***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: 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 STUDY QUESTION Does unilateral volume-adjusted laparoscopic diathermy increase the chances of ovulation in women with polycystic ovary syndrome ( PCOS ) ? SUMMARY ANSWER Although unilateral laparoscopic ovarian drilling ( ULOD ) using adjusted thermal doses was more efficient than bilateral laparoscopic ovarian drilling ( BLOD ) using fixed doses , the chances of ovulation were improved in patients irrespective of the technique used . WHAT IS KNOWN ALREADY The adjustment of the thermal dose to ovarian volume in BLOD increases ovulation and pregnancy rates compared with fixed-dose treatment , but BLOD causes the formation of adhesions , particularly on the left ovary , and increases the risk of damage to ovarian tissue . In contrast , ULOD with a fixed thermal dose minimizes the risk of ovarian tissue damage , and can increase the activity in both right and left ovaries , although this varies in humans and in other species . STUDY DESIGN , SIZE , DURATION This prospect i ve , longitudinal , study , between September 2009 and January 2013 , included 96 infertile women with PCOS who were unresponsive to clomiphene citrate treatment and had underwent either ULOD or BLOD .  After surgery , the groups were followed up for 6 months to assess ovulatory response . PARTICIPANTS / MATERIAL S , SETTING , METHODS Patients were assigned to two groups ; one group underwent laparoscopic ovarian drilling of the right ovary alone , while both ovaries were treated in the second group . The ULOD group ( n = 49 ) received thermal doses adjusted to the volume of the right ovary ( 60 J/cm³ ) . The BLOD group ( n = 47 ) received fixed doses of 600 J per ovary , regardless of its volume . The two treatment groups were matched by the number of participants , age and baseline parameters . MAIN RESULTS AND THE ROLE OF CHANCE The ovulation rate during the first menstrual cycle after LOD was significantly higher in the ULOD group than in the BLOD group [ 73 versus 49 % ; absolute risk reduction ( ARR ) , -0.25 ; 95 % confidence interval ( CI ) , -0.44 to -0.03 ; P = 0.014 ] . Treatment  with ULOD on the right ovary significantly increased the chances of ovulation in patients with a larger right ovary compared with those who had a smaller right ovary ( 100 versus 36 % ; ARR , -0.64 ; 95 % CI , -0.84 to -0.37 ; P = 0.004 ) . Interestingly , the chances of ovulation were also significantly higher in patients in the BLOD group who had a larger right ovary compared with those who had a smaller right ovary ( 88 versus 33 % ; ARR , -0.55 ; 95 % CI , -0.73 to -0.28 ; P = 0.002 ) . The pregnancy rate was also significantly higher in patients with a larger right ovary compared with those with a smaller right ovary , regardless of the treatment group . LIMITATIONS , REASONS FOR CAUTION The 6-month follow-up was too short to demonstrate any long-term differences in the ovulation rates . Future research should therefore extend the follow-up beyond 6 months . Another limitation is that ULOD was used to treat only the right ovary . Future studies should investigate whether ULOD treatment of the larger ovary , whether left or right , would significantly increase the ovulation rate . WIDER IMPLICATION S OF THE FINDINGS This study represents an advance in the determination of the optimal laparoscopic treatment for women with PCOS , as it was shown that improved results can be achieved using less thermal energy in volume-adjusted ULOD Background Laparoscopic ovarian drilling ( LOD ) is an alternative method to induce ovulation in polycystic ovary syndrome ( PCOS ) patients with clomiphene citrate ( CC ) resistant instead of gonadotropins . This study aim ed to compare the efficacy of unilateral LOD ( ULOD ) versus bilateral LOD ( BLOD ) in CC resistance PCOS patients in terms of ovulation and pregnancy rates . Material s and Methods In a prospect i ve r and omized clinical trial study , we included 100 PCOS patients with CC resistance attending to Al-Zahra Hospital in Rasht , Guilan Province , Iran , from June 2011 to July 2012 . Patients were r and omly divided into two ULOD and BLOD groups with equal numbers . The clinical and biochemical responses on ovulation and pregnancy rates were assessed over a 6-month follow-up period . Results Differences in baseline characteristics of patients between two groups prior to laparoscopy were not significant ( p>0.05 ) . There were no significant differences between the two groups in terms of clinical and biochemical responses , spontaneous menstruation ( 66.1 vs. 71.1 % ) , spontaneous ovulation rate ( 60 vs. 64.4 % ) , and pregnancy rate ( 33.1 vs. 40 % ) ( p>0.05 ) . Following drilling , there was a significant