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The surgical management of anovulatory infertility in polycystic ovary syndrome (PCOS) has traditionally involved the use of clomifene citrate and then gonadotrophin therapy or laparoscopic ovarian surgery in those who are clomifene-resistant. Laparoscopic ovarian surgery is a useful therapy for anovulatory women with PCOS who need a laparoscopic assessment of their pelvis or who live too far away from the hospital to be able to attend for the intensive monitoring required for gonadotrophin therapy. Commonly employed methods for laparoscopic surgery include monopolar electrocautery (diathermy) and laser. The risk of periovarian adhesion formation can be reduced by abdominal lavage and early second-look laparoscopy, with adhesiolysis if necessary. The chance of achieving a continuing pregnancy within 6 months is less than with carefully conducted ovulation induction with gonadotrophins but, if adjuvant ovulation induction agents are used in those who do not initially respond, the 12-month pregnancy rates are similar.
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