MRCP2-1574

MRCP2-1574

A 30-year-old female presents to the infertility clinic with an inability to conceive. She is overweight, with a body-mass index of 30 kg/m², and has noticed increased hair growth over her face and chest over the last 12 months. Her periods are irregular and she has also noticed a deepening of her voice. An ultrasound of the pelvis has revealed the presence of multiple cysts in both ovaries. She has been treated with cyproterone acetate for her hirsutism but was informed that she should not attempt conception whilst on the drug. She now wishes to conceive.

On examination, she has a cushingoid appearance, with abdominal striae and her blood pressure is 140/85 mmHg.

Laboratory investigations reveal:

9:00 am Cortisol 710 nmol/l (170 700 nmol/l)
LH 28 iU/l (1 20 iU/l)
Basal FSH 4.7 iU/l (1.0 8.8 iU/l)
DHEAS 509 µg/dl (31 228 µg/dl)
Prolactin 602 mU/l (<360 mU/l)
17 OH Progesterone 54 ng/dl (<80 ng/dl) What is the most appropriate treatment option for infertility in this patient?