الفهرس 
POLYCYSTIC OVARY SYNDROMEOnly 14 pages are availabe for public view
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Abstract
The criteria for PCOS which likely identifies the core group of patients arose from the proceedings of a 1990 NIH conference, which noted the features of the disorder to be clinical and / or biochemical hyperandrogenism with chronic anovulation, after the exclusion of related disorders such as hyperprolactinemia, thyroid disorders, and NCAH. The Rotterdam 2003 conference criteria expanded the 1990 NIH criteria for PCOS by creating 2 new phenotypes for PCOS, one including women with polycystic ovaries and signs of androgen excess, but no signs of ovulatory dysfunction and another including women with polycystic ovaries and ovulatory dysfunction, but no signs of androgen excess. It is clear that the prevalence of PCOS will depend to a great degree on the criteria used to define the syndrome (The Rotterdam ESHRE/ASRM, 2004).
Although CC is very successful in inducing ovulation, there is usually a discrepancy between ovulation and pregnancy rates (PR) (only 50% of those who ovulate will conceive). This may be partly explained by the peripheral antiestrogenic effects at the level of the endometrium and cervical mucus, by hypersecretion of LH, or due to negative effects of CC on oocytes or granulosa cells (GC). Approximately 15% of women who take CC have poor postcoital test results, and IUI is recommended for these women. It can be argued that these negative effects are augmented by the relatively long half-life of CC. Therefore, if treatment is started late in the cycle these negative effects are more likely to be extended into the sensitive peri-implantation period (Bilijan et al., 1999).
Badawy et al., 2009 tested a novel protocol of luteal phase administration of CC for ovulation induction in women with polycystic ovary syndrome (PCOS), and concluded that early administration of CC in patients with PCOS will lead to more follicular growth and endometrial thickness, which might result in a higher pregnancy rate.
In the present study, total of one hundred (100) infertile women aged 20-40 years old with the diagnosis of PCOS, who presented to Ain Shams University Maternity Hospital at the Infertility Outpatient Clinic, were recruited for the study, with the diagnosis of PCOS being based on the 2003 ESHRE/ASRM (Rotterdam) Criteria.
All recruited women were less than 40 years old, with no major pelvic pathology, no other infertility factors, no ovarian masses, no major uterine pathology and no liver disease. After full history taking and full clinical examination, basal serum hormonal profile was measured before CC treatment.
Withdrawal bleeding was achieved using 10-mg tablets of medroxyprogesterone acetate (MPA) daily for 5 days, then all subjects were randomly divided into two groups:
Group I (study group): included 50 patients to whom 100 mg of clomiphene citrate (CC) (Clomid; Hoechest Marion Russel, Cairo, Egypt) was administered daily for five days starting the next day after finishing medroxyprogesterone acetate (MPA) 10-mg tablets for 5 days to induce withdrawal bleeding.
Group II (control group): included 50 patients to whom 100 mg of clomiphene citrate (CC) was administered daily for five days starting on day three of the cycle induced by medroxyprogesterone acetate (MPA) 10-mg tablets for 5 days.
Transvaginal ultrasound folliculometry was done 5-7 days after end of CC treatment. Transvaginal Colored Doppler (TVCD) was performed at time of human Chorionic Gonadotrophin (hCG) injection and again 7 days later to determine the endometrial and subendometrial blood flows resistance indices (RI).
Serum estradiol (pg/ml) was measured at time of human Choronic Gonadotrophin (hCG) injection and serum progesterone (ng/ml) was measured 7 days after hCG injection.
In the present study, there were no significant differences between women in both groups as regards demographic data or basal serum hormonal profile (P>0.05).
In the present study, the proportion of women who had one or more mature follicle(s) was slightly lower among women in study group (28 women) when compared to women in control group (29women); the difference was, however, insignificant (P>0.05). However, the proportion of women who had two mature follicles was significantly higher in women in study group (14 women) when compared to women in control group (5 women) (P=0.009).
In the present study, the mean endometrial thickness at day of hCG administration was significantly higher among women in study group (Mean±SD=9±0.55) when compared to women in control group (Mean±SD=8.19±0.55) (P=0.009).
In the present study, the mean endometrial and subendometrial resistance indices (RIs) at day of hCG administration were significantly lower (denoting higher endometrial blood flow) among women in study group (Mean±SD=0.74±0.03 and 0.72±0.02 respectively) when compared to women in control group (Mean±SD=0.77±0.02 and 0.74±0.03 respectively) (P=0.002 and 0.003 respectively). Also, the mean midluteal endometrial and subendometrial RIs were significantly lower (denoting higher endometrial blood flow) in women in study group (Mean±SD=0.68±0.05 and 0.64±0.07 respectively) when compared to women in control group (Mean±SD=0.73±0.04 and 0.69±0.05 respectively) (P=0.001 and 0.006 respectively).
In the present study, there was a significant negative correlation between midluteal subendometrial RI and age (P=0.04) and there was a significant positive correlation between midluteal endometrial RI and basal serum LH:FSH ratio (P=0.01).