الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 64 |  |  |
| | | from | 64 | | |
Abstract
In fact, PCOS is one of the multisystem endocrinal disorders and one of the leading causes of anovulatory infertility, responsible for seventy to eighty percent of cases because of anovulation.
The clinical presentation of PCOS might include hyperandrogenism (that can be diagnosed clinically or biochemically), menstrual irregularities , PCO, infertility, increased body weight, HTN, disturbed lipid profile, IR, and T2DM. Such endocrinal disorder influences approximately eight percent of females during reproductive age.
For >40 y, CC was considered the standard therapy for ovulation induction in cases suffering PCOS. In spite of the improved ovulatory rates of ” " ~ " ” 85percent, fifteen to twenty percent of cases suffering PCOS show resistance to CC .
Also, several adverse impacts were documented with the use of CC like long-lasting adverse influence on cervical mucus and development of the endometrium resulting in different ovulation & pregnancy rate and a relatively prolonged T1/2 (two weeks).
Letrozole is an aromatase inhibiting agent used to induce ovulation since> 20 y. The essential concern of congenital abnormalities accompanying it are debated by 2 big multicentric studies.
Letrozole reduces the biosynthesis of estrogen and results in a decrease in the circulating level. This releases the HPA from the negative feedback of estrogen with consequently elevation in FSH.
Letrozole is also utilized as a good alternative to induce ovulation as it has no antiestrogenic influence on the endometrial layer. However, since it had short T1/2 (” " ~ " ” 48 h), its excretion is fast from the blood , enabling increase in the estrogen levels. This has good outcomes on the endometrial layer and pregnancy rate.
Carnitine is a quaternary ammonium element that’s formed of a,a lysine and methionine. In human, it causes increased transfer of FAs from the cytoplasm into the mitochondria.
It’s widely present as a nutritional supplement. Carnitine is present in 2 stereoisomers: LC that’s the biological active type, and D-carnitine that’s the biologically inactive type.
LC had an essential role in energy release, OS and glucose metabolism. IT can stabilize the mitochondrial membrane, enhance energy supply to the organelles, and guard the cell against apoptosis.
Besides, it’s used for treating IR. However, females with PCO had decreased level of plasma LC. The reduction was correlated to hyperandrogenic as well as hyperinsulinemia markers.
Vit D has a physiological role in reproductive functions such as ovarian follicular growth and luteinization via altering AMH signaling, FSH sensitivity and progesterone release.
In addition, it changes glucose homeostasis through many roles. The prevalence of Vit D deficiency in females suffering PCOS is ” " ~ " ” 85percent. Decreased 25(OH)Vit D level may enhance the manifestations of PCOS such as IR, ovulation, menstrual irregularity, infertility, increased androgen, increased body weight and increase the risk of CVS diseases.
Recent studies suggest a probable role of Vit D in correcting the metabolic disturbance accompanying PCOS, but more research is necessary to investigate the therapeutic effect in PCOS.
Thus, this study was carried out and aimed at investigating the efficiency of combining LC with Vit D and letrozole in comparison with letrozole only to induce ovulation in infertile females suffering PCOS as regards the endometrial thickness, ovulation rates, pregnancy rates, rate of mono-follicular development and time to conception.
This prospective randomized cohort study was carried out at Alexandria Main University Hospitals (El Shatby Hospital), Egypt from February 2022 until February 2023.
During this study, 94 infertile females were enrolled, following consenting each of them and classified into 2 groups; as regard the 1st group participants, they were administered ovulation induction + oral LC (3gm) supplements in addition to combined with 600 IU Vit D daily for 2 cycles or till the conception in conjunction with letrozole, whereas the 2nd group participants administered letrozole as 5mg once a day for 5 days (from day 3-7) following spontaneous or progesterone induced hemorrhage and increased to 7.5mg in the following cycle if ovulation didn’t occur. Serial TVS was carried out by consultant on alternate days between the 11th-14th days via the use of probe frequency of 6.5 MHz of diagnostic US system.
Our study revealed that females who administered ovulation induction along with oral-carnitine supplements in addition to Vit D had better outcome of ovulation induction in comparison with females administered ovulation induction only. Numbers of mature follicles was more, and endometrium thickness, ovulation and pregnancy rate were better.
In conclusion, in treatment of infertile females suffering PCOs, LC supplements and Vit D are recommended to be used in addition to ovulation induction therapy because they were documented to promote ovulation induction outcome.
The present study can burden the knowledge and shed some light on future prospective studies with greater sample size to reassess our findings and conclusions.