الفهرس 
Polycystic Ovary SyndromeOnly 14 pages are availabe for public view
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Abstract
Polycystic ovary syndrome is one of the most common endocrine disorders in women of reproductive age and metabolic disorder in which patients will benefit for early recognition and treatment. The prevalence of PCOS varies between 5% and 10% of all women.
The fundamental pathophysiologic defect still remains unknown. PCOS appears to be a heterogeneous disorder in which ovarian, and possibly adrenal androgen excess is present along with varying degrees of gonadotropic and metabolic abnormalities. Additionally insulin resistance, hyperinsulinism, type II Diabetes Mellitus, endometrial carcinoma, dyslipidemia and psychosocial dysfunction are presented as other clinical consequences associated with PCOS (Azziz et al., 2004).
Clomiphene citrate (CC) is the traditional first-line treatment for the chronic anovulation that characterizes PCOS. In addition, clinical data revealed a discrepancy in ovulation rates and conception rates During CC treatment (Nakamura et al., 1997). A progestin is a synthetic progestogen that has progestational effects similar to progesterone. The two most common uses of progestins are for hormonal contraception (either alone or with an estrogen), and to prevent endometrial hyperplasia from unopposed estrogen in hormone replacement therapy. Progestins are also used to treat secondary amenorrhea, dysfunctional uterine bleeding and endometriosis, and as palliative treatment of endometrial cancer, renal cell carcinoma, breast cancer, and prostate cancer. High-dose megestrol acetate is used to treat anorexia, cachexia, and AIDS-related wasting. (Battino et al., 1996).
Traditional management of ovulation induction in patients with polycystic ovary syndrome (PCOS) has been to provoke a withdrawal bleed by administration of a progestin followed by administration of clomiphene citrate starting on day 3 or day 5 of the induced cycle. The clomiphene citrate dose typically is stepped up cycle by cycle until ovulation occurs. However, neither the advantage nor possible detrimental effect of such practice of endometrial preparation was described.
Multiple studies indicated that pregnancy success were associated with adequate endometrial receptivity, which can be partially assessed by endometrial thickness. Therefore, we may conclude that P-induced withdrawal bleed have negative effect on endometrial-thickness and receptivity(Diamond et al., 2012).
The aim of the work is to study the efficacy of progestin-induced endometrial shedding before ovulation induction in rates of conception in women with PCOS.
This study included 140 patients of those attending the infertility clinic at Ain- Shams University hospital. In the period starting from first February 2013 till March 2014. All patients were subjected to medical history, clinical examination and measurement of serum LH and FSH levels. Also serum level of free testosterone and DHEA.
Our study revealed the following:
• There were no significant differences between both control and study groups as regards age and BMI.day3 FSH, LH and No. of follicles>18 mm in diameter.
• There were significant differences between both control and study groups as regards conception rate.
• There was no significant difference as regard ovulation rate
• There were significant differences between both control and study groups in ovulation rate as regards BMI and serum progesterone level day 21.
• There were significant differences in peak endometrial thickness between both group.
• There were significant differences in conception rate as regards peak endometrial thickness and serum progesterone level day 21.