We thank Dr Siristatidis and colleagues for their interest in our clinical opinion on ovulation induction in polycystic ovary syndrome and for taking the time to raise interesting questions. This opinion was specifically directed at helping general obstetricians and gynecologists and not at the specialist reproductive endocrinology and infertility specialist. However, we have highlighted the potential complication and strategies to reduce multiple pregnancies under “Complications of ovulation induction.” The opinion is focused on ovulation induction in women with polycystic ovary syndrome; therefore, we did not include management of other factors such as male factor infertility that may coexist in couples struggling with infertility. We have mentioned in the last paragraph of the introduction that consideration be given to evaluating the male partner as well as the uterine cavity and fallopian tubes.

The authors raise an important question regarding endometrial thickness. There are multiple studies in the literature attesting to a graded increase in pregnancy rates with increasing endometrial thickness measured by sonography. At the same time, endometrial thickness is not a good predictor of pregnancy either. Therefore, we believe that it is not the most critical factor for the general obstetrician and gynecologist making the first attempt at achieving pregnancy in the anovulatory woman.

As the authors of the letter acknowledge, the use of dexamethasone as an adjunct agent in combination with selective estrogen receptor modulators has been addressed by us under the heading “Selective estrogen receptor modulators.” As mentioned earlier, this opinion was focused on the general obstetrician and gynecologist and we did not discuss use of gonadotropins in anovulatory patients. Use of gonadotropins requires intense monitoring and is best performed by specialist reproductive endocrinology and infertility physicians.

We agree with the comment that research is needed to elucidate the molecular mechanisms involved in ovulation and endometrial health.