الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Polycystic Ovary Syndrome (PCOS) is not only the most common endocrine disorder in reproductive age women, but also a predominant cause of anovulatory infertility. from the epidemiological point of view, a prevalence rate of 20 % has been reported recently based on the Rotterdam diagnostic criteria according to ESHRE/ARSM workshops. The Rotterdam diagnostic consensus included at least two of the following three criteria: oligoovulation or anovulation, clinical and/or biochemical evidence of hyperandrogenism, and sonographic features of polycystic ovaries, with the exclusion of medical conditions such as congenital adrenal hyperplasia, androgensecreting tumors, or Cushing’s syndrome. Although a majority of cases with PCOS are obese/overweight, a small but significant proportion of patients present with normal body mass index (BMI ≤ 25 kg/M2) that makes diagnostic work up and therapeutic approach more difficult. These cases are termed lean PCOS. Other endocrine and genetic disorders with similar clinical picture need to be excluded in such cases before the clinicians can make appropriate management plans. Laparoscopic ovarian drilling (LOD) has been widely used to induce ovulation in PCOS women after failure of treatment with clomiphene citrate (CC). Many authors have reported high ovulation (80%) and pregnancy (60%) rates following LOD. However,20–30% of anovulatory PCOS women fail to respond to LOD. The mechanism of action of LOD is not fully understood and therefore it is not exactly clear why some PCOS patients do not respond to this treatment. A possible explanation is that the amount of ovarian tissue destroyed during LOD is not sufficient to produce an effect in some patients