title: Insulin resistance does not affect early embryo development but lowers implantation rate in in vitro maturation-in vitro fertilization-embryo transfer cycle.
abstract: OBJECTIVE
  Although extensive evidence indicates the hyperinsulinemia directly contributes to reproductive dysfunction in polycystic ovarian syndrome (PCOS), influence of insulin resistance (IR) on assisted reproductive technology outcomes is poorly understood. In this study we aimed to evaluate the effects of IR on in vitro maturation-in vitro fertilization-embryo transfer (IVM-IVF-ET) in patients with PCOS.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Women with PCOS (n = 115) commencing IVM.
  
  
  METHODS
  IR (n = 51) and non-IR (n = 64) women with PCOS ready to commence an IVM cycle were recruited. IR was diagnosed using the glucose tolerance test (GTT) and homeostasis model assessment (HOMA) index. Patients with an abnormal GTT and/or HOMA index >2·4 were considered IR. Patients underwent 115 cycles of unstimulated hCG-primed IVM.
  
  
  RESULTS
  Maturation, fertilization, cleavage rates, the number of good-quality embryo, and blastocyst formation rates were not significantly different between groups. However, implantation (11·6% vs 28·7%, P = 0·001, respectively), clinical pregnancy (23·5% vs 53·1%, P = 0·002, respectively), and ongoing pregnancy rates (21·6% vs 46·9%. P = 0·006, respectively) were significantly decreased in the IR group. The negative effect of IR on pregnancy outcomes remained after controlling for age, body mass index (BMI) and lipid profiles (OR 4·928, 95% CI 1·735-13·991, P = 0·003).
  
  
  CONCLUSIONS
  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.
authors.affiliation: CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul, 135-081, Republic of Korea.
authors.forename: Eun M
authors.initials: EM
authors.lastname: Chang
authors.forename: Ji E
authors.initials: JE
authors.lastname: Han
authors.forename: Hyun H
authors.initials: HH
authors.lastname: Seok
authors.forename: Dong R
authors.initials: DR
authors.lastname: Lee
authors.forename: Tae K
authors.initials: TK
authors.lastname: Yoon
authors.forename: Woo S
authors.initials: WS
authors.lastname: Lee
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D010064:Embryo Implantation / Q000502:physiology*; D004624:Embryo Transfer / Q000379:methods; D047108:Embryonic Development / Q000502:physiology*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006706:Homeostasis; D006801:Humans; D059471:In Vitro Oocyte Maturation Techniques / Q000379:methods; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D016015:Logistic Models; D015999:Multivariate Analysis; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000503:physiopathology*; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted
chemical_list: D001786:Blood Glucose; D007328:Insulin