Arya S, Hansen KR, Peck JD, et al. - Women with polycystic ovary syndrome (PCOS) are commonly obese. Researchers herein investigated how metabolic syndrome (MetS) associates with ovulation induction (OI) live birth rate and pregnancy complications in obese women with PCOS. In addition, they examined if these outcomes differ by specific agent used for OI. This prospective cohort analysis was conducted on data retrieved from participants in the Pregnancy in Polycystic Ovary Syndrome II (PPCOSII) clinical trial performed by the Reproductive Medicine Network. In PPCOSII, randomization of 750 women with PCOS and infertility was done to either clomiphene citrate or letrozole for OI for 1-5 cycles or until pregnancy occurred. A clinical pregnancy (20.5% vs 29.7%) or a live birth (16.5% vs 27%) was achieved in fewer women in the presence of MetS. Overall findings suggest correlation of MetS with a risk of lower live birth rate with OI for women with PCOS independent of obesity; this is particularly linked with a lower live birth rate for clomiphene compared with letrozole users. In addition, risk for pregnancy complications was higher for obese letrozole users in presence of MetS. Risk for gestational diabetes and macrosomia is higher in correlation with having the MetS.