Zhang Ruiteng, Wang Xuejin, Mo Meilan, Liu Zhiqiang, Liu Su
Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen Zhongshan Obstetrics & Gynecology Hospital, Shenzhen, Guangdong, China.
Guangdong Engineering Technology Research Center of Reproductive Immunology for Peri-Implantation, Shenzhen, Guangdong, China.
Reprod Biol Endocrinol. 2025 Sep 1;23(1):120. doi: 10.1186/s12958-025-01453-5.
This retrospective cohort study aimed to evaluate the impact of insulin resistance (IR) on clinical outcomes in polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.
A total of 1,768 PCOS patients undergoing IVF/ICSI cycles at Shenzhen Zhongshan Obstetrics & Gynecology Hospital between October 2010 and November 2024 were stratified into two cohorts: non-IR group (HOMA index < 2.69, n = 867) and IR group (HOMA index ≥ 2.69, n = 901). Baseline characteristics and clinical outcomes were compared between the groups. Linear logistic regression and multivariate logistic regression analysis were conducted to assess the independent impact of IR on fertilization efficiency and pregnancy outcomes.
Patients with IR exhibited significantly higher BMI (25.44 ± 3.55 vs. 21.59 ± 3.20, p < 0.001), longer infertility duration (3.74 ± 2.75 vs. 3.25 ± 2.43, p < 0.001), increased antral follicle counts (26.74 ± 10.74 vs. 25.05 ± 9.79, p < 0.001) and lower basal follicle-stimulating hormone (FSH) level (9.78 ± 3.25 vs. 10.64 ± 3.83, p < 0.001) compared to those without IR. Additionally, the fertilization rate (82.02% vs. 83.86%, p = 0.005) and 2PN rate (81.07% vs. 83.96%, p < 0.001) were significantly lower in PCOS patients with IR. Linear regression indicated that IR had a more pronounced inverse effect on 2PN rate (B: -2.540, p = 0.009) than on fertilization rate (B: -0.664, p = 0.490). Subgroup analysis and interaction analysis demonstrated that IR functioned as an independent risk factor for impaired oocyte fertilization in normal-weight PCOS patients (B: -22.694, p = 0.011). No statistically significant associations between IR status and clinical or live birth pregnancy outcomes were observed in the regression models.
IR adversely affects oocyte fertilization competence and early embryonic development in normal-weight PCOS patients undergoing assisted reproductive technology (ART). These effects may be attributable to IR-induced metabolic dysregulation, which compromises folliculogenic and cytoplasmic maturation processes critical to gamete competence. These findings underscore the importance of addressing metabolic dysfunction in IR-affected PCOS populations to optimize ART outcomes.
This is a retrospective study.
本回顾性队列研究旨在评估胰岛素抵抗（IR）对接受体外受精（IVF）或卵胞浆内单精子注射（ICSI）治疗的多囊卵巢综合征（PCOS）患者临床结局的影响。
2010年10月至2024年11月期间在深圳中山妇产科医院接受IVF/ICSI周期治疗的1768例PCOS患者被分为两个队列：非IR组（HOMA指数<2.69，n = 867）和IR组（HOMA指数≥2.69，n = 901）。比较两组的基线特征和临床结局。进行线性逻辑回归和多变量逻辑回归分析，以评估IR对受精效率和妊娠结局的独立影响。
与无IR的患者相比，IR患者的体重指数显著更高（25.44±3.55 vs. 21.59±3.20，p<0.001），不孕持续时间更长（3.74±2.75 vs. 3.25±2.43，p<0.001），窦卵泡计数增加（26.74±10.74 vs. 25.05±9.79，p<0.001），基础促卵泡激素（FSH）水平更低（9.78±3.25 vs. 10.64±3.83，p<0.001）。此外，IR的PCOS患者的受精率（82.02% vs. 83.86%，p = 0.005）和2PN率（81.07% vs. 83.96%，p<0.001）显著更低。线性回归表明，IR对2PN率（B：-2.540，p =
