title: Laparoscopic ovarian diathermy after clomiphene failure in polycystic ovary syndrome: is it worthwhile? A randomized controlled trial.
abstract: OBJECTIVE
  Laparoscopic ovarian diathermy (LOD) represents a successful treatment option for women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). However, in case of CC failure PCOS, LOD offers several theoretical advantages. This study was conducted to compare the efficacy of LOD versus continuation of CC up to six further cycles in PCOS patients who failed to achieve pregnancy despite the previous successful CC induced ovulation.
  
  
  METHODS
  One hundred and seventy six infertile women with CC failure PCOS were selected in this randomized controlled trial. Patients (n = 87) underwent LOD with 6 months follow-up or received CC (n = 89) up to six cycles. Outcome measures were; clinical pregnancy rate, midcycle endometrial thickness, cycle length, miscarriage and live birth rates.
  
  
  RESULTS
  The clinical pregnancy rate per patient and the cumulative pregnancy rate after six cycles were comparable in both groups (39 vs. 33.7% and 47 vs. 39.2%, respectively). Four twin pregnancies occurred in CC group and none in LOD group and the difference was statistically significant (p < 0.05). No significant difference in midcycle endometrial thickness was observed (8.8 ± 1.2 mm vs. 7.7 ± 1.1 mm). Improvement in cycle length, miscarriage and live birth rates were comparable in both groups. No cases of ovarian hyperstimulation syndrome occurred in either group.
  
  
  CONCLUSIONS
  LOD during the 6 months follow-up period and CC for up to six further cycles are equally effective for achieving pregnancy in CC failure PCOS patients.
authors.affiliation: Department of Obstetrics & Gynecology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. hatem_ah@hotmail.com
authors.forename: Hatem
authors.initials: H
authors.lastname: Abu Hashim
authors.forename: Osama
authors.initials: O
authors.lastname: Foda
authors.forename: Essam
authors.initials: E
authors.lastname: Ghayaty
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elawa
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use; D003972:Diathermy / Q000379:methods*; D004717:Endometrium / Q000187:drug effects; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000628:therapy*; D010535:Laparoscopy / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene