OBJECTIVE To compare the effect of ovarian electrocautery versus an intranasal (IN) luteinizing hormone-releasing hormone agonist (LH-RH-a) in the response of patients with polycystic ovarian disease (PCOD) to human menopausal gonadotropin (hMG) therapy. METHODS A prospective study with serial randomization of patients in two groups for treatment with ovarian electrocautery + hMG or LH-RH-a + hMG. METHODS A teaching hospital reproductive endocrinology clinic. METHODS Thirty-three women with PCOD who failed to conceive after six treatment cycles with hMG. METHODS Midcycle and luteal phase endocrinology, ovulation, pregnancy rates (PRs), and miscarriage rates. RESULTS There was no difference in the ovulation or PRs between the two groups. However, the number of cycles with multiple dominant follicles, the luteal phase serum testosterone, and the miscarriage rate were lower in the group pretreated with ovarian electrocautery. CONCLUSIONS Pretreatment of patients with PCOD with ovarian electrocautery may be a better alternative to IN LH-RH-a therapy for induction of ovulation with hMG.