***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 
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    ***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 OBJECTIVE To compare the hormonal-metabolic profiles and reproductive outcomes in clomiphene-resistant patients with polycystic ovary syndrome and insulin resistance between women receiving metformin and those undergoing laparoscopic ovarian drilling . METHODS A total of 110 eligible participants were r and omly allocated to diagnostic laparoscopy plus metformin therapy ( group 1 , n=55 ) or laparoscopic ovarian drilling ( group 2 , n=55 ) . The t test was used for mean comparisons of hormonal-metabolic parameters and OGTT values before and after treatment . The chi(2 ) test was used for comparisons of ovulation , pregnancy , and abortion rates . RESULTS Groups 1 and 2 showed a significant decline in testosterone , insulin-like growth factor-1 ( P<0.001 vs P<0.001 ) , and luteinizing hormone ( P<0.05 vs P<0.001 ) , while the glucose to insulin ratio was significantly increased ( P<0.001 vs P<0.05 ) compared with baseline . Group 2 patients had more regular cycles and higher rates of ovulation and pregnancy compared with group 1 : 76.4 % [ 42/55 ] vs 58.2 % [ 32/55 ] , P<0.04 ; 50.8 % [ 131/258 ] vs 33.5 % [ 94/281 ] , P<0.001 ; and 38.2 % [ 21/55 ] vs 20.0 % [ 11/55 ] , P<0.03 , respectively . The difference in the early abortion rate between the groups was not statistically significant . CONCLUSION Although metformin results in a better attenuation of insulin resistance , laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy The aim of the present study was to compare the reproductive outcomes of letrozole and laparoscopic ovarian drilling ( LOD ) in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome ( PCOS ) . A total of 141 women with CC-resistant PCOS were enrolled and r and omly allocated into groups A and B. Group A ( n=71 ) received 2.5 mg letrozole from days 5 to 10 of menses for up to six cycles , and group B ( n=70 ) underwent LOD . A 6-month follow-up was performed . No statistically significant difference was found in the baseline clinical characteristics and the major serum hormone profiles , including luteinizing hormone , follicle-stimulating hormone , estradiol and free testosterone , between the two groups . Women receiving letrozole had a lower rate of spontaneous abortion ( 6.9 vs. 15.8 % ) and higher clinical pregnancy ( 40.8 vs. 27.1 % ) and live birth ( 38.0 vs. 22.9 % ) rates ; however , the differences were not statistically significant . Letrozole had superior reproductive outcomes compared with LOD in women with CC-resistant PCOS ; therefore , letrozole could be used as the first-line treatment for women with CC-resistant PCOS 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 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 OBJECTIVE To assess pain control in patients with polycystic ovary syndrome ( PCOS ) who are undergoing ovarian drilling during minilaparoscopy under local anesthesia and conscious sedation  and to evaluate the efficacy of this protocol compared with the traditional approach in terms of operative and discharge times , subsequent ovulation , and pregnancy . DESIGN Prospect i ve r and omized study . SETTING University hospitals and private day-surgery unit . PATIENT(S ) Sixty-two infertile women with PCOS . INTERVENTION(S ) Group A underwent minilaparoscopic ovarian drilling under local anesthesia and conscious sedation . Group B ( control group ) was treated with traditional ovarian drilling by laparoscopy under general anesthesia . MAIN OUTCOME MEASURE(S ) Intraoperative pain score in group A. Hormonal profile before and after surgery , operative and discharge times , postoperative analgesic requirements , and reproductive follow-up in both groups . RESULT ( S ) Group A showed a good intraoperative pain score . The hormonal profile after surgery did not differ between groups A and B. Operative times were also similar for both groups . The number of patients discharged within 2 hours after surgery was significantly higher in group A. The need for postoperative analgesics was significantly higher in group B. No statistically significant differences were noted between the groups in terms of pregnancy and ovulation rates . CONCLUSION ( S ) Intraoperative