胰岛素抵抗的稳态模型评估是多囊卵巢综合征患者在体外受精/卵胞浆内单精子注射和胚胎移植周期前进行二甲双胍预处理的判断标准。
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.
机构信息
The Reproductive Medical Center, Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
出版信息
Front Endocrinol (Lausanne). 2023 Feb 9;14:1106276. doi: 10.3389/fendo.2023.1106276. eCollection 2023.
PURPOSE
The 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 fertilization/intracellular sperm injection (IVF/ICSI) and embryo transfer (ET) for polycystic ovarian syndrome (PCOS) patients.
MATERIALS AND METHODS
The 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.
RESULTS
A 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%, = 0.821 and 63.8% vs. 60.9%, = 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%, = 0.658 and 70.6% vs. 66.7%, = 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, = 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%, = 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.
CONCLUSION
HOMA-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.
目的
本研究旨在探讨胰岛素抵抗（HOMA-IR）作为多囊卵巢综合征（PCOS）患者行体外受精/卵胞浆内单精子注射（IVF/ICSI）及胚胎移植（ET）前二甲双胍预处理的判断标准的价值。
材料与方法
回顾性分析 2017 年 1 月至 2021 年 9 月接受 IVF/ICSI-ET 的 PCOS 患者的临床和实验室资料。我们比较了所有未按 HOMA-IR 分组的 PCOS 患者、HOMA-IR<2.71 的 PCOS 患者和 HOMA-IR≥2.71 的 PCOS 患者中接受二甲双胍预处理的患者与未接受二甲双胍预处理的患者之间的临床妊娠率（主要结局）和控制性卵巢刺激（COS）相关参数（次要结局）。
结果
本研究共纳入 969 例接受 GnRH 拮抗剂方案的 PCOS 患者。对于所有 PCOS 患者，与对照组相比，二甲双胍组新鲜 ET 周期和冷冻 ET 周期的临床妊娠率相似（55.9% vs. 57.1%，=0.821 和 63.8% vs. 60.9%，=0.497）。对于 HOMA-IR<2.71 的 PCOS 患者，两组新鲜 ET 周期和冷冻 ET 周期的临床妊娠率均无统计学差异（61.5% vs. 57.6%，=0.658 和 70.6% vs. 66.7%，=0.535）。对于 HOMA-IR≥2.71 的 PCOS 患者，新鲜 ET 周期两组的临床妊娠率相似（51.5% vs. 56.3%，=0.590），但冷冻 ET 周期二甲双胍组的临床妊娠率明显高于对照组（57.1% vs. 40.0%，=0.023）。与对照组相比，二甲双胍组获卵数较少，卵裂率较低，可用 D3 胚胎率、囊胚形成率和可用囊胚率较低。
结论
HOMA-IR 是 PCOS 患者行 IVF/ICSI-ET 前二甲双胍预处理的判断标准。对于 HOMA-IR≥2.71 的 PCOS 患者，在冷冻 IVF/ICSI-ET 周期中添加二甲双胍预处理可提高临床妊娠率。
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