{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T01:19:31Z","timestamp":1772155171807,"version":"3.50.1"},"reference-count":21,"publisher":"The Korean Society for Reproductive Medicine","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["ecerm.org"],"crossmark-restriction":true},"short-container-title":["Clin Exp Reprod Med"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:p>Objective: Clomiphene citrate (CC) is the first-line treatment for ovulation induction in women with polycystic ovary syndrome (PCOS), yet a substantial proportion exhibit CC resistance. This study compares clinical outcomes following treatment with gonadotropins, letrozole, or unilateral laparoscopic ovarian drilling (LOD) in women with CC\u2010resistant PCOS.Methods: In this prospective, randomized clinical trial conducted at the infertility clinic of the Maternity Hospital from May 2021 to May 2024 (Clinical Trial No. NCT06486870), 183 middle-aged, anovulatory infertile women with CC-resistant PCOS, diagnosed using the Rotterdam criteria, were included. Participants were randomly assigned to one of three groups: letrozole (n=61), gonadotropins (n=61), or unilateral LOD (n=61). The primary outcome was the cumulative pregnancy rate over 6 months. Statistical analyses were performed using IBM SPSS Statistics ver. 24.Results: Baseline demographics were comparable across groups. The gonadotropin\u2010treated cohort achieved the highest cumulative pregnancy rate (41%), followed by letrozole (32.8%) and LOD (18%). Gonadotropin therapy also yielded the highest ovulation rate and the lowest incidence of oligo\/amenorrhea. In contrast, LOD produced greater reductions in luteinizing hormone, anti\u2010M\u00fcllerian hormone, and antral follicle count, and more patients attained menstrual regularity. Although LOD was associated with a lower pregnancy rate, it conferred a reduced risk of multiple gestations and ovarian hyperstimulation syndrome (OHSS).Conclusion: Gonadotropins and letrozole are more effective than unilateral LOD for inducing ovulation and achieving pregnancy in women with CC\u2010resistant PCOS. Nevertheless, LOD remains a viable alternative, offering the advantage of lower rates of multiple pregnancy and OHSS.<\/jats:p>","DOI":"10.5653\/cerm.2024.07731","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T05:08:22Z","timestamp":1766552902000},"page":"10-18","update-policy":"https:\/\/doi.org\/10.5653\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative study of two ovulation induction therapies and laparoscopic ovarian drilling on clinical outcomes in women with clomiphene citrate-resistant polycystic ovary syndrome"],"prefix":"10.5653","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4078-7149","authenticated-orcid":true,"given":"Safaa Ibrahim","family":"Mahmoud","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeinab Ali Mohamed","family":"Ahmedy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2747-3353","authenticated-orcid":true,"given":"Ahmed Nagy","family":"Shaker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mamdouh","family":"Sheeba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mai Nabil","family":"Ageez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3624","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1186\/s40834-019-0102-4"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad096"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13061113"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogc.2014.09.007"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12154943"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd013505"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.5468\/ogs.21275"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.5468\/ogs.2014.57.3.216"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2015.2690"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.mefs.2017.02.003"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1186\/s12958-019-0461-3"},{"key":"ref12","volume-title":"","author":"Nagori","year":"2021"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58081002"},{"key":"ref14","first-page":"531","volume-title":"Laparoscopic ovarian electrocautery versus gonadotropin therapy in infertile women with clomiphene citrate-resistant polycystic ovary syndrome: a systematic review and meta-analysis","author":"Moazami Goudarzi","year":"2014"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2021.1958310"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-013-2808-x"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s42000-024-00531-4"},{"key":"ref18","first-page":"4","volume-title":"Letrozole following laparoscopic ovarian drilling in clomiphene resistant polycystic ovary syndrome women","author":"Abdelazim","year":"2021"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.21608\/bmfj.2021.18571.1126"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2010.11.026"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10006-1525"}],"container-title":["Clinical and Experimental Reproductive Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ecerm.org\/upload\/pdf\/cerm-2024-07731.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/ecerm.org\/journal\/view.php?doi=10.5653\/cerm.2024.07731","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/ecerm.org\/upload\/pdf\/cerm-2024-07731.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:43:15Z","timestamp":1772152995000},"score":1,"resource":{"primary":{"URL":"http:\/\/ecerm.org\/journal\/view.php?doi=10.5653\/cerm.2024.07731"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,3]]}},"URL":"https:\/\/doi.org\/10.5653\/cerm.2024.07731","relation":{},"ISSN":["2233-8233","2233-8241"],"issn-type":[{"value":"2233-8233","type":"print"},{"value":"2233-8241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,1]]},"assertion":[{"value":"2024-11-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-24","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-01","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}