***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: 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 STUDY OBJECTIVE To analyze the efficacy of laparoscopic ovarian drilling using monopolar diathermy in women with anovulatory infertility with clomiphene-resistant polycystic ovary syndrome ( PCOS ) , and to determine factors influencing pregnancy rate and pregnancy outcomes . DESIGN Prospect i ve study ( Canadian Task Force classification II-2 ) . SETTING Infertility clinic in a tertiary referral teaching hospital . PATIENTS Seventy women with clomiphene-resistant PCOS . INTERVENTION Laparoscopic ovarian drilling , with follow-up for 4.5 years . MEASUREMENTS AND MAIN RESULTS Follow-up data , which were available for 66 patients , showed a spontaneous ovulation rate of 81.8 % , cumulative ovulation rate of 93.9 % , and pregnancy rate of 54.5 % . Successful pregnancies were commonly complicated by gestational diabetes mellitus and pregnancy-induced hypertension . Pregnancy rates ( 23.5 % ) were low in women with tuboperitoneal disease and those whose partners had subfertile male factors . Statistical evaluation using a proportion test ( Z test ) and multivariable logistical regression analysis showed that elevated luteinizing hormone levels ( > 10 IU/L ) , short duration of infertility ( <3 yrs ) , and absence of preexisting tubal disease were associated with better outcomes . CONCLUSION Laparoscopic ovarian drilling is an effective surgical procedure in women with clomiphene-resistant PCOS 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 BACKGROUND Long-term effects of laparoscopic electrocautery of the ovaries are unknown . To study the long-term effects of laparoscopic electrocautery of the ovaries and gonadotrophins , we followed women with clomiphene-resistant polycystic ovary syndrome ( PCOS ) r and omly allocated to one of these treatments until 8 - 12 years after their initial treatment . METHODS Between February 1998 and October 2001 168 women with clomiphene citrate-resistant PCOS were included in a r and omized controlled trial comparing an electrocautery strategy to a strategy starting with rFSH . In 2009 these women were contacted about their reproductive outcome and menstrual cycle regularity . Analysis was by intention-to-treat . We compared time to conception result ing in live birth , subsequent pregnancies , ectopic and multiple pregnancies , menopause , as well as minimal and maximal menstrual cycle length . RESULTS After 8 - 12 years , the cumulative proportion of women with a first child was 86 % in women who had been allocated to electrocautery versus 81 % in women who had been allocated to immediate rFSH [ relative ratio ( RR ) : 1.1 ; 95 % confidence interval ( CI ) : 0.92 - 1.2 ] . Treatment with electrocautery result ed in a significantly lower need for stimulated cycles to reach a live birth ; 53 % after electrocautery versus 76 % after rFSH ( RR : 0.69 ; 95 % CI : 0.55 - 0.88).The cumulative proportion of women with a second child was 61 % after electrocautery versus 46 % after immediate rFSH ( RR : 1.4 ; 95 % CI : 1.00 - 1.9 ) . Overall , there were 7 twins out of 134 deliveries ( 5 % ) after electrocautery versus 10 twins out of 124 deliveries ( 8 % ) in the rFSH group ( RR : 0.65 ; 95 % CI : 0.25 - 1.6 ) . Fifty-four per cent of the women allocated to electrocautery had a regular menstrual cycle 8 - 12 years after r and omization versus 36 % in those allocated to rFSH ( RR : 1.5 ; 95 % CI : 0.87 - 2.6 ) . CONCLUSION In women with clomiphene-resistant PCOS , laparoscopic electrocautery of the ovaries is as effective as ovulation induction with FSH treatment in terms of live births , but reduces the need for ovulation induction or ART in a significantly higher proportion of women and increases the chance for a second child . Clinicians may use these data when informing clomiphene-resistant anovulatory women about treatment options Abstract Objective To compare the effectiveness of an electrocautery strategy with ovulation induction using recombinant follicle stimulating hormone in patients with polycystic ovary syndrome . Design R and omised controlled trial . Setting Secondary and tertiary hospitals in the Netherl and s. Participants 168 patients with clomiphene citrate resistant polycystic ovary syndrome : 83 were allocated electrocautery and 85 were allocated recombinant follicle stimulating hormone . Intervention Laparoscopic electrocautery of the ovaries followed by clomiphene citrate and recombinant follicle stimulating hormone if anovulation persisted , or induction of ovulation with recombinant follicle stimulating hormone . Main outcome measure Ongoing pregnancy within 12 months . Results . The cumulative rate of ongoing pregnancy after recombinant follicle