الفهرس 
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Abstract
Polycystic ovary syndrome is defined by chronic anovulation or oligo-ovulation, hyperandrogenism, and polycystic ovaries and occurs in 8%–17% of women. Women with Polycystic ovary syndrome often present with infertility, obesity, and clinical features of hyperandrogenism, such as hirsutism, acne, and alopecia. Women with Polycystic ovary syndrome are at greater risk than non- Polycystic ovary syndrome women for insulin resistance and associated diseases (eg, diabetes, cardiovascular disease), endometrial cancer, and psychiatric problems such as depression and anxiety disorders. Treatment for Polycystic ovary syndrome generally follows a multipronged, biopsychosocial approach depending upon the medical needs and desires of the patient.
A single treatment modality, however, usually ameliorates more than one abnormality in polycystic ovary syndrome. For example, metformin, a biguanide insulin sensitizer, can be prescribed to combat insulin resistance and improve fertility. Another common medication, the oral contraceptive pill, improves hirsutism and acne and may reduce the risk of developing endometrial cancer
Low-dose aspirin has been shown to increase both ovarian and uterine blood flow through inhibiting the synthesis of thromboxane A2 resulting in vasodilatation and inhibition of platelets aggregation. It was suggested that Low-dose aspirin treatment significantly improves ovarian responsiveness, folliculogenesis, uterine and ovarian blood flow velocity, and implantation and pregnancy rates in in vitro fertilization patients.
Significant number of anovulatory infertile women is resistance to anti-estrogens treatment and need another treatment modality to improve ovulation induction results before shifting to other expensive protocols. In the literature, Low-dose aspirin could be added to clomiphene citrate as an adjuvant modality.
Low-dose aspirin has been used for its anti-inflammatory, vasodilator, and platelet aggregation inhibition properties in order to improve blood flow, promote fertility and lead to higher success with in vitro fertilization regimens. This property along with the low cost, high availability and minimal side effects of low-dose aspirin gives it the potential to greatly benefit women who are undergoing ovulation induction.
The aim of our study was to evaluate the efficacy of co-administration of low-dose aspirin with clomiphene citrate on ovulation rates, endometrial thickness and clinical pregnancy rates in cases of clomiphene citrate resistant Polycystic ovary syndrome women at Minia university hospital over one year.
This was a clinical trial, that was conducted at Minia maternity university hospital, the study included women presented to the outpatient clinic due to Polycystic ovary syndrome with an ovulatory infertility with exclusion of other factors of infertility, the study was carried out from July 2019 to July 2020 over one year.
The main results of the study revealed that:
Ovulation rate in the studied group 21.1%. These is determined by presence of at last one dominant follicle ≥18mm and serum progesterone level at day 21 ≥10 ng .
Clinical pregnancy rate of the studied group show that 4 (5.2%) while 72 (94.7%) were non pregnant of total number 76 patient .
Endometrial thickness before TTT was ranged between 2_7mm with a mean value of 4.42±1.967 % while after TTT it was ranged between 2– 8mm with a mean value of 6.57±1.82 % which with no statistically significant differences between before and after TTT with P value(0.846).
Women ovarian volume before TTT was ranged between 22-38 with a mean value of 29.53±3.423% while after TTT was ranged between 23-35 with a mean value of 29.48±3.511% with no statistically significant differences between before and after TTT.
Dominant follicles of the studied group before TTT show that all follicle was <1.8 cm while after TTT 16(21.1%) had follicles ≥1.8 cm. Follicles before TTT was ranged between 0.2 – 0.9 cm with a mean value of 0.53±0.229 % while after TTT it was ranged between 1 – 3 cm with a mean value of 1.63±1.167 % with no statistically significant differences between before and after TTT with P value (0.121).
Endometrial thickness appearance of the studied group show that 76(100%) of patients with non-triple layer, while after TTT results show that 60 (78.9%) with non-triple layer and 16 (21.1 %) with triple layer shape which with no statistically significant differences between before and after TTT with P value (0.121).
Early follicular stromal ovarian blood flow. PSV follicular stromal ovarian blood flow was ranged between 7 – 24 cm/s with a mean value of 15.31±5.255 cm/s. PI follicular stromal ovarian blood flow was ranged between 0.21 – 1.97 with a mean value of 0.98±0.532. RI follicular stromal ovarian blood flow was ranged between 0.40 – 0.80 with a mean value of 0.60±0.109. S/D ratio follicular stromal ovarian blood flow was ranged between 1 – 4 with a mean value of 2.58±1.071.
CONCLUSION
In conclusion, our clinical trial showed that low-dose aspirin administration results in slightly high pregnancy rate, our study shows promising results that highlight the potential role for LDA with clomiphene citrate as an additional co-factor to improve ovarian response; prepare the endometrium to increase the chances of pregnancy. LDA seems to be a useful, effective, cheap and safe treatment in patients who undergo ovulation induction.