Background
The use of gonadotrophins as a first‐line treatment for anovulatory infertility has been limited by a perception of a risk of multi‐fetal gestation and ovarian hyperstimulation syndrome (OHSS). However, it has recently been recognised as an acceptable first‐line treatment if appropriate monitoring is performed.

Aims
To determine the cumulative live birth rate, incidence of multiple gestation, cycle cancellation rate and incidence of OHSS for therapy‐naïve anovulatory women undergoing ovulation induction with gonadotrophins.

Materials and Methods
A prospective observational study of 258 patients undergoing ovulation induction with a ‘low‐dose step‐up’ protocol was performed over a three‐year period across two fertility centres (40% of patients were currently or recently prescribed metformin).

Results
Twenty‐six percent of patients required concurrent use of luteinising hormone. The cumulative pregnancy and live birth rates were 22.5% and 18.2%, 40.3% and 34.5%, 47.7% and 41.1% after completion of the first, second and third cycles of stimulation, respectively, with a median duration of stimulation of 15 days. No patients developed OHSS and 10.5% of cycles were cancelled due to an excessive or no follicular response. The multiple pregnancy rate was 2%. The cumulative pregnancy rate was reduced for women over 35 years of age (23.8 vs 55.3%, P = 0.006) and for women with a body mass index greater than 25 kg/m2 (40.6 vs 56.7%, P = 0.027).

Conclusions
This study demonstrated that ovulation induction with gonadotrophin therapy, in the context of appropriate monitoring, is a safe and effective treatment for young therapy‐naïve patients with anovulatory infertility.