Which treatment modality is considered first-line for ovulation induction in women with PCOS who desire pregnancy?

Letrozole is recognized as the first-line treatment for ovulation induction in women with polycystic ovary syndrome (PCOS) who wish to conceive. Research has demonstrated that letrozole is more effective than clomiphene citrate in achieving ovulation and pregnancy rates in this particular population. It functions by inhibiting aromatase, leading to decreased estrogen levels, which subsequently stimulates the hypothalamus and pituitary to increase follicle-stimulating hormone (FSH) secretion, thereby promoting ovarian follicle development.

In contrast, while clomiphene is also a well-known agent for stimulating ovulation in women with PCOS, letrozole has shown better outcomes in recent studies regarding efficacy and side effects, making it the preferred option in many practice guidelines.

Metformin, although helpful in managing insulin resistance in women with PCOS, is not primarily a treatment for ovulation induction. It may assist with regulating menstrual cycles and improving ovulatory function when used in conjunction with other therapies but is not considered first-line for this specific purpose.

Likewise, spironolactone is primarily an anti-androgen and is used to treat hirsutism and acne in PCOS patients, rather than directly inducing ovulation