Nulliparous patient 26 years old, married for 5 years, known case of PCOD, has undergone complete hormonal evaluation including LH, FSH, TSH, PROLACTIN, DHEAS, TESTOSTERONE, Laparoscopic ovarian drilling and chromo perturbation done. Tubes patent Amh: 3.3 LH: 11 FSH 4 ON DAY 2 OF CYCLE, FASTING INSULIN: 15 WEIGHT 78 BMI: 26 Taking myoinositol 4 g daily since 2 months, did not respond to clomiphene, breakthrough bleeding present in stimulated cycle, next cycle stimulation was done by letrozole 5 mg, responded well, day 11 tvs revealed follicle of 22 mm, HCG 10000 given for ovulation trigger, ovulation did not occur, on day 14 cystic follicle of 3.5 cm was seen.
Kindly suggest what are the alternates to be given for ovulation trigger in next cycle, management, and prevention of unruptured follicle.
