Background: Polycystic ovary syndrome (PCOS) presents with several clinical aspects, but anovulation, inflammation,
and infertility are its cornerstone characteristics. Objectives: The current study aimed to compare the gynecological and
metabolic outcomes of triple medical therapy (TMT) using metformin, myoinositol, and α-lipoic acid (Met/MI/ALA)
to laparoscopic ovarian drilling (LOD) for PCOS women.
Patients and Methods: 157 PCOS women were divided into the LOD group and the TMT group, who received Met
500 mg three times, MI 2000 mg tab twice daily, and ALA 600 mg tab once daily for a 6-month (m) duration. The US
evaluation of ovarian volume, body mass index (BMI), the homeostasis model assessment for insulin resistance
(HOMA-IR) score, and serum levels of total testosterone (TT), luteinizing hormone (LH), and follicle-stimulating
hormone (FSH) levels with the calculation of the LH/FSH ratio was evaluated at 6-m and compared to baseline values.
Results: Ovarian volume was significantly reduced in all patients, with a significantly lower volume in patients in the
LOD group. Both LOD and TMT significantly decreased levels of testosterone and LH/FSH ratio, the hirsutism score,
and acne grade compared to before therapies, with insignificant differences between both groups. At 6-m follow-up, 93
women (59.2%) resumed regular menstrual patterns, and 37 of the 95 married women (38.9%), got pregnant with a
significant difference in favor of LOD. Conclusion: LOD is highly beneficial for PCOS women, especially infertile
women. The triple therapy using Met/MI/ALA is appropriate for the management of PCOS women, especially those
with fulminant metabolic and endocrinal manifestations.