الفهرس 
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Abstract
Polycystic ovarian syndrome (PCOS), which is thought to afflict 6 to 10% of women globally, is a major contributor to infertility in women of reproductive age.
Reduced ovulation frequency, menstruation disruption, and increased androgen are the main reproductive problems associated with this complex endocrine condition.
However, PCOS is also linked to several metabolic traits including insulin resistance, obesity, and a greater chance of getting cardiovascular disease, type 2 diabetes, and the metabolic syndrome.
Although the specific cause of PCOS is unknown, it is believed that both insulin resistance and hyperinsulinemia, which causes obesity, are important factors in the disease’s pathophysiology.
Weight loss is a crucial part of PCOS treatment for obese women. In women with PCOS, even a small weight loss of 5% has been demonstrated to significantly reduce visceral fat mass, improve metabolic parameters, and improve clinical symptomatology, menstrual function, and trigger spontaneous ovulation.
While strict dieting and regular exercise are advised as first-line treatments, these lifestyle changes may not have the same effect on all women. As a result, patients with class 3 obesity have been offered bariatric surgery as a new and effective alternative therapy option for PCOS.
While bariatric surgery has been demonstrated to benefit PCOS, its effect on PCOS-related infertility is less apparent. Currently, pharmacologic agents such as metformin are widely used to target insulin insensitivity and lessen hyperandrogenism in PCOS, which in turn improves the reproductive symptoms of the disease.
Consequently, this study was conducted and aimed to evaluate the effect of laparoscopic sleeve gastrectomy versus insulin sensitizers on both resumption of ovulation and insulin resistance in patients with poly cystic ovarian syndrome.
This prospective randomized cohort study was conducted at Alexandria Main University Hospitals (El Shatby Hospital), Egypt from February 2022 until February 2023. During this study, 20 infertile women were enrolled, after consenting each of them and divided into two groups; group A included 10 patients who already decided to undergo sleeve gastrectomy (from bariatric surgery clinic) that fulfilled inclusion and exclusion criteria (cases) and group B included 10 patients from infertility clinic received metformin (500mg) three times per day (controls).
To the best of our knowledge, there are no studies to date, however, that compared the effects of bariatric surgery to those of metformin on fertility and pregnancy outcomes and most of other studies that disagreed with our results were due to several causes as different study methodology, outcomes, sample size and different medical conditions of studied cases at time of enrollment.
Our study revealed that there was improvement of ovulation, fasting insulin level; HOMA-IR and body mass index and % of weight loss rated 3 and 6 months posttreatment in both study groups but with no significant differences between them.
In conclusion, bariatric surgery and insulin sensitizers promote significant weight loss and resumption of ovulation, which is linked to the improvement of menstrual irregularities, insulin resistance, and ovulatory dysfunction