Snapshot A 26-year-old woman presents for the evaluation of infertility. She has been trying to conceive for over one year. She reports to missing menstrual periods and has been frequently shaving the hairs on her upper lip, chin, and chest. The patient's height is 5'1" (155 cm) and weighs 169 lbs (76.7 kg). On physical exam, she has acne on the face with hair above the lip and chin. The patient is educated about the diagnosis and counseled on healthy dieting and exercise. She is also prescribed clomiphene citrate to treat her infertility. (Polycystic ovarian syndrome) Introduction Mechanism of action the precise mechanism of action is unclear; however, clomiphene acts on hypothalamic estrogen receptors thus impairing the normal estrogenic negative feedback which results in increased pulsatile gonadotropin releasing hormone (GnRH) subsequently leading to increased follicle-stimulating hormone (FSH) and luteinizing hormone (LH) Clinical use first-line treatment to treat infertility in polycystic ovarian syndrome (PCOS) infertility Toxicity hot flashes multiple pregnancies ovarian enlargment visual disturbances