Laparoscopic ovarian diathermy vs clomiphene citrate plus metformin as second-line strategy for infertile anovulatory patients with polycystic ovary syndrome: a randomized controlled trial.
OBJECTIVE
The purpose of this study was to compare the effectiveness of laparoscopic ovarian diathermy (LOD) vs clomiphene citrate (CC) plus metformin in infertile patients with CC-resistant polycystic ovary syndrome (PCOS).


METHODS
Fifty primary infertile patients with CC-resistant PCOS were assigned randomly to receive LOD followed by a 6-month observation (group A) or 6-cycle course of CC plus metformin (group B). Reproductive and safety outcomes were analyzed.


RESULTS
No significant difference between 2 groups in pregnancy (15/92 women [16.3%] vs 14/107 women [13.1%]; P = .521) and live-birth (13/92 women [14.1%] vs 12/107 women [11.2%]; P = .536) rates per cycle was observed. With the use of a Cox regression analysis, patients under medical treatment, compared with patients who received surgical treatment, had a relative risk of pregnancy of 1.2 (95% confidence interval, 0.61-2.44; P = .582) and a relative risk of live-birth of 1.4 (95% confidence interval, 0.63-2.96; P = .425).


CONCLUSIONS
LOD and CC plus metformin seem to be 2 effective approaches to treat infertility in patients with CC-resistant PCOS.
Palomba
Stefano
S
Department of Obstetrics and Gynecology, University Magna Graecia of Catanzaro, Catanzaro, Italy. stefanopalomba@tin.it
Falbo
Angela
A
Battista
Lucia
L
Russo
Tiziana
T
Venturella
Roberta
R
Tolino
Achille
A
Orio
Francesco
F
Zullo
Fulvio
F
D000022:Abortion, Spontaneous; D000858:Anovulation / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D015992:Body Mass Index; D002996:Clomiphene / Q000627:therapeutic use*; D003972:Diathermy; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007247:Infertility, Female / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D010535:Laparoscopy; D050498:Live Birth; D008687:Metformin / Q000627:therapeutic use*; D010053:Ovary / Q000601:surgery; D010062:Ovulation Induction / Q000379:methods; D018579:Patient Selection; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D005300:Fertility Agents, Female; D007004:Hypoglycemic Agents; D002996:Clomiphene; D008687:Metformin