HOMA-IR for predicting clinical pregnancy rate during IVF

Abstract

Objective

To determine the cutoff values of HOMA-IR for predicting clinical pregnancy rate in normal weight patients during their first IVF.

Materials and methods

The data was retrospectively analyzed from 329 normal-weight women aged 21–40 years with BMI <25 kg/m² who received first IVF-ET during the period from December 2018 to June 2019.We assessed the associations between HOMA-IR and clinical pregnancy rates during IVF in the women with or without PCOS according to different BMI ranges.

Results

In non PCOS,clinical pregnancy rate was significantly decreased at the HOMA-IR values ranging from 2.2 to 3.15 (OR, 0.188, 95% CI, 0.084-0.42; p < .05) and at those >3.15 (OR, 0.018, 95% CI, 0.004–0.081; p < .05).In PCOS, clinical pregnancy rate significantly decreased at the HOMA-IR >3.15 (OR, 0.15, 95% CI, 0.044–0.507; p < .05). In non PCOS with BMI <21.45 kg/m², clinical pregnancy rate was decreased with HOMA-IR >2.2, and a significant cutoff point at HOMA-IR >3.15; with 21.45 ≤ BMI <25 kg/m², clinical pregnancy rate was declined significantly at the HOMA-IR >1.56 (OR, 0.196, 95% CI, 0.055–0.704).In PCOS with BMI <21.45 kg/m², clinical pregnancy rate was decreased as the HOMA-IR increased, but there was no significant cutoff point; with 21.45 ≤ BMI < 25 kg/m², clinical pregnancy rate was declined significantly at the HOMA-IR > 3.15 (OR, 0.186; 95% CI, 0.04–0.872).

Conclusion

HOMA-IR and BMI had adverse effects on the IVF outcome of infertility women. Moreover, obesity can increase the degree of insulin resistance in infertility women. These findings suggested that only better HOMA-IR and BMI will lead to better IVF results.

HOMA-IR用于预测 IVF 期间的临床妊娠率 摘要

目的：确定HOMA-IR的临界值, 用于预测正常体重患者在第一次试管婴儿期间的临床妊娠率。

材料和方法：回顾性分析了2018年12月至2019年6月期间接受首次IVF-ET的329名年龄在21-40岁, BMI < 25 kg/m2的正常体重女性的数据。

结果：非PCOS患者HOMA-IR值在 2.2 到 3.15（OR, 0.188, 95% CI, 0.084-0.42; p<.05）和那些HOMA-IR值>3.15 （OR, 0.018, 95% CI,0.004–0.081;p<.05）临床妊娠率显著下降。在PCOS患者中, 在HOMA-IR > 3.15时, 临床妊娠率显著降低（OR, 0.15, 95% 置信区间, 0.044–0.507;p<.05）。在BMI < 21.45 kg/m2的非PCOS临床妊娠率, 在HOMA-IR > 2.2时降低, HOMA-IR > 3.15时是 明显的临床分界点;在21.45 < BMI < 25 kg/m²时, 临床妊娠率在HOMA-IR > 1.56（OR, 0.196, 95%CI, 0.055–0.704)时显著降低。BMI < 21.45 kg/m2的PCOS中, 随着HOMA-IR的升高, 临床妊娠率降低, 但没有显著的截点。21.45 < BMI < 25 kg/m², 临床妊娠率在HOMA-IR > 3.15（OR, 0.186;95% CI, 0.04–0.872）时显著下降。

结论：HOMA-IR和BMI对不孕女性的IVF结局有不良影响。此外肥胖会增加不孕女性的胰岛素抵抗程度。这些发现表明只有更好的HOMA-IR和BMI才能带来更好的IVF结局。

Keywords:

• Homeostasis model assessment-insulin resistance
• insulin resistance
• in vitro fertilization
• clinical pregancy rate

Acknowledgements

The authors thank all the participants in the study.

Ethics approval and consent to participate

Ethics were approved by The Institutional Review Board at the Center for Reproductive Medicine of Shandong University (2018 No.59). Written informed consent was informed to the participants in the study.

Author contributions

YS designed the main study. HS and ZY contributed to data collection. HS and PL performed the statistical analysis and interpreted the results. HS wrote the manuscript, YW and YS contributed to the critical revision of the article. All authors reviewed and approved the final version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The complete data are available from the corresponding author upon reasonable request. The data are not applicable due to the privacy of research participants.

Strengths and limitations

Our results demonstrate that HOMA-IR and BMI produce adverse effects on the IVF outcome of normal-weight women with infertility regardless of their PCOS status. There are also limitations in this research,including a retrospective study,a small sample size and insufficent follow-ups.First, the retrospective approach could have led to many unknown factors influencing the pregnancy outcomes. Next, we plan to conduct more research in a large multicenter with randomized clinical trials with a sufficient number of participants and long-term follow-ups. This will help us analyze the cutoff value of HOMA-IR to predict pregnancy outcomes among women of normal weight with or without PCOS in their first IVF. We will acquire more interesting results.

Additional information

Funding

The National Key R&D Program of China [2018YFC1003202, 2017YFC1001004] and the Taishan scholar project special funds [No. ts201712103] supported YS for this study.