A 34-year-old woman with PCOS and anovulatory infertility is started on letrozole by the fertility clinic. After two cycles, she has not ovulated (con...

Question

A 34-year-old woman with PCOS and anovulatory infertility is started on letrozole by the fertility clinic. After two cycles, she has not ovulated (confirmed by day 21 progesterone

Accepted Answer

Increase the dose of letrozole and monitor for response - dose escalation is standard practice before switching agents

Answer

Continue the same dose of letrozole for 6 more cycles

Answer

Switch immediately to gonadotrophin injections

Answer

Offer IVF as letrozole has failed

Answer

Add metformin as a substitute for letrozole

uk-drcog MCQ (SBA): Letrozole Dose Escalation

A 34-year-old woman with PCOS and anovulatory infertility is started on letrozole by the fertility clinic. After two cycles, she has not ovulated (confirmed by day 21 progesterone <10 nmol/L). Which is the single most appropriate next step?