الفهرس 
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Abstract
PCOS is a prevalent metabolic dysfunction that affects the ovulation process and the fertility of up to 10% of women. Patients with polycystic ovarian syndrome presented with an ovulation plus either hyperandrogenism or polycystic ovarian morphology.
The aim is to study the effect of adding HCG ovulation trigger in cases of polycystic ovarian syndrome undergoing ovulation induction by letrozole.
Patients were enrolled from those attending the infertility clinic, in the Shatby Maternity hospital. The study included 160 patient who randomized blindly to two groups:
1. group (A): included (80) patients with PCOS received Letrozole.
2. group (B): included (80) patients with PCOS received Letrozole and HCG.
All patients were subjected to complete history taking, clinical evaluation including signs of hirsutism and body mass index , laboratory investigations including(day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), prolactin hormone (PRL) ) and transvaginal ultrasound to diagnose polycystic ovaries and confirm eligibility and role out exclusion criteria.
Artificially induced menstrual cycle using Duphaston 10mg three times per day for seven days was done followed by Letrezole 2.5mg twice daily will be given starting from day five to day ten.
Follicular scanning starting after end of treatment. When follicular size > 14mm, patients will be randomized into two groups:
1. group A (80 patients) ” timing only ”,
2. group B (80 patients) that will receive HCG10.000 IU when follicular size ≥18 mm.
The main outcome to be evaluated was number of cases responded by dominant follicles and number of follicles seen before randomization of patients into two groups (A) and (B), serum progesterone level “P4” , estradiol level “E2” and E2/P4 ratio will be measured at group (B) after eight days of HCG administration and in group (A) after seven days of ovulation which will be diagnosed sonograghically . Secondary outcomes were clinical ongoing pregnancy, miscarriage rate, timing of menses in non-pregnant women to assess the length of luteal phase and non responding cases to Letrizole.
Letrozole is a potent drug in ovulation induction in PCOS patient with high ovulatory rate .It is also mainly a mono-follicular drug which assure less rate of multiple pregnancy and ovarian hyperstimulation.
Results pr