الفهرس 
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Abstract
Polycystic ovary syndrome is a heterogeneous disorder that was first described by Stein and Leventhal in 1935. A clinical syndrome was identified that consisted of anovulation, hirustism, obesity and infeitility in association with bilaterally enlarged cystic ovaries.
It is extremely unlikely to find one single cause wheather genetic or environmental of PCOD, so apolygenic background with involvement of both two factors can be involved in the pathogenesis of the disease as the ovary, the adrenal gland and the hypothalamic pituitary axis.
The normal aberrations encountered in polycystic ovarian disease present as a vicious circle of causes and events. The initiating and sustaining event is the ambiguity of the steroid signal influencing pituitary gonadotropin secretion. Inappropriate feedback in the form of non-cyclic estrogen masks the usual mandatory recycling stimuli.
A growing body of evidence supports the view that PCOD is metabolic disorder that happens to have its principal manifestation as a reproductive endocrinopathy. The clinical spectrum is broad and extends from relatively normal menses to chronic oligomenorrhea or amenorrhea and from no hirustism to virilization.
The diagnosis of polycystic ovarian disease depends on the clinical features, laboratory investigations as gonadotropms, androgens and sex steroid levels in the urine and plasma, also by ultrasonography MRI and laparoscopy.
By trans-vaginal ultrasonography, the ovary was considered as being polycystic if there were multiple small follicles (10 or more) 2-8 mm in diameter together with increased echogenice stroma. These follicles are either peripherally around a hyperechogenic core of stroma described as ”Pearl necklace appearance ” of follicles or scattered throughout it or both. The ovaries were usually but not always enlarged. Endocrinological diagnosis of PCOD was based on elevated LH with normal or decreased FSH: (reversed FSH: LH ratio more than 2.5. By laparoscopy the typical features of PCO (enlarged with thick white glistering capsule with lost corrugations and stigmata of ovulation).
Different treatment modes have been tried to deal with defect. Among the different medical therapies, clomiphene citrate appeared be the most successful and accepted mode of treatment for these patients. Laparoscopic ovarian drilling by electrocautery has been advocated as alternative treatment to exogenous gonadotropin therapy in anovulatory patients with PCOD failing to respond to medical induction of ovulation.
One hundred patients with a diagnosis of pcos and were resistant to clomiphene citrate were included in this study.All women were informed about the study and a detailed written informed consent was obtained from all patients prior to the study .clomiphene citrate resistance was defined as 3 cycles with CC(150mg)daily without ovulation .All patients were randomized in two groups according to the mode of treatment.