In women with PCOS, there are sufficient number of eggs inside the ovaries. The only problem is that the eggs cannot grow and are released ("Ovulation"). Therefore, if the Fallopian Tubes and the Sperms are normal, the treatment of PCOS Infertility is "Ovulation Induction (OI)"- the treatment to stimulate the eggs to grow and ovulate.
Before ovulation induction, the main advice is weight control. If weight is optimum, the response of the ovaries by the medicines increases. Sometimes, some medicines (Metformin, Inositol) can be added..The first line of medicines used for OI are orally taken medicines like Clomiphene Citrate (CC) and Letrozole. Whether you need to try CC or Letrozole first depends on your condition. But if you take medicine for OI, Do NOT take it without TVS Follicular Study. This is important to see whether your ovaries are responding to the medicine in the first month. If you are responding by the medicines (eggs are growing and are ovulating), in one month the chance of pregnancy is 15%, that means out of 100 women having adequate response to the medicines, only 15 can conceive within one month, provided they have regular unprotected intercourse.
So, if your ovaries are responding to the medicines but you cannot get pregnant, you can take the same medicines for next 3-4 months without further TVS. If you cannot get pregnant by these months, you need to move to the next step.
Again, if you do not respond to the medicines by the first month, taking the medicines months after months, is simply the waste of time and money.
The picture (uploaded with kind permission) is from a woman with PCOS with eight years of Infertility. She took CC and low dose Letrozole, before coming to us, but without TVS. We advised her weight loss and prescribed Metformin and Inositol. Then we started ovulation induction with higher dose of Letrozole and performed TVS Follicular Study and found that she was responding to the medicines. We advised them to try the same medicines for next 3-4 months without any need to visit us. But, they visited us just after missed period with the good news.
Please pray for them.