According to the PPCOS II trial, which agent is superior to clomiphene citrate as first-line ovulation induction in obese women with PCOS?

• A Metformin
• B Low-dose FSH
• C Letrozole ✓
• D Clomiphene plus metformin combination

Explanation

The PPCOS II trial (Legro et al., NEJM 2014) randomized women with PCOS to letrozole vs clomiphene and found that letrozole produced a significantly higher live birth rate (27.5% vs 19.1% per cycle) and ovulation rate, particularly in obese women. Letrozole is now endorsed as first-line ovulation induction for PCOS in major guidelines (ESHRE 2023, ASRM). Metformin alone is inferior for ovulation induction but useful for metabolic parameters. The trial definitively established letrozole's superiority.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.