الفهرس 
Polycystic ovary syndrome (PCOS)Only 14 pages are availabe for public view
 |  | from | 72 |  |  |
| | | from | 72 | | |
Abstract
Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in women. II typically presents with symptoms of anovulation (amenorrhoea. oligomenorrhoea or irregular cycles) associated with clinical and/or biochemical evidence of androgen excess (hirsutism, acne or alopecia) and polycystic ovary by ultrasound. It is by far the most common cause at anovulatory infertility but is now recognized to be a major risk factor for development of type 2 diabetes.
Clomiphene citrate (CC) is the first common oral pharmacologic drug has been used to prompt ovulation in these women, but some women fail to conceive with this therapy. Clomiphene citrate (CC) is a non-steroidal selective estrogen receptor modulator that acts primarily by binding with estrogen receptors at the hypothalamus. This competitive inhibition results in a perceived DROP of circulating estrogen to the hypothalamus and eventually leads to increased gonadotrophin secretion and subsequent induction of ovulation. Although CC results in ovulation in most patients, the pregnancy rates are disappointing.
Tamoxifen (TMX) is a diphenylethylene derivative, another anti-estrogenic agent which is like to CC in structure has been considered for ovulation dysfunction treatment. Tamoxifen has revealed acceptable results in CC failure cases too. The improved in ovulation and pregnancy rates are likely because of a higher score of cervical mucus &improved the corpus 1uteum function infertile women who are not responding to anti-estrogens agents may require a different treatment.
Letrozole, a potent, non-steroidal selective reversible aromatase inhibitor, it could be used for ovulation with obvious lack of anti-estrogen adverse outcome as thin endometrium and poor cervical mucus due to its half-Life is shorter than clomiphene, so pregnancy rate is improved. This study has been formed to compare the effect of Tamoxifen compared to Letrozole for induction of ovulation & pregnancy rate in clomiphene citrate resistant women with Polycystic Ovarian Syndrome .
This prospective random study was conducted in the Obstetrics & gynecology department of Menoufia University Hospital. Written informed consents was obtained from all participants. This study was carried out on (80) CC resistant women.
The patients were diagnosed as clomiphene citrate resistant polycystic ovary syndrome; clomiphene citrate resistance is defined as failure to ovulate after receiving 150mg clomiphene citrate daily for 5 days per cycle for at least three successive cycles (113).
The selected cases were divided into two groups randomly selected:
• group (1): included (40) women who carried odds numbers & they were received letrozole 2,5 mg tab orally twice per day from day 5 to day 7 of the menstrual cycle for three successive cycles.
• group (2): included (40) women who were carried even numbers & they were receive Tamoxifen 20 mg tab once per day starting from day 5 to day 7 of the menstrual cycle for three successive cycles.
Summary
45
Inclusion criteria:
− Age from 20 to 35 year.
− Primary or secondary infertility.
− Diagnosed as polycystic ovary syndrome according to Rotterdam Criteria which must have two of three of these criteria; oligomenorrhea and/or anovulation, clinical and/or biochemical signs of hyperandrogenism and/or polycystic ovary on ultrasound (108).
− Patent both tubes on hysterosalpingography or laparoscopy.
− Normal semen analysis for the husband.
− Complete hormonal profile (FSH, LH, TSH, prolactin, free testosterone).
Exclusion criteria:
− Infertility due to other causes of uterine & tubal pathologies.
− Male factor infertility.
− History of the pelvic inflammatory process.
For each patient the following will be done:
• History taking
• General examination:
• Transvaginal ultrasonographic: Serial Transvaginal ultrasonographic follow up were performed for each case for revealing ovulation, beginning from day 10 of the menstrual cycle & every other day with measurement of number & size of follicles & endometrial thickness.
The occurrence of ovulation was determined by one or more of the following criteria:
• The development of a dominant follicle of size ≥17 mm followed by its disappearance;
• A change in the shape of the follicle or the appearance of internal echoes within the follicle; and
• Free fluid in the pouch of Douglas.
Results of the current study could be summarized as follow:
• There were no statistically significant differences between the studied patients in both groups (letrozole and tamoxifen) regarding age, weight, height and BMI.
• There were no statistically significant differences between the studied patients in both groups (letrozole and tamoxifen) regarding basal FSH, basal LH, TSH, Prolactin, and AMH.
Summary
46
• There were no statistically significant differences between the studied patients in both groups (letrozole and tamoxifen) regarding type of infertility and the duration of infertility.
• About (75%) of the letrozole group had primary infertility and (25%) had secondary infertility. In addition, (80%) of the tamoxifen group had primary infertility and 20% had secondary infertility. The mean duration of infertility in letrozole group was 5.67±1.14 years, whilst it was 5.45±1.93 years in the other group.
• In letrozole group the mean number of mature follicles >18 mm in diameter on the day of hCG administration, during the third month of letrozole therapy was 1.20, and the collective number of patients with follicles >18 mm which was 24.
• In tamoxifen group the mean number of mature follicles >18 mm in diameter on the day of hCG administration, during the third month of tamoxifen therapy was 9.20, and the accumulative number of patients with mature follicles >18 mm which was 11.
• The diameter of the dominant follicle was significantly higher in day 14 and 10 of the 1st and 2nd cycle in patients who received letrozole (18.0±0.50 and 8.16±5.90 mm) than in patients received tamoxifen (14.10±2.08 and 6.30±0.85 mm) with a p-value of 0.034 and 0.045 respectively.
• There were no statistically significant differences between the studied patients in both groups (letrozole and tamoxifen) regarding pregnancy rate.
• Ovulation rate was significantly higher in letrozole group than tamoxifen group. About (52.5%) of the letrozole group had +ve ovulation rate, while (63.75%) of tamoxifen group had –ve ovulation rate. Also, (94.44%) of the letrozole group, and (96.25%) of tamoxifen group had –ve pregnancy rate.