Impact of insulin resistance on in vitro fertilization outcomes in overweight and obese women: a retrospective cohort study.

IF 1.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Human Fertility Pub Date : 2025-12-01 Epub Date: 2025-07-20 DOI:10.1080/14647273.2025.2526768

Xi Bai, RuiQi Chang, Mengjiao Qing, Beilei Jiang, Chanyu Zhang

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引用次数: 0

Abstract

This retrospective cohort study evaluated 1,193 women undergoing first fresh IVF cycles to assess the effects of insulin resistance (IR) and overweight/obesity on outcomes. Participants were stratified by BMI and IR status. Overweight/obese women without IR exhibited comparable IVF outcomes to normal-weight controls. Untreated IR, however, significantly impaired outcomes, including fewer oocytes retrieved, 2PN zygotes, available embryos, and good-quality embryos all p ≤ 0.002), alongside lower fresh cycle live birth rates (34.4% vs. 53.3%, p = 0.038), implantation rates (32.1% vs. 47.8%, p = 0.023), cumulative pregnancy rates (45.8% vs. 68.4%, p = 0.001), and cumulative live birth rates (41.7% vs. 58.4%, p = 0.006). Notably, IR correction improved 2PN zygote formation (p = 0.026), numbers of available embryos (p = 0.021), fresh cycle live birth rates (57.6% vs. 34.4%, p = 0.034), cumulative pregnancy rates (63.2% vs. 45.8%, p = 0.018), and cumulative live birth rates (56.8% vs. 41.7%, p = 0.041). Multivariate analysis confirmed homeostasis model assessment of insulin resistance (HOMA-IR) as an independent negative predictor of live birth (OR = 0.49, 95% CI 0.30-0.82, p = 0.006). The findings challenge BMI-centric risk stratification in ART, emphasizing IR's role in compromising embryo quality and clinical outcomes. Preemptive IR screening and treatment in overweight/obese women are crucial.

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胰岛素抵抗对超重和肥胖妇女体外受精结果的影响：一项回顾性队列研究。

这项回顾性队列研究评估了1193名接受第一次新鲜试管婴儿周期的妇女，以评估胰岛素抵抗（IR）和超重/肥胖对结果的影响。根据BMI和IR状态对参与者进行分层。没有IR的超重/肥胖妇女的体外受精结果与体重正常的对照组相当。然而，未经IR治疗的结果明显受损，包括较少的卵母细胞，2PN合子，可用胚胎和优质胚胎（p≤0.002），以及较低的新鲜周期活产率（34.4%对53.3%,p = 0.038），着床率（32.1%对47.8%,p = 0.023），累积妊娠率（45.8%对68.4%,p = 0.001）和累积活产率（41.7%对58.4%,p = 0.006）。值得注意的是，IR校正改善了2PN合子形成（p = 0.026）、可用胚胎数量（p = 0.021）、新鲜周期活产率（57.6% vs. 34.4%, p = 0.034）、累积妊娠率（63.2% vs. 45.8%, p = 0.018）和累积活产率（56.8% vs. 41.7%, p = 0.041）。多因素分析证实胰岛素抵抗稳态模型评估（HOMA-IR）是活产的独立阴性预测因子（OR = 0.49, 95% CI 0.30-0.82, p = 0.006）。研究结果挑战了ART中以bmi为中心的风险分层，强调了IR在损害胚胎质量和临床结果中的作用。对超重/肥胖妇女进行预防性IR筛查和治疗至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Human Fertility OBSTETRICS & GYNECOLOGY-REPRODUCTIVE BIOLOGY

CiteScore

3.30

自引率

5.30%

发文量

期刊介绍： Human Fertility is a leading international, multidisciplinary journal dedicated to furthering research and promoting good practice in the areas of human fertility and infertility. Topics included span the range from molecular medicine to healthcare delivery, and contributions are welcomed from professionals and academics from the spectrum of disciplines concerned with human fertility. It is published on behalf of the British Fertility Society. The journal also provides a forum for the publication of peer-reviewed articles arising out of the activities of the Association of Biomedical Andrologists, the Association of Clinical Embryologists, the Association of Irish Clinical Embryologists, the British Andrology Society, the British Infertility Counselling Association, the Irish Fertility Society and the Royal College of Nursing Fertility Nurses Group. All submissions are welcome. Articles considered include original papers, reviews, policy statements, commentaries, debates, correspondence, and reports of sessions at meetings. The journal also publishes refereed abstracts from the meetings of the constituent organizations.