{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:07:03Z","timestamp":1790140023547,"version":"4.0.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"\n Objective<\/jats:title>\n To evaluate the dose-response relationship between HOMA-IR as a continuous variable and embryo development outcomes in fresh IVF\/ICSI cycles of PMOS patients (formerly PCOS), distinguishing IR effects on oocyte yield (ovarian responsiveness) from effects on embryo developmental efficiency (per-oocyte conversion potential), and to evaluate differential IR impacts on cumulative implantation versus pregnancy maintenance.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Single-center retrospective cohort study of all fresh IVF\/ICSI cycles from July 2022 to March 2026, comprising 3058 de-duplicated patients (2799 non-PMOS, 259 PMOS; PMOS-nonIR n=115, PMOS-IR n=144, cut-off \u22652.5). Spearman correlation and multivariable linear regression (adjusted for age, BMI, AMH) were used to evaluate the independent associations of HOMA-IR with oocyte maturation, fertilization, and embryo development at each stage.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Oocyte maturation rate showed no correlation with HOMA-IR (r=-0.014,\n P<\/jats:italic>\n \u00a0=\u00a00.8178). HOMA-IR was negatively correlated with oocyte count (r=-0.226,\n P<\/jats:italic>\n \u00a0=\u00a00.0002), and oocyte yield was significantly lower in PMOS-IR vs PMOS-nonIR. Transferable embryo and usable blastocyst counts were negatively associated with HOMA-IR, but transferable embryo rate showed no association with HOMA-IR (adjusted \u03b2=0.817,\n P<\/jats:italic>\n \u00a0=\u00a00.3940), nor did blastocyst formation rate or usable blastocyst rate. Cumulative \u03b2-hCG positive and clinical pregnancy rates were significantly higher in PMOS-IR (85.4% and 81.9%) versus Non-PMOS (72.8% and 69.0%,\n P<\/jats:italic>\n \u00a0=\u00a00.0024 and\n P<\/jats:italic>\n \u00a0=\u00a00.0022), largely driven by greater transfer opportunity (97.9% vs 89.0%). By contrast, clinical pregnancy loss (no live birth among clinical pregnancies with a known outcome) showed a graded upward trend (13.5% vs 15.6% vs 17.2%), but the between-group difference was not statistically significant; owing to the limited number of loss events in the PMOS subgroups, this comparison should be interpreted with caution. Cumulative live birth rates did not differ significantly across groups (56.9% vs 56.5% vs 54.5%,\n P<\/jats:italic>\n \u00a0=\u00a00.7853).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In PMOS patients, IR exhibits multi-stage differential effects \u2014 impairing oocyte yield while preserving embryo developmental competence. Once oocytes are retrieved, their developmental efficiency is unaffected by IR status. Higher cumulative implantation in PMOS-IR was largely driven by greater transfer opportunity, whereas clinical pregnancy loss showed an upward trend without statistical significance, indicating that IR-related reproductive impairment primarily involves oocyte yield and transfer opportunity, while post-implantation pregnancy maintenance merits further evaluation. This warrants prospective validation. HOMA-IR should be integrated into pre-IVF ovarian response stratification but not used to predict embryo developmental competence.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fendo.2026.1930083","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:49:19Z","timestamp":1790138959000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantity down, quality preserved: a continuous HOMA-IR analysis of IVF\/ICSI outcomes in PMOS patients"],"prefix":"10.3389","volume":"17","author":[{"given":"Huiyi","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Reproductive Medicine, Quanzhou Women and Children\u2019s Hospital (Quanzhou Children\u2019s Hospital)","place":["Quanzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Quanzhou Women and Children\u2019s Hospital (Quanzhou Children\u2019s Hospital)","place":["Quanzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunni","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Quanzhou Women and Children\u2019s Hospital (Quanzhou Children\u2019s Hospital)","place":["Quanzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Quanzhou Women and Children\u2019s Hospital (Quanzhou Children\u2019s Hospital)","place":["Quanzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dew218","article-title":"The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and 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