Traditionally, controlled ovarian stimulation in women undergoing assisted reproductive technology (ART) treatment was designed in a standardized fashion taking into account the age and body weight of the patient. A standardized treatment protocol has been described as a “one-size-fits-all” approach that does not take into account inter-individual differences.

Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrinopathies affecting 5 to 10 percent of women of reproductive age [1;2]. Characteristic clinical features of PCOS include menstrual irregularity such as oligomenorrhea/amenorrhea and signs of hyperandrogenemia including hirsutism, acne, and/or obesity. The syndrome was first clearly described by Stein and Leventhal in 1935 [3]. While the primary etiology remains poorly defined [4], insulin resistance with compensatory hyperinsulinemia is a prominent feature of the condition and appears to be an underlying cause of hyperandrogenemia identified in both lean and obese women [5]. Hyperinsulinemia promotes increased ovarian androgen biosynthesis in vivo and in vitro [6;7]. It also decreases sex hormone-binding globulin production in the liver [8], which results in the increased bioavailability of free androgens and exacerbates the signs of androgen excess.

Surgical methods of ovulation induction for women with clomiphene (clomifene) citrate-resistant polycystic ovary syndrome (PCOS) include laparoscopic ovarian drilling with diathermy. This technique has replaced the more invasive and damaging technique of ovarian wedge resection first introduced by Gjønnaess in the early 1980s [1]. Laparoscopic ovarian surgery is free from the risks of multiple pregnancy and ovarian hyperstimulation, which makes it an attractive procedure for PCOS women, but surgery is not without risks. The techniques of laparoscopic ovarian diathermy have been described previously [2;3]. Studies suggest that four punctures per ovary with application of diathermy current via needle cautery set at 30 watts for 5 seconds per puncture (i.e., no more than 600 J per ovary) should produce an optimal response. The greater the damage to the surface of the ovary the greater the risk of peri-ovarian adhesions estimated at 60 percent (ranging from 0 to 100 percent) in treated women.