الفهرس 
Polycystic Ovarian Syndrome (PCOSOnly 14 pages are availabe for public view
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Abstract
Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, with a prevalence of approximately 4-6%. Its cardinal features are hyperandrogenism and polycystic ovaries.
The Rotterdam conference of 2003, recommended that at least two of the following three features are for PCOS to be diagnosed:
4- Oligo-ovulation or anovulation; manifested as oligomenorrhea or amenorrhea.
5- Hyperandrogenism (clinical evidence of androgen excess) or hperandrogenemia (biochemical evidence of androgen excess).
6- Polycystic ovaries (as defined on ultrasonography as 12 or more follicles in at least 1 ovary measuring 2-9 mm in diameter or a total ovarian volume of >10m3.
Clomiphene citrate (C/C) was the first agent used in experiments for ovulation induction in oligo-menorrhaic women. For many years it was and may still be the first therapeutic option managing anovulatory infertility.
This work was done to compare the standard traditional protocol of induction of ovulation with CC with the stair step protocol regarding number of follicles, ovulation rate and time.
Sixty women with polycystic ovarian syndrome were divided in two groups:
group 1. (Traditional protocol) representing patients who were treated by 50mg/d for 5 days from 2 to day 7 of the cycle. Patients who regained normal regular cycles or get pregnant were considered to have treatment success, others continued CC therapy for the next cycle by the same regimen with a dose of 100 mg/d. If not responded, the dose was increased to 150mg/d in the third cycle and increased to 200mg/d in the fourth cycle if not responded. Failure of response to this dose was considered as treatment failure.
And group 2. (Stair step protocol) representing patients who were treated with 50 mg clomiphene for 5 days from the second day of the menstrual cycle and vaginal ultrasound were performed at 11-14. When there is no response (no follicle > 10 mm), 100 mg clomiphene is initiated immediately for 5 days, and Ultrasound is repeated 1 week after the first Ultrasound and when there is no response. 150 mg clomiphene is initiated immediately for 5 days and ultrasound was performed 1 week after the second ultrasound.
There were no significant differences in both groups in the clinical criteria of patients regarding age, type of infertility and gravidity of the patients, body mass index (BMI), menstrual irregularity, basal FSH, LH, prolactin and TSH, so the two groups were matched.
There were no significant differences in the ovulation between both groups with the dose of 50mg CC per day but with the doses 100 and 150 the stair step protocol shows significantly higher ovulation rates.
There was significantly shorter ovulation time, higher ovulation rate, increased in numbers of follicles and endometrial thickness in stair step protocol.
The current study concluded that the stair step protocol is safe, effective for the patient, and has practical advantages over the traditional protocol.