Table 4 List of RRM medications used

Letrozole 2.5 mg

Follicle stimulation to improve follicle function. Titrate dose from 12.5 mg to 17.5 mg for 1–3 days, starting on day 3 of cycle. Aim to produce one follicle

HCG 10,000 iu

Bolus HCG mid cycle timed with positive LH surge, helps follicle to rupture

Cyclogest 400 mg

Taken vaginally for 10 nights from day 3 after ovulation to improve progesterone levels in the luteal phase of the cycle

Prednisolone 5 mg

Combined with letrozole, to improve follicle function in resistant cases

Metformin 500 mg

2–3 times daily, to treat insulin resistance and improve follicle function

Myoinositol 2000 mg

2 times daily, to treat insulin resistance and improve follicle function

Levothyroxine 25–75 mcg

To treat borderline underactive thyroid. Aim to keep TSH 1–2 IU

Naltrexone

To treat clinical low endorphins presenting with PMS, fatigue, and low mood