Mehlman High Yield Practice Exam

In PCOS, the main barrier to conception is ovulation not occurring regularly, so the goal is to stimulate the ovaries to ovulate. The medication most commonly used for this purpose is clomiphene citrate, a selective estrogen receptor modulator. It works by blocking estrogen receptors in the hypothalamus, tricking the brain into thinking estrogen levels are low. That reduces negative feedback and increases GnRH pulses, which then raise FSH and LH from the pituitary. With higher FSH, a dominant follicle can mature and ovulation can occur, improving chances of pregnancy in PCOS. Clinically, clomiphene is typically started early in the cycle (for example, on days 3–5) at a standard dose such as 50 mg daily, with potential gradual increases in subsequent cycles if ovulation doesn’t occur. Expectation is that many patients will ovulate, though pregnancy rates per cycle are modest and multiple gestation risk is a consideration. Metformin, if insulin resistance is present, can help some patients regain ovulation and is sometimes used in combination, but it is not the primary ovulation-inducing agent. OCPs regulate cycles or prevent pregnancy, not induce ovulation, and spironolactone targets androgen excess rather than triggering ovulation.