The surgical management of anovulatory infertility in polycystic ovary syndrome (PCOS) has traditionally involved the use of clomifene citrate and then gonadotrophin therapy or laparoscopic ovarian surgery in those who are clomifene-resistant. Laparoscopic ovarian surgery is a useful therapy for anovulatory women with PCOS who need a laparoscopic assessment of their pelvis or who live too far away from the hospital to be able to attend for the intensive monitoring required for gonadotrophin therapy. Commonly employed methods for laparoscopic surgery include monopolar electrocautery (diathermy) and laser. The risk of periovarian adhesion formation can be reduced by abdominal lavage and early second-look laparoscopy, with adhesiolysis if necessary. The chance of achieving a continuing pregnancy within 6 months is less than with carefully conducted ovulation induction with gonadotrophins but, if adjuvant ovulation induction agents are used in those who do not initially respond, the 12-month pregnancy rates are similar.

Ultrasound examination is as effective a diagnostic test as hysteroscopy or laparoscopy for the diagnosis of uterine abnormalities. Three-dimensional ultrasound has been used to assess uterine anatomy and to detect congenital anomalies of the uterus. Ultrasound examination is used to monitor endometrial growth and ovarian response to the medical treatment. Appropriate endometrial growth indicates good endometrial receptivity. Appropriate ovarian response to gonadotrophin stimulation increases the chances that good quality eggs will be released in ovulation induction cycles and that good embryos will be available for embryo transfer in in vitro fertilisation (IVF) cycles. Ultrasound is also used to monitor embryo transfer. Both greyscale ultrasound examination of the endometrium and Doppler ultrasound examination of the uterine arteries have been used to assess 'endometrial receptivity' in IVF cycles. Ultrasound greyscale imaging is regarded as sufficiently accurate to be used alone for monitoring follicular growth during gonadotrophin therapy.