With the introduction of bilateral ovarian wedge resection (BOWR) in 1935, Stein and Leventhal were the first to describe an effective treatment for the chronic anovulation and associated infertility resulting from what was later to become known as polycystic ovary syndrome (PCOS). Since that time, many less invasive methods of ovulation induction and enhancement have been developed. While the success of medical ovulation induction led to the almost complete replacement of BOWR by the late 1970's, the presence of a group of women who are not optimally treated by medical methods has maintained the interest in surgical approaches. Surgical and nonsurgical methods of treatment for anovulatory women have continued to be refined. This manuscript reviews this literature and attempts to provide a framework for the role that modern surgical methods of ovulation induction might play in the current scheme of treatment for anovulatory infertility in women with PCOS.