الفهرس 
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Abstract
As the most common endocrinopathy of reproductive-age women, polycystic ovary syndrome (PCOS) remains a poorly understood and yet a liberally diagnosed condition. While the exact mechanisms that underlie the chronic course of ovulatory dysfunction and hyperandrogenemia of PCOS still remain elusive, the complexity of the pathophysiological underpinnings and the diversity of recognized clinical sequelae have only expanded since 1935, when Stein and Leventhal originally described the combination of oligo-ovulation and hyperandrogenism.
The Rotterdam consensus includes three diagnostic criteria, and states that any two of the three must be present in order to make the diagnosis (3). The revised criteria include (1) oligo- or anovulation, (2) clinical or biochemical signs of hyperandrogenism, and (3) polycystic appearing ovaries (PCO) on imaging the most recent set of diagnostic criteria to be released was compiled by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society in 2009 (4).
Tamoxifen the first triphenylethylene antiestrogen was found to be antiestrogenic effects in the treatment of infertility and breast cancer. Although these agents are widely described as antiestrogens, they are best characterized pharmacologically as partial estrogen agonists.(90, 91) The estrogenic or antiestrogenic effects of these agents depend on level of endogenous estrogen and the target organ affected, Tamoxifen is generally considered to increase fertility rates in a similar way to clomiphene. It has been postulated that tamoxifen improves follicular development by direct action on the ovary rather than through the hypothalamic-pituitary axis. (95, 96)
This study was conducted aiming to determine the level of ovarian volume, antral follicular count and body mass index of polycystic ovaries women who ovulate in response to tamoxifen.
The study was conducted upon 80 PCO women indicated for ovulation induction, each patient was given tamoxifen 20 mg twice daily. They were recruited from the infertility clinic of El – Shatby University Maternity Hospital from January 2013 to December 2016.
All patients were subjected to:
• Informed consent then complete history taking and Complete examination.
• Transvaginal Ultrasound: which done in the day 2 of the cycle, basal scanning to assess the uterus (as regards the endometrial thickness), the ovaries (as regards the ovarian volume, the antral follicular count and the size of the follicles) and to exclude the presence of any ovarian or adnexal pathology.
• Tamoxifen twenty milligram twice daily (two tablets), starting on day 2 of the cycle for 5 days is to be given.
• Follow up by transvaginal ultrasound every 3 days for the following two weeks will be done to evaluate the ovarian response by defining the number of growing follicles in both ovaries and detection of the ovulation by either disappearance of the mature follicle, Corpus luteum formation, trilaminar endometrium and minimal fluid collection in the douglus pouch.