Multistep approach to treatment of anovulatory infertility associated with polycystic ovary syndrome

	Treatment	Cost	Multiple pregnancy risk
First line	Weight loss for high body mass index	Low	Not increased
First line	Letrozole (alternative: clomiphene citrate)	Low	Low
Second line	Follicle-stimulating hormone injections	High	High, includes high-order multiples
Second line	Ovarian drilling	High	Not increased
Third line	In vitro fertilization	Very high	High but reducible with single embryo transfer

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