Laparoscopic ovarian diathermy vs clomiphene citrate plus metformin as second‐line strategy for infertile anovulatory patients with polycystic ovary syndrome: a randomized controlled trial
Abstract
Objective The purpose of this study was to compare the effectiveness of laparoscopic ovarian diathermy (LOD) vs clomiphene citrate (CC) plus metformin in infertile patients with CC-resistant polycystic ovary syndrome (PCOS).Study design Fifty primary infertile patients with CC-resistant PCOS were assigned randomly to receive LOD followed by a 6-month observation (group A) or 6-cycle course of CC plus metformin (group B). Reproductive and safety outcomes were analyzed.Results No significant difference between 2 groups in pregnancy (15/92 women [16.3%] vs 14/107 women [13.1%]; P = .521) and live-birth (13/92 women [14.1%] vs 12/107 women [11.2%]; P = .536) rates per cycle was observed. With the use of a Cox regression analysis, patients under medical treatment, compared with patients who received surgical treatment, had a relative risk of pregnancy of 1.2 (95% confidence interval, 0.61-2.44; P = .582) and a relative risk of live-birth of 1.4 (95% confidence interval, 0.63-2.96; P = .425).Conclusion LOD and CC plus metformin seem to be 2 effective approaches to treat infertility in patients with CC-resistant PCOS.
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One high-quality RCT with low risk of bias found clomiphene citrate plus metformin was better than laparoscopic ovarian surgery for ovulation rate per cycle (P=0.02), but there was no difference for live birth rate, pregnancy rate per cycle and miscarriage rate per pregnancy.
“One high-quality RCT (level II) with a low risk of bias found that clomiphene citrate plus metformin was better than laparoscopic ovarian surgery for ovulation rate per cycle ( P =0.02), but there was no difference for live birth rate, pregnancy rate per cycle and miscarriage rate per pregnancy. 256”
From Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline (2011) · cites this paper as [256]
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Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline
Teede, H. J., Misso, M. L., Deeks, A. A., Moran, L. J., Stuckey, B. G. A., Wong, J. L. A., Norman, R. J., Costello, M. F., & Groups, O. B. O. T. G. D. (2011) · Medical Journal of Australia · doi:10.5694/mja11.10915 · Cited by 379 · see citing works
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- Authors
- Palomba, S., Falbo, A., Battista, L., Russo, T., Venturella, R., Tolino, A., Orio, F., & Zullo, F.
- Affiliations
- Magna Graecia University (IT)
- Federico II University Hospital (IT)
- Parthenope University of Naples (IT)
- Corresponding author
- Palomba, Stefano
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 202
- Issue
- 6
- Pages
- 577.e1-577.e8
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2055814246
- Cited by
- 33
- References
- 41
- Citations by year
- 2025: 1 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 2 · 2018: 1 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 2 · 2013: 2 · 2012: 6
- FWCI
- 5.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Keywords
- clomiphene citrate, metformin, polycystic ovary syndrome, anovulatory infertility, pregnancy rate, live birth rate, surgical versus medical treatment
- MeSH terms
- Abortion, Spontaneous, Anovulation, Clomiphene, Diathermy, Drug Therapy, Combination, Female, Fertility Agents, Female, Humans, Hypoglycemic Agents, Infertility, Female, Metformin, Ovary, Ovulation Induction, Laparoscopy, Polycystic Ovary Syndrome, Pregnancy, Surveys and Questionnaires, Body Mass Index, Treatment Outcome, Patient Selection, Live Birth
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