A 28-year-old woman with oligo-amenorrhea, acne, and hirsutism has ultrasound showing bilateral polycystic ovaries. Serum LH:FSH ratio is 2.8:1, testosterone is mildly elevated, and fasting insulin is elevated. She is trying to conceive. What is the FIRST-LINE pharmacological treatment for ovulation induction in this patient?
- A Clomiphene citrate
- B Gonadotropin injections (FSH)
- C Letrozole (aromatase inhibitor) ✓
- D Metformin alone
Correct answer: C. Letrozole (aromatase inhibitor)
Explanation
Letrozole has superseded clomiphene citrate as the first-line agent for ovulation induction in PCOS-related anovulatory infertility following evidence from the PPCOS II trial showing higher live birth rates with letrozole. Letrozole, an aromatase inhibitor, transiently reduces estrogen levels, stimulating FSH secretion without the anti-estrogenic effect on endometrium seen with clomiphene. Metformin alone has modest ovulation induction efficacy and is used as an adjunct. Gonadotropins are reserved for women who fail oral agents.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.