***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM To evaluate the effects of metformin on insulin resistance , and rogen concentration , ovulation rates and pregnancy rates in infertile women with polycystic ovary syndrome ( PCOS ) . METHODS Forty-two infertile women with PCOS were selected in this r and omized clinical study . Basal steroid and gonadotropin levels were measured , and oral glucose tolerance test ( OGTT ) was performed . The patients were r and omly divided into group 1 ( n = 21 ) and group 2 ( n = 21 ) . Group 1 patients were treated with laparoscopic ovarian drilling ( LOD ) . Group 2 patients underwent laparoscopic ovarian drilling ( LOD ) and received 1700 mg per day of metformin for 6 months . LOD was performed in women with PCOS using a unipolar electrode . Serum progesterone ( P ) level > 5 ng/mL was considered as a confirmation of ovulation . Ovulation and pregnancy rates were determined after six cycles . RESULTS Serum and rogens and insulin response to OGTT decreased significantly after metformin therapy . Mean serum P levels and endometrial thickness were significantly higher in cycles treated with metformin plus LOD ( 34.6 + /- 25.4 ng/mL , 8.4 + /- 1.1 mm ) than in those treated with LOD alone ( 26.2 + /- 24.7 ng/mL , 7.9 + /- 2.8 mm ) ( P < 0.05 ) . The ovulation ( 56 of 65 cycles , 86.1 % vs 29 of 65 cycles , 44.6 % ) and pregnancy rates ( nine of 21 women , 47.6 % vs four of 21 women , 19.1 % ) were significantly higher in group 2 than in group I. CONCLUSIONS Metformin improves insulin resistance , reduces and rogen levels and significantly increases the ovulation and pregnancy rates in infertile women , following LOD Laparoscopic Nd-YAG laser photocoagulation of the ovaries was performed in 40 anovulatory women with clomiphene citrate-resistant polycystic ovary disease . Following this procedure , the subjects were r and omly assigned to have either a second-look laparoscopy with lysis of adhesions within 3 - 4 weeks of the initial laparoscopy ( N=19 ) or expectant management ( N=20 ) . One patient assigned to the laparoscopy group refused the procedure . Minimal and mild adhesions that did not distort the normal tubo-ovarian relationship were encountered in 13 patients ( 68 % ) in the second-look laparoscopy group ; these adhesions were easily lysed using sharp or blunt dissection . The pregnancy rates over 6 months were similar in the two groups ( 47 % in the second-look group and 55 % in the expectant-management group ; P>.05 ) . These data suggest that early laparoscopic lysis of adhesions does not improve short-term conception rates following laparoscopic Nd-YAG laser photocoagulation of polycystic ovaries Objectives Laparoscopic ovarian drilling ( LOD ) has been put forward as the treatment of choice in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome ( PCOS ) , with tubo-ovarian adhesion formation as the major disadvantage . Our study proposed to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in terms of ovulation and pregnancy rate with the expected advantage of decreasing postoperative adhesion rate and change in fimbiro ovarian relationship with unilateral drilling . Methods This prospect i ve r and omized study included 44 patients with anovulatory infertility due to PCOS . Twenty-two patients underwent unilateral ovarian drilling  in group-I and 22 patients underwent bilateral ovarian drilling in group-II between June 2005 and June 2007 . The number of drilling site in each ovary was limited to five . The clinical and biochemical response , ovulation and pregnancy rates over a follow-up period of 1 year were compared . Tubo-ovarian adhesion rate was compared during cesarean section or during repeat laparoscopy . Results There was no statistical difference between the two groups in terms of clinical and biochemical response , ovulation rate and pregnancy rate . Postoperatively , tubo-ovarian adhesions could be assessed in 36.3 % of the patients and no adhesions were found in a single case in either group . Conclusion Unilateral drilling cauterization of ovary is equally efficacious as bilateral drilling in inducing ovulation and achieving pregnancy .  