الفهرس 
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Abstract
A significant proportion of women with PCOS suffer from IR and compensatory HI. Growing evidence indicates that elevated serum insulin induces hyperandrogenism, which in turn leads to anovulation and infertility. These concepts provide a rationale for therapies focused on treatments of IR.
Metformin is the most extensively studied insulin-sensitizing agent for the treatment of women with PCOS. Use of metformin leads to a decrease in serum insulin and androgen levels, as well as an improvement in ovulatory function. Obese and non obese women with PCOS may benefit from the use of metformin through the reduction of hyperandrogenemia, total cholesterol, and possibly by restoration of regular menstrual cycles.
The aim of the present study was to show if there is any association between leptin concentration and IR in obese and non obese women with peas, and to evaluate the effects of 12 weeks therapy of metformin on serum leptin concentration and insulin secretion in obese and non obese women with PCOS, with respect to changes in menstrual pattern, ovulatory rate and pregnancy rate after treatment.
This prospective controlled study was conducted in the
department of Obstetrics and Gynecology, Faculty of Medicine, EIIMinia University, from April 2006 to August 2007 after being accepted by department comittee .
Sixty women with PCOS were recruited from the attendees of the Gynecology clinic at Suzan Mubark University Hospital. As a control group 20 healthy fertile women were recruited. A written informed
consent was obtained from each women prior to participating in the study. The recruited women were subjected to history taking, general examination, local pelvic examination, trans - vaginal ultrasound examination to document ultrasound criteria of pcas. Blood samples were obtained from each patient in the study and control groups and the following were measured FSH , LH, testosterone, insulin, leptin and blood glucose. Patients in the study groups whether obese or non-obese were given metformin 500mg t.d.s orally for a period of a 12 wks. Following the course of metformin blood samples were obtained from each patient in both study groups to determine the levels of the previously measured parameters
Comparison between the different groups as regard the clinical characteristics and hormonal levels before and after treatment. Correlation between serum leptin, serum insulin and BMI was done. All patients in the study groups were followed up for a period of 6 months posttreatment. Menstrual pattern, ovulation rate and pregnancy rate was evaluated and compared in the 2 groups.
There was statistically non significant difference between the groups as regarding age, duration of marriage, duration of infertility, type of infertility, SBP, and DBP. However, parity was significantly low and BMI was significantly higher in obese patients with pcas when compared to non obese patients and control.
Both groups of pcas showed a significant improvement III menstrual pattern and ovulation, but the improvement was more obvious with non obese patients with pcas. There was non significant difference in pregnancy rates after treatment in both groups. In obese patients, pregnancy occurred in 5 patients (12.5%), however, in non obese patients,