Abstract 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 pro-cedures 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 groupA 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 men-struation, 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 pregnancywithin 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 re-sumption of spontaneous ovulation and spontaneous pregnancy. Theoretical less adhesion formation following bi-polar LOD requires a second-look laparoscopy study. In the meantime, spread of bipolar LOD should be encouraged.