Objective: To compare treatment outcome oj transvaginal ultrasound (US)-guided Jollicular aspiration versus laparoscopic ovarian diathermy (WD) in the management oj antiestrogen-resistant anovulation associated with polycystic ovarian disease (PCOD) and to define selection criteria oJpatients sUitableJorJollicular aspiration. Study dysign: A prospective randomized study. Materials and methods: Forty-nine inJertile patients with PCOD, who Jailed to achieve ovulation with clomiphene citrate, were recruited in the study. All paticipants had transvaginal ultrasound examination Jor estimation oj ovarian volume. number oj subcapsular Jollicles. stromal volume and stromal echogenicity and pretreatment hormonal profile oj LH, FSH, total testosterone, androstenedione and DHEAS. Patients were randomized into two management groups; US-guided Jollicular aspiration (26 cases) and LOD (23 cases). Both groups were compared with respect to eVidence oj ovulation and occurrence ojpregnancy and abortion. In the group treated by US-guided Jollicular aspiration, hormonal assays were reassessed during the earlyJollicular phase ojthefirst postprocedural cycle.