الفهرس 
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Abstract
Summary
PCOS is the most common form of type II anovulatory infertility and is associated with hyperandrogenemia. Moreover, PCOS is the most common endocrine abnormality in reproductive age women. The diagnostic criteria for PCOS include two of the following three factors: chronic oligomenorrhea or anovulation, hyperandrogenism, and polycystic ovarian morphology.Women with PCOS are more likely to be obese and have insulin resistance or impaired glucose tolerance. In fact, studies have shown that weight loss through dietary interventions and exercise can improve insulin resistance, hyperandrogenism, and restore ovulation in women with PCOS who are obese or overweight.
The aim of this work was to compare the efficacy of clomiphene citrate vs letrozole vs tamoxifen in ovulation induction in cases of PCO syndrome.
90PCOS subjects were enrolled in this study, all received metformin 1000 mg per day, and divided as follows:
group I: (n = 30) received clomiphene citrate in a dose of 100 mg per day from day 5 to day 9 of menstrual cycle.
group II: (n = 30) received letrozole in a dose of 2.5 mg per day from day 5 to day 9 of menstrual cycle.
group III: (n = 30) received tamoxifen in a dose of 20 mg per day from day 5 to day 9 of menstrual cycle.
All groups were subjected to:
Full history taking, full clinical examination, and gynecological examination.
Routine laboratory investigations (CBC, thyroid functions, liver functions and kidney functions) were done.
Hormonal analysis in the form of FSH, LH, E2, and prolactin on the 3rd day of the cycle, progesterone in the 21st day of the cycle.
Fasting blood sugar, fasting insulin were measured. Glucose to insulin ratio (G/I) was calculated by dividing the fasting blood sugar on the fasting insulin.
They were followed up for three cycles by transvaginal ultrasound folliculometrystarting from day 11 of the cycle and repeated in day 13, 15 and 17. Number and size of follicles were reported, follicles measure more than 18 mm were considered mature. Serum progesterone on day 21 of the cycle was measured to document ovulation.
Results revealed that:
When we compared between the three groups regarding clinical data, we showed that there was no statistically significant difference between groups regarding age and BMI. There was no statistically significant difference between the study groups regarding duration or type of infertility.
Regarding laboratory investigations; there was no statistically significant difference between groups in FSH, LH, E2, and prolactin levels.There was no statistically significant difference between groups regarding fasting blood sugar level, fasting insulin level, glucose/ insulin ratio.
The endometrial thickness in group A ranged from 4.0 to 12.0 with mean of 8.10±1.71. In group B, it ranged from 7.0 to 13.0 with mean 10.27±1.41, and in group C, it ranged from 6.0 to 14.0 with mean 9.34±1.67. There was statistically significant difference between groups (p <0.001).
There was no statistically significant difference between the study groups regarding mid-luteal progesterone level, mean follicular diameter, number of follicles more than 18, pregnancy rate.
There was no significant difference between the three groups regarding side effects; mood swing, visual disturbances, ovarian cysts, ovarian hyperstimulation syndrome, and twin’s pregnancy.