الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder which has eluded definitive description because of the varied combination of clinical, biochemical and ultrasonographic features which may occur. The commonest association is of hyperandrogenism and chronic anovulation; recognition of characteristic ovarian ultrasound features together with clinical symptoms of oligomenorrhoea, hyperandrogenism, infertility or obesity is presently the preferred approach to diagnosis (Trivax and Azziz , 2007). The criteria for PCOS which likely identifies the core group of patients arose from the proceedings of a 1990 NIH conference, which noted the features of the disorder to be clinical and/ or biochemical hyperandrogenism with chronic anovulation, after the exclusion of related disorders such as hyperprolactinemia, thyroid disorders, and NCAH. The Rotterdam 2003 conference criteria expanded the 1990 NIH criteria for PCOS by creating 2 new phenotypes for PCOS, one including women with polycystic ovaries and signs of androgen excess, but no signs of ovulatory dysfunction and another including women with polycystic ovaries and ovulatory dysfunction, but no signs of androgen excess. It is clear that the prevalence of PCOS will depend to a great degree on the criteria used to define the syndrome (The Rotterdam ESHRE/ASRM, 2004). The evaluation of the patient suspected of having PCOS initially consists of a through history and physical, determining among other features, the degree of hirsutism as assessed by the mFG score. This should be followed by a targeted laboratory assessment which should include, at a minimum, the measurement of a basal 17-HP level in the follicular phase of the cycle to exclude NCAH, and possibly TSH and prolactin to exclude thyroid dysfunction and hyperprolactinemia. Androgen levels (total and free T, and DHEAS measured using high quality assays) should be obtained, although they have the most relevance in patients without overt clinical signs of hyperandrogenism (i.e, without hirsutism). Ovarian morphology determined by TV-US should be assessed when possible (Legro, 2007). There is no doubt that three dimensional ultrasound is a challenging and rewarding field in which to under-take technology research. It requires the latest generation of computers with large memories and high quality displays (Kyei-Mensah et al., 1998). The advent of sophisticated new systems such as computerized three-dimensional (3D) ultrasound scanning permits visualization of the transverse plane of the pelvis and more accurate measurement of the total ovarian volume. The precision and high degree of reproducibility of ovarian and endometrial volume measurements obtained using this technique have been reported (Pan et al., 2002). The aim of this prospective observational study in women with PCOS was to study the 2 D ultrasound features of the polycystic ovary including quantitative assessment of follicle count, ovarian volume, stromal volume and blood flow within the ovary as a whole compared with a control population. In our study sixty consecutive infertile women presented to the Gynecological Outpatient Clinic at Menofiya University Hospital and El Galaa Teaching Hospital, were recruited to the study , none of them had any medical disorders and there was no recent history of any drug intake. Based on clinical menstrual history, physical examination, biochemical data and ultrasound findings, the women were divided into two groups: Group I: 40 women diagnosed as polycystic ovarian syndrome, by having two of the following criteria; first, a previous history of anovulatory cycles and/or oligomenorrhea; secondly clinical or biochemical evidence of hyperandrogenism and finally; the presence of polycystic ovaries by 2-D transvaginal-ultrasound (The Rotterdam ESHRE/ASRM, 2004). Group II: 20 women (the control group), they all had regular spontaneous menstrual cycles ranging from 21-35 days with a baseline transvaginal scan showing normal ovaries. They had no clinical or laboratory evidence of medical, gynecological or hormonal abnormalities. Body mass index (BMI) was calculated for all patients, Serum LH and FSH concentrations were determined on day 3-5 of the cycle .3 D ultrasound was done to measure antral follicle count (AFC), total ovarian volume by using the rotational method through the virtual organ computer-aided analysis(VOCAL)-imaging program, stromal volume by subtracting the total follicular volume from the total ovarian volume and stromal echogenicity through the assessment of the mean greyness (MG) of the ovary. Using the histogram facility of VOCAL™ software, three vascular indices were generated: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). In the comparison between PCOS and control group in our study, there was a statistical significant difference (P < 0.01) as regards BMI. Women with PCOS had significantly larger total ovarian volume (12.9 ± 2.52 vs. 6.2 ± 1.47, p<0.0001), higher antral follicle count (15.7 ± 1.67 vs. 6.0 ± 0.92 P<0.0001) and ovarian stromal volume (9.4 ± 1.39 vs. 3.1 + 0.81 p<0.0001) than their controls. There were no significant differences in the echogenicity of the ovaries, measured using the mean grey value (MG) between PCOS and control groups. 3D measures of ovarian vascularization revealed significant differences in VI (5.2 ± 1.07 vs. 3.9 ± 1.99, P<0.01) and VFI (2.1 ± 0.33 vs. 1.6 ± 0.90, p<0.05) between PCOs women & their controls while there were no significant differences in the ovarian Flow Index value between the groups. There were also no significant differences in any measurements derived from the pulsed-wave Doppler waveform analysis between the groups. In the subgroups analysis, 11 women with PCOs who were of normal weight (BMI < 25 kg/m2) had significantly higher antral follicle count (16.3 ± 1.56 vs. 14.1 ± 1.41, p<0.05), mean grey value (25.2±7.86 vs. 18.9±8.24, P<0.05) and ovarian vascularity as measured by 3D ultrasound (VI: 4.3 ± 1.83 vs. 3.1 ± 2.37, p<0.05 and VFI: 1.53 ± 0.81 vs. 1.31 ± 1.06, p<0.05) than their 18 obese counterparts. A group of 26 women with PCOS who were clinically hirsute had significantly increased antral follicle count (16.7 ± 1.8 vs. 14.7 ± 1.2, P<0.05), stromal volume (19.8 ± 1.5 vs. 9.6 ± 1.13, p<0.05) and ovarian vascularity measured by 3D ultrasound (FI: 35.8 ± 6.9 vs. 30.3 ± 9.18, p<0.05) than their 14 non-hirsute counterparts. A group of 34 women with PCOs who were anovulatory had significantly increased stromal volume (10.3 ± 1.61 vs. 8.0±1.49, p<0.001) than their 6 ovulatory counterparts.