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

Yang, Tianli; Yang, Yuanyuan; Zhang, Qiong; Liu, Donge; Liu, Nenghui; Li, Yumei; Yao, Zhongyuan; Zhang, Yeqing; Fen, Tian; Zhao, Jing; Li, Yanping

doi:10.3389/fendo.2022.880518

Cited by 9 publications

(17 citation statements)

References 40 publications

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“…HOMA-IR is a simple and convenient indicator to evaluate the degree of IR ( 15 ). Patients with a higher HOMA-IR were reported to have a lower implantation rate ( 15 ), a lower clinical pregnancy rate ( 15 , 16 ), and a higher risk of early miscarriage ( 17 ) and late miscarriage ( 10 ) than patients with a lower HOMA-IR in IVF/ICSI-ET cycles. Metformin is a synthetically derived biguanide that is widely used in PCOS patients because it improves insulin sensitivity ( 18 , 19 ), but the application of metformin is full of controversy.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who received a metformin pre-treatment form at least 3 months before their IVF/ICSI-ET cycles constituted the metformin group; patients without metformin pre-treatment made up the control group, and other patients were excluded. The subgroup analyses were based on HOMA-IR < 2.71 and HOMA-IR ≥ 2.71 according to a previous study, which reported that HOMA-IR ≥ 2.71 is a significant risk factor of adverse pregnancy outcomes for women who received fresh IVF/ICSI-ET ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

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The homeostasis model assessment of insulin resistance is a judgment criterion for metformin pre-treatment before IVF/ICSI and embryo transfer cycles in patients with polycystic ovarian syndrome

Gao

Qin²,

Li³

et al. 2023

Front. Endocrinol.

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PurposeThe aim of this study was to explore the value of the homeostasis model assessment of IR (HOMA-IR) as a judgment criterion for metformin pre-treatment before in vitro fertilization/intracellular sperm injection (IVF/ICSI) and embryo transfer (ET) for polycystic ovarian syndrome (PCOS) patients.Materials and methodsThe clinical and laboratory information of PCOS patients who received IVF/ICSI-ET from January 2017 to September 2021 was retrospectively analyzed. We compared the clinical pregnancy rate (primary outcome) and controlled ovarian stimulation (COS)-related parameters (secondary outcomes) between patients with and without metformin pre-treatment for all PCOS patients not grouped by HOMA-IR, PCOS patients with HOMA-IR < 2.71, and PCOS patients with HOMA-IR ≥ 2.71.ResultsA total of 969 PCOS patients who received the GnRH-antagonist protocol were included in this study. For all PCOS patients, the metformin group showed comparable clinical pregnancy rates in fresh ET cycles and frozen ET cycles compared with the control group (55.9% vs. 57.1%, p = 0.821 and 63.8% vs. 60.9%, p = 0.497). For PCOS patients with HOMA-IR < 2.71, the clinical pregnancy rates in both fresh ET cycles and frozen ET cycles were statistically similar between the two groups (61.5% vs. 57.6%, p = 0.658 and 70.6% vs. 66.7%, p = 0.535). For PCOS patients with HOMA-IR ≥ 2.71, the clinical pregnancy rate in fresh ET cycles was comparable between the two groups (51.5% vs. 56.3, p = 0.590), but it was statistically higher in the metformin group than in the control group in frozen ET cycles (57.1% vs. 40.0%, p = 0.023). The metformin group had less oocytes retrieved, a lower cleaved oocyte rate, a lower available D3 embryo rate, a lower blastocyst formation rate, and a lower available blastocyst rate than the control group.ConclusionHOMA-IR is a judgment criterion for metformin pre-treatment before IVF/ICSI-ET in patients with PCOS. Metformin pre-treatment could be added for PCOS patients with HOMA-IR ≥ 2.71 during frozen IVF/ICSI-ET cycles to improve the clinical pregnancy rate.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The homeostasis model assessment of insulin resistance is a judgment criterion for metformin pre-treatment before IVF/ICSI and embryo transfer cycles in patients with polycystic ovarian syndrome

Gao

Qin²,

Li³

et al. 2023

Front. Endocrinol.

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“… 10–12 Moreover, IR may adversely impact the in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) outcomes. 13 …”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] Moreover, IR may adversely impact the in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) outcomes. 13 In the setting of IVF and ICSI, the homeostasis model assessment of IR (HOMA-IR) has been widely used as an important surrogate measure of IR. Direct, dynamic methods for measuring IR are accurate but inconvenient for clinical practice in large populations.…”

Section: Introductionmentioning

confidence: 99%

Association of HOMA-IR with Ovarian Sensitivity Index in Women Undergoing IVF/ICSI: A Retrospective Cohort Study

