A randomized controlled trial of laparoscopic ovarian diathermy versus gonadotropin therapy for women with clomiphene citrate-resistant polycystic ovary syndrome

Objective: To compare the effectiveness of laparoscopic ovarian diathermy with gonadotropin ovulation induction for women with clomiphene citrate-resistant polycystic ovary syndrome. Design: Randomized controlled trial. Setting: A tertiary referral fertility clinic. Patient(s): Women with anovulatory infertility secondary to clomiphene-resistant polycystic ovary syndrome. Inclusion criteria were age of <39 years, body mass index of <35 kg/m(2) failure to ovulate with 150 mg of clomiphene citrate for 5 days in the early follicular phase, > 12 months of infertility, and no other causes of infertility. Intervention(s): Laparoscopic ovarian diathermy versus three cycles of urinary or recombinant gonadotropins. Main Outcome Measure(s): Cumulative pregnancy and miscarriage rates. Result(s): Cumulative pregnancy rates were 28% at 6 months for laparoscopic ovarian diathermy and 33% for three cycles of ovulation induction with gonadotropins. There were three miscarriages in each group. Women in the laparoscopic ovarian diathermy arm of the study had four additional spontaneous pregnancies 6 to 12 months after surgery. Conclusion(s): There was no statistically significant difference in pregnancy or miscarriage rates during the 6-month follow-up period or the three cycles. Laparoscopic ovarian diathermy is a safe and effective alternative to ovulation induction with gonadotropins.