insulin resistance

[ruby]

Hi Dr Potter,

How does insulin resistance effect an IVF cycle ? How and when should you be tested for it ?

Thankyou.

[Mykids]

I am not Dr p. But i am cycling with Dr P & i was diagonised with Insulin Resistance after my first failed cycle. I think it will effect your egg quality.So Dr P put me on Metformin, i am on that from past 6 weeks, first week 500 mg per day, 2nd week 1000 mg per day from & after 3rd week 1500 mg per day.

Metformin is given to help your egg quality.

I hope to see some more information from Dr P

[Dr. Potter]

Hi Dr Potter,

How does insulin resistance effect an IVF cycle ? How and when should you be tested for it ?

Thankyou.

Hi Ruby. 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 <4.5 at any point but typical insulin resistant patients will have ratios much lower that this. I hope that this helps.
Dr. P

[ruby]

Thankyou very much for a detailed answer. It does help. I was concerned that I may need to be tested for insulin resistance, but I don't fit the criteria you have mentioned.

Thanks again Dr Potter.

[Dr. Potter]

Thankyou very much for a detailed answer. It does help. I was concerned that I may need to be tested for insulin resistance, but I don't fit the criteria you have mentioned.

Thanks again Dr Potter.

we are always happy to order the test. It is simple and inexpensive.