ArticleFrontiers in endocrinology2026
Quantity down, quality preserved: a continuous HOMA-IR analysis of IVF/ICSI outcomes in PMOS patients.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To evaluate the dose-response relationship between HOMA-IR as a continuous variable and embryo development outcomes in fresh IVF/ICSI cycles of PMOS patients (formerly PCOS), distinguishing IR effects on oocyte yield (ovarian responsiveness) from effects on embryo developmental efficiency (per-oocyte conversion potential), and to evaluate differential IR impacts on cumulative implantation versus pregnancy maintenance. Design: Single-center retrospective cohort study of all fresh IVF/ICSI cycles from July 2022 to March 2026, comprising 3058 de-duplicated patients (2799 non-PMOS, 259 PMOS; PMOS-nonIR n=115, PMOS-IR n=144, cut-off ≥2.5). Spearman correlation and multivariable linear regression (adjusted for age, BMI, AMH) were used to evaluate the independent associations of HOMA-IR with oocyte maturation, fertilization, and embryo development at each stage. Results: Oocyte maturation rate showed no correlation with HOMA-IR (r=-0.014, Conclusions: In PMOS patients, IR exhibits multi-stage differential effects - impairing oocyte yield while preserving embryo developmental competence. Once oocytes are retrieved, their developmental efficiency is unaffected by IR status. Higher cumulative implantation in PMOS-IR was largely driven by greater transfer opportunity, whereas clinical pregnancy loss showed an upward trend without statistical significance, indicating that IR-related reproductive impairment primarily involves oocyte yield and transfer opportunity, while post-implantation pregnancy maintenance merits further evaluation. This warrants prospective validation. HOMA-IR should be integrated into pre-IVF ovarian response stratification but not used to predict embryo developmental competence.
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