Ovulation Induction

A 31-year-old woman with PCOS and anovulation has undergone 3 cycles of clomiphene citrate (CC) 100 mg daily for 5 days without achieving ovulation. Baseline FSH is 4.2 mIU/mL, LH is 18 mIU/mL, and testosterone is 0.8 ng/mL. She has no contraindications to gonadotropins. What is the most appropriate next step in management?

A 32-year-old woman with PCOS and secondary infertility for 18 months presents with irregular cycles (45–60 days). BMI is 28 kg/m². Basal FSH is 6 IU/L, LH is 18 IU/L (LH:FSH ratio 3:1), and free testosterone is elevated. She has not conceived after 6 months of clomiphene citrate 100 mg daily (days 3–7) with documented ovulation on ultrasound. What is the most appropriate next step in management?

A 32-year-old woman with anovulatory infertility is being counselled about ovulation induction agents. She has a BMI of 24 kg/m², normal prolactin and TSH levels, and a diagnosis of idiopathic anovulation. Which is the most commonly used first-line agent for ovulation induction in such patients?

A 32-year-old woman with hypothalamic amenorrhea (BMI 18.5 kg/m², normal prolactin and TSH) has failed to conceive despite 18 months of unprotected intercourse and weight restoration. What is the drug of choice for ovulation induction in this patient?

A 28-year-old woman with primary infertility for 2 years presents to the fertility clinic. Semen analysis of her husband is normal. Her menstrual cycles are regular (28 days), and transvaginal ultrasound shows normal ovaries with multiple follicles. Serum progesterone on day 21 of the cycle is 8 ng/mL (normal luteal phase >10 ng/mL). What is the most appropriate next step in management?