Hello anonymous,

The Rotterdam criteria for the Diagnosis of PCOS require that a patient meet 2 of 3 features, which include irregular cycles, clinical or laboratory signs of hyperandrogenism (elevated androgens) which include excessive hair growth and acne, and PCOS ovaries on ultrasound. There are some women with stress or low body fat related hypothalamic dysfunction which can appear like PCOS, but are less likely to respond to Clomid or Femara and may require injectable gonadotropins (FSH and LH).

Some women with PCOS will not respond to 50 mg of Clomid, and can respond to Femara. Depending on your age, a trial of Femara may be a really good idea. If you do not respond to Femara, then a visit with a reproductive endocrinologist to discuss injectable gonadotropins or other options is a good idea. Unless your own physician is comfortable using injectable gonadotropins.

Best of luck with your fertility journey.

L. April Gago MD