A secondary analysis of the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) clinical trial examined the effect of prepregnancy insulin resistance on fertility and pregnancy outcomes in 746 women aged 18–40 years with polycystic ovarian syndrome (PCOS) undergoing ovulation induction with clomiphene citrate or letrozole. Researchers assessed insulin resistance using HOMA-IR and the glucose-to-insulin ratio. Higher prepregnancy insulin resistance was associated with lower ovulation rates, declining from 93.5% to 73.8%.
Clinical pregnancy rates decreased from 36% to 26.5%, while live-birth rates dropped from 35.5% to 18.2% across higher insulin resistance quartiles. The risk of gestational diabetes increased from 13.8% to 45.7% in women with greater insulin resistance. Notably, improvement in insulin resistance during treatment increased the odds of clinical pregnancy and reduced the…
