الفهرس 
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Abstract
olycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain etiology, but there is strong evidence that it can to a large degree be classified as a genetic disease.
PCOS includes a heterogeneous collection of signs and symptoms with varying degree of mildness and severity in affecting the reproductive, endocrine and metabolic functions.The classic triad of the disorder includes hirsutism, menstrual dysfunction, and obesity.
In recent years, transvaginal ultrasound has become the most commonly used diagnostic method for the identification of polycystic ovaries. In order to make a diagnosis of polycystic ovaries, either 12 or more follicles measuring 2–9 mm in diameter, or increased ovarian volume (>10 cm3) should be present on scanning.
Three-dimensional (3D) ultrasound is a relatively new imaging modality that has the potential to improve the sensitivity and specificity of ultrasound in the diagnosis of PCOS.
Medical treatment of PCOS is tailored to the patient’s goals. Broadly, these may be considered under four categories: Lowering of insulin levels, Restoration of fertility,treatment of 14Thirsutism14T or acne and restoration of regular menstruation.
P
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Clomiphene citrate is still the first line treatment in women with PCOS, yet a significant proportion of women do not respond to treatment with clomiphene citrate. In these clomiphene citrate-resistant women, laparoscopic electro-cautery or ovulation induction with gonadotrophins is indicated. The mechanism of action is unknown but is believed to be related to endocrine changes that result from the procedure.
The aim of the current study was to study the impact of laparoscopic ovarian drilling on E2/FSH ratio and ovarian stromal blood flow in women with polycystic ovary syndrome.
In order to achieve this objective, 53 women with PCOS fulfilling the Rotterdam criteria were recruited from infertility clinic of Ain Shams University Maternity Hospital. Venous blood samples for the assessment of serum E2 and FSH were withdrawn on day 2 of the menstrual cycle. Transvaginal 3-D ultrasonography was carried out by the same operator on day 11 or 12 of the menstrual cycle for the assessment of vascular flow index, vascularization index and flow index which were carried out using the VOCAL program (Virtual Organ Computer Aided Analysis). Bilateral laparoscopic ovarian drilling was carried out postmenstrual in laparoscopy unit at Ain Shams Maternity Hospital. Blood samples for E 2 and FSH were re-collected on day 2 of the next menstrual cycle. Transvaginal 3-D Doppler parameters were repeated on day 11 or 12 of the next menstrual cycle.
The vascularizaton index (VI) represents the number and/or size of vessels within the volume of interest and
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therefore the degree of vascularity. The mean power Doppler signal intensity is reported as the flow index (FI) whichreflects volume flow rate. Finally, the vacularization flow index (VFI) is calculated by multiplying the other two indices and therefore provides a single value for both vascularity and volume flow and is suggested as being representative of tissue perfusion.
The results of this study showed that serum estradiol and FSH levels were significantly increased in women with PCOS after performing bilateral laparoscopic ovarian drilling(P< 0.001).
The increase in serum estradiol level was greater than that of FSH level after drilling, thus, E2 over FSH ratio increased significantly (P< 0.001).
The results showed that ovarian stromal blood flow indices (VI, FI, VFI), measured by transvaginal three dimensional ultrasound, significantly increased after the procedure (P< 0.001),and therefore, using three dimensional ultrasound can be used to predict the outcome of ovarian drilling.
The results showed that the percentage of change in E2/FSH in patients with PCOS who had diabetes mellitus was less than those who were medically free; however, this change was statistically non-significant (P˃0.05).
In the current study the percentage of change of E2/FSH ratio in PCOS patients who had symptoms of excess androgen activity (hirsutism, acne) was less than those who had normal androgen levels, however, this change was statistically non-significant (P˃0.05).