Insulin resistance does not affect early embryo development but lowers implantation rate in <i>in vitro</i> maturation–<i>in vitro</i> fertilization–embryo transfer cycle

Chang, Eun Mi; Han, Ji Eun; Seok, Hyun; Lee, Dong R.; Yoon, Tae Ki; Lee, Woo S.

doi:10.1111/cen.12099

Cited by 57 publications

(43 citation statements)

References 44 publications

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“…Interestingly, embryo development was not affected in patients with insulin resistance, indicating that, in fact, insulin-resistant patients with PCOS have impaired endometrial receptivity. 58 The pathophysiology behind insulin resistance is complex. Most authors believe that, in obese patients, insulin resistance is determined by liver accumulation of free fatty acids (FFAs) released by visceral fat.…”

Section: Hyperinsulinemiamentioning

confidence: 99%

Obesity and PCOS: The Effect of Metabolic Derangements on Endometrial Receptivity at the Time of Implantation

2015

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Successful embryonic implantation is the result of a receptive endometrium, a functional embryo at the blastocyst stage and a synchronized dialog between maternal and embryonic tissues. Successful implantation requires the endometrium to undergo steroid-dependent change during each menstrual cycle, exhibiting a short period of embryonic receptivity known as the window of implantation. The term ''endometrial receptivity'' was introduced to define the state of the endometrium during the window of implantation. It refers to the ability of the endometrium to undergo changes that will allow the blastocyst to attach, penetrate, and induce localized changes in the endometrial stroma. These changes are metabolically demanding, and glucose metabolism has been proven to be important for the preparation of the endometrium for embryo implantation. Obesity and polycystic ovary syndrome (PCOS) represent 2 common metabolic disorders that are associated with subfertility. The aim of this review is to summarize the effect of obesity and PCOS on endometrial receptivity at the time of implantation. Focus will be on metabolic alterations that regulate decidualization, including glucose metabolism, hyperinsulinemia, and hyperandrogenism.

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Section: Hyperinsulinemiamentioning

confidence: 99%

Obesity and PCOS: The Effect of Metabolic Derangements on Endometrial Receptivity at the Time of Implantation

2015

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“…For example, in patients with polycystic ovary syndrome, higher IR altered the implantation rate after in-vitro fertilization. 30 Similarly, Paretti et al 31 demonstrated that preeclampsia can be predicted by simple insulin sensitivity indexes measured independently in both early and late pregnancy. Hauth et al 32 confirmed these findings in a large cohort of patients tested between the 22nd and 26th weeks of gestation.…”

Section: Resultsmentioning

confidence: 98%

Association between preconceptional treatment with insulin pumps and improved metabolic status in early pregnancy in women with type 1 diabetes

