***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 BACKGROUND Recombinant FSH ( rFSH ) is the current st and ard treatment for ovulation induction in women with polycystic ovary syndrome ( PCOS ) that do not respond to clomiphene citrate . Ovulation induction with rFSH is known to be costly due to the necessity of daily injections and intensive monitoring . An alternative strategy , starting with electrocautery of the ovaries , may be a less costly option . METHODS An economic evaluation was set up alongside a multicentre r and omized clinical trial comparing laparoscopic electrocautery of the ovaries , followed by clomiphene citrate and rFSH when anovulation persisted , and treatment with rFSH in 168 women with clomiphene citrate-resistant PCOS . Data on re sources used for treatment and productivity loss were collected prospect ively up to an eventual ongoing pregnancy with a time horizon of 12 months . RESULTS At 12 months the ongoing pregnancy rates were 67 % for both the electrocautery strategy and rFSH treatment . Mean total costs per woman were 5308 euros for the electrocautery strategy and 5925 euros for treatment with rFSH , result ing in a mean difference of 617 ( 95 % CI : -382 euros to 1614 euros ) . CONCLUSIONS The total treatment costs up to an ongoing pregnancy are comparable for rFSH treatment and an alternative strategy starting with electrocautery . Due to a lower number of multiple pregnancies , the electrocautery strategy can be expected to result in lower total costs when costs of the delivery are included Abstract Objective : The aim of this work was to investigate the value of laparoscopic ovarian drilling ( LOD ) compared with GnRH antagonist flexible protocol combined with cabergoline ( Cb ) , as a prophylaxis against the re-development of ovarian hyperstimulation syndrome ( OHSS ) in women with clomiphene citrate-resistant polycystic ovary disease ( CCR-PCOD ) who had severe OHSS before in a previous ICSI cycle . Study design : It is a prospect i ve controlled study , where 250 CCR-PCOD women ( n = 250 ) with a history of severe OHSS before , had been recruited for the study . LOD had been performed for 120 ( n = 120 ) of the recruited women before ovarian induction , and considered as group A. GnRH antagonist ( Cetrotide 0.25 mg ) was added when a leading follicle reaches 14–16 mm combined with oral Cb in a dose 0.5 mg a day before hCG , and for 8 d for another 130 ( n = 130 ) women , and considered as group B. Pregnancy was diagnosed with BhCG level ≥25 IU/L , ± 14 d after embryo transfer , followed with transvaginal ultrasound scanning ( TVS ) 2 weeks later to confirm intra-uterine pregnancy ( IUP ) . Women were followed up weekly for 3 months for the possible development of any signs and symptoms of OHSS . Results : None of the participants in group A developed severe OHSS , and only six women ( 5 % ) developed mild to moderate OHSS . The incidence of severe OHSS was significantly higher ( n = 3 , 15 % ) in group B compared with group A ( p < .001 ) . Another ( n = 17 , 13.3 % ) women in group B developed mild to moderate OHSS . The probability of developing severe OHSS was also significantly higher in group B as well ( p = .031 ) . Pregnancy rate ( PR ) was significantly higher in group A more than group B ( 67 % versus 39 % , respectively ) , and all were single intrauterine pregnancies ( IUP ) and all developed after fresh embryo transfer ( ET ) , compared with frozen embryo transfer ( FET ) which was performed in 42 cases in group B after postponing ET due to significantly severe OHSS developed . Conclusion : LOD could be considered a good prophylactic measure against OHSS , in addition to improving the total outcome of IVF cycles in women with CCR-PCOS 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 The aim of this r and omized double-blind placebo-controlled pilot study was to evaluate N-acetyl-cysteine ( NAC ) as an adjunctive therapy following unilateral laparoscopic ovarian drilling ( LOD ) for clomiphene citrate-resistant women with polycystic ovary syndrome ( PCOS ) . A total of 60 patients with clomiphene citrate-resistant PCOS who underwent unilateral LOD were assigned r and omly to receive