الفهرس 
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Abstract
This study was conducted to evaluate the use of laparoscopic ovarian multiple punches with haemostasis by endocoagulator for treatment of peOD patients resistant to ovarian stimulation therapy. Twenty patients with PCOD were selected for this work, from those attending the outpatient clinic of the Gynaecology Department, Mansoura University Hospital starting at April 1995 and were followed up till March 1996. Their mean age was 27.2±3.92 years. 17 cases were suffering pnmary infertility and 3 were suffering secondary infertility. The diagnosis of PCOD was based on clinical, ultrasonographic and . laparoscopic documentation. Based on routine investigations, there were no other factors explaining infertility other than anovulation, and all our patients were resistant to ovarian stimulation therapy by clomiphene citrate and lIMG. The procedure was performed by triple puncture technique. Using the punch biopsy forceps, 6 to 8 ovarian punches were taken from each-ovary with haemostasis of its beds by the point endocoagulator (After Semm) and the time taken to complete the procedure was between 20-40 minutes with a mean value of27 .2±4.52 minutes. Withdrawal bleeding occurred in 18 cases (90%), resumption of regular menses in 17 cases (85%), while, neither with drawal bleeding, nor resumption of regular menses in 2 cases (10%). Follow np docnmented ovulation by transvaginal sonography (TYS) in 18 cases (90% of all cases, 100% of the spontaneonsly cycling cases), Two cases of those spontaneonsly cycling women got pregnant within the first three spontaneous cycles as an effect of the procedure alone and the mean time between the procedure and pregnancy was 2 ± 1.4 months, For those with neither withdrawal bleeding, nor resumption of spontaneous regular menses (2 cases, 10%), progesterone withdrawal bleeding was induced followed by ovarian stimulation therapy by clomiphene citrate, One ofthe latter two cases got pregnant which may be attributed to increased sensitivity to clomiphene citrate postoperatively, The same stimulation protocol was also followed for spontaneously cycling women in whom pregnancy was not achieved after three spontaneous successive cycles and in all stimulated cycles, ovulation was documented by TVS monitoring .