الفهرس 
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Abstract
SUMMARY
Polycystic ovarian syndrome (PCOS) is one of the most common female endocrinal disorders affecting 5-10 % of women in reproductive age 15-40 years. It characterized by obesity. anovulation, infertility, amenorrhea, hirsutism, acne, excessive amount of male hormone (androgen) insulin resistance , diabetes, and abnormal lipid profile.
In 2003 a consensus workshop sponsored by ESHRE / ASRM in Rotterdam indicatedPCOS to be present if 2 out of 3 criteria are met :
- Oligoovulation and / or anovulation.
- Excess anderogen activity.
- Ploycystic (by gynecologic ultrasound) and other endocrine disorders arc excluded.
Women with PCOS are at risk of endometrial hyperplasia and endometrial cancer due to over accumulation of uterine lining , and also lack of progesterone in prolonged stimulation of uterine cells by estrogen. It is however unclear if this risk is directly due to the syndrome or from the associated obesity. hyperinsulinemia and hyperandrogwnism .
L Arginine is alpha protein amino acid it is one of the 20 most common natural amino acid it present in all forms on the earth , L Arginine is semi essential amino acid that is needed for normal body functions and healing .Arginine is precursor not only for protein production but also for nitric oxide ,urea ,creatinine, polyamine,proline and agmatine .
L Arginine stimulate secretions of human growth hormone, prolactin and protein formations. Arginine increases plasma insulin (hyperinsulineamia) and patient liable to diabetic, It improve blood flow which can reduce heart attack. It ideal for use in sexual dysfunctions in men and women. It improves immune system. It lowers blood pressure and cholesterol (LDL), so has antiatherosclerosis
Aim of Work :
To estimate levels of the L-arginine in obese and lean patients with polycystic ovarian syndrome , and define any correlation between L-arginine and hormonal ( LH , FSH , PRL , SHBG , DHEAS , TT and fasting insulin ) parameters .
Patients and Methods:
- The study included a total of 40 infertile women who were diagnosed as having PCOS and dividing into three group each one include 20 infertile women .
Inclusion criteria
1) Diagnosis of PCOS was based on the Rotterdam criteria, whereby diagnosis of PCOS require the presence of two of three criteria after the exclusion of other etiologies:
• Chronic anovulation or dysfunction, defined as oligomenorrhea or amenorrhea.
• Clinical or/and laboratory manifestation of the hyperandogenism.
• Diagnosis of polycystic ovaries by transvaginal ultrasound which includes the presence of 12 or more follicles in either ovary measuring 2-9 mm in diameter and/ or increased ovarian volume (> l0 ml)
2) Age between 18-39 years.
3) Period of infertility ≥ 2 years.
4) Absence of the other factor which might contribute to infertility (i.e. no tubal factor and no male factor).
Exclusion criteria:
A. Patients with endocrinopathy induced obesity as hypothyroidism, Cushing syndrome and congenital adrenal hyperplasia.
1) Patients under treatment with L-arginine or any hormonal treatment in the last three months.
2) Patient with liver or kidney dysfunction.
3) Hyperprolactenemia.
4) Diabetes Mellitus or/ andhypertention.
5) Smoking .
All women were subjected to :
1)Full history talking
2)Complete clinical examination
3)Anthropometric measures
4)Hormonal assays
5)Transvaginal ultrasound examination
As regarding the results. The following was observed :
1) Nosignificant different in serum level of L arginine in PCOS patients when compared with healthy control .
2) serum level of L arginine did not correlate with hormonal parameters in patients with PCOS
3)Insulin resistance in obese PCOS is more than non-obese PCOS and control .
4) Obesity increase risk of insulin resistance .
5) Lean PCOS have some degree of insulin resistance .
These results were in agreement with most but not all studies concerned with serum level of L arginine with PCOS