A Randomized Controlled Trial of Laparoscopic Ovarian Diathermy versus Aromatase Inhibitors for Clomiphene-Resistant Polycystic Ovary Syndrome

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 543–554

DOI: 10.46882/2026/IJOG/000526

Original Research Article

Title: A Randomized Controlled Trial of Laparoscopic Ovarian Diathermy versus Aromatase Inhibitors for Clomiphene-Resistant Polycystic Ovary Syndrome

Names of Authors: Anita P. Nwosu¹, Samuel T. Kudoyin²

Authors’ Affiliations:
¹ Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynecology, Lagos State University Teaching Hospital, Ikeja, Nigeria
² Department of Radiology, College of Medicine, University of Lagos, Lagos, Nigeria

Abstract:
Clomiphene citrate resistance complicates ovulation induction algorithms in women with Polycystic Ovary Syndrome (PCOS). This prospective randomized active-controlled trial compared the clinical efficacy, baseline endocrine changes, and cumulative live birth rates of Laparoscopic Ovarian Diathermy (LOD) against oral letrozole therapy. One hundred infertile women meeting the Rotterdam criteria for PCOS with confirmed clomiphene resistance were randomized into two equal groups (n = 50 per group). The LOD cohort underwent surgical puncture with a unipolar electrocautery needle, while the letrozole cohort received oral letrozole (2.5 mg daily for 5 days, up to six consecutive cycles). The primary outcome evaluated was the cumulative ovulation rate per group over a 6-month follow-up window. Spontaneous ovulation was achieved in 72.0% of women in the LOD group and 78.0% of the letrozole group, demonstrating no statistically significant variation between the interventions (p = 0.48). Mean serum anti-Müllerian hormone (AMH) levels dropped significantly from baseline in both groups (p < 0.001). The 6-month cumulative clinical pregnancy rates were 44.0% for LOD and 48.0% for letrozole (p = 0.69), while cumulative live birth rates were 38.0% and 42.0%, respectively (p = 0.68). The incidence of multiple pregnancies was 0.0% in both arms. Letrozole therapy provides ovulation induction outcomes and live birth rates equivalent to laparoscopic ovarian diathermy in clomiphene-resistant polycystic ovary syndrome, offering an efficient, non-invasive first-line alternative to surgical interventions.

Keywords: Polycystic Ovary Syndrome; Letrozole; Laparoscopic Ovarian Diathermy; Clomiphene Resistance; Ovulation Induction; Live Birth Rate.

Manuscript Timeline: Received: June 10, 2026; Revised: July 28, 2026; Accepted: August 08, 2026; Published: August 31, 2026.

Citation: Nwosu AP, Kudoyin ST. A Randomized Controlled Trial of Laparoscopic Ovarian Diathermy versus Aromatase Inhibitors for Clomiphene-Resistant Polycystic Ovary Syndrome. International Journal of Obstetrics and Gynecology. 2026; 14(8): 543–554.

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