Original Articles Vol. 3 No. 3 (2026): Bioscience Insights Published 2026-10-13

TRIGLYCERIDE–GLUCOSE INDEX AS A PREDICTOR OF LETROZOLE RESISTANCE IN WOMEN WITH PCOS UNDERGOING OVULATION INDUCTION

Authors

  • Joy Okon Lazarus The First Affiliated Hospital of Nanchang University (Department Gynaecology), Nanchang, Jiangxi, China. Pakistan Author
  • Maha Safder Doctorate of Physical Therapy, Abasyn University Islamabad Campus, Islamabad, Pakistan. Pakistan Author
  • Saif Ullah Student MBBS, Nanchang University, Nanchang, China. Pakistan Author
  • Ibad Khan Student MBBS, Nanchang University, Nanchang, China. Pakistan Author
  • Muhammad Sohaib MBBS, Nanchang University. FCPS Internal Medicine, CPSP Fellow Endocrinology, Bahria International Hospital Lahore, Pakistan Pakistan Author
  • Muhammad Umar Khan MBBS, Nanchang University. FCPS Internal Medicine, CPSP Fellow Endocrinology, Bahria International Hospital Lahore, Pakistan. Pakistan Author
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Abstract

Background: Polycystic ovary syndrome (PCOS) is a seen cause of anovulatory infertility, more times driven by underlying insulin resistance. Letrozole is the most commonly used drug for ovulation induction, but letrozole resistance and therapeutic failure are often the norm and the standard metabolic parameters are not precise in predicting the return.   Objective: To evaluate the predictive utility of baseline triglyceride-glucose (TyG) index for ovulation failure after standard letrozole induction in women with PCOS and to compare its association with follicular growth, time to ovulation and clinical pregnancy with conventional metabolic markers.   Methods: 90 anovulatory PCOS women were randomized to a parallel-group randomized controlled trial (RCT) in Islamabad. Patients were randomly allocated (1:1) to receive standard letrozole induction followed by active monitoring (Intervention, n=45) or letrozole and matched placebo (Control, n=45). Initial TyG index, HOMA_IR was computed. In the last group analyzed (n=84), follicular maturation, serum progesterone and clinical pregnancy rates were assessed. Logistic regression and repeated measures ANOVA were run.   Results: Ovulation failure was found in 29.3% (n=12) of the intervention group and 32.6% (n=14) of the control group (p=0.745). Baseline TyG index significantly predicted ovulation failure ("OR"=3.82, 95% CI:1.64-8.91, p=0.002), outperforming HOMA-IR ("OR"=1.45, p=0.145). A positive association was observed between TyG index and TTillov (r=0.48, p<0.001). Time significantly affected follicular growth trajectories (F=214.5, p<0.001), but there was no significant difference between the time $\times$ group interaction (F=0.38, p=0.685).   Conclusion: TyG index can be used as an independent predictor of letrozole resistance and delayed ovulation in women with PCOS by using the baseline value of TyG index. The TyG index can be considered as a new risk stratification tool to be used before the initiation of treatment to direct metabolic adjustments to achieve the best results in fertility conclusions.

Keywords

  • Anovulation; Glucose; Hyperinsulinism; Insulin Resistance; Letrozole; Polycystic Ovary Syndrome; Triglycerides

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