A quantitative prospective cohort study will be conducted, where blood samples will be collected at different timings during the IVF protocol, to assess the impact of fertility medications on metabolic parameters of patients undergoing IVF treatment.

Numerous factors predispose women to develop pregnancy-related complications, these include gestational diabetes (GDM), pre-pregnancy obesity, advanced maternal age (> 35 years) and gestational age, abnormal weight gain during pregnancy, family history of diabetes, PCOS and low parity. Evidenced-based studies reported that women with PCOS have a significantly higher risk of developing GDM compared with women without PCOS, independently of the obesity factor; this risk is higher when both factors coexist.

Given the known effect of reproductive hormones on weight-gain, controversies still exist on whether ART predispose women to more adverse obstetric outcomes compared to normal pregnancy. ART describes different procedures to help women become pregnant, with In Vitro Fertilization (IVF) being the most commonly performed. It has been demonstrated that IVF is associated with glucose intolerance in mice and it will be interesting to determine whether this physiologic phenomenon is also altered by IVF medication (such as estrogen and progesterone) in humans. While some studies reported that singleton pregnancies conceived by ART (IVF or ovulation induction) were strongly associated with GDM compared to spontaneous conceptions, other studies did not find significant differences in the risk of GDM. Increased GDM risk presented with IVF can be associated with prenatal obesity or secondary to maternal PCOS condition. The former studies did not specify the body mass index (BMI) and the medical history of participants undergoing IVF, such as the presence of PCOS. Due to limited available data, we still cannot distinguish whether these adverse pregnancy outcomes are due to the pre-existing conditions such as PCOS, or are secondary to the IVF therapy itself.

Any patient presenting to us for fresh IVF with the following:

Inclusion Criteria:

• Presenting with or without PCOS
• Presenting with structural or mechanical infertility, such as fallopian tube obstruction, endometriosis, fibroids
• Presenting with male factor
• Presenting with or without insulin resistance
• Combination of more than one of the listed above criteria

Exclusion Criteria:

• Pre-diabetes or diabetes patients (confirmed by impaired or abnormal OGTT)
• Age above 39 years of age
• Taking glucose-lowering meds, such as metformin or janumet.
• Taking corticosteroids

We will have two main groups of: Obese (BMI: 30-38) and non-obese (BMI: 18.5-29.9) women with the following criteria

A convenience sample from adult women of < 39 years of age undergoing fresh IVF treatment at Fakih IVF Clinic in Dubai will be chosen. Participants who will fulfill the inclusion criteria will be recruited.

All the study information will be kept confidential. Patients' names will not be identified in any publication or presentation of the study findings. Only groups' results will be reported.

After conducting data collection and analysis the results will be available upon official publication.

Data access requests will be reviewed by an external independent committee. Requestors will be required to sign a Data Access Agreement.

9 months

Study is observational and non-experimental. No invasive procedures were used.