Clomiphene citrate (CC) is the traditional first-line treat-
ment for chronic anovulation that characterizes polycystic
ovary syndrome (PCOS) (1). Clomiphene citrate is accu-
mulated in the body with low clearance rate and long
half-life (5 days). Significant plasma concentrations of the
active zu-isomer of CC can be detected up to 6 weeks after
administration. However, 20%-25% of PCOS women fail
to ovulate with incremental doses of CC. In addition,
clinical data revealed a discrepancy between ovulation
rates (75%-80%) and conception rates (30%-40%) during
CC treatment (2). For these patients who do not respond to
CC, there are a few limited adjunctive therapies that can be
tried before moving on to gonadotropin therapy or laparo-
scopic ovarian drilling, including bromocriptine (in the
presence of hyperpolactinemia or galactorrhea), dexameth-
asone (to reduce adrenal androgen production), insulin
sensitizers (to treat hyperinsulinemia), oral contraceptives
(for pretreatment suppression of LH), pulsatile GnRH (to
preserve physiologic interactive feedback), and extended
doses of CC (3). However, their usefulness is limited to
specific abnormalities, because many women with CC fail-
ure do not present with any overt signs of a treatable
disorder (4).