Li¹,

Jiang²,

Zhang³

et al. 2023

DMSO

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Background Insulin resistance (IR) may adversely impact the in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) outcomes. However, the association of IR with ovarian sensitivity during controlled ovarian hyperstimulation (COH) remains controversial. Purpose We aimed to explore the association between homeostasis model assessment of insulin resistance (HOMA-IR) and ovarian sensitivity index (OSI). Patients and Methods In this retrospective cohort study, 7836 patients aged between 20 and 39 years with good ovarian reserve were included consecutively between June 2018 and May 2022. HOMA-IR was calculated to evaluate the degree of IR and OSI was used to measure ovarian sensitivity. Owing to skewed distribution, HOMA-IR and OSI were log e transformed to Ln HOMA-IR and Ln OSI. Smoothing splines were generated by generalized additive models to explore the correlation between Ln HOMA-IR and Ln OSI. Then, the relationship between Ln HOMA-IR and Ln OSI was tested with multivariable linear regression model after adjustments for the potential confounders. Results We observed negative association between Ln HOMA-IR and Ln OSI after adjustment for potential confounders by using smoothing spline fitting curves in generalized additive model. In the multivariable linear regression model, after full adjustments, each one unit increase in Ln HOMA-IR was related to reduced Ln OSI values (β = −0.12, 95% CI, −0.15, −0.09). As sensitivity analysis, those who had HOMA-IR of quartile 3 (HOMA-IR 2.33–3.43) and quartile 4 (HOMA-IR ≥3.43) had decreases in Ln OSI values (β = −0.07, 95% CI −0.11, −0.03 and β = −0.18, 95% CI −0.22, −0.13, respectively) when compared with patients in the quartile 1 (HOMA-IR <1.63). Furthermore, stratified and interaction analysis showed a strong inverse association of Ln HOMA-IR with Ln OSI in subgroups of PCOS patients and overweight/obese populations ( P -value for interaction <0.0001). Conclusion HOMA-IR value was negatively associated with the ovarian sensitivity assessed by OSI. Among the PCOS and overweight/obese populations, this inverse relationship may be strong. These findings will increase the understanding of the contribution of IR to the development of decreased ovarian sensitivity within the assisted reproductive technology (ART) setting. It may have implications for optimizing gonadotropin dose manipulation in patients with IR undergoing IVF/ICSI.

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“…The expansion of this tissue contributes to altered adipokine profiles, with a predominance of proinflammatory cytokines (mainly interleukin-6 and tumor necrosis factor-α), resulting in low-intensity chronic inflammation that can cause muscle and liver insulin resistance [ 19 ]. Obese women are thus prone to chronic low-grade inflammation and insulin resistance, both of which are associated with impaired reproductive function and late spontaneous abortion after ART [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Nutritional Status and Its Influence on Ovarian Reserve: A Systematic Review

Prieto-Huecas,

Piera-Jordán,

Serrano De La Cruz-Delgado

et al. 2023

Nutrients

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Background: Nowadays, there is a growing interest in the relationship among lifestyle, reproductive health, and fertility. Recent investigations highlight the influence of environmental and lifestyle factors such as stress, diet, and nutritional status on reproductive health. The aim of this review was to determine the influence of nutritional status on ovarian reserve in order to improve the reproductive health of women of childbearing age. Methods: A systematic literature review was carried out following the PRISMA method. The quality of the studies was assessed using the Cochrane Collaboration Risk of Bias tool. Data were extracted, and the results were summarized into two blocks: according to the technique used to assess ovarian reserve and nutritional status; according to the results found in the relationship between ovarian reserve and nutritional status. Results: A total of 22 articles involving 5929 women were included. In 12 of the included articles (54.5%), a relationship between nutritional status and ovarian reserve was demonstrated. In seven publications (31.8%), the increased body mass index (BMI) led to a decrease in ovarian reserve, two of them (0.9%) in patients with polycystic ovary syndrome, showing a decrease only if BMI > 25. In two articles (0.9%), there was a negative relationship between ovarian reserve and waist-to-hip ratio, and in one (0.45%), a positive relationship was shown between ovarian reserve and testosterone levels, the latter being related to body mass index. In five articles (22.7%), body mass index was used as a confounder and was negatively related to ovarian reserve, and in another four (18%), no correlation was found. Conclusions: Ovarian reserve appears to be influenced by nutritional status. A high body mass index has a negative impact on the ovary, decreasing antral follicle count and anti-Müllerian hormone. Oocyte quality is compromised, increasing the rate of reproductive problems and the demand for assisted reproductive techniques. Further studies are needed to understand which dietary factors have the greatest effect on ovarian reserve in order to promote reproductive health.

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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

Cited by 9 publications

References 40 publications

The homeostasis model assessment of insulin resistance is a judgment criterion for metformin pre-treatment before IVF/ICSI and embryo transfer cycles in patients with polycystic ovarian syndrome

The homeostasis model assessment of insulin resistance is a judgment criterion for metformin pre-treatment before IVF/ICSI and embryo transfer cycles in patients with polycystic ovarian syndrome

Association of HOMA-IR with Ovarian Sensitivity Index in Women Undergoing IVF/ICSI: A Retrospective Cohort Study

Assessment of Nutritional Status and Its Influence on Ovarian Reserve: A Systematic Review

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