Prevalence of hyperinsulinaemia among normozoospermic donors at Medfem Clinic, South Africa

Effects of fasting hyperglycemia in men on pregnancy outcomes of singleton pregnant women with cryo-thawed embryo transfer

BACKGROUND

The relationship of metabolic issues to pregnancy outcomes during assisted reproductive technology (ART) is gaining much attention. Fasting Plasma Glucose (FPG) is one of the most common metabolic indicators. Abnormal FPG not only affects the quality of life of human body, but also has a bearing on reproductive health. However, most attentions are paid on women's physical health and reproductive assessment, the health status of the male partner on pregnancy outcomes during ART treatment is often neglected. This study investigated whether male fasting hyperglycemia (FH, FPG > 6.1 mmol/L) can affect live birth rates (LBR) in singleton intrauterine clinical pregnancy women with cryo-thawed embryo transfer (CET) cycles.

MATERIAL AND METHODS

A retrospective cohort study (370 CET cycles with first singleton clinical intrauterine pregnancy and grouped by male FPG) was conducted to analyze the relationship between male FH and clinical pregnancy outcomes using binary logistic regression; the odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as a measure of relevancy. Live birth rate was the main outcome measure.

RESULTS

The live birth rate (LBR) was significantly lower [58.6% vs. 81.8%, P = 0.007, adjusted OR 0.635, 95% CI 0.456-0.884] and miscarriage rate (MR) was significantly higher [41.4% vs. 18.2%, P = 0.007, adjusted OR 1.575, 95% CI 1.131-2.195] in the FH group when compared with the Con group. There was no difference in healthy baby rate [88.2% vs. 89.6%, P = 0.058, adjusted OR 2.143, 95% CI 0.974-4.716] or abnormal birth weight rate (23.5% vs. 11.8%, P = 0.238, adjusted OR 2.859, 95% CI 0.777-10.460] between the FH and control group. No birth defects were observed in the present study.

CONCLUSION

Male FH is an independent risk factor for lower LBR and higher MR in singleton intrauterine pregnancy women with CET cycles.

Effect of metformin therapy and dietary supplements on semen parameters in hyperinsulinaemic males

Previous reports indicated that hyperinsulinaemic men may exhibit a higher percentage of poorly compacted DNA in their spermatozoa and less success in an IVF programme (Andrologia, 45, 2003, 18; Andrologia, 2014, doi: 10.1111/and.12227). The aim of this study was to investigate the effect of metformin (Glucophage®) and antioxidant treatment (StaminoGro®) on the semen parameters of hyperinsulinaemic men. Nineteen hyperinsulinaemic male patients were treated for 3 months with metformin alone (Group A), and fifteen patients used metformin in combination with the nutritional supplement (Group B). Combined data of the two groups (pre- and post-treatment) differ significantly regarding sperm morphology (P = 0.0003) and CMA3 (P < 0.0001) values. The improvement in sperm morphology after treatment was similar for the two respective groups (P < 0.05). The morphological normal sperm forms increased from the mean percentage of 3.9 to 5.5% and from 4.2 to 5.5% for Group A and B respectively. Where a combination of metformin and the supplement were used (Group B), the combination treatment proved to be superior in obtaining enhanced chromatin packaging quality although not statistically significant (P = 0.5929) when compared with the metformin (Group A) group. The chromatin packaging quality in Group B improved with 10% while the improvement in Group A was approximately 8.3%. Therefore, infertile hyperinsulinaemic men can benefit from metformin treatment and should be advised on the use of nutritional supplements with antioxidant properties.

Influence of male hyperinsulinaemia on IVF outcome

The IVF outcome of a group of hyperinsulinaemic men (group B) was compared with a group of IVF males with normal insulin levels (group A). The participating females in the study groups were younger than 38 years old, had blocked Fallopian tubes and/or endometriosis, had normal insulin levels and produced five or more ova on stimulation. The male participants in both groups were normozoospermic with motility above 50% and sperm morphology between 5 and 13% normal forms (G-pattern according to Tygerberg strict criteria). The two groups did not differ statistically in terms of age or semen parameters (P = 0.39; P < 0.05).The group of men that presented with normal insulin levels had a higher fertilisation rate (79.15% versus 74.57%) and superior embryo quality on day 3 (55.77% versus 50.39%) than the group that presented with hyperinsulinaemia, but these differences were not statistically significant (P = 0.28, P = 0.40; P < 0.05). The clinical pregnancy rate of the group with normal insulin was significantly higher than that of the hyperinsulinaemic group, 57.9% versus 31.8% respectively (P = 0.03). The results suggest that hyperinsulinaemia had a negative impact on IVF outcome and patients should be advised accordingly.