الفهرس 
POLYCYSTIC OVARY SYNDROME
Pathology of Polycystic Ovary Disease:Only 14 pages are availabe for public view
 |  | from | 184 |  |  |
| | | from | 184 | | |
Abstract
Polycystic ovary disease is a common endocrine problem related to puberty and menopause. The prevalence of polycystic ovary disease in community based on clinical, endocrinilogical and radiological data was found to be 21-22%. The syndrome is seen in the second and third decade of life (26) . The polycystic ovary syndrome (PCOS) is a common and complex endocrine disorder affecting 5-10% of women of reproductive age (23) . Clinically, it is characterized by hyperandrogenesim and chronic anovualtion leading to menstrual irregularities and subfertility. Despite its high prevalence little is known about its etiology (241) . Laparoscopic ovarian surgery has replaced ovarian wedge resection as the surgical treatment for clomiphene resistant women with polycystic ovarian disease. It is free of risks of multiple pregnancy and ovarian hyper-stimulation. In addition, it does not require intensive ultrasound monitoring. Furthermore, ovarian diathermy appears to be as effective as routine gonadotrophin therapy in the treatment of clomiphene resistant women with polycystic ovarian disease (271) . Anti-mullerian hormone (AMH) also known as mullerian inhibiting substance (MIS), is a marker for the quantitative aspect of ovarian reserve and ovarian ageing (2) . The aim of our study was to measure changes in serum AMH , FSH, LH and E2 in response to laparoscopic ovarian drilling to see whether this could explain the mechanism of action of laparoscopic ovarian drilling . The study involved 30 women with anovulatory PCOS, all women were subjected to full history taking general and local examination, hormonal profile (FSH, LH, AMH and E2) and ultrasonography (antral follicle count and ovarian volume) were done for all patients before and after bilateral ovarian drilling. All women were 30-40 years, with BMI 25-30 Kg/m2 and duration of infertility was one to four years. Before and after LOD, AMH was strongly positively correlated with ovarian volume, preantral follicle count, estradiol, LH, LH/FSH raio. After LOD, there was a significant decrease of ovarian volume and preantral follicle count. Also LOD resulted in a significant DROP of LH levels and consequently LH/FSH ratio. AMH levels decreased significantly (p<0.001).there was also significant increase in level of E2. Laparoscopic ovarian drilling results in 25% reduction of plasma level of AMH .The baseline AMH level can predict ovarian responsiveness to laparoscopic ovarian drilling . So pretreatment measurement of serum AMH may be a useful tool in predicting the outcome of LOD .This could help in patient selection for treatment and may help with counseling PCOS patients concerning the expected success of ovulation induction. According to the results of this study , hormonal (AMH,FSH, LH,E2) and sonographic (ovarian volume, antral follicle) assessment before bilateral laparoscopic ovarian drilling is very important to detect ovarian reserve as well as ovarian responsive after bilateral laparoscopic ovarian drilling. Failure of LOD in women with relatively high level of AMH may be due to severity of the PCOS condition in these women. It is possible that the extent of follicle destruction by LOD was not enough to reduce intra ovarian AMH to a level consistent with consumption of ovulation. Further studies should evaluate whether increasing the number of punctures or the energy per puncture could improve the response to LOD.