Grade II obesity is an independent predictor of poor response to ovulation induction with oral letrozole in infertile women with PCOS: A prospective cohort study from North India.

BACKGROUND

Letrozole is an effective ovulation-inducing agent for women with Polycystic Ovary Syndrome (PCOS), but its efficacy may be influenced by obesity. This study examines obesity's impact on letrozole-induced ovulation in infertile women with PCOS.

MATERIAL AND

METHODS

A prospective cohort study was conducted at a tertiary medical center in North India with 80 anovulatory women with PCOS. Participants received letrozole (5 mg daily, days 2-6) for up to three cycles. Ovulation was monitored through transvaginal ultrasound, and human chorionic gonadotrophin (HCG) was administered when a dominant follicle reached ≥ 17 mm. The association between obesity and letrozole response was assessed, considering clinical, metabolic, and hormonal parameters. Categorical variables were analyzed using the Chi-square test, and continuous variables were compared via Student's t-test. Logistic regression assessed the relationship between obesity and ovulation, adjusting for age, body mass index (BMI), and baseline antimullerian hormone (AMH).

RESULTS

Eighty participants were recruited in the study including 51 (63.75%) responders and 29 (36.25%) nonresponders. Higher BMI, elevated AMH, and increased testosterone levels were linked to a negative response to letrozole. Grade II obesity (BMI ≥30 kg/m²) significantly reduced the likelihood of ovulation (adjusted OR 8.49, 95% CI 1.06-67.56, P = 0.043). Elevated AMH (>16 ng/mL) was also associated with poor response (adjusted OR 5.15, 95% CI 1.52-17.47, P = 0.009).

CONCLUSIONS

Grade II obesity is an independent risk factor for poor response to letrozole ovulation induction in PCOS. Personalized treatment based on BMI may enhance success rates.