A 30-Year-Old Nulligravid Woman and Her 31-Year-Old Husband Come to the Office

A 30-year-old nulligravid woman and her 31-year-old husband come to the office for an infertility evaluation.  They have been unable to conceive despite 2 years of unprotected intercourse.  The patient has had irregular periods since menarche, ranging between 30 and 70 days each cycle.  Her BMI is 34 kg/m².  Examination shows a small, anteverted uterus and bilateral enlarged ovaries.  A urine pregnancy test is negative.  The patient is prescribed letrozole for ovulation induction therapy.  Which of the following is the mechanism of action of this medication?

A) Activation of pituitary dopamine receptors
B) Depletion of hypothalamic estrogen receptors
C) Increased proliferation of endometrial tissue
D) Inhibition of hypothalamic gonadotropin secretion
E) Suppression of ovarian estradiol production

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