A 30-year-old woman with PCOS and BMI 30 kg/m² has failed 6 cycles of ovulation induction with letrozole. Her partner's semen analysis is normal, and tubal patency is confirmed. What is the next recommended step?
- A Gonadotropin ovulation induction with low-dose step-up protocol ✓
- B Laparoscopic ovarian drilling
- C In vitro fertilization
- D Continue letrozole for 3 more cycles at 7.5 mg
Correct answer: A. Gonadotropin ovulation induction with low-dose step-up protocol
Explanation
After failure of first-line oral agents (letrozole or clomiphene), gonadotropin ovulation induction with a low-dose step-up protocol is the next evidence-based step before proceeding to IVF. Laparoscopic ovarian drilling is an alternative but is less commonly used now. IVF is reserved for gonadotropin failure or additional indications.
Reference: Te Linde's Operative Gynecology, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.