运动处方数字疗法改善超重/肥胖合并胰岛素抵抗女性的体外受精-胚胎移植结局OA

Objectives:To investigate whether a weight management program centered on digital therapeutics with exercise prescription can improve the outcomes of in vitro fertilization-embryo transfer(IVF-ET)in overweight/obese women with insulin resistance(IR). Methods:This prospective real-world study included 129 overweight/obese women with IR who underwent IVF-ET at our hospital from January to Pecember 2023.Based on the intervention strategy,women were divided into an intervention group(n=87,receiving digital therapeutics with exercise prescription and dietary guidance)and an observation group(n=42,receiving general exercise and dietary guidance only).Baseline characteristics,ovarian stimulation and embryo development parameters,and pregnancy outcomes were compared between the two groups.Additionally,IVF-ET outcomes were analyzed among subgroups with different magnitudes of weight reduction within the intervention group. Results:No significant differences were observed in baseline characteristics between the intervention and control groups(P＞0.05).The number of two-pronuclear(2PN)zygotes,2PN fertilization rate,and the number of available embryos were significantly higher in the intervention group than those in the observation group(P＜0.05).The embryo implantation rate was significantly higher in the intervention group than that in the observation group(50.6％vs.29.0％,P=0.036).Clinical pregnancy rate and live birth rate showed an increasing trend in the intervention group compared to the observation group,but the differences were not statistically significant(P＞0.05).Following digital therapeutics with exercise prescription and dietary guidance,patients in the intervention group showed significant reductions in both body weight[(65.2±6.5)kg vs.(69.7±7.2)kg,P＜0.001]and the homeostasis model assessment of insulin resistance(HOMA-IR)index[(2.2±0.7)vs.(4.9±1.7),P＜0.001].Within the intervention group,the subgroup with ≥ 5％weight reduction had a significantly greater decrease in HOMA-IR compared to the subgroup with＜5％reduction(P＜0.05).Furthermore,the subgroup with ≥10％weight reduction demonstrated both a significantly greater decrease in HOMA-IR and a significantly higher clinical pregnancy rate(92.3％vs.60.0％)compared to the subgroup with＜10％reduction(P＜0.05). Conclusions:Weight management centered on digital therapeutics with exercise prescription can effectively improve IVF-ET outcomes in overweight/obese women with IR.It is recommended that this population get at least 10％weight loss prior to undergoing IVF-ET treatment.