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  1. DrPotter
  2. Infertility Discussion
  3. Sunday, 03 March 2013
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I get many questions about insulin resistance and how it affects IVF success.

Here is some info:

It is very complicated but here it goes. Patients with insulin resistance need to make excessive amounts of insulin to keep their blood sugar in the normal range. The excess insulin (hyperinsulinemia in medical talk) has many adverse effects on the person that has it. Among these effects is a disruption of the hypothalamus-pituitary-ovary axis. The hypothalamus is an area of your brain that controls your anterior pituitary gland secretions including the secretion of the pituitary hormones FSH and LH. FSH causes follicles to grow in the first part of the menstrual cycle and LH promotes progesterone secretion in the second half of the menstrual cycle. FSH and LH share a common hypothalamic releasing hormone called GnRH. GnRH causes the pituitary to primarily release FSH with slower pulse frequencies and LH with higher pulse frequencies. As insulin levels rise with insulin resistance, they cause the pulse generator to get stuck in the rapid position, causing excess and inappropriate release of LH early in the menstrual cycle. The result is retarded follicular development and excess androgen secretion among other things. This can cause hyper-response or hypo-response to fertility medications and poor egg quality. Correcting or lowering the insulin levels with an insulin-sensitizer like Metformin can result in a more normal response to fertility drugs and better egg quality. Candidates to be tested for insulin resistance include those with hyper- or hypo-response, poor egg quality, irregular periods or a family history of type 2 diabetes in the parents. I test for insulin resistance with a 2 hour glucose tolerance test with insulin levels at each draw. Insulin resistance is indicated when the glucose to insulin ratio is
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