الفهرس 
Causes of infertilityOnly 14 pages are availabe for public view
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Abstract
PCOS is a common cause of infertility and is associated with chronic anovulation and hyperandrogenemia. It affects up to 6% of reproductive age women. CC is still the first-line therapy for ovulation induction in these patients. However, clomiphene resistance is common and occurs in approximately 15%–40% in women with PCOS. CC may have a negative effect on the cervical mucus and endometrium and is associated with a discrepancy between ovulation and conception rates. Approximately 50%–70% of all women with PCOS have some degree of insulin resistance. Hyperinsulinemia probably contributes to the hyperandrogenism, which is responsible for the signs and symptoms of PCOS. Metformin, a biguanide, has been used to treat insulin resistance in women with PCOS with the goals of reducing ovarian androgen production. This may directly affect follicular development and inducing ovulation. Furthermore, many reports confirmed that the addition of Metformin to CC in the CC-resistant PCOS was highly effective in achieving ovulation in 68.6%–77.7% of patients. Letrozole, an aromatase inhibitor, has attracted the attention for a long time to induce ovulation with a reported ovulation rate of 70%–85% and a pregnancy rate (PR) of 20%–27% per cycle. In addition, its use in patients with CC-resistant PCOS achieved ovulation 54.6% to 84.4% of the time. In the current study we aimed to compare the effect of administration of combined Metformin–Clomiphene Citrate to that of combined Metformin–Letrozole in induction of ovulation in infertile overweight women with PCOS. 40 infertile overweight cases with PCO were included. Cases were randomly allocated in two groups: each group included 20 cases: group A: metformin– clomiphene citrate. group B: metformin– letrozole. Results:- -We found that the mean age was 26.40 ± 5.20 years for CC group and 26.50 ± 5.10 years for Letrozole group. BMI was 27.50 ± 1.43 for CC group A and 27.45 ± 1.36 for Letrozole group. The duration of infertility was 2.90 ± 1.40 years for CC group A and 2.88 ± 1.21 for Letrozole group. There was no statistically significant difference between the two groups. -In addition, we found that there was no statistically significant difference between the two groups as regards the follicles >18mm and endometrial thickness. But as regards progesterone level there was statistically significant increase in Letrozole group than CC group (P-value< 0.005). Concerning pregnancy rate, there was insignificant difference between the two studied groups.