decrease in mean serum concentrations of luteinizing hormone ( LH ) ( p=0.001 ) and testosterone ( p=0.001 ) in both the groups . Mean decrease in serum LH ( p=0.322 ) and testosterone concentrations ( p=0.079 ) were not statistically significant between two groups . Mean serum level of follicle stimulating hormone ( FSH ) did not change significantly in two groups after LOD ( p>0.05 ) . Conclusion Based on results of this study , ULOD seems to be equally efficacious as BLOD in terms of ovulation and pregnancy rates ( Registration Number : I RCT 138903291306N2 ) STUDY OBJECTIVE To evaluate fertiloscopy ovarian drilling with bipolar energy in women with clomiphene citrate-resistant polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve study ( Canadian Task Force classification II ) . SETTING University teaching hospital and private clinic . PATIENTS Eighty women with clomiphene citrate-resistant PCOS . INTERVENTION Operative transvaginal fertiloscopy with a coaxial bipolar electrode . MEASUREMENTS AND MAIN RESULTS During a mean follow-up of 18.1 months ( + /- 6.4 ) , 73 women ( 91 % ) recovered regular and ovulatory cycles . The cumulative pregnancy rate was 60 % ( 44/73 ) for spontaneous and stimulated cycles , with 39.7 % ( 29/73 ) imputed to drilling alone . The mean time to conceive was 3.9 months ( range 1 - 11.8 ) . There were eight miscarriages ( 18 % ) , and no ectopic pregnancies or multiple pregnancy . No complications occurred . CONCLUSION Ovarian drilling by transvaginal fertiloscopy with bipolar electrosurgery appears to be an effective minimally invasive procedure in patients with PCOS resistant to clomiphene citrate OBJECTIVE To evaluate a new minimally invasive surgery for treatment of the polycystic ovary syndrome ( PCOS ) in clomiphene-resistant infertile women . DESIGN Prospect i ve study . SETTING University teaching hospital . PATIENT(S ) Thirteen clomiphene citrate-resistant anovulatory women with PCOS . INTERVENTION(S ) Operative transvaginal hydrolaparoscopy ( THL ) using a coaxial bipolar electrode . MAIN OUTCOME MEASURE(S ) Feasability , ovulation rate , and pregnancy rate . RESULT ( S ) Ovarian drilling was performed by THL in all patients ; no surgical complications occurred . Mean ( + /-SD ) duration of follow-up time was 6.3 + /- 3.3 months . Six patients recovered to have regular ovulatory cycles . Six pregnancies occurred ; three were spontaneous , two occurred after stimulation and intrauterine insemination , and one occurred after IVF . The cumulative pregnancy rate was 33 % at 3 months after THL and 71 % at 6 months after THL . No miscarriages occurred . CONCLUSION ( S ) Transvaginal hydrolaparoscopy with ovarian drilling using bipolar electrosurgery appears to be an alternative minimally invasive in patients with PCOS who are resistant to clomiphene therapy Abstract Women with polycystic ovary syndrome seem to have a larger ovarian reserve . However , regardless of a greater reserve , diminished ovarian reserve has been reported after laparoscopic diathermy . The aim of this article was to determine whether the doses adjusted unilateral laparoscopic ovarian drilling with diathermy ( ULOD ) diminishes ovarian reserve to compare with bilateral laparoscopic ovarian drilling with diathermy ( BLOD ) . Ninety-six women were assigned in two groups . One group underwent ULOD receiving thermal doses ( 0–840 J per ovary ) adjusted to volume one ovary . The other group underwent BLOD receiving fixed doses ( 600 J per ovary ) . Ovarian reserve markers [ anti-Müllerian hormone ( AMH ) ; antral follicle count ( AFC ) and ovarian volume ] were measured before and after surgery ( 1 and 6 months ) . Both groups showed a decrease in AMH after surgery , but it was significantly more distinct in the BLOD versus ULOD group ( 2.0 ng/mL versus 1.3 ng/mL ; p = 0.018 ) in the first follow-up month and remained significantly different through the sixth follow-up month ( 1.9 ng/mL versus 1.15 ng/mL ; p = 0.023 ) . In contrast , in the sixth month , the ULOD versus BLOD showed a significantly greater increase AFC ( p < 0.001 ) and volume ( p = 0.013 ) . Our findings evidence d that the dose-adjusted unilateral diathermy ( 60 J/cm3 ) does not have significant and long-term effects on ovarian reserve . Chinese abstract 患有多囊卵巢综合征的妇女似乎具有更多的卵巢储备，然而也有腹腔镜透热打孔术后卵巢储备功能降低的报道。本篇文章的目的为探究与双侧腹腔镜下卵巢打孔术(BLOD)相比，调整透热剂量单侧腹腔镜下卵巢打孔术(ULOD)对卵巢储备降低是否有影响。96名妇女被分为两组，一组接受了根据其一侧卵巢体积所调整透热剂量的ULOD（0 - 840J每卵巢），另一组接受了固定透热剂量的BLOD（600J每卵巢）。在术前和术后（1个月及6个月）均测定了卵巢储备指标[抗苗勒氏管激素（AMH）；窦卵泡计数（AFC）和卵� 
    Output:
    
Conclusions After carefully weighing up the well-known benefits of BLOD against a potential risk to ovarian reserve , clinicians could be advised to offer the fixed-dose ULOD to their infertile patients with clomiphene-resistant PCOS .