الفهرس 
Polycystic Ovary SyndromeOnly 14 pages are availabe for public view
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Abstract
Polycystic ovary disease is a condition in which there are many small cysts in the ovaries, which can affect a woman’s ability to get pregnant. Recently, a revised definition of PCOS was agreed it requires the presence of two from the following three diagnostic criteria, Oligo and/ or anovulation, Clinical and/ or biochemical features of hyperandrogenism and the presence of polycystic ovary morphology (Rotterdam ESHRE/ASRM sponsored PCOS Consensus Workshop group, 2004). The PCOS phenotype can be structured into three components: an ovulation, hyperandrogenism and the metabolic syndrome (of which hyperinsulinism, secondary to insulin resistance, is the central abnormality) (Jacobs, 1987; Webber et al., 2003). PCO is the most common cause of anovulatory infertility affecting between 4%and 6%of women of reproductive age. PCO has been diagnosed with increased frequency following technological development in automated hormone assay and in diagnostic ultrasound; most clinical data originate from highly specialized tertiary clinics, which may not reflect the picture in population at large. However, several attempts have been made to quantify the prevalence of polycystic ovaries in community-based studies suggesting that approximately 20 %of women of reproductive age demonstrate ultrasound picture of polycystic ovaries with half that number having clinical or biochemical signs of anovulation or androgen excess (Royal college of obstetricians and gyneacologist,2003).
Anti-mullerian hormone (AMH) is a member of the transforming growth factor B family of growth and differentiation factors. In the ovary, AMH has an inhibitory effect on primordial follicles recruitment as well as on the responsiveness of growing follicles to FSH. In the ovary AMH exerts a specific expression pattern in granulose cells of growing non selected follicle pool. So, AMH seemed to be a good marker for the quantitative aspect of ovarian reserve as well as ovarian dysfunction (Jenny A et al., 2006). Laparoscopic ovarian drilling (LOD) has been a powerful and effective tool for inducing ovulation in patient with clomiphene citrate resistant PCOS However, a major drawback LOD via diathermy is the Potential risk of ovarian damage (Kriplani A et al., 2001). This study was across-sectional study that included 50 women with a diagnosis of clomiphene-citrate (CC) – resistant PCOS (defined as failure of ovulation at the maximum dose of CC [200 mg/day for 5 days] for at least 3 cycles) (Albakry MM, 1999) PCOS was diagnosed according to criteria stated by European Society of Human Reproduction and Embryology (ESHRE) and American Society of Reproductive Medicine (ASRM) by at least 2 out of 3 of the following: menstrual disturbance (amenorrhea or oligomenorrhea), clinical and/or biochemical sign of hyperandrogenism and / or typical ultrasonographic finding of PCO( with 1 ovary being sufficient for diagnosis), defined as the presence of 12 or more follicles measuring 2 to 9 mm in diameter or ovarian volume over 10 ml (Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group, 2004). In the current study AMH significantly decreased after drilling: indicating that LOD is a good treatment for PCOS. However, decreased AFC after LOD showed its possible destructive effect on ovarian tissue. The decline in serum AMH and AFC following LOD may not necessarily indicate a reduction in ovarian reserve. It may, however, denote a sort of ”treating” the endocrine dysfunction associated with PCOS.