Management of Ovulation Induction in Primary Infertility

Step 3: Choose Appropriate Ovulation Induction Protocol

• The American Academy of Family Physicians recommends starting with clomiphene citrate as first-line therapy once thyroid function is optimized, as it has the best evidence for efficacy and safety, with approximately 80% of women with ovulatory dysfunction achieving ovulation and 50% achieving pregnancy 1
• Clomiphene citrate should be started with the lowest effective dose, typically 50 mg daily for 5 days, to minimize risks of ovarian hyperstimulation, and is superior when combined with thyroid hormone replacement for treating luteal phase defects in patients with subclinical hypothyroidism 1
• If clomiphene fails, progress to low-dose gonadotropin therapy rather than high-dose protocols, as this induces monofollicular development with lower risk of ovarian hyperstimulation syndrome, as recommended by the American family physician 1