الفهرس 
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Abstract
An association between resistant PCOS and vitamin D deficiency has been reported in several studies. However, the actual pathogenesis has not yet been elucidated. vitamin D deficiency may lead to ovulation and reproductive abnormalities in PCOS.
The aim of the study was to detect the prevalence of vitamin D deficiency among resistant cases of PCOS, detection the effect of supplementation of Vitamin D to those cases for improvement of ovulation and pregnancy were the main outcome of this.
The present study was a randomized controlled clinical trial that included 130 PCOS patients. It was conducted in The Obstetrics and Gynecology Department at Sohag University Hospital.
The recruited cases were fulfilling the inclusion criteria and accepted to participate in the study.
The recruited patients were randomly included two groups. group I; included (60) Patients with vitamin D deficiency and received vitamin D, group II (n=70): Patients with vitamin D deficiency and didn’t receive vitamin D, both groups received Letrozole (2.5mg twice daily for five days from the 2rd day of cycle and folliculometry was done and triggering of ovulation by 5000iu HCG ) for three consecutive cycles.
Detection of ovulation and occurrence of pregnancy was followed for three consecutive cycles
Summary of our results:
The prevalence of vitamin D deficiency in PCOS about 68%, while in resistant cases represent about 82%.
The mean level of serum vitamin D in non- resistant and resistant cases was (22.7±6.78 versus 15.5±5.54 respectively, p=0.005)
The mean age of two groups was (27.65±4.65 vs 28.4±4.04 respectively, p=0.318) with more than 77% of them less than 35 years.
The mean of BMI was (26.45±5.32 vs 27.46±6.27 respectively , p=0.53).
Lean patients represented(15% vs 9% respectively in group I& II ,p=0.547)
The overweight patients represented (25% vs 17% respectively in group I&II, p=0.491)
The obese women represented (33% vs 41% respectively, p=0.641)
Morbid obesity detection was (11.5% vs 14% respectively, p=0.351).
The mean of duration of infertility in both groups was (4.07±2.65 and 4.74±2 respectively, p=0.103) with about 80% of them were suffering from 1ry infertility in both groups, p=0.972.
Phenotype A was the most prevalent about 37% then phenotype D about 23%.
Phenotype A in both groups was (34% vs 40%, respectively p=0.857 ). While phenotype D was (23% vs 22% respectively, p=0.857).
Clinical hyperandrogenism was detected in 80% of cases, it was (85% vs 77% in group I&II respectively, p=0.453)
Menstrual abnormalities was detected in 82% of all studied cases, It was (80% vs 84% in group I&II respectively, p=0.356)
polycystic ovarian morphology was detected in 48% of cases, it was (48 vs 47 respectively, p=0.456).
The mean serum AMH level was about( 5.35±2.1 vs 5.3±1.97 in group I&II respectively p=0.873). With a level less than 5ng/ml in (50% vs 35% in group I&II respectively, p=0.725), while it was more than 5ng/ml and less than 7.5ng/ml in (30% vs 38% respectively, p=0.491), The AMH level was more than 7.5ng/ml in(20% vs 25% in group I&II respectively ,p=0.345)
Cumulative ovulation rate over three cycles was 60% in group I versus 34% in group II with significant difference Pvalue =0.003.
The ovulation rate in first cycle was (16%, vs 8% respectively,p=0.075)
The ovulation rate in the 2nd cycle was (43% vs 15% respectively, p=0.03).
The ovulation rate in the 3rd cycle was (76% vs 25% respectively, p=0.003)
The ovulation rate increase progressively through cycles in both groups .
The clinical pregnancy in the 1st cycle was (8% vs 5% respectively ,p=0.234).
The clinical pregnancy in the 2nd cycle was (15% vs 9% respectively, p=0.346)
The clinical pregnancy in the 3rd cycle was (15% vs 10% respectively ,p=0.177).
The cumulative pregnancy rate was 36% in group I versus 25% in group II, p=0.177).
There was negative correlation between serum vitamin D and BMI ,R-0.206 and P value =0.018.
There was negative correlation between serum vitamin D and serum level of AMH R-0.241 and P value =0.005.
vitamin D deficiency is more prevalent among resistant cases of polycystic ovary syndrome (PCOS).
Vitamin D deficiency represents about more than 80% of resistant cases while about 67% of non- resistant PCOS.
Vitamin D supplementation in patients with PCOS and vitamin D deficiency improves the response to ovulation induction and pregnancy rate.
There is negative correlation between serum vitamin D and BMI and AMH levels.
High level of AMH especially above critical level more than (7.5ng/ml) has negative impact on ovulation in PCOS.
High body mass index has negative impact on ovulation and increase the resistance to ovulation induction.
The classic form of PCOS (phenotype A) represented the most prevalent and worst prognosis of all forms of PCOS.
High LH level represented 100% of all resistant cases of PCOS.
Hyperandrogenism affects more than two thirds of cases of resistant PCOS.