Prognostic Significance of Uterine and Ovarian Artery Doppler Velocimetry in Clomiphene Citrate Cycle in Patients with Polycystic Ovary Syndrome

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders that cause subfertility. PCOS is a complex, heterogeneous disorder of uncertain etiology, but there is strong evidence that it can to a large degree be classified as a genetic disease. PCOS includes a heterogeneous collection of signs and symptoms with varying degree of mildness and severity in affecting the reproductive, endocrine and metabolic functions.The classic triad of the disorder includes hirsutism, menstrual dysfunction, and obesity. In recent years, transvaginal ultrasound has become the most commonly used diagnostic method for the identification of polycystic ovaries. In order to make a diagnosis of polycystic ovaries, either 12 or more follicles measuring 2–9 mm in diameter, or increased ovarian volume (>10 cm3) should be present on scanning. Medical treatment of PCOS is tailored to the patient's goals. Broadly, these may be considered under four categories: Lowering of insulin levels, Restoration of fertility,treatment of hirsutism or acne and restoration of regular menstruation. Clomiphene citrate is still the first line treatment in women with PCOS, yet a significant proportion of women do not respond to treatment with clomiphene citrate. In these clomiphene citrate-resistant women, laparoscopic electro-cautery or ovulation induction with gonadotrophins is indicated. The mechanism of action is unknown but is believed to be related to endocrine changes that result from the procedure. The aim of the current study was to evaluate the prognostic significance of uterine and ovarian artery Doppler vielocemetry in clomiphene citrate cycle in patient with polycystic ovary syndrome. In order to achieve this objective, 75 women with PCOS fulfilling the Rotterdam criteria were recruited from infertility clinic of Ain Shams University Maternity Hospital. Color Doppler sonography was performed once for every patient on day 3 of the menstrual cycle while the patients were in the lithotomy position with a 4-9-MHz probe and a Sonoline Versa Plus 7.0.0 system (SonoAce-R5 Samsung).All patients were received oral clomiphene citrate, 100mg daily, from day 3 to day 7 of their menestural cycle for one cycle.All patients were followed up by folliculometry and mid leuteal progesterone level.