الفهرس 
Polycystic Ovarian SyndromeOnly 14 pages are availabe for public view
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Abstract
The PCOS is the commonest hyperandrogenic disorder in women and one of the most common causes of ovulatory infertility, with an estimated prevalence of 4-7%, complex genetic, endocrine and metabolic disorder, and diagnostic worldwide. Polycystic ovary syndrome (PCOS) is diagnosied by chronic anovulation, polycystic ovaries and biochemical and clinical manifestations of hyperandrogenism.
The ultimate goals of treatment include decreasing androgen levels to improve hirsutism, protecting the endometrium, optimizing reproductive function in those desiring fertility, and reducing the long-term sequelae of insulin resistance. The initial therapeutic strategy in the management of PCOS should be directed at management of the patient’s presenting symptoms.
The first-line of treatment for ovulation induction is clomiphene citrate (CC), which is an antioestrogenic compound. CC treatment will successfully induce ovulation in approximately 80% of properly selected candidates. Approximately 70% to 75% of anovulatory women who respond to CC (50 mg/day to 150 mg/day, as required) may be expected to conceive within six to nine cycles of treatment.
The present study was carried at infertility clinic in (Gynecology & Obstetrics and Pediatric hospital, Ministry of Health in Assiut and Assiut Maternity hospital during the period from November 2010 to August 2012, to compared trigger ovulation with GnRHa rather than with HCG in patients with PCOS. The study included 70 infertile women who were diagnosed as having PCOS (55 patients from Gynecology & Obstetrics and Pediatric hospital, Ministry of Health in Assiut & 15 patients from Assiut Maternity hospital).
Patients were assigned randomly to either group A or B through closed envelop and the patient choose their group blindly
group A: includes 35 women who received LHRH analogue (Triptorelin) in a single dose of 0.2mg subcutaneous in the day of follicular maturation (by to trans-vaginal ultrasonograghy when follicle reach 18-20 mm in diameter) to trigger ovulation followed by planned intercourse within the following 36 hours.
group B: includes 35 women who received HCG in a dose of 10,000 IU IM day of follicular maturation (by to trans-vaginal ultrasonograghy when follicle reach 18-20 mm in diameter) to trigger ovulation followed by planned intercourse within the following 36 hours.
The following parameters were compared in both groups: ovulation rate, occurrence of luteal phase sufficiency, pregnancy rate and measurement of LH level on the third day of menstrual cycle.
This study shows no significant difference of pregnancy rate along three cycles between both groups. No pregnancy occurred in the the first two cycle for group A, while an increase of up to 17.1% during the third cycle. On the other hand, group B showed a variation in pregnancy rate which increased up to 12.5% during the third cycle.
This study showed no significant difference in occurrence of luteal phase defect during the first and second cycles in both groups as opposed to the third cycle.
The occurrence of luteal phase defect showed a decrease over the three cycles in both groups with more decrease detected in group A (8.6%) in the third cycle in compared to group B (31.2%) during the third cycle.
Clomiphene Citrate (CC) was used for ovarian stimulation during the follicular phase, and because of the long half-life of CC, a higher pituitary secretion of LH during the luteal phase could be expected counteracting the luteolytic action following the GnRHa trigger.
This study showed no significant differences between the two groups in ovulation rate in the first, second cycles but a significant difference was detected in the third cycle.
This study shows a significant difference between the two groups in LH level in the third day of menstrual cycle along the second, third and last cycle. GnRHa leading to a significant reduction in the circulating endogenous LH level compared with hCG.