Luo Zhuoye, Wang Lili, Wang Yizhuo, Fan Yanli, Jiang Lei, Xu Xin, Du Yuanjie, Hao Guimin
Hebei Clinical Research Center for Birth Defects, Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
J Clin Med. 2023 Jan 19;12(3):818. doi: 10.3390/jcm12030818.
Ovarian sensitivity index (OSI) is an accurate index to reflect the ovarian sensitivity to exogenous gonadotropins in in vitro fertilization (IVF). How insulin resistance (IR) affects OSI and pregnancy outcomes during IVF remains unclear.
This was a large retrospective, cohort study. A total of 2055 women with polycystic ovary syndrome (PCOS) undergoing the first fresh IVF cycle were enrolled. They were grouped into terciles based on the homeostasis model assessment of insulin resistance (HOMA-IR) values as control, medium and IR group for comparison. Multivariate regression analysis was also conducted.
HOMA-IR had a significantly negative impact on OSI (adjusted β = -0.24; 95% CI, -0.35 to -0.13), especially in lean patients with an adjusted β of -0.33 (95% CI, -0.51 to -0.16). The interaction analysis revealed an interactive association between HOMA-IR and body mass index (BMI) ( = 0.017). IR was related to an increased early miscarriage risk independently with an odds ratio (OR) of 2.21 (95% CI, 1.13 to 4.33), without significant impact on pregnancy and live birth rate.
IR decreased the ovarian response in PCOS patients undergoing IVF, especially in the lean subgroup. IR may result in a higher risk of early miscarriage, but did not impair pregnancy and live birth rate.
卵巢敏感性指数（OSI）是反映体外受精（IVF）中卵巢对外源性促性腺激素敏感性的准确指标。胰岛素抵抗（IR）如何影响IVF期间的OSI和妊娠结局仍不清楚。
这是一项大型回顾性队列研究。共纳入2055例接受首次新鲜IVF周期的多囊卵巢综合征（PCOS）女性。根据胰岛素抵抗稳态模型评估（HOMA-IR）值将她们分为三分位数，作为对照组、中度组和IR组进行比较。还进行了多变量回归分析。
HOMA-IR对OSI有显著负面影响（调整后的β=-0.24；95%CI，-0.35至-0.13），尤其是在瘦患者中，调整后的β为-0.33（95%CI，-0.51至-0.16）。交互分析显示HOMA-IR与体重指数（BMI）之间存在交互关联（P=0.017）。IR与早期流产风险增加独立相关，优势比（OR）为2.21（95%CI，1.13至4.33），对妊娠和活产率无显著影响。
IR降低了接受IVF治疗的PCOS患者的卵巢反应，尤其是在瘦亚组中。IR可能导致早期流产风险更高，但不影响妊娠和活产率。
