Insulin Resistance and Free Androgen as Predictors for Ovarian Hyperstimulation Syndrome in Non-PCOS Women

Abstract

We evaluated the effect of insulin resistance and free androgen index (FAI) in non-PCOS (polycystic ovary syndrome) infertile women following controlled ovarian hyperstimulation. A prospective study was done on 144 infertile non-PCOS women with regular menstrual cycle. At first, insulin resistance (IR), free androgen index (FAI), PCOM (polycystic ovary morphology), AFC (antral follicle count), and AMH (anti-Müllerian hormone) were assessed. The patients underwent assisted reproductive technology (ART), and then preovulatory follicles and oocytes retrieved were recorded. The variables of the study were compared between two groups of patients with ovarian hyperstimulation syndrome (OHSS) (n=66) and non-OHSS patients (n=78). Of the 9 variables: BMI, HOMA-IR, FAI, AFC, AMH, PCOM, and preovulatory follicles were risk factors, while the age and retrieved oocytes were not. The 7 variables that showed significance in the univariate analyses were determined as independent variables included in the multivariable logistic regression analysis, as a result, a total of 5 risk factors, BMI, HOMA-IR, FAI, PCOM, and preovulatory follicles entered the equation. The maximum contribution was HOMA-IR followed by PCOM, FAI, preovulatory follicles and BMI. Patients with OHSS had higher chance to have ovaries with polycystic morphology (74%), about three times more than patients who did not develop OHSS (29%) (p<0.001). The best cut-points for IR, FAI, AFC, AMH, and preovulatry follicles were 2.36, 3.9, 8, 3.3 ng/ml, and 10, respectively. Patients with a higher value of BMI, FAI, HOMA-IR, and preovulatory follicles and the presence of PCOM are more likely to develop OHSS, which are not confined to PCOS patients.

Evaluation of oocyte quality in Polycystic ovary syndrome patients undergoing ART cycles

“…There was also a significant correlation between the level of AMH and the number of retrieved oocytes and embryos. In a recent study it was shown that AMH is a main predictor of OHSS in non-PCOS patients [13]. Moreover, Chen and colleagues have also shown there is a positive correlation between AMH and fertility rate, embryo quality, and oocyte number [14].…”

Nomogram Model to Predict the Probability of Ovarian Hyperstimulation Syndrome in the Treatment of Patients With Polycystic Ovary Syndrome

“…Both the basal serum AMH level (odds ratio, 1.7856; P = 0.0003) and serum E2 level on the day of hCG injection administration (odds ratio, 1.0005; P = 0.0455) proved to be significant predictors of OHSS by logistic regression analysis (9). Furthermore, some studies have demonstrated that the high risk factors associated with OHSS mainly include (6,14): (1) 6) having a history of OHSS (15,16). Studies have also shown that multiple follicles developed at the same time during the ovulation induction cycle, higher number of eggs obtained in the ART cycle and higher doses of exogenous human chorionic gonadotropin administration during the ovulation induction cycle, as well as pregnancy, may lead to an increased risk of OHSS (17).…”

“…Patients selection and inclusion criteria were according to the Rotterdam criteria, at least possessing two of the following three criterions can be defined as PCOS: (1) rare ovulation or chronic anovulation; (2) having hyperandrogenemia or hiperandrogen clinical manifestation; (3) demonstrating polycystic ovarian changes by ultrasound determination and exclusion of other etiologies (4,6). Patients with the following exclusion criteria were included: IVF/ICSI contraindications, uterine malformations, chromosomal abnormalities, rheumatic immune system diseases, untreated endometrial lesions, drug allergies, severe mental system diseases, pituitary tumors, congenital diseases, and abnormalities of blood glucose, blood pressure, thyroid function, prolactin, and so on.…”

“…However, a study showed that the AMH level does not reduce the incidence of OHSS for women with PCOS undergoing an ART treatment (5). Another study showed that patients with a higher value of BMI, free androgen, AFC, follicle number on the day of hCG injection and AMH are more likely to develop OHSS, but not confined to PCOS patients (6). Several studies showed that obese patients with PCOS have a higher OHSS probability than normal-weight patients, and overweight and high serum total cholesterol were risk factors for the outcome of IVF/ICSI cycles in PCOS patients (7).…”

Insulin Resistance Adversely Affect IVF Outcomes in Lean Women Without PCOS

“…Additionally, the response of granulosa cells to FSH during the gonadotropin-dependent stage of folliculogenesis can be enhanced by insulin growth factors ( 27 ). Therefore, in the IVF setting, the risk of developing multifolliculogenesis or ovarian hyperstimulation syndrome to exogenous gonadotropin stimulation is higher in IR than non-IR patients ( 28 ).…”