The Effect Of Insulin Resistance And Obesity On IVF Outcome In PCOS Patients

Objective:To explore the relationship between PCOS and insulin and weight,as well as the effect on endocrine and fertility in the process of IVF,and to increase the understanding and management of PCOS insulin resistance and obesity.Methods:This is a retrospective analysis,590 PCOS patients were selected from the first periodic fresh embryo transfer/frozen embryo transfer(IVF-ET/FET)of the Yantai Yuhuangding Hospital reproductive medical center in 2015-2017.The patients were divided into PCOS-IR,PCOS-non IR group and PCOS normal,overweight and obese group according to HOMA and BMI respectively.Weight,luteinizing hormone(LH),follicle stimulating hormone(FSH),estradiol(E2),prolactin(PRL),testosterone(T)and anti Mueller hormone(AMH),fasting glucose(FPG),fasting insulin(FINS),triglyceride(TG),cholesterol(CHOL),low density lipoprotein(LDL),and high-density lipoprotein(HDL)were measured and the dosage of gonadotropin,the days of gonadotropin,number of dominant follicles on HCG day,number of retrieved oocytes,number of IVFMII embryos,number of 2PN embryos and the number of excellent embryos during the IVF treatment were recorded.Result:normal control group,respectively,compared with PCOS-NIR and PCOS-IR,there were significant differences in AMH,b-LH,b-FSH,b-T,CHOL,LDL,TG,Gn,number of dominant follicles on HCG day,number of IVFMII embryos,number of 2PN embryos and the number of excellent embryos(P<0.05).There were statistical differences in BMI,AMH,b-LH,b-FSH,HDL,TG and clinical pregnancy rate between PCOS-IR and PCOS-NIR(P<0.05).PCOS normal weight,PCOS overweight,and PCOS obese group were compared with the normal control group.The AMH,b-LH,b-FSH,b-T,CHOL,LDL,TG,Gn,number of dominant follicles on HCG day,number of retrieved oocytes,number of IVF MII embryos,number of 2PN embryos and the number of excellent embryos and the clinical pregnancy rate were statistically different(P<0.05).Compared PCOS overweight,PCOS obese group with normal weight,respectively,HOMA-IR,b-LH,HDL,TG,implantation rate and clinical pregnancy rate were statistically different(P<0.05).Conclusion:1.PCOS-IR group,PCOS overweight group and PCOS obesity group are often accompanied by more serious endocrine abnormalities and lipid metabolism disorders,such as increased serum LH and T,slightly decreased FSH,and significantly increased CHOL,LDL and TG.2.Compared with the normal control group,the number of large follicles per day,the number of eggs retrieved and MIl,the number of 2PN eggs and the number of eugenic embryos in PCOS patients increased significantly,but there was no significant difference among the subgroups of PCOS patients.3.Obesity can aggravate insulin resistance in PCOS patients.4.The implantation rate and clinical pregnancy rate of IVF-assisted pregnant women in PCOS-IR group,PCOS overweight group and PCOS obesity group decreased significantly.