stimulating hormone was 67 % . With only electrocautery it was 34 % , which increased to 49 % after clomiphene citrate was given . Subsequent recombinant follicle stimulating hormone increased the rate to 67 % at 12 months ( rate ratio 1.01 , 95 % confidence interval 0.81 to 1.24 ) . No complications occurred from electrocautery with or without clomiphene citrate . Patients allocated to electrocautery had a significantly lower risk of multiple pregnancy ( 0.11 , 0.01 to 0.86 ) . Conclusion The ongoing pregnancy rate from ovulation induction with laparoscopic electrocautery followed by clomiphene citrate and recombinant follicle stimulating hormone if anovulation persisted , or recombinant follicle stimulating hormone , seems equivalent to ovulation induction with recombinant follicle stimulating hormone , but the former procedure carries a lower risk of multiple pregnancy BACKGROUND Ovulation induction with gonadotrophins is the st and ard treatment strategy for women with clomiphene citrate (CC)-resistant polycystic ovary syndrome ( PCOS ) .  Laparoscopic electrocautery of the ovaries is an alternative treatment modality , leading to a comparable cumulative pregnancy rate . In deciding which treatment to opt for , women 's health-related quality of life ( HRQoL ) should be taken into account . METHODS A total of 168 CC-resistant women with PCOS were r and omly assigned to receive either the electrocautery strategy , entailing laparoscopic electrocautery of the ovaries followed by CC and recombinant FSH ( rFSH ) if anovulation persisted , or ovulation induction with rFSH . We assessed women 's HRQoL with the st and ard question naires Short Form-36 , Rotterdam Symptom Checklist and Center for Epidemiological Studies Depression Scale , administered before r and omization and 2 , 12 and 24 weeks thereafter . RESULTS The intention to treat analysis revealed no significant differences between the treatment groups on any of the scales at any point during follow-up . In women without an ongoing pregnancy , those treated with rFSH showed significantly more depressive symptoms than women allocated to the electrocautery strategy , with or without CC , although differences were small . CONCLUSIONS Overall , HRQoL was not affected in both groups . In women still under treatment , rFSH was slightly more burdensome for women 's HRQoL than electrocautery with or without CC This prospect i ve , r and omized study included 18 polycystic ovarian syndrome ( PCOS ) patients with severe ovarian dysfunction , who were evaluated by st and ard  clomiphene and FSH stimulation .  In this group of patients , a 6 month down-regulation with gonadotrophin-releasing hormone ( GnRH ) analogues gave outcomes similar to laparoscopic ovarian laser diathermy with respect to stimulatory outcome and pregnancy rate .  Clomiphene stimulation with 50 mg of clomiphene/day and FSH stimulation in a low-dose , step-up protocol with purified FSH did not result in oligofollicular development ; thus patients were divided into two subgroups : one subgroup received laparoscopic laser drilling and the other received 6 months of therapy with GnRH analogues plus add-back therapy after diagnostic laparoscopy . Subsequently , three cycles of low-dose , step-up stimulation with recombinant FSH were started . In both groups , approximately 30 % of cycles still remained anovulatory . In the down-regulated subgroup , this mainly happened in the first cycle . In each group , ovulation was achieved in 14 cycles , intrauterine insemination was performed , and five pregnancies were obtained . This result ed in a pregnancy rate of 36 % per ovulatory cycle in both groups . Overall , 50 % of the formerly unreactive patients in both groups overcame childlessness . In achieving this , long-term treatment with GnRH analogues was as successful as laparoscopic laser diathermy OBJECTIVE To compare the effectiveness of laparoscopic ovarian diathermy with gonadotropin ovulation induction for women with clomiphene citrate-resistant polycystic ovary syndrome . DESIGN R and omized controlled trial . SETTING A tertiary referral fertility clinic . PATIENT(S ) Women with anovulatory infertility secondary to clomiphene-resistant polycystic ovary syndrome . Inclusion criteria were age of < 39 years , body mass index of < 35 kg/ 
    Output:
    
Our result revealed that there was no evidence of a significant difference in rates of clinical pregnancy and miscarriage in women with clomiphene citrate-resistant PCOS undergoing LOD compared to the gonadotropin arm .
The decrease in multiple pregnancies rate in women undergoing LOD makes this option attractive .
The increase in live birth rate in the gonadotropin group may be because of the higher rate of multiple pregnancies in these women .