In a woman with PCOS planning conception, which Rotterdam criterion combination predicts the BEST response to clomiphene citrate ovulation induction?

• A Polycystic morphology on USG with hyperandrogenism and oligomenorrhoea
• B Oligomenorrhoea alone with normal androgen levels and no USG criteria
• C Hyperandrogenism with polycystic morphology but regular cycles
• D Oligomenorrhoea with polycystic morphology but normal androgens ✓

Explanation

Women with the 'milder' PCOS phenotype — oligomenorrhoea with polycystic ovarian morphology but normal androgen levels (PCOS phenotype D by Rotterdam criteria) — tend to have lower AMH, less severe metabolic derangement, and better response to ovulation induction agents like clomiphene. Hyperandrogenic phenotypes, especially those with all three Rotterdam criteria, are more likely to be clomiphene-resistant and require gonadotrophins or letrozole.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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