The Influence of the Clinical Insulin Suppressing Diet on Female Infertility

Jensen, Tanja Kim

4. term

Medicine with Industrial Specialisation, Master

2014

2014-05-28

31

Insulinresistens og forhøjede insulinniveauer er forbundet med tilstande, der kan nedsætte kvinders frugtbarhed. Dette studie undersøgte, om KISS-diæten (klinisk insulinsænkende), der har til formål at sænke insulin og målrette insulinresistens, kan forbedre resultatet af fertilitetsbehandling. Vi gennemgik retrospektivt journaler fra Gynækologisk Klinik Taastrup (GKT) for kvinder behandlet med intrauterin insemination med partners sæd (n=799) eller donorsæd (n=91). Alle havde fået ordineret KISS-diæten. Vi forventede, at kvinder med hyperinsulinæmi før kostinterventionen ville respondere bedre end kvinder med normale insulinniveauer, og antog derfor, at dem, der blev gravide, ville have højere baseline C-peptid (en markør for insulinproduktion) end dem, der ikke blev gravide. Vi sammenlignede også graviditetsrater efter donorinsemination i GKT med det nationale gennemsnit rapporteret af National Danish Fertility Society og brugte 95 % konfidensintervaller til at vurdere forskelle. Derudover sammenholdt vi den spontane graviditetsrate blandt kvinder behandlet med partners sæd i GKT med rater rapporteret andre steder. Resultater: Der var ingen forskel i baseline C-peptid mellem gravide og ikke-gravide, hverken i partner- eller donorgrupperne (P>0,05). Blandt kvinder under 40 år, der fik donorsæd, var graviditetsraten i GKT og landsgennemsnittet ens (12,3 % vs. 12,9 %). Hos kvinder på 40 år eller derover var graviditetsraten i GKT 14,9 % (95 % KI 7,4–25,7), hvilket var højere end landsgennemsnittet på 5,7 % (95 % KI 4,8–6,7), da konfidensintervallerne ikke overlappede. Den spontane graviditetsrate blandt kvinder behandlet med partners sæd i GKT var 33,3 %, højere end i andre studier, men vi kunne ikke vurdere, om forskellen var statistisk sikker. Da KISS-diæten kan være den væsentligste forskel mellem GKT og andre klinikker, kan resultaterne pege på, at kosten forbedrer fertilitetsbehandlingsresultater, især hos kvinder af højere alder. En vigtig begrænsning er mangel på en passende kontrolgruppe og det retrospektive design, så resultaterne bør tolkes med forsigtighed. Der er behov for randomiserede, kontrollerede forsøg, gerne på tværs af flere centre, for at afklare KISS-diætens effekt på infertilitet.

Insulin resistance and high insulin levels are linked to conditions that can reduce female fertility. This study examined whether the KISS diet (Clinical Insulin Suppressing), designed to lower insulin and target insulin resistance, improves outcomes for women undergoing fertility treatment. We retrospectively reviewed records from Gynækologisk Klinik Taastrup (GKT) for women treated with intrauterine insemination using partner semen (n=799) or donor semen (n=91). All were prescribed the KISS diet. We expected that women with hyperinsulinemia before the diet would respond better than women with normal insulin levels, and therefore hypothesized that those who became pregnant would have higher baseline C-peptide (a marker of insulin secretion) than those who did not. We also compared pregnancy rates after donor insemination at GKT with the national average reported by the National Danish Fertility Society, using 95% confidence intervals to judge differences. In addition, we compared the spontaneous pregnancy rate among women treated with partner semen at GKT with rates reported elsewhere. Results: There was no difference in baseline C-peptide between pregnant and non-pregnant women in either the partner or donor groups (P>0.05). Among women under 40 receiving donor semen, the pregnancy rate at GKT was similar to the national average (12.3% vs 12.9%). Among women aged 40 or older, the pregnancy rate at GKT was 14.9% (95% CI 7.4–25.7), higher than the national average of 5.7% (95% CI 4.8–6.7), as the confidence intervals did not overlap. The spontaneous pregnancy rate among women treated with partner semen at GKT was 33.3%, higher than in other studies, but statistical significance could not be assessed. Because the KISS diet may be the main difference between GKT and other clinics, these findings may indicate that this diet improves fertility treatment outcomes, particularly in women of advanced age. The study is limited by the lack of an appropriate control group and its retrospective design, so the findings should be interpreted cautiously. Randomized controlled trials, preferably across multiple centers, are needed to clarify the effect of the KISS diet on infertility.

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