Purpose of therapy	Drug	Dosage range	Side effects and warnings*	Comments	Cost†
Ovulation induction and pregnancy	Clomiphene citrate (Clomid)	50 to 100 mg per day on cycle days 5 through 9	Multiple births, hot flushes, ovarian hyperstimulation, ocular toxicity	75 percent effective in inducing ovulation, but only 30 to 40 percent effective for facilitating pregnancy	$44 to 88 (34 to 68) per month
	Follicle-stimulating hormone: follitropin alpha (Gonal-F)	75 to 300 IU per day SC; maximum of 10 days	Multiple births (high order), ovarian hyperstimulation, pulmonary or vascular problems	Administer hCG just before ovulation (1 day after last follitropin alpha dose).	80 to 315 per day
Hyperandrogenism, hirsutism, acne and dysmenorrhea	Combination oral contraceptive pills such as ethinyl estradiol with norgestimate (Ortho-Cyclen)	One tablet per day for 21 days followed by a 7-day pill-free interval	Gastrointestinal distress, breast tenderness	Least androgenic progestin component preferred; avoid norgestrel and levonorgestrel	28 per month
Hirsutism	Spironolactone (Aldactone)	50 to 200 mg per day	Hyperkalemia (rare), potential abnormal sexual differentiation of a male fetus	Irregular bleeding may occur; no FDA labeling for treatment of hirsutism	24 to 81 per month
Possible treatment of hyperinsulinemia, hyperandrogenism, ovulation and cardiovascular risks	Metformin (Glucophage)	500 mg twice daily 850 mg twice daily 850 mg three times daily (maximum dosage)	Gastrointestinal distress, unpleasant metallic taste, lactic acidosis (rare; mortality rate of nearly 50 percent), numerous drug interactions	Insulinemia, androgenemia, resumption of ovulation; pregnancy category B; no FDA labeling for treatment of polycystic ovary syndrome	36 to 92 per month
Prevention of endometrial hyperplasia	Leuprolide (Lupron)	3.75 mg IM per month for up to 6 months or 11.25 mg IM every 3 months (depot form)	Hot flushes, decreased bone mineral density, atrophic vaginitis	Pregnancy category X; use with caution for short periods because of hypoestrogenemic effects; FDA labeling for treatment of endometriosis	485 per month1,455 for 3 months
	Medroxyprogesterone (Provera)	5 to 10 mg per day for 10 days in each month	Nausea, abdominal pain, weight gain, acne, hirsutism	Pregnancy category X	7 to 8 per 10-day course