الفهرس 
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Abstract
Polycystic ovarian disease (PCOD) is one of the most common endocrine disorders, although its etiology remains unknown. This heterogeneous disorder may present, at one end of the spectrum, with the single finding of polycystic ovarian morphology as detected by pelvic ultrasound. At the other end of the spectrum symptoms such as obesity, hyperandrogenism, menstrual cycle disturbance and infertility may occur either singly or in combination. The original descriptive triad is amenorrhea, obesity and hirsutism(Stein Leventhal syndrome) appears to be the extreme end of the spectrum of the disorder.
Endocrine disturbances (elevated serum concentrations of luteinising hormone, testosterone, insulin and prolactin) are common and may have profound implications on the long term health of women with PCOD.
The most accepted definition of PCOS is eugonadotropichyperandrogenic anovulation with the detection of polycystic ovaries by ultrasonography ( enlarged ovaries with more than 10 cysts 2-8 mm in diameter, scattered either around or through an echodense, thickened central stroma, plus symptoms of oligo-amenorrhea, obesity and hyperandrogenism ( acne, hirsutism and alopecia )
Pcois extremely unlikely that we shall find one single, genetic or environmental cause of PCOS. The first and most pressing reason is that it is unlikely that PCOS is a single condition, and a widespread heterogeneity of clinical presentations is accepted. At the very least, therefore, we can expect a polygenic background with involvement of both genetic and environmental factors. Rather, several factors may contribute to the development of PCOS.
The polycystic ovary is usually enlarged and is characterized by a smooth pearly white capsule. For years, it was erroneously believed that the thick sclerotic capsule acted as a mechanical barrier to ovulation. A more accurate concept is that the polycystic ovary is a consequence of the loss of ovulation.
The hormonal aberrations encountered in polycystic ovarian disease present as a vicious circle of causes and events. The initiating and sustaining event is the ambiguity of the steroid signal influencing pituitary gonadotropin secretion. Inappropriate feedback in the form of non-cyclic estrogen masks the usual mandatory recycling stimuli. The distortionfeedback of signal is caused by abnormal excessive gonadal production of androgen.Abnormalities of estrogen production are resulting from extra glandular conversion of androgen to estrogen.
PCOS management usually starts by weight reduction. 35%-60%of PCOS women have BMI>30, obesity is associated with anovulation and is related to poor response to induction of ovulation.
Omega-3 fatty acids, which have positive effects on health, are found in fish oil. Most studies in the past ten years have shown the positive relationship between omega-3 fatty acids intake and androgen levels.andfor this reason omega-3 could be useful as an adjuvant in hyperandrogenism conditions including polycystic ovarian syndrome (PCOS).
The present study was designed to compare the efficacy of metformin versus omega-3 in treatment of PCOS. Our study was done on 60 patients diagnosed as having PCOS. Patients were collected from Outpatient infertility clinic in El fashn general hospital and infertility outpatient clinic in Beni-Suef University hospital. Informed consents were taken from patients after approval of our study by ethical committee of Beni-Suef University hospital. PCOS patients with age between 20-40years, BMI between 25 and 35 kg/m2.
Patients were divided into 2 groups each contained 30 PCOS patients. First group received 4gm omega-3 fatty acid 4sachet each sachet 1gm 2sachet at morning and 2 sachet at nignt(omega-fit sachet)for 12 weeks Second group: received 1500mg metformin(cidophag tab) 3tablets each tablet 500mg.Tab half hour before meals for 12 weeks.These cases followed for three months by investigations total testesterone, SHBG,fasting insulin, and fasting glucose and finally calculate free androgen index and insulin resistance.
After 3 months we found that lower fasting glucose and fasting insulin were associated with Metformin than Omega-3, and increase sex hormone binding globulin levels were associated with metformin. Therefore we propose that metformin can be offered as first-line therapy in all anovulatory women with PCOS desiring pregnancy.
We concluded in our study that metformin is effective in treatment of PCOS patients when used in the therapeutic dose range,But was shown to have several side effects such as flatulence, diarrhea, and nausea, so that patients who do not tolerate 500 mg 3 times a day are sometimestakenoffthemedication.Instead,thedoseshould be decreased according to tolerance, because it can still be effective.
The results of the present study revealed that metformin is the first-line therapy in treatment of PCOS patients and omega-3 can be used as adjuvant therapy.