الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Ovulation dysfunction represents one of the most common problems in couples presenting for infertility evaluation. Clomiphene citrate is the most commonly used drug used for ovulation induction. If ovulation achieved this is continued for 6 cycles (Branigan et al., 2005).
In women who failed to respond to Clomiphene citrate therapy. Many adjuvant or alternative treatment had been suggested. (Stephen et al .,2000).
Low dose HCG was firstly suggested by Brangan et al .,2005 as an adjuvant therapy to CC. Branigan et al concluded that the low dose HCG was efficient to complete folliculogenesis in patients with CC resistant.
The aim of this study was to evaluate whether adding or not micro doses of human chorionic gonadotropin (HCG) to clomophine citrate (CC) results in successful ovulation and pregnancy in resistant Polycystic ovary syndrome (PCOS) patients.
Our study included fifty women, selected from those visited the outpatient clinic of Obstetrics and Gynecology department, Benha University Hospital, Complaining of infertility and diagnosed as having Clomiphene Citrate resistant PCOS by certain criteria.
In this study we used the same patient to be the control for her self . we started a dose of 150 mg CC from day five and for 5 days . On day 7 of CC vaginal U/S monitoring started and began low-dose HCG injection when a leading follicle reached 12 mm in diameter. ( Damewood et al., 1989)
When the leading follicle reached 18: 22 mm, the daily injection of HCG was stopped and a dose of 5000: 10,000 IU of HCG was injected and intercourse was planned 36 hours after the HCG injection, endometrial thickness and pattern was evaluated on day 14 of the cycle.
Our results showed that the response rate was 70% after the low dose HCG ( 35 out of 50 patients). The ovulation rate in the responding patients was 85% (30 out of 35 patients.). Also the number of mature follicles were few.
Regarding endometrial thickness , the thickness was 13 mm in the responding patients compared to 6 mm in non responder.
Pregnancy rate was 30% in our study (9 out of 30 patients).
from the results of our study we may conclude that the use of micro dose HCG after CC in the late follicular phase results in continued follicle growth, improve ovulation and pregnancies rate in CC resistant PCOS patients.
Lastly, Recommendation to use the micro dose HCG as a new efficient and low cost alternative treatment for CC resistant PCOS patients before moving to gonadotropin therapy.