***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 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 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 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 
    Output:
    
There was no evidence of a significant difference in rates of clinical pregnancy , live birth or miscarriage in women with clomiphene-resistant PCOS undergoing LOD compared to other medical treatments .
The reduction in multiple pregnancy rates in women undergoing LOD makes this option attractive .