The results of the study showed a higher cumulative ovulation rate and a higher cumulative live birth rate in patients receiving letrozole, with no significant differences in the overall birth defect rate, miscarriage rate, or twin pregnancy rate between the two groups. Side effects were more common in clomiphene-induced hot flashes and in letrozole-induced malaise and dizziness, with no significant differences in other adverse effects between the two groups. 1. Weight loss, exercise, and lifestyle changes have been shown to be effective in restoring ovulatory cycles and enabling successful pregnancy in overweight patients with PCOS and should be the first-line option for these patients (II-3A). Morbidly obese patients should seek expert opinion regarding the risk of pregnancy (III-A).2. Clomiphene has been shown to be effective in promoting ovulation in patients with PCOS and should be considered first-line therapy. Patients should be informed of the increased risk of multiple pregnancies with clomiphene ovulation (I-A). 3. Compared with clomiphene alone, metformin combined with clomiphene may increase ovulation rate and pregnancy rate but not significantly increase live birth rate (I-A). Clomiphene-resistant patients who are older and abdominally obese may be treated with additional metformin. (I-A) 4. Gonadotropins should be the second-line treatment for fertility in anovulatory PCOS patients. Treatment requires ultrasound and laboratory monitoring. High cost, as well as the risk of multiple pregnancies and ovarian hyperstimulation syndrome are disadvantages of treatment. (II-2A) 5. Patients with clomiphene-resistant PCOS may be considered for laparoscopic ovarian perforation, especially if other laparoscopic indications for surgery are available (I-A). Surgical risks need to be considered in these patients. (III-A) 6. In vitro fertilization is recommended in patients with polycystic ovary syndrome who have failed gonadotropin therapy or in the presence of other indications for IVF. (II-2A).