A 28-year-old woman with PCOS fails to conceive after 3 cycles of clomiphene citrate at 150 mg/day. Her BMI is 26 kg/m². The NEXT evidence-based ovulation induction agent with reduced multiple pregnancy risk compared to clomiphene is:
- A Tamoxifen 20 mg/day
- B Gonadotropin injections (FSH/LH)
- C Letrozole 2.5 mg/day ✓
- D Metformin alone
Correct answer: C. Letrozole 2.5 mg/day
Explanation
The PPCOS-II trial (Legro et al., NEJM 2014) demonstrated that letrozole (aromatase inhibitor) achieved higher live birth rates than clomiphene in PCOS, with a significantly lower rate of multiple gestations due to its mono-follicular stimulation pattern and shorter half-life. Letrozole is now recommended as first-line ovulation induction in PCOS by ASRM and FOGSI guidelines. Gonadotropins carry substantial multiple pregnancy risk and require intensive monitoring.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.