The effect of BMI and lipid metabolism on pregnancy outcome of PCOS patients undergoing IVF/ICSI using GnRH antagonist protocol

Abstract

To explore the effect of body mass index (BMI) and lipid metabolism on ovarian response, embryo quality and pregnancy outcome of polycystic ovary syndrome (PCOS) patients, who undergoing their first oocyte retrieving cycle using GnRH antagonist protocol and following fresh/frozen-thawed embryo transfer cycles. Retrospective, single-center clinical cohort. From January 2013 to June 2016, 762 infertile PCOS patients, younger than 40 years old, undergoing their first IVF/ICSI oocyte retrieving cycle using GnRH antagonist protocol were recruited to the research. Among these PCOS patients, 244 patients undergoing their fresh embryo transfer cycles. Those patients didn’t get pregnancy in fresh embryo transfer cycles, or who used a freeze-all strategy after oocyte retrieve undergoing 758 frozen-thawed embryo transfer cycles. The values of BMI, total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low-density lipoprotein (LDL) was collected to analyze their effects on ovarian response and embryo quality. Binary Logistic regression analysis was using to investigate the influence of BMI and lipid metabolism on clinical pregnancy outcome. 1.There was a positive correlation between BMI and TG/LDL,and negative correlation between BMI and HDL(P <0.05). 2. BMI and LDL negatively correlated with the index of ovarian response and embryo quality, while HDL positively correlated with the ovarian response and embryo quality (P <0.05). For those PCOS patients with BMI less than 28, the BMI showed no correlation with the clinical pregnancy rate. 3. In fresh embryo transfer cycles, Binary Logistic regression analysis showed that for each additional unit of HDL, the chance of clinical pregnancy rate increased by 3.86 times (P=0.011,OR=3.856), which means HDL was the protective factor in clinical pregnancy outcome. Even in frozen-thawed embryo transfer cycles, LDL/TC still were the risk factors in clinical pregnancy outcome, for each additional unit of LDL/TC, the chance of clinical infertility increased by 1.33 times/1.59 times(P=0.040,OR=0.753;P=0.015,OR=0.628). Excessive BMI and abnormal lipid metabolism adversely affected PCOS patient’s ovarian response, embryo quality and clinical pregnancy outcome in GnRH antagonist protocol. For improve the clinical pregnancy results of PCOS patients, pretreatment before IVF / ICSI will not only include weight losing, but also need attach great importance to the lipid metabolism screen and management. In particular, re-evaluation and treatment of abnormal BMI and lipid metabolism before frozen-thawed embryo transfer could improve the cumulative pregnancy rate.