The objective of this study is to compare the safety
and efficacy of laparoscopic ovarian drilling (LOD) utilizing
monopolar versus bipolar needle in clomiphene-resistant
polycystic ovaries (PCO) in infertile women. This study is a
prospective randomized comparative diagnostic trial. The procedures
were performed in an endoscopic unit of a tertiary
care referral facility and university hospital. Eighty
clomiphene-resistant PCO patients were randomly assigned
by using a computerized random table into group A and group
B for monopolar and bipolar LOD of 40 patients in each
group, respectively. The intervention was LOD using
monopolar or bipolar needle in groups A and B, respectively.
The main outcome measures are resumption of regular menstruation,
spontaneous ovulation, and pregnancy. Both groups
showed a significant postoperative improvement of menstrual
patterns and hormonal profiles if compared to preoperative
levels without significant difference between both groups.
Spontaneous ovulation resumed in 13 (32.5 %) and 25
(62 %), p = 0.007, while spontaneous pregnancy within 1 year
after LOD occurred in 9 (22.5 %) and 18 (45 %) cases
(p = 0.033) in both groups, respectively. Both monopolar
and bipolar needles are effective tools for LOD in clomiphene
citrate (CC)-resistant PCO infertile patients as a second-line
therapy. Utilizing bipolar LOD is superior to monopolar LOD
due to a significantly higher postoperative incidence of resumption
of spontaneous ovulation and spontaneous
pregnancy. Theoretical less adhesion formation following bipolar
LOD requires a second-look laparoscopy study. In the
meantime, spread of bipolar LOD should be encouraged.