What is a common management approach for anovulatory infertility in PCOS?

• A. Immediate IVF
• B. Weight loss and ovulation induction with letrozole or clomiphene citrate; metformin may be used in some cases
• C. Surgical removal of ovaries
• D. Hormone suppression with GnRH agonists

Answer: (B)

In anovulatory infertility from PCOS, the first-line approach targets both metabolic health and ovulatory function. Weight loss in overweight individuals can improve insulin resistance and hormonal balance, often restoring ovulation on its own. If ovulation does not occur with lifestyle changes, pharmacologic ovulation induction is used, with letrozole or clomiphene citrate as the common agents. Letrozole is an aromatase inhibitor that lowers estrogen levels, increasing FSH drive and promoting follicular development; clomiphene citrate works by blocking estrogen receptors to lift the pituitary’s release of gonadotropins. Metformin is considered in some patients, especially those with insulin resistance or metabolic syndrome, as it can improve insulin sensitivity and may support ovulation when combined with other agents.

Immediate IVF is not the typical first step in PCOS-related infertility, surgical removal of ovaries is inappropriate, and GnRH agonists are not standard monotherapy for initiating ovulation in this context.