PREDICTORS OF TREATMENT RESISTANCE IN WOMEN WITH POLYCYSTIC OVARY SYNDROME-RELATED INFERTILITY UNDERGOING OVULATION INDUCTION
Keywords:
Polycystic ovary syndrome; PCOS; infertility; ovulation induction; treatment resistance; letrozole; clomiphene citrate; anti-Müllerian hormone; AMH; insulin resistance; hyperandrogenism; testosterone; BMI; ovarian response; reproductive outcomes; infertility management.Abstract
Background
Polycystic ovary syndrome (PCOS) is one of the leading causes of anovulatory infertility among women of reproductive age. Although ovulation induction improves fertility outcomes in many patients, a considerable proportion of women show poor or delayed response to treatment. Identification of factors associated with treatment resistance may help clinicians develop individualized fertility management strategies.
Objective
To identify clinical, hormonal, and metabolic predictors associated with resistance to ovulation induction therapy among women with PCOS-related infertility.
Methods
This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Bashir Begum Hospital, Burewala, Pakistan. Medical records of 180 women diagnosed with PCOS-related infertility and treated with ovulation induction were reviewed. Patients were divided into two groups according to treatment response: responsive group and treatment-resistant group. Demographic characteristics, infertility duration, body mass index (BMI), menstrual pattern, hormonal profile, metabolic parameters, ultrasound findings, and ovulation outcomes were evaluated. Statistical analysis was performed using comparative tests and multivariable logistic regression to determine independent predictors of treatment resistance.
Results
Among 180 women, 68 (37.8%) demonstrated treatment resistance, while 112 (62.2%) showed adequate response to ovulation induction. Women with poor response had significantly higher BMI, longer infertility duration, increased anti-Müllerian hormone (AMH) levels, elevated testosterone concentration, higher LH/FSH ratio, and greater frequency of insulin resistance compared with responders (p<0.05). Multivariable analysis identified BMI ≥30 kg/m² (OR 3.12; 95% CI 1.54–6.31), AMH ≥7 ng/mL (OR 2.89; 95% CI 1.43–5.82), insulin resistance (OR 2.71; 95% CI 1.32–5.54), and prolonged infertility duration (OR 2.46; 95% CI 1.21–4.98) as significant independent predictors of treatment failure.
Conclusion
Treatment resistance in PCOS-related infertility is associated with a combination of metabolic and hormonal abnormalities. Higher BMI, increased AMH, hyperandrogenism, insulin resistance, and prolonged infertility duration may help identify women who require individualized ovulation induction strategies. Early assessment of these predictors may improve treatment planning, reduce repeated unsuccessful cycles, and enhance fertility outcomes.
