Ovarian Sensitivity Decreased Significantly in Patients With Insulin Resistance Undergoing in vitro Fertilization and Embryo Transfer

Zheng, Yanjun; Pan, Ye; Li, Ping; Wang, Zhongyuan; Wang, Ze; Shi, Yuhua

doi:10.3389/fphys.2021.809419

Cited by 10 publications

(9 citation statements)

References 31 publications

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“…Few studies have been performed on the association between HOMA-IR and OSI. To our knowledge, only one research depicted a decreased OSI in 131 IR-PCOS women compared with 52 non-IR PCOS subjects ( 11 ). However, the sample size was small and the effect size of IR on OSI was unclear.…”

Section: Discussionmentioning

confidence: 90%

“…Thus, the identification of heterogenous ovarian sensitivity in PCOS populations is the key to striking a balance between ovarian hyperstimulation syndrome (OHSS) and poor ovarian response (POR). Some clinical parameters, including age, body mass index (BMI), anti-mullerian hormone (AMH), and antral follicle count (AFC) have been widely used as predictive markers of ovarian response ( 11 ). However, these markers cannot properly reflect the dynamic process of follicular growth in response to exogenous gonadotropin (Gn) ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Association between HOMA-IR and ovarian sensitivity index in women with PCOS undergoing ART: A retrospective cohort study

Wang²,

Liu³

et al. 2023

Front. Endocrinol.

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IntroductionInsulin resistance (IR) may play a central role in the pathophysiology of polycystic ovary syndrome (PCOS). Controlled ovarian stimulation (COS) in PCOS women in the setting of assisted reproductive technology (ART) is always a challenge for clinicians. However, it remains unclear whether IR in women with PCOS correlates with reduced ovarian sensitivity to exogenous gonadotropin (Gn). This study aimed to explore the association between homeostasis model assessment of insulin resistance (HOMA-IR) and ovarian sensitivity index (OSI).MethodsIn this retrospective cohort study, we explored the association between Ln HOMA-IR and Ln OSI based on smoothing splines generated by generalized additive model (GAM). Then the correlation between HOMA-IR and OSI was further tested with a multivariable linear regression model and subgroup analysis.Results1508 women with PCOS aged 20-39 years undergoing their first oocyte retrieval cycle were included consecutively between 2018 until 2022. We observed a negative association between Ln HOMA-IR and Ln OSI by using smoothing splines. In multivariable linear regression analysis, the inverse association between Ln HOMA-IR and Ln OSI was still found in PCOS women after adjustment for potential confounders (β = -0.18, 95% CI -0.25, -0.11). Compared with patients with the lowest tertile of HOMA-IR, those who had the highest tertile of HOMA-IR had lower OSI values (β = -0.25, 95% CI -0.36, -0.15).DiscussionOur study provided evidence for the inverse correlation between IR and the ovarian sensitivity during COS in PCOS women. Herein, we proposed new insights for individualized manipulation in PCOS patients with IR undergoing ART.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Association between HOMA-IR and ovarian sensitivity index in women with PCOS undergoing ART: A retrospective cohort study

Wang²,

Liu³

et al. 2023

Front. Endocrinol.

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“… 36 Previously, in a case–control study, Zheng et al reported that a limited number of PCOS patients with IR had lower OSI levels than that of PCOS individuals without IR undergoing ART. 24 However, they found no statistical difference in OSI levels between the IR and non-IR groups in non-PCOS patients which was probably due to the small sample size. In our cohort study, the inverse relationship between HOMA-IR and OSI remained significant in all subgroups after careful adjustments, including the stratifications of age, BMI, COH protocol PCOS and other main infertility factors.…”

Section: Discussionmentioning

confidence: 91%

“… 23 Ovarian sensitivity index (OSI) has been suggested as an evaluation of ovarian sensitivity in IVF procedure, which could reflect the potential of follicles to produce oocytes in response to exogenous Gn stimulation. 24 , 25 The OSI improves the definition of ovarian response patterns. For instance, among young women, OSI showed a log-normal distribution with levels for poor and high response at 1.697 and 10.07, respectively.…”

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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“…Insulin resistance has previously been shown to have a negative correlation with ovarian sensitivity [ 37 ]. Metformin has been the most commonly-studied insulin sensitizer in PCOS patients.…”

Section: Ivf Preparationmentioning

confidence: 99%

Women with PCOS who undergo IVF: a comprehensive review of therapeutic strategies for successful outcomes

Kotlyar

Seifer

2023

Reprod Biol Endocrinol

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Polycystic ovarian syndrome (PCOS) is a widespread syndrome that poses unique challenges and constraints to the field of assisted reproductive technology. This condition is the most common cause of anovulation among infertile couples. Debate exists over the best therapeutic course of action when patients with PCOS proceed to IVF. In this review, we evaluate the best-performing and safest methods of IVF preparation, ovarian stimulation, trigger method for maturation of stimulated egg growth, and planning for embryo transfer. Pre-IVF considerations include being aware of individual AMH and vitamin D levels as well as BMI prior to selecting an ovarian stimulation protocol. Numerous supplements such as myo-inositol complement the benefits of lifestyle change and may enhance IVF performance including oocyte yield and pregnancy rate. Concerning stimulation protocols, antagonist cycles with the judicious use of GnRH agonist trigger, pre-treatment with metformin and vitamin D repletion may help mitigate the accompanied risk of ovarian hyperstimulation syndrome (OHSS). Following ovarian stimulation, PCOS patients typically undergo programmed frozen embryo transfer (FET) cycles which are more conducive for women with irregular cycles, but likely carry a higher risk of hypertensive disorders of pregnancy. However, newer stimulated FET protocols using Letrozole may offer improved outcomes. Overall, patients with PCOS require careful individual tailoring of their IVF cycle to achieve optimal results.

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Ovarian Sensitivity Decreased Significantly in Patients With Insulin Resistance Undergoing in vitro Fertilization and Embryo Transfer

Cited by 10 publications

References 31 publications

Association between HOMA-IR and ovarian sensitivity index in women with PCOS undergoing ART: A retrospective cohort study

Association between HOMA-IR and ovarian sensitivity index in women with PCOS undergoing ART: A retrospective cohort study

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

Women with PCOS who undergo IVF: a comprehensive review of therapeutic strategies for successful outcomes

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