الفهرس 
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Abstract
The aim of this study was to compare the effect of the following drugs : clomiphene citrate -metformin, letrozole -metformin on ovulation induction in clomiphene citrate resistant patients with PCOS as regards.
- Pregnancy rate ( primary outcome ).
- Ovulation rate (secondary outcome)
- Number of follicles
- Endometrial thickness. The study included 90 infertile women who already diagnosed as PCOS by signs, symptoms, hormonal profile and ultrasound and were known clomiphene citrate resistant patients . All Women will be divided randomly into 2 groups
1-First group:
included 45 women that were given metformin (cidophage;Chemical Industries Development (C I D) ,Cairo,Egypt) ,500 mg three times daily for 6-8 weeks then after the end of this period, women were added clomiphene citrate (Clomid; Aventis pharma S.AE, Global Napi pharmaceuticals, Cairo, Egypt ) 100 mg starting on day 3 till 7 day of cycle .The drug administration was continued in three cycles for all women
2-Second group:
included 45 women that were given metformin 500 mg three times daily for 6-8 weeks then after the end of this period, women were added letrozole (Femara; Novertis pharma AG, Basle, Switzerland) 2.5mg/ day starting on day 3 till 7 day of cycle . The drug administration was continued in three cycles for all women
Women participating in this study were submitted for:
1. Full history taking.
2. General examination.
3. Abdominal examination.
4. Local examination.
5. Base line ultrasound.
6. Hormonal profile. (FSH, LH, TSH, Prolactin)
7. Regular follow up of ovulation with folliculometry by transvaginal ultrasound starting from cycle day 3 for growing of follicle to reach 18 mm or more, the endometrial thickness in (mm) was measured at this time.
8. hCG (5000 IU) was given when at least one follicle has reached 18mm or more.
9. Women advised to have intercourse 24 – 36 hours after hCG.
10. Serum hCG was measured after 2 weeks of hCG injection in the absence of menstruation for diagnosis of pregnancy.
The results of this study can be summarized in the following:
There were no statistical significant differences as regard age, duration of infertility, BMI, and the relative incidence of clinical signs of PCOS among women included in the study.
There was no statistically significant difference between the two groups as regard the number of stimulated mature follicles, follicular diameter > 18,
There was a highly statistical significant difference in endometrial thickness as measured by trans-vaginal ultrasound among women of group II it ranged from (4-13 mm) as compared to women of group I (3-11.1 mm) at time of hCG administration.
There was no statistical significant difference as regard the number of women showing evidence of ovulation in group I (8women) as compared to women of group II (11 women).
Follicular maturity was achieved in a relatively shorter period among women in group I (13 -20days) compared to women of group II (13 -17days).
There wasno a significant difference as regard percentage of pregnancy in group I (2women 4.4%) compared to group II (4women 8.8%).