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Polycystic ovary syndrome — MCCQE Part 1 MCQ

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ModerateInfertilityPolycystic ovary syndromeMCCQE Part 1

28-year-old woman presents with infertility and irregular menses. She has acne, hirsutism and polycystic ovarian morphology after exclusion of mimics. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Offer lifestyle support and ovulation induction pathway such as letrozole when pregnancy desired

Offer lifestyle support and ovulation induction pathway such as letrozole when pregnancy desired is best because anovulatory infertility with hyperandrogenism is consistent with PCOS. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Letrozole is commonly first-line for ovulation induction in PCOS.

Reference: SOGC PCOS guidance