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PCOS-related anovulatory infertility — SCE Endocrinology MCQ

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HardReproductive endocrinologyPCOS-related anovulatory infertilitySCE Endocrinology

A 37-year-old woman with PCOS and BMI 34 kg/m2 wants pregnancy. She has oligomenorrhoea and no other infertility factor is found. HbA1c is 41 mmol/mol and partner semen analysis is normal. What is the most appropriate ovulation-induction management?

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Correct answer: E — Letrozole after lifestyle optimisation and preconception counselling

Letrozole after lifestyle optimisation and preconception counselling is best because letrozole is preferred first-line pharmacological ovulation induction for anovulatory infertility in PCOS. The alternatives are less appropriate because the combined pill prevents conception; cabergoline requires hyperprolactinaemia; glucocorticoids are not first-line PCOS treatment; radioiodine is unrelated. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: International PCOS Guideline 2023