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 35-year-old woman with secondary infertility and normal ovulatory cycles presents for fertility counseling. Husband's semen analysis is normal. Hysterosalpingography shows patent tubes bilaterally. She has undergone 3 cycles of intrauterine insemination (IUI) with clomiphene citrate (CC) 100 mg/day (days 5–9) without conception. Serum progesterone on day 21 is 8 ng/mL (ovulation confirmed). What is the most appropriate next step in management?

A 28-year-old nulliparous woman with PCOS and BMI 32 kg/m² presents with primary infertility for 2 years. She has irregular menses (cycle length 45–90 days), hirsutism, and elevated androgen levels. Baseline investigations show FSH 6 IU/L, LH 18 IU/L, and normal prolactin. She was counselled on lifestyle modification for 3 months without improvement. You decide to initiate ovulation induction. Which of the following is the MOST appropriate first-line pharmacological agent and the rationale for its choice in this clinical scenario?

A 29-year-old woman with a history of recurrent ovulation induction failures presents with primary infertility for 3 years. She has regular menstrual cycles (28–30 days), normal BMI (22 kg/m²), normal FSH (6 mIU/mL), normal prolactin (18 ng/mL), and normal thyroid function. Transvaginal ultrasound shows bilateral polycystic ovaries with 12–15 follicles per ovary. She has undergone three cycles of clomiphene citrate (50–100 mg daily for 5 days) without ovulation. Which is the most appropriate next step in management?