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Independent and joint effects of β-cell dysfunction and insulin resistance on reproductive outcomes of IVF cycles in infertile PCOS patients
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  • Chang Liu,
  • Lin Ding,
  • Yan Li,
  • Peiyu Wang,
  • Jia Lin,
  • Haiyan Yang,
  • liangshan mu
Chang Liu
The First Affiliated Hospital of Wenzhou Medical University
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Lin Ding
Shandong Qianfoshan Hospital
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Yan Li
The First Affiliated Hospital of Wenzhou Medical University
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Peiyu Wang
The First Affiliated Hospital of Wenzhou Medical University
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Jia Lin
The First Affiliated Hospital of Wenzhou Medical University
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Haiyan Yang
The First Affiliated Hospital of Wenzhou Medical University
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liangshan mu

Corresponding Author:[email protected]

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Abstract

Objective To investigate the independent and joint effects of insulin resistance and β-cell dysfunction on reproductive outcomes in women with polycystic ovary syndrome (PCOS) undergoing in-vitro fertilization (IVF). Design A single-centre, retrospective cohort study. Population Infertile women with PCOS undergoing their first IVF cycle between September 2010 and December 2019. Methods Insulin resistance and β-cell dysfunction were measured by homeostasis model assessment of insulin resistance (HOMA-IR) and the HOMA of β-cell function (HOMA-β) index, respectively. Data of reproductive outcomes were analyzed according to the quartile groups of HOMA-IR and HOMA-β. Main outcome measures Main outcome measure was miscarriage rate. Results In quartiles of HOMA-IR, the incidence of miscarriage dramatically increased from 7.4% (Q1) to 32.6% (Q4) (P for trend <0.001). Likewise, the incidence of miscarriage in quartiles of HOMA-β also showed the similar trend (P for trend < 0.001). In terms of the live birth rate in quartiles of HOMA-IR and HOMA-β, there exhibited a significantly decreasing trend in both unadjusted model and adjusted models. Women with the highest HOMA-IR and the highest HOMA-β group exhibited the highest risk for miscarriage (RR=5.16, 95%CI 3.26-8.17) compared with all other groups. Furthermore, higher HOMA-IR value was associated with higher risk of miscarriage among participants regardless the levels of HOMA-β values. Conclusions Both β-cell dysfunction and insulin resistance are independently and synergistically associated with increased risk of miscarriage in women with PCOS, and the influence of insulin resistance overweighs that of β-cell dysfunction.