles ( 173 ). Insulin primarily acts on its own receptors located on the theca cells surrounding the stromal and granulosa cells, thereby stimulating ovarian steroidogenesis ( 174 ).…”

Section: Pancreasmentioning

confidence: 99%

“…Research shows that inflammation (elevated levels of IL-6 and IL-17) accompanying insulin resistance and obesity affect ovulation and fertilization and increase the risk of early miscarriage. Moreover, obese people show increased levels of estrogens due to the overexpression of aromatase in adipose tissue, which in turn disturbs ovulation ( 173 , 175 ).…”

Section: Pancreasmentioning

confidence: 99%

Endocrine disorders and fertility and pregnancy: An update

et al. 2023

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It is estimated that more and more couples suffer from fertility and pregnancy maintenance disorders. It is associated with impaired androgen secretion, which is influenced by many factors, ranging from genetic to environmental. It is also important to remember that fertility disorders can also result from abnormal anatomy of the reproductive male and female organ (congenital uterine anomalies – septate, unicornuate, bicornuate uterus; acquired defects of the uterus structure – fibroids, polyps, hypertrophy), disturbed hormonal cycle and obstruction of the fallopian tubes resulting from the presence of adhesions due to inflammation, endometriosis, and surgery, abnormal rhythm of menstrual bleeding, the abnormal concentration of hormones. There are many relationships between the endocrine organs, leading to a chain reaction when one of them fails to function properly. Conditions in which the immune system is involved, including infections and autoimmune diseases, also affect fertility. The form of treatment depends on infertility duration and the patient’s age. It includes ovulation stimulation with clomiphene citrate or gonadotropins, metformin use, and weight loss interventions. Since so many different factors affect fertility, it is important to correctly diagnose what is causing the problem and to modify the treatment regimen if necessary. This review describes disturbances in the hormone secretion of individual endocrine organs in the context of fertility and the maintenance of pregnancy.

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