Evaluation of Serum TNF-α in Insulin Resistant Non PCOS Pa - tients Undergoing ICSI: A Randomized Clinical Trial


Background:With the rapid evolution of assisted reproductive technologies,more and more studies are concerned about the possible influential factors onthe success rates of these procedures, with the efforts are now mainly directedtoward defining these factors in a trial to increase these rates. Of these factors,inflammation is considered among the most remarkable and is in the focus ofthe updated studies. However, most of these studies are evaluating the role ofinflammation in patients with polycystic ovarian syndrome(PCOS) , while theimpact of this inflammation in insulin resistant non PCOS patients is underestimatedand not well evaluated .Objectives:This study is a trial to elucidate the importance of one of the inflammatorymediators , Tumor Necrosis Factor-alpha (TNF – α) , in insulin resistantpatients undergoing IVF ( ICSI ) cycles .Patients and Methods:A group of 27non-PCOS infertile patients were selectedfor this clinical randomized prospective study from patients attending thehigh institute for infertility diagnosis and assisted reproductive technologies /Al-Nahrain University and subjected to intra-cytoplasmic sperm injection (ICSI)procedure. BMI was measured for all patients and they were classified accordingto WHO classification into 3 groups : Acceptable , overweight and obese . Fastingplasma level of glucose and insulin was investigated and insulin resistanceindex (HOMA) was calculated. Serum TNF-α has been measured using ELISAand the relation with insulin resistance was investigated. Finally, the pregnancyrate, as a primary reproductive endpoint was compared according to TNF -a andinsulin resistance levels between different study subjects.Results: Of the 27 infertile patients , 17(63 %) were non obese and 10 (37%)were obese , 15(55.5%) were having HOMA index < 1.6 and 12 (44.5 %) werehaving HOMA index ≥ 1.6 . BMI was found to be positively correlated with higherHOMA index ( P = 0.01 and R= 0.4 in spearman correlation). Investigating therelation between TNF-α with BMI revealed that TNF-α levels are increasing withthe increment in BMI, However , the difference in the mean TNF-α between thethree BMI groups failed to achieve statistical significance (P=0.1). In contrastto that, when stratifying for HOMA index , TNF-α was significantly correlatedwith it ( spearman correlation R= 0.4 , P=0.01 ) , and patients with HOMA index≥1.6 were found to have higher levels of TNF-α (The effect of insulin resistance was also implicated on pregnancy rates , as those with highinsulin resistance were shown to have significantly lower pregnancy rates when compared tothose with low indices of resistance (P = 0.03) . However, the impact TNF-α on pregnancyrates was apparently less significant (P= 0.5).Conclusion: Rate of asymptomatic bacterial vaginosis was 32.6 % in pregnant women comparedto 73.3% in non- pregnant group, being highly significant higher in those women whofailed to get pregnant.