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Types of Infertility Treatment Drugs Ovulation induction drugs are categorised as: SERMs: Clomiphene citrate Aromatase inhibitors: Letrozole Gonadotropins: FSH, LH preparations Adjunct therapies: Insulin sensitisers (e.g., metformin) Luteal phase support (progesterone) Step-by-Step Ovulation Induction Protocol Patient Selection Confirm anovulation Assess ovarian reserve (AMH, AFC) Exclude: Tubal pathology Severe male factor infertility Drug Selection PCOS Letrozole General anovulation Clomiphene/Letrozole Resistant cases Gonadotropins Monitoring Follicular tracking starting Day 910 Dominant follicle: 1820 mm Endometrial thickness: 7 mm Trigger & Timing Administration of hCG trigger (mimics LH surge) Ovulation occurs ~36 hours post-trigger Timed intercourse or intrauterine insemination is planned accordingly Risks and Complications Ovarian Hyperstimulation Syndrome (OHSS) More common with gonadotropins Pathophysiology: Increased vascular permeability due to VEGF Features: Ascites, enlarged ovaries, hemoconcentration Multiple Pregnancy Clomiphene: Increased twin rate Gonadotropins: Higher risk of multifetal gestation Other Adverse Effects Functional ovarian cysts Vasomotor symptoms (clomiphene) Abdominal discomfort Ovulation Induction in PCOS Patients Key pathophysiology: Increased LH: FSH ratio Hyperandrogenism Arrested follicular development Management principles: Letrozole as a first-line agent Lifestyle modification (weight reduction improves ovulation) Metformin in insulin-resistant individuals Clomiphene resistance is defined as failure to ovulate at the maximum dosage

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