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Endocrine and reproductive effects of polycystic ovarian syndrome. Management strategies for overweight and obese women with polycystic ovarian syndrome (PCOS) who desire fertility should include weight loss. Even a small reduction in body weight can improve ovulatory function and pregnancy rate and reduce adverse obstetric outcomes. New data suggest that letrozole should be considered as the new first-line medical treatment of anovulatory infertility in PCOS over clomiphene citrate. Second-line treatments for anovulatory infertility include in vitro fertilization, gonadotropins, or ovarian drilling.