ABSTRACT:
Background: Despite the recent advances in the management of different leading causes of infertility, assisted reproductive techniques are still one of the most popular treatment options. However, the outcome of these procedures is influenced by many factors. Of these, the impact of age and metabolic parameters is still of great concern. Aim: Is to investigate the effect of age related variation in the body mass index and insulin resistanceon the main outcomes of the intracytplasmic injection procedures. Patients and methods: A group of 36 infertile patients were selected randomly for this prospective study from patients attending the high institute for infertility diagnosis and assisted reproductive technologies/Al-Nahrian University and subjected to intra-cytoplasmic sperm injection (ICSI) procedure. Patients were classified into two groups according to their age (<35 and =35). BMI was measured for all patients and they were classified according to WHO classification. Fasting plasma level of glucose and insulin was investigated and insulin resistance index (HOMA) was calculated. Gonadotrophins dose and duration of stimulation in addition to the total number of oocytes, M2 oocytes and fertilization rates were noticed and compared between the different BMI, insulin resistance and age categories. Finally, the pregnancy rate, as a primary reproductive endpoint was compared according to the above groups of classification between different study subjects. Results: Of the 36 infertile patients, 24(66.7%) were non obese and 12 (33.3%) were obese, 9(25%) were having HOMA index =2 and 15(41.7%) were = 35 years. Higher BMI was found to be associated with higher HOMA index (R= 0.4 by spearman correlation). Likewise, higher BMI was found to be associated with advanced maternal age (P=0.03). The difference in the median HOMA index between the three BMI groups was significant (p=0.008), unlike the difference between the two age groups in which the relation wasn't significant (P=0.6). Oocyte count was significantly reduced with advancing in age (P= 0.009) and older patients needed a longer stimulation than young age groups (P= 0.01). Pregnancy rate was comparable between the study groups in the various classifications with a significant drop in obese young patients (< 35 years) in comparison to those in the same age group and acceptable BMI( P= 0.04), However, this impact of BMI is diminished after the age of 35 and became non -significant (p=0.4). Conclusion: Higher BMI is associated with relatively higher levels of insulin resistance. Advanced maternal age appeared to be independently and directly associated with poor IVF outcome mainly affecting oocyte count and the duration to induce ovarian stimulation.