Unilateral ovarian drilling may be a suitable option in clomiphene citrate resistant infertility patient of PCOS which can replace bilateral ovarian drilling with the potential advantage of decreasing the chances of adhesion formation Objective : We compared 12-month pregnancy and live birth rates in patients with polycystic ovarian disease undergoing 5- , 10- , and 15-point laparoscopic ovarian electrocauterization .  Methods : This was a prospect i ve , r and omized study performed at the Dabirashrafi Fertility and Endoscopy Research Center , Tehran , Iran . The study included 187 patients with polycystic ovarian disease who were r and omly assigned to 3 groups . Group I comprised 67 patients whose ovaries received 5-point electrocauterization . Group II comprised 57 patients whose ovaries received 10-point electrocauterization . Group III comprised 63 patients whose ovaries received 15-point electocauterization . Laparoscopic ovarian electrocauterization with a unipolar current was used . The main outcome measures were 12-month pregnancy and live birth rates . Results : Patients were homogeneous for age , body mass index , and type and duration of infertility . Twenty pregnancies result ed in Group I , with a pregnancy rate of 29.9 % ( 20/67 ) and a live birth rate of 20.9 % ( 14/57 ) . Eighteen pregnancies result ed in Group II , with a pregnancy rate of 31.6 % ( 18/57 ) , and a live birth rate of 28.1 % (16/57).Thirty-three pregnancies result ed in group III , with a pregnancy rate of 52.4 % ( 33/63 ) , and a live birth rate of 47.6 % ( 30/63 ) . Comparison of Group III with Groups I and II revealed a statistically significant increase in pregnancies ( P=0.016 ) and live birth rates ( P=0.004 ) . Conclusion : We recommend 15-point electrocauterization of ovaries in patients with polycystic ovarian disease In this prospect i ve , r and omized , controlled clinical study , 21 women underwent a second-look laparoscopy 2 - 11 weeks after st and ardized laparoscopic electrosurgical treatment for polycystic ovarian syndrome ( PCOS ) . Following bilateral ovarian treatment , one ovary was r and omly chosen to have Interceed applied to its surface using a specially design ed applicator , with the other ovary serving as a control . Peri-adnexal adhesions of significant extent and severity developed in 57 % of the women and 38 % of the adnexa . The incidence of adhesions on the Interceed-treated side was 43 % , while on the control side it was 33 % . In addition , the extent and severity of the adhesions appeared to be similar on the Interceed-treated and control side . However , larger numbers would be required to determine statistically the effects of Interceed on de-novo adhesion formation after laparoscopic electrosurgical treatment of PCOS , as described here Objectives Rosiglitazone , an insulin sensitizing agent is used currently in women with clomiphene citrate ( CC ) resistant polycystic ovarian syndrome ( PCOS ) . Our study proposed to compare the efficacy of rosiglitazone and CC with laparoscopic ovarian drilling ( LOD ) and CC in terms of biochemical effects , ovulation rate and pregnancy rate in patients of PCOS resistant to CC . Methods This prospect i ve r and omised trial included 43 patients of PCOS resistant to CC . Twenty-two women were assigned to the rosiglitazone ( 4 mg twice daily ) and CC group and other 21 patients underwent unilateral LOD and then received CC and multivitamins . The treatment continued for six cycles in both the groups . The biochemical response , ovulation rate and pregnancy rate over a follow up period of 6 months were compared . Results Treatment with rosiglitazone and CC or LOD and CC result ed in increased ovulation ( 80.8 vs. 81.5 % ) and pregnancy ( 50 vs. 42.8 % ) , respectively . There was no statistical difference between the two groups in terms of biochemical response , ovulation rate and pregnancy rate . Conclusion To avoid the risk of adverse effects of LOD preference may be given to the use of rosiglitazone and CC therapy in patients of PCOS resistant to CC Fifty women with polycystic ovaries took part in a prospect i ve r and omized study . All women required treatment by in-vitro fertilization ( IVF ) for reasons other than anovulation . They