Abstract
Background: To explore the role of insulin resistance (IR) in patients with recurrent pregnancy loss (RPL) and/or recurrent implantation failure (RIF) treated with assisted reproductive technology (ART).Methods: We conducted a case-control study in a tertiary hospital from 2012 to 2018, We included 212 cases of simple RPL (only involved in RPL), 123 cases of simple RIF (only involved in RIF), 67 cases involved in both conditions (complicated group). We screened 123 women as the control cohort, who underwent ART due to male infertile, with no adverse pregnant outcomes. We examined the plasm glucose and insulin level in both fasting and postprandial condition after the oral glucose tolerance test (OGTT) and calculated the area under the curve of glucose (AUGG) and insulin (AUCI) as well as the homeostasis model assessment for insulin resistance and β-cell function (HOMA-IR and HOMA-β).Results: Both the simple RPL group and the complicated group had significantly higher fasting insulin (FINS), HOMA-IR and HOMA-β than the control group. The simple RIF group had the lowest level of FINS, HOMA-IR and HOMA-β. The incidences of IR were significantly higher in both the simple RPL group and the complicated group than the other two groups. After adjusted for age and waist-hip ratio (WHR), the simple RIF group had the highest fasting plasma glucose (FPG) [adjusted-mean (95%CI), 5.20 (5.09-5.33) mmol/L] and lower FINS [adjusted-mean (95%CI), 10.77 (9.25-12.29) mU/L] and HOMA-β [adjusted-mean (95%CI), 127.76 (83.56-171.97)]; the simple RPL group had the highest FINS [adjusted-mean (95%CI), 12.09 (11.21-12.98) mU/L] and HOMA-β [adjusted-mean (95%CI), 189.74 (164.29-215.18)] and a lower FPG [adjusted-mean (95%CI), 5.03 (4.97-5.10) mmol/L]. The FINS tended to increase with times of implantation failure among those patients with implantation failure fewer than six times. However, patients with more than six times implantation failure had extremely low FINS when compared with those with a history of five or six times (P<0.05). Conclusion: In patients undergoing ART, insulin resistance may be a common etiopathogenesis of RPL and RIF and insulin secretion impairment may be related to RIF.
Role of <i>P53</i> p.Arg72Pro Variant in Recurrent Pregnancy Loss, Recurrent Implantation Failure and IVF Outcome
