What is the first-line ovulation induction agent for patients with PCOS?

The first-line ovulation induction agent for patients with polycystic ovary syndrome (PCOS) is letrozole. Letrozole is an aromatase inhibitor that has been shown to be effective in inducing ovulation in women with PCOS, particularly for those who may not respond well to clomiphene citrate. It works by lowering estrogen levels, leading to an increase in follicle-stimulating hormone (FSH), which stimulates the ovaries to produce follicles and consequently ovulate.

Letrozole has gained preference over clomiphene citrate due to its better outcomes in terms of live birth rates and fewer side effects. In clinical practice, it is often recommended as first-line therapy, especially for women who have not achieved ovulation with clomiphene citrate or who may have contraindications to its use.

While clomiphene citrate is also a well-known ovulation inducer and has been traditionally used, letrozole is becoming the more favored option based on recent guidelines and studies. Gonal-f, which is a form of FSH, is generally used in more specialized settings or in cases of treatment-resistant anovulation. Metformin, although it plays a role in managing insulin resistance in women with