and postoperative local anesthesia plus conscious sedation allows outpatient bilateral ovarian drilling by minilaparoscopy to be performed without general anesthesia . The high pregnancy rates , the simplicity of the method , and the faster discharge time offer a new option for patients with PCOS who are resistant to clomiphene citrate . Moreover , ovarian cauterization can be performed simultaneously with a diagnostic minilaparoscopy and integrated into the infertility workup of these patients This study was conducted to evaluate the efficacy of metformin compared with ovarian drilling in the treatment of clomiphene citrate ( CC ) resistant women with polycystic ovary syndrome . A total of 161 infertile , CC-resistant women with PCOS aged 22 - 34 years ( mean 25.5 ± 4.4 ) were evaluated prospect ively during the period between January 2000 and December 2001 . Patients were allocated into two groups ; group 1 includes 64 women who received metformin , 850 mg twice daily throughout the cycle , and group 2 which includes  97 women who underwent laparoscopic ovarian drilling .  If spontaneous ovulation or pregnancy was not achieved within 3 months after treatment , CC was added with increments of 50 mg ( up to 150 mg/day ) for both groups . Clinical and menstrual characteristics in addition to the hormonal profile were evaluated before and after the treatment . There were no significant differences between the two groups in terms of age , body weight , BMI , duration of infertility and serum hormone levels ( and rogens , gonadotrophins , insulin ) before starting the treatment . A significant improvement in the regularity of menstrual cycles ( P<0.05 ) and a significant reduction in the serum levels of testosterone ( P<0.01 ) , and rostenedione ( P<0.01 ) , DHEAS ( P<0.05 ) , LH ( P<0.01 ) and LH : FSH ratio ( P<0.05 ) were noted after the treatment . There were no significant differences between the metformin group compared with the drilling group in the rates of ovulation ( 79.7 % vs. 83.5 % ) and pregnancy ( 64.1 % vs. 59.8 % ) . It is concluded that CC-resistant patients with polycystic ovary syndrome can be treated effectively either by metformin or by laparoscopic ovarian drilling . Menstrual cycle pattern and the rates of ovulation and pregnancy are improved significantly , due most probably to the significant decrease in the levels of and rogens and luteinising hormone Purpose To compare the effect of letrozole with laparoscopic ovarian diathermy ( LOD ) for ovulation induction in clomiphene citrate ( CC ) resistant women with polycystic ovary syndrome ( PCOS ) . Methods Two hundred and sixty anovulatory women with CC-resistant PCOS were selected in this r and omized controlled trial . Group A ( n = 128 ) received 2.5 mg letrozole daily for 5 days for up to six cycles . Group B ( n = 132 ) underwent LOD with 6 months follow-up . Outcome measures were ovulation rate , midcycle endometrial thickness , pregnancy , miscarriage and live birth rates . Results Ovulation occurred in 335/512 cycles ( 65.4 % ) in letrozole group and 364/525 cycles ( 69.3 % ) in LOD group without significant difference between both groups . Resumption of regular menstruation was similar in both treatment groups . A significant increase in midcycle endometrial thickness was observed in letrozole group ( 8.8 ± 1.1 mm vs. 7.9 ± 1.2 mm ) ( P < 0.05 ) . Pregnancy rate was similar in both groups ( 15.6 vs. 17.5 % ) . There were no statistical significant differences as regards miscarriage and live birth rates between both groups . No multiple pregnancy or ovarian hyperstimulation occurred in either group . Conclusion Letrozole and LOD are equally effective for inducing ovulation and achieving pregnancy in CC-resistant P 
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AUTHORS ' CONCLUSIONS There was no clear evidence that LOD  improves menstrual regularity or the and rogenic symptoms of PCOS , compared to most of the medical treatments used in the included studies .
LOD was associated with fewer gastrointestinal side effects compared to metformin and clomiphene .
There was also no clear evidence of different effectiveness between types of LOD , except that LOD with four to five punctures per ovary may be more effective than two or fewer punctures .
However , gonadotrophins are seldom used for this indication