To compare the efficacy of extended Letrozole regimen versus laparoscopic ovarian drilling (LOD) for ovulation induction in clomiphene citrate (CC) resistant women with polycystic ovary syndrome (PCOS). Study design: Prospective randomized controlled trial. Setting: Gynecology and Obstetrics Department, Faculty of Medicine, Benha University, and Al-Iman Alkhairy Private Hospital, between July 2010 and December 2011. Patients & Methods: Ninety anovulatory women with CC-resistant PCOS were scheduled randomly into two equal groups. Group A received letrozole (2.5 mg/day from cycle day 1 to10) for up to six cycles. Group B underwent LOD and were followed up for 6 months. The rates of ovulation, pregnancy, and abortion, and midcycle endometrial thickness were evaluated. Results: There were nonsignificant differences between both groups as regards the rates of ovulation per cycle, pregnancy, miscarriage, and first trimester abortion. The number of follicles> 18 mm, midcycle endometrial thickness, and midcycle serum estradiol level were significantly higher in the extended letrozole group. One twin pregnancy occurred in the extended letrozole group. No ovarian hyperstimulation syndrome or ectopic pregnancies were encountered in both groups. Conclusion: Extended letrozole regimen and laparoscopic ovarian drilling are comparably effective for ovulation induction and achieving pregnancy among cases of clomiphene resistant PCOS.