Clomiphene citrate is often the first choice to induce ovulation in women with the polycystic ovary syndrome (PCOS). However, approximately 20% of women with PCOS remain anovulatory after receiving this agent. Clomiphene-resistant patients often receive low doses of gonadotropins to induce ovulation. Despite careful monitoring, this treatment has a significant risk of ovarian hyperstimulation and multiple pregnancies. Ovarian surgery using laparoscopic electrocautery has been an effective alternative in effecting the resumption of normal ovulatory cycles in clomiphene-resistant patients. However, surgery is associated with many complications, including adhesion formation. Previous studies have suggested that transvaginal laparoscopy may be a first-line alternative procedure to standard laparoscopy for examination and visualization of the tubo-ovarian structures. The transvaginal approach offers the possibility of minimally invasive surgical procedures.