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Departments of Obstetrics and Gynecology (S.P., A.F., T.R., D.C., F.Z.) and Experimental Medicine (P.D.), University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy; Departments of Molecular and Clinical Endocrinology and Oncology (F.O., G.L., A.C.), and Obstetrics and Gynecology (A.T.), University "Federico II" of Naples, 80131 Naples, Italy; and Imperial College (L.G.N.), St. Mary’s Hospital, London W2 1NY, United Kingdom
Address all correspondence and requests for reprints to: Stefano Palomba, M.D., Department of Gynecology and Obstetrics, University "Magna Graecia" of Catanzaro, Via Nicolardi 188, 80131 Naples, Italy. E-mail: stefanopalomba{at}tin.it.
At present, it is unclear what the role is of laparoscopic ovarian diathermy (LOD) and of metformin administration as second-line treatments for ovulation induction in women with polycystic ovary syndrome (PCOS) after failure of clomiphene citrate (CC) treatment. The aim of the present study was to compare in a randomized double-blind placebo-controlled fashion the effectiveness of LOD with metformin administration in the treatment of CC-resistant women with PCOS. A total of 120 overweight primary infertile anovulatory CC-resistant women with PCOS were enrolled and randomized into two groups of treatment. Group A underwent diagnostic laparoscopy, whereas group B underwent LOD. At hospital discharge, the patients were treated for 6 months with metformin cloridrate (group A; 850 mg twice daily) or with multivitamins (group B). The ovulation, pregnancy, abortion, and live-birth rates were evaluated. At the end of the study, the total ovulation rate was not statistically different between both treatment groups (54.8 vs. 55.1% in groups A and B, respectively), whereas the pregnancy (18.6 vs. 13.4%), the abortion (15.4 vs. 29.0%), and the live-birth (82.1 vs. 64.5%) rates were significantly (P < 0.05) different between the two groups. Our data show that metformin administration is more effective than LOD in overall reproductive outcomes in overweight infertile CC-resistant women with PCOS.
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