A 35-year-old woman with PCOS and BMI 38 kg/m² presents with infertility. She has failed 6 cycles of ovulation induction with letrozole. Her partner has normal semen analysis. HSG shows patent tubes. What is the most appropriate next step in management?
- A Laparoscopic ovarian drilling
- B Continue letrozole for 3 more cycles at 7.5 mg/day
- C Proceed to IVF-ET ✓
- D Add metformin and repeat letrozole for 6 cycles
Correct answer: C. Proceed to IVF-ET
Explanation
After failed ovulation induction (typically 3-6 ovulatory cycles without conception or failure to ovulate on maximum letrozole dose), the next step is IVF-ET. Option A (ovarian drilling) is an alternative for clomiphene-resistant cases but has largely been superseded by IVF. Option B is not indicated after 6 failed cycles. Option D is too slow; adding metformin does not rescue failed ovulation induction.
Reference: Speroff's Clinical Gynecologic Endocrinology and Infertility, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.