The Effect of Insulin Resistance on Oocyte Maturation and Embryo Quality in PCOS Patients Undergoing ICSI

Download PDF

Background: Poly cystic ovarian syndrome (PCOS) is a common endocrine disorder, and it is one of the important causes of female infertility; the syndrome acquired its widely used name from the common sign on ultrasound examination of multiple (poly) ovarian cysts, and PCOS is multifactorial in origin. It is caused by the combination of genetic and environmental factors. The pathogenesis of PCOS leads to the insulin resistance and hyperinsulinemia, which are commonly observed in these patients, it has been assumed that when an insulin signal transduction changes in PCOS patients, it may result in insulin resistance, which consequently leads to the abnormal ovarian steroidogenesis. Objective: To study the effect of insulin resistance on the oocyte maturation, and the number of good quality embryos in PCOS patients undergoing ICSI. Patients and method: This prospective study was undertaken in the Higher Institute of Infertility diagnosis and Assisted Reproductive Techniques / Al-Nahrain University and in Kamal AL-Samarai Hospital (Baghdad/Iraq) during the period from July 2016 to April 2017. The participants of the study were 58 infertile women, forty of them had Polycystic ovary syndrome (twenty of them had insulin resistance (IR) and the other twenty were non-insulin resistant (NIR)), and eighteen non PCOS women were considered as the control. Controlled ovarian hyperstimulation was conducted on all of them for intracytoplasmic sperm injection cycle. Long agonist protocol was used as the ovulation induction protocol in all the cases. The assessment of oocyte maturation was done for all the cases. Results : The total numbers of oocytes, MII, fertilized MII, and embryos were significantly higher in the PCOS (NIR) group than the PCOS (IR) and the control groups; and the p-values were (0.006, 0.005, 0.001, 0.002); respectively. The duration of stimulation was significantly shorter in PCOS (NIR) group than the other two groups; and the p-value was (0.035). Conclusion: Insulin resistance can be assumed as an indicator of poor oocyte maturation, poor embryo quality, and long duration of stimulation.