الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
PCOS is the most common cause of infertility in women. The symptoms of PCOS may present in adolescence with menstrual irregularities, or it may be asymptomatic until later in life when symptoms and/or infertility occur.PCO can be presented by many clinical features such as: menstrual disorders mostly oligomenorrhea, infertility, hairsutism, metabolic disorders such as central obesity and insulin resistance, acanthosis nigricans and acne.Clomiphene citrate is nonsteroidal selective estrogen receptor modulator (SERM) that inhibits estrogen receptors in the hypothalamus, inhibiting negative feedback of estrogen on gonadotrophin release, leading to up-regulation of the hypothalamic-pituitary-gonadal axis. It is the first line of choice for ovulation induction in normogonadotrophic anovulatory women as in PCO patients.Insulin resistance caused by PCO leads to an increase in insulin levels which in turn stimulate the ovaries to produce more testosterone. Metformin which is a biguanide derivative increase the body sensitivity to insulin reducing its concentration. Thus, it is one of the most used drugs in PCO for its efficacy lowering PCOS-related disturbances, such as menstrual disorders and anovulatory infertility.Orlistat is a derivative of lipstatin which is a potent natural inhibitor of pancreatic and gastric lipase. Orlistat promotes loss of weight by decreasing fat absorption from the intestine lumen by about 30%. As weight loss is fundamental factor for improvement ovarian functions in PCO patients, orlistat contribution in to increase ovulation in those patients emerge.This study was designed to prospectively evaluate the efficacy and safety of ovulation induction in PCO patients using the combination of clomiphene citrate with metformin on one hand, and clomiphene citrate and orlistat on the other hand on 140 PCO patients.So, this study was originally started with 140 patients which number was reduced to 117 due to compliance factors, the patients were divided in two groups, starting metformin first as a sensitizing agent for two months without clomiphene citrate in one group, while using orlistat in the other group in the other group for the same purpose. After two months both groups started clomiphene citrate 50 mg twice per day from day 3 to day 7 in combination with sensitizing drugs for three consecutive cycles.The results of the study were tabulated and statistically analyzed and revealed: no statistical difference between the two groups regarding age, BMI, type and duration of infertility, diagnostic criteria for each patient (Rotterdam criteria), clinical features or hormonal profile.Folliculometry, endometrial thickness measurement ovulation rate and pregnancy rate were done each cycle and the difference between the two groups was also statistically insignificant