had all previously undergone ovarian stimulation with gonadotrophin therapy which had failed to result in pregnancy or had been ab and oned due to high risk of developing ovarian hyperstimulation syndrome ( OHSS ) . Twenty-five women were treated by long-term pituitary desensitization followed by gonadotrophin therapy , oocyte retrieval and embryo transfer ( group 1 ) . Twenty-five women underwent laparoscopic ovarian electrocautery after pituitary desensitization followed by gonadotrophin therapy , oocyte retrieval and embryo transfer ( group 2 ) . A significantly higher number of women in group 1 had to have the treatment cycle ab and oned due to impending or actual OHSS , determined by endocrine and clinical findings . In addition , the development of moderate or severe OHSS in completed cycles was higher in group 1 . The pregnancy rate and miscarriage rates in the two treatment groups were similar . The authors propose that laparoscopic ovarian electrocautery is a potentially useful treatment for women who have previously had an IVF treatment cycle cancelled due to risk of OHSS or who have suffered OHSS in a previous treatment cycle BACKGROUND Laparoscopic ovarian diathermy ( LOD ) is currently accepted as a successful second-line treatment for ovulation induction ( OI ) in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome ( PCOS ) . The aim of this study was to test the hypothesis that LOD may be superior to CC as a first-line treatment . METHODS The study included 72 anovulatory women with PCOS who were r and omized to LOD ( n = 36 ) or CC ( n = 36 ) . Women who remained anovulatory after LOD were offered CC . Similarly , women receiving CC who failed to ovulate or conceive were offered LOD .  Pregnancy rates were compared between the two groups using chi(2 ) and odds ratio with 95 % confidence interval ( OR , 95 % CI ) . RESULTS After r and omization , six women conceived before starting treatment and another patient postponed treatment . The remaining 65 women received the treatment ( 33 underwent LOD and 32 received CC ) . After the primary treatment , more pregnancies ( 44 % ) occurred in women receiving CC than in those undergoing LOD ( 27 % ) , although the difference did not reach statistical significance [ P = 0.13 , OR 2.1 ( 0.7 - 5.8 ) ] . After adding the second treatment , the pregnancy rate was still higher , but to a less extent , in the CC group [ 63 % versus 52 % , P = 0.2 , OR 1.6 ( 0.6 - 4.2 ) ] . CONCLUSIONS LOD is not superior to CC as a first-line method of OI in women with PCOS . The trial is registered with Clinical Trials.gov with an identifier number NCT00220545 The diagnostic criteria used to identify patients suffering from polycystic ovary syndrome remain controversial . The present prospect i ve longitudinal follow-up study was design ed to identify whether certain criteria assessed during st and ardized initial screening could predict the response to ovulation induction with clomiphene citrate ( CC ) in 201 patients presenting with oligomenorrhea or amenorrhea and infertility .  Serum FSH levels were within the normal range ( 1 - 10 IU/L ) , and all patients underwent spontaneous or progestin-induced withdrawal bleeding . Initial CC doses were 50 mg daily for 5 days starting on cycle day 3 . In the case of an absent response , doses were increased to 100 and 150 mg daily in subsequent cycles . First ovulation with CC was used as the end point . After a complete follow-up ( in the case of a nonresponse , at least 3 treatment cycles with daily CC doses up to 150 mg ) , 156 patients ( 78 % ) ovulated . The free and rogen index ( FAI = testosterone/sex hormone-binding globulin ratio ) , body mass index ( BMI ) , cycle history ( oligomenorrhea vs. amenorrhea ) , serum and rogen ( testosterone and /or and rostenedione ) levels , and mean ovarian volume assessed by transvaginal sonography were all significantly different ( P < 0.01 ) 
    Output:
    
There was no evidence of a difference in the live birth rate and miscarriage rate in women with clomiphene-resistant PCOS undergoing LOD compared to gonadotrophin treatment .
The reduction in multiple pregnancy rates in women undergoing LOD makes this option attractive .