Abstract
Pancreatic Autoimmunity is defined as the presence of autoantibodies and more frequent need for insulin treatment. Affected women presenting recurrent implantation failure (RIF) or recurrent miscarriage (RM) are often misdiagnosed. The objective of thestudy was to describe clinical and metabolic profiles suggestive of Pancreatic Autoimmunity and therapeutic strategy in patients with RIF/RM. We analyzed retrospectively 735 patients, and have identified a subset (N = 20) with similar metabolic characteristics. At the same time, we included a control group (n = 39), with similar demographic characteristics and negative for pancreatic, thyroid or celiac disease autoimmunity. The patients identified with autoimmune metabolic problem (N = 20) had relatives with diabetes mellitus. At 120 minutes after Oral Glucose Tolerance Test (OGTT) low level of insulin secretion (<2 IU/ml) was found in 70% of patients. Glutamic acid decarboxylase 65 (GAD 65) antibodies, with or without other autoantibodies, were positive in80% of patients and anti-IA2 alone were positive I the rest. Since pregestational period, insulin administration was recommended for 10 patients, metformin for 4 patients and exclusively diet control in 5 of them. Significantly increased live bith rates (LBR) per cycle were observed after metabolic control (52%) compared with live birth rate (LBR) after cycles without control (7.5%) (p<0.0001). We noticed 2 cases of pre-eclampsia and 6 low-birth weights. Insulin administration was needed during the pregnancy in 68% of patients and after childbirth in 31.57% of them. In our control group, all of patients (n = 39) underwent ART (53.8% SET and 46.1% DET) with a 50% (SET) and 61.9% (DET) live birth rate (LBR) per cycle. Patients with RIF/RM, normal BMI, low insulin levels after OGTT could benefit from additional metabolic immune testing. A correct diagnosis and treatment could have a positive impact on their reproductive results and live birth rate.
Highlights
In the last decade, mean age of infertile women undergoing assisted reproductive treatment (ART) has increased
The most striking finding of this subgroup of patients is that they had a very low live birth rate (LBR)/cycle (7.5%), before metabolic study, that is well below of LBR/cycle reported in our clinic for a similar age group (31.9% own oocytes cycles; 41.5% donor oocytes cycles)
At 120 minutes after OGTT (Oral Glucose Tolerance Test) low level of insulin secretion was found in 14 patients (70%), high levels (>60 IU/ml) in 4 (20%), and normal (
Summary
Mean age of infertile women undergoing ART has increased. Age is one of the main risk factors for disorders like functional glucose impairment or hypertension. In the clinical work up of the patients, only fasting glucose levels are included among metabolic tests. During ART, the “silent” metabolic disorders and their impact over reproductive outcome has been less studied. Women suffering from recurrent implantation failure (RIF) or recurrent miscarriage (RM) may undergo different tests trying to understand their poor reproductive outcome. Metabolic routine screening for all infertile patients is not recommended, but a tailored approach may be needed for some subsets of patients that could improve their reproductive outcome
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
