Insulin resistance and free androgen index correlate with the outcome of controlled ovarian hyperstimulation in non-PCOS women undergoing IVF

Abstract

The dual effects of insulin and androgen on the ovary act to promote early folliculogenesis. In the context of polycystic ovarian syndrome (PCOS), the presence of hyperinsulinaemia, resulting from increased insulin resistance (IR), and hyperandrogenaemia lead to the appearance of multiple antral follicles and frequently a multi-follicular response to gonadotrophin stimulation for assisted reproductive treatments (ARTs). The effect of IR and androgen status in women without PCOS on the follicular outcome of controlled ovarian hyperstimulation (COH) is not known. We assessed the IR [using the homeostasis model assessment (HOMA)] and androgen status of 49 women without PCOS undergoing an ART cycle. This was then related to the treatment cycle outcome. We found a significant positive correlation between HOMA and BMI, and free androgen index (FAI) and testosterone. The FAI significantly positively correlated with total follicle count after COH. The total follicle count was significantly higher in those with a HOMA >2.5, and HOMA positively correlated with total follicle count in this group of IR women (HOMA > 2.5). Our results suggest a positive correlation of HOMA-IR levels above a threshold level of 2.5 and a continuous positive correlation of free androgen (FAI) to total ovarian follicle count following COH in the non-PCOS patient.