The Association Between The Gene LRP-5 (rs3736228 Locus) Polymorphism And PCOS Pancreatic β-cell Function Comparison Of Intramuscular Versus Vaginal Natural Progesterone For Luteal Phase Support After IVF

Chapter one:Objective: To Analysis of metabolism characteristics about 170 PCOS patients and assess the potential role of C/T (rs3736228) polymorphism of the low-density lipoprotein receptor-related protein-5 gene in insulin secretion .Methods: Clinical metabolism data of 170 patients who suffered from PCOS were collected , including oral glucose tolerance test (OGTT), insulin release test (IRT) , fasting blood lipids. Calculated the insulin resistance index HOMA-IR=FPG×FINS/22.5 and insulin secretion index HOMA-IS =20×FINS/ (FPG-3.5) by HOMA model. Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) was used to amplify the SNP of the gene LRP-5 at rs3736228(C/T) locus for all 170 PCOS patients and the control group(135 healthy subjects).Results: 1. The incidence rate of Impaired Glucose Tolerance is 14.24%. When HOMA-IR>1.78, the incidence of insulin resistance associated with the IRT completely, about 53.85%. 77.74% of the PCOS patients with HOMA-IS less than 200. CC homozygotes (n=102) had statistically significantly higher HOMA-IS, BMI, WHR, TG than CC+TT (n=68, P=0.045, P=0.015, P=0.041, P=0.038). Regarding insulin sensitivity, no differences between T-allele carriers and CC homozygotes were observed in HOMA-IR. Glucose, insulin levels during OGTTs and TG,HDL,LDL,apoBwere not influenced by the carriership of the C/T allele.Conclusion: 1. PCOS with the majority of child-bearing age is still in theβ-cell secretory function in decompensated 2.C/T (rs3736228) polymorphism in the LRP-5 gene might be associated withβ-cell function of insulin secretion and lipid metabolism but does not influence insulin sensitivity, and the T allele may be genetic markers for susceptibility to type 2 diabetes.Chapter two:Objective: To evaluate vaginal compared to intramuscular (IM) progesterone supplementation for luteal phase support after in vitro fertilization and embryo transfer (IVF-ET).Methods: A total of 334 ART patients were randomized to two groups: Endometrin 600 mg daily (n =166) and 80 mg every day IM progesterone in oil (n=167). Serum progesterone levels on the day+7 after ET, Clinical pregnancy and ongoing pregnancy were compared between the two groups.Results: Serum progesterone levels on the day+7 after ET was significantly lower in vaginal progesterone compared to intramuscular (29.29±69.69; 71.61±63.03 P=0.000) ; There were no differences in outcomes between the vaginal and IM progesterone treatment groups. There were 95 pregnancies (57.23%) among patients treated with vaginal progesterone and 96 pregnancies (57.48%) among matched IM progesterone patients. The ongoing pregnancy rates were 52.41% in the vaginal versus 51.50% in the IM progesterone groups. There were no statistically significant differences in pregnancy, ongoing pregnancy rates and birth rate of fetus between groups.Conclusion : Regardless of apparent differences of serum progesterone levels on the day+7 after ET ,there were no significant differences in treatment outcomes between vaginal and IM progesterone supplementation, yielding similar clinical, ongoing pregnancy and birth rates.