A 28-year-old woman with PCOS undergoes ovulation induction with clomiphene citrate 100 mg for 5 days. Follicle tracking shows no dominant follicle 18 mm or greater on day 16. She is diagnosed with clomiphene resistance. The NEXT most appropriate intervention is:

• A Increase clomiphene dose to 200 mg
• B Add letrozole 2.5 mg to the next cycle
• C Switch to letrozole as first-line oral ovulation induction ✓
• D Proceed directly to IVF

Explanation

Letrozole (aromatase inhibitor) is recommended as first-line oral ovulation induction in PCOS by ESHRE/ASRM guidelines and has replaced clomiphene due to higher live birth rates and lower multiple pregnancy risk. After confirmed clomiphene resistance (failure at 150 mg), switching to letrozole is appropriate before proceeding to injectable gonadotropins or IVF. Doses of clomiphene above 150 mg are not recommended.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.