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    Subjects/OBG/Ovulation Induction
    Ovulation Induction
    hard
    baby OBG

    A 32-year-old woman from Mumbai with a 5-year history of secondary infertility and irregular cycles (35–45 days) presents for ovulation induction. Her BMI is 28 kg/m². Pelvic ultrasound reveals multiple small follicles in both ovaries (>12 follicles of 2–8 mm per ovary) with increased ovarian stroma. Serum FSH is 6.5 mIU/mL, LH 18 mIU/mL, and testosterone 0.8 ng/mL (elevated). Free androgen index is 4.2 (elevated). She is diagnosed with polycystic ovary syndrome (PCOS). After 3 months of lifestyle modification and metformin 1500 mg daily, she still has irregular cycles. She is now started on clomiphene citrate 50 mg daily from day 3 to day 7. On day 12, ultrasound shows 4 follicles measuring 16–18 mm, 14 mm, 12 mm, and 10 mm. Endometrial thickness is 9 mm. What is the most appropriate next step?

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