The Effect Of Insulin Resistance On The Clinical Outcome Of IVF/ICSI In Patients With Polycystic Ovary Syndrome

Objective: Polycystic ovary syndrome(PCOS),as a common reproductive endocrine disease of department of gynaecology,it is t able to cause the body's endocrine dysfunction and metabolic disorder.The incidence of insulin resistance accounts for 70%-80% of obese PCOS and 20%-25% of thin PCOS,which is a major risk factor for the development of metabolic abnormalities.According to statistics,the prevalence of PCOS in women of childbearing age is estimated to be 5%-18%.Although insulin resistance(IR)is not a necessary diagnostic standard for PCOS,studies have shown that IR is of great significance in the pathophysiological process of PCOS.The purpose of this study is to 1)explore the effectiveness of insulin sensitizer combined with oral contraceptive in improving the reproductive function of patients with polycystic ovary syndrome;2)to study the differences of IVF / ICSI cycle indexes of insulin resistant patients in PCOS and non insulin resistant infertile patients after assisted reproductive therapy.Methods: 1)the influence of insulin abnormality on the reproductive function of PCOS patients was indirectly understood by systematic meta-analysis of published literatures on reproductive regulation of PCOS patients;2)From November 2017 to January 2019,241 infertile women(241 cases)who were treated in reproductive Hospital of the first hospital of Lanzhou University and received IVF / ICSI assisted pregnancy and fresh embryo transfer(ET)or(and)frozen thawed embryo transfer(FET)were analyzed retrospectively.PCOS group(142 cases)and control group(99cases)were divided according to whether they had PCOS or not.By the steady-state assessment of insulin resistance index(HOMA-IR),patients in PCOS group were divided into two subgroups: ir-pcos group with IR(84 cases)and nir-pcos group without IR(58 cases).The general condition and treatment process were recorded,andthe differences in clinical treatment outcomes were statistically analyzed.Results:Meta analysis:1)metformin combined with Diane-35 was superior to Diane-35 alone in promoting ovulation and improving pregnancy rate in PCOS patients;2)metformin combined with Diane-35 could effectively reduce the serum LH,testosterone and fasting insulin levels in patients with polycystic ovary syndrome,and alleviate the endocrine and metabolic disorders in patients with polycystic ovary syndrome.The results of retrospective case-control study were as follows:1)compared with ir-pcos group and nir-pcos group,AMH,b-LH,b-T level and basic antral follicle number(AFC)were significantly reduced in the control group,while compared with ir-pcos group,b-lh,b-e2 were significantly increased,serum T level was lower in the nir-pcos group;2)hCG daily target follicle number,M?egg number,2PN egg number and superior embryo number dropped significantly.The implantation rate and clinical pregnancy rate of ir-pcos group were significantly lower than those of pcos-nir group and control group.Conclusion:1)when metformin and Diane-35 are used together,PCOS patients are more sensitive to ovulation promoting drugs and have a higher probability of pregnancy.The disordered endocrine metabolism and glycolipid metabolism will be improved and more beneficial.2)During IVF/ICSI assisted pregnancy,the implantation rate and clinical pregnancy rate of PCOS patients with insulin resistance decreased significantly.