Gutaj¹,

Zawiejska²,

Brązert³

et al. 2015

Polish Archives of Internal Medicine

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INTRODUCTION An adverse intrauterine environment in early pregnancy in women with type 1 diabetes is associated with several perinatal complications including spontaneous abortions, fetal congenital defects, and preeclampsia.ObjECTIvEs We compared metabolic parameters in the first trimester of pregnancy between women with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) and those treated with multiple daily injections (MDI).PATIENTs AND mEThODs A total of 168 women in the first trimester of pregnancy (33 using CSII and 135 using MDI) were enrolled in this cross-sectional single-center study. Anthropometric parameters, fasting serum levels of hemoglobin A 1c (HbA 1c ), lipid profile, and estimated glucose disposal rate (eGDR) were determined. REsULTsPatients did not differ in gestational or maternal age, diabetes duration, and the frequency of planned pregnancies. Women using CSII before pregnancy had lower body mass index and waist-to-hip ratio than those using MDI (22.3 vs 23.3 and 0.77 vs 0.79, respectively, P = 0.01). A similar number of women had hypertension; however, the CSII group had lower diastolic blood pressure (P = 0.02). Moreover, the CSII group had a significantly lower insulin requirement (0.54 vs 0.63 units/kg; P = 0.02), significantly higher eGDR (11.3 vs 10.5 mg/kg/min; P = 0.0007), and significantly lower serum triglyceride levels (53.1 vs 61.8 mg/dl; P = 0.004). In a multiple regression analysis, CSII therapy was associated with higher eGDR, lower HbA 1c , and lower serum triglyceride levels.CONCLUsIONs The use of CSII before pregnancy in patients with type 1 diabetes is associated with better metabolic profile in the first trimester. ORIGINAL ARTICLEAssociation between preconceptional treatment with insulin pumps and improved metabolic status in early pregnancy in women with type 1 diabetes Paweł Gutaj, Agnieszka Zawiejska, Jacek Brązert, Ewa Wender-Ożegowska (7 patients). Two patients refused to participate in the study.All study participants were Caucasians. They were all treated with functional intensive therapy before pregnancy; 135 patients received MDI and 33-CSII. All CSII users had been using this method of therapy for at least 6 months. A basal-bolus protocol used in patients on MDI involved 3 injections of short-acting insulin analog before meals and 1 or 2 injections of intermediate-acting insulin at bedtime or at bedtime and in the morning. Women on CSII received short-acting insulin analog (continuous basal rate and 3 premeal boluses).Of all patients, 61 women using MDI and 20 women using CSII received prepregnancy counseling delivered by a diabetologist or an obstetrician with a special interest in diabetic pregnancy. These data were self-reported by participants. The remaining women received standard care for nonpregnant patients with type 1 diabetes delivered by diabetologists as recommended by the PTD. According to the PTD, blood glucose and HbA 1c targets for women planning their pregnancies or already pregnant compared with those nonp...

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“…Blood pressures, waist circumference, and body mass index were measured as described by Ryu and colleagues [24]. The level of serum gonadotropins and other hormones were measured as described previously [26]. …”

Section: Methodsmentioning

confidence: 99%

Correlation between Expression of Glucose Transporters in Granulosa Cells and Oocyte Quality in Women with Polycystic Ovary Syndrome

et al. 2014

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BackgroundThe glucose transporters (GLUTs) exhibit different tissue-specific expression. This study aimed to investigate the types of GLUTs expressed in human granulosa cells (GCs) obtained from women with polycystic ovary syndrome (PCOS) and their relationship with insulin resistance (IR) and the outcomes of in vitro maturation (IVM) of immature oocytes.MethodsExpression of GLUTs was evaluated in GCs from women with PCOS with or without IR. Thirty-six women with PCOS undergoing an IVM program were included. Differential gene expression between the insulin sensitive (IS) and IR group was measured by reverse transcription polymerase chain reaction.ResultsExpression of GLUTs 1, 3, 5, 8, and 13 was constitutive, whereas expression of GLUTs 2 and 7 was not observed in human GCs. The remaining GLUTs, 4, 6, 9, 10, 11, and 12, were differentially expressed among patients according to metabolic status, such as insulin sensitivity. A higher number of GCs from patients with IR (92%) expressed GLUT6 than GCs from IS PCOS patients (46.3%). Logistic regression showed that expression of GLUTs 9, 11, and 12 correlates with rates of IVM at 48 hours, fertilization, and implantation, respectively.ConclusionThis is the first report describing the expression pattern of all 13 members of the GLUT family in human GCs. Results of the present study suggest that patients' insulin sensitivity regulates GLUT expression in GCs in PCOS patients, and this may control oocyte quality for IVM and subsequent processes such as fertilization and implantation in patients taking part in an in vitro fertilization program.

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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

Abstract: 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.

Cited by 57 publications

References 44 publications

Obesity and PCOS: The Effect of Metabolic Derangements on Endometrial Receptivity at the Time of Implantation

Obesity and PCOS: The Effect of Metabolic Derangements on Endometrial Receptivity at the Time of Implantation

Association between preconceptional treatment with insulin pumps and improved metabolic status in early pregnancy in women with type 1 diabetes

Correlation between Expression of Glucose Transporters in Granulosa Cells and Oocyte Quality in Women with Polycystic Ovary Syndrome

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