Objective: To assess the effectiveness of different hormonal therapies in improving ovulation and pregnancy rates among women with PCOS. Methodology: This study investigated the impact of hormonal therapy on fertility outcomes in women diagnosed with polycystic ovary syndrome (PCOS), focusing on the effectiveness of various hormonal treatments. A total of 50 women with PCOS were enrolled and received one of four treatments: clomiphene citrate, letrozole, gonadotropins, or a combination of letrozole and metformin. The study followed a prospective observational design over a six-month period, assessing ovulation rates, pregnancy rates, and live birth outcomes. Lifestyle factors, such as body weight and insulin resistance, were also considered. Data collection included regular monitoring of ovulatory function through ultrasound and blood tests, while pregnancy outcomes were tracked through clinical follow-ups. Results: The results indicated that letrozole was more effective than clomiphene citrate, with an ovulation rate of 85% and a pregnancy rate of 60%, confirming its superiority as a first-line treatment. Gonadotropins yielded a high ovulation rate (90%) and pregnancy rate (72%) but were associated with increased risks of multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). The combination of letrozole and metformin demonstrated a high success rate in women with insulin resistance, with an ovulation rate of 88% and a pregnancy rate of 66%. Lifestyle modifications, such as weight loss, further enhanced fertility outcomes, with 75% of participants achieving pregnancy when these interventions were combined with hormonal therapy. Conclusion: This study supports the growing preference for letrozole over clomiphene citrate in treating infertility in women with PCOS, highlighting its efficacy and lower adverse effects. While gonadotropins are highly effective, they require careful monitoring due to the associated risks. The combination of letrozole and metformin presents a promising option for women with insulin resistance, underscoring the importance of addressing metabolic factors alongside reproductive challenges.