الفهرس 
Introduction and RationaleOnly 14 pages are availabe for public view
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Abstract
PCOS is multifaceted syndrome with significant endocrinal, metabolic and reproductive manifestation. Diagnosis according to Rotterdam criteria requires two of three features: anovulation or oligo-ovulation, clinical and/or biochemical hyperandrogenism, and polycystic ovarian morphology (PCOM) seen on ultrasound.
Incidence of PCOS according to diagnostic criteria is 6% to 20% of reproductive aged women are affected.
Treatment should be individualized based on the patient’s presentation and desire for pregnancy. Treatment strategies for infertility in PCOS include weight loss, life style modification, metformin and ovulation induction using clomiphene citrate, aromatase inhibitors as the first line , gonadotropin as second line and laparoscopic ovarian drilling as a third line of management and finally In vitro fertilization.
Clomiphene citrate was the first line of treatment of PCOS, it acts as selective estrogen receptor modulator (SERM) with mixed agonist and antagonist activity, depending upon the target tissue consequently increasing levels of endogenous gonadotropins and the dominant follicle with highest number of FSH receptors is recruited, the antiestrogenic effect affects endometrium as well as cervical mucus.
Metformin is an insulin sensitizer commonly used as treatment for type 2 diabetes. Also, metformin lowers androgen production by theca cells, decreasing the activity of ovarian cytochrome P450c17a and expression of steroidogenic acute regulatory protein.
Our prospective observational study carried on infertile PCOS patients attending Obstetrics & Gynecology outpatient clinic of Suez Canal University hospital, the patients were divided into 2 groups, group (A) “Stair Step protocol” in which CC was administrated on second day of menses for 5 days then transvaginal ultrasound (TVUS) is done on day 8. Follicular diameter less than 11 mm on cycle day 14