夫妻双方胰岛素抵抗对体外受精-胚胎移植治疗结局的影响  

Effect of insulin resistance in couples on IVF-ET treatment outcomes

作　　者：雷若冰 李维宏[1] LEI Ruobing;LI Weihong(Reproductive Medical Center,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院生殖医学中心,重庆400016

出　　处：《陆军军医大学学报》2024年第6期623-629,共7页Journal of Army Medical University

基　　金：国家自然科学基金(81501335);重庆市自然科学基金(CSTB2022NSCQ-MSX0086)。

摘　　要：目的 探讨原发不孕夫妻双方胰岛素抵抗对新鲜周期胚胎移植妊娠结局的影响。方法 纳入2022年10月-2023年10月在重庆医科大学附属第一医院生殖医学中心首次行体外受精-胚胎移植/卵泡浆内单精子显微注射(in vitro fertilization and embryo transfer/intracytoplasmic sperm injection, IVF-ET/ICSI)助孕并进行新鲜周期胚胎移植的原发不孕夫妻101例。根据患者夫妇单方是否合并胰岛素抵抗(insulin resistance, IR),分别分为两组:女方IR组(49例),女方无IR组(52例)。男方IR组(49例),男方无IR组(52例)。比较女方IR组和非IR组,男方IR组和非IR,各组间基础资料、促排卵情况、胚胎移植情况和妊娠结局的差异,Logistic回归分析胰岛素抵抗对妊娠结局及促排卵实验室指标的影响。结果 (1)IR女性组的体质量、BMI与非IR女性组比较均显著升高(P<0.05),AFC与非IR女性组比较显著减少(P<0.05)。(2)女性空腹血糖与获卵数、MII卵数、可移植胚胎数、优质胚胎数均呈负相关(P<0.05);女性空腹胰岛素与GN天数及总量呈正相关(P<0.05);女性HOMA-IR与GN天数及总量呈正相关(P<0.05)。(3)IR女性组胚胎种植率、临床妊娠率与非IR女性组相比均显著降低(P<0.05)。(4)男性IR组的BMI与男性非IR组比较显著升高(P<0.05)。(5)三组夫妻(双方IR组、一方IR组、双方均无IR组)的胚胎种植率、临床妊娠率有降低趋势,但无统计学差异。(6)女性空腹血糖显著负向影响获卵数、MII卵数、可移植胚胎数、优质胚胎数。结论 胰岛素抵抗影响原发不孕女性IVF/ICSI周期的胚胎质量;原发不孕夫妻双方胰岛素抵抗可能对IVF/ICSI周期的胚胎种植率和临床妊娠率有负面影响。Objective To investigate the effect of insulin resistance(IR)in primary infertile couples on pregnancy outcomes in fresh cycle embryo transfer.Methods A total of 101 primary infertile couples who underwent first IVF-ET/ICSI assisted conception with fresh cycle embryo transfer in our reproductive medical center from October 2022 to October 2023 were retrospectively included.According to whether they had combined IR unilaterally,these couples were divided into female IR group(n=49)and female non-IR group(n=52),and male IR group(n=49)and male non-IR group(n=52).The basic data,ovulation promotion,embryo transfer and pregnancy outcome were compared between the female IR group and non-IR group,and between the male IR group and non-IR group.Logistic regression analysis was applied to determine the effect of IR on pregnancy outcome and laboratory indicators of ovulation promotion.Results①The IR female group had significantly higher body weight and BMI,and lower antral follicle count(AFC)when compared with the non-IR female group(P<0.05).②Female fasting blood glucose was negatively correlated with the number of acquired eggs,number of metaphase II(MII)oocytes,number of transferable embryos,and number of high-quality embryos(P<0.05);and both female fasting insulin level and female HOMA-IR were positively correlated with the days and total amount of gonadotropin(GN)(P<0.05).③Embryo implantation and clinical pregnancy rates were significantly lower in the female IR group than the female non-IR group(P<0.05).④The male IR group had significantly higher BMI than the male non-IR group(P<0.05).⑤Embryo implantation rate and clinical pregnancy rate were in declining trend in all following 3 groups of couples(both IR groups,single IR group,and neither IR group).⑥Female fasting blood glucose level showed a negative effect on number of acquired eggs,number of MII oocytes,number of transferable embryos,and number of high-quality embryos.Conclusion IR affects embryo quality in IVF/ICSI cycles in women with primary infertilit

关 键 词：胰岛素抵抗 不孕症 体外受精-胚胎移植 妊娠结局 

分 类 号：R181.32[医药卫生—流行病学] R587.1[医药卫生—公共卫生与预防医学] R711.6