either NAC 1.2 g/d ( group A=30 ) or placebo ( group B=30 ) for 5 days starting at day 3 of the cycle for 12 consecutive cycles . The primary outcome was pregnancy rate ; secondary outcomes were ovulation rates , endometrial thickness and pregnancy outcome . Baseline clinical , endocrine , and sonographic characteristics were similar in the two groups . A significant increase in both ovulation and pregnancy rates was observed in the NAC group , compared with placebo [ 87 % versus 67 % ( RR 1.3 ; 95 % CI 1.2 - 2.7 ) and 77 % versus 57 % ( RR 1.4 ; 95 % CI 1.1 - 2.7 ) , respectively , P<0.01 ] . Moreover , miscarriage rates were significantly lower and live birth rates were significantly higher in the NAC group [ 8.7 % versus 23.5 % ( RR 0.4 ; 95 % CI 0.1 - 3.7 ) and 67 % versus 40 % ( RR 1.7 ; 95 % CI 0.3 - 3.5 ) , respectively , P<0.01 ] . In conclusion , NAC is a novel adjuvant therapy after unilateral LOD which might help improve overall reproductive outcome OBJECTIVE This study aim ed to compare two methods of treatment of infertility with gonadotropin with laparoscopic ovarian electrocauterization in patients with clomiphene citrate-resistant polycystic ovary syndrome ( PCOS ) . METHODS A number of 104 nulipara patients with polycystic ovary syndrome , who were resistant to clomiphene citrate  were r and omly assigned to two groups . One group received gonadotropin ; after the bleeding withdrawal and from the third day of the cycle , the injection of human menopausal gonadotropin ( HMG ) was started with 10 mg medroxy progesterone . The patients were followed with serial trans-vaginal sonographies . When the diameter of follicles reached to 18 mm , human chorionic gonadotropin ( HCG ) was prescribed . The other group was treated with laparoscopic ovarian electrocauterization under general anesthesia . If after 3 cycles , the anovulation was established with progesterone measurement , the clomiphene citrate was prescribed . Gonadotropin was administered , if the lack of ovulation persisted . RESULTS No significant difference was documented between the two groups in terms of the obesity indexes , duration of infertility , age , sonographic and laboratory findings . In the gonadotropin group , 37 cases ( 71 % ) of pregnancy occurred . The rate of pregnancy was the same in the other group consisting of 18 cases treated by electrocautery , 9 cases with cautery + clomiphene , and 10 cases with clomiphene + cautery + gonadotropin . In the group treated with gonadotropin , there were 1 triple and 4 twins pregnancies . In the group treated with ovarian electrocautery , one twin pregnancy was observed . In the group treated with gonadotropin , 2 cases of ovarian hyperstimulation syndrome , 1 case of ectopic pregnancy and 6 cases of miscarriage occurred ; the corresponding figure in the ovarian electrocautery group consisted of 5 cases of miscarriage . CONCLUSION Our findings suggest that ovarian electrocauterization is an appropriate method with good efficacy and low complication rate for infertility treatment of women with clomiphene citrate-resistant polycystic ovary syndrome 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 
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AUTHORS ' CONCLUSIONS Laparoscopic ovarian drilling with and without medical ovulation induction may decrease the live birth rate in women with anovulatory PCOS and CC resistance compared with medical ovulation induction alone .
But the sensitivity analysis restricted to only RCTs at low risk of selection bias suggests there is uncertainty whether there is a difference between the treatments , due to uncertainty around the estimate .
Moderate- quality evidence shows that LOD probably reduces the number of multiple pregnancy .
Low- quality evidence suggests that there may be little or no difference between the treatments for the likelihood of a clinical pregnancy , and there is uncertainty about the effect of LOD compared with  ovulation induction alone on miscarriage .
LOD may result in less OHSS .
The quality of evidence is insufficient to justify a conclusion on live birth , clinical pregnancy or miscarriage rate for the analysis of unilateral LOD versus bilateral LOD .