OBJECTIVE: Hyperandrogenism is one of the diagnostic criteria for polycystic ovary syndrome. Women with polycystic ovary syndrome suffer from infertility due to anovulation. Hyperandrogenism results in follicular arrest at the antral stage during folliculogenesis. baseline intrinsic hyperandrogenism affects the success of ovulation induction or not. The relationship between baseline serum androgen levels and ovulation induction cycle outcomes by using clomifene citrate among infertile women with polycystic ovary syndrome has not been investigated thoroughly. STUDY DESIGN: Ovulation induction cycle outcomes of 35 infertile women diagnosed with polycystic ovary syndrome according to Rotterdam criteria who have received 50-100 mg/day clomifene citrate have been evaluated retrospectively. Menstrual cycle day 2-5 serum levels for gonadotropins, androgens, metabolic parameters, and ovulation induction cycle outcomes have been compared between women who have and have not achieved clinical pregnancy following treatment. RESULTS: Serum basal follicular stimulating hormone, LH, E2, fasting cholesterol, glucose, and HOMA-IR levels were comparable between these two groups of patients. Unlike other serum androgens, baseline serum-free testosterone level is significantly lower for patients who have achieved clinical pregnancy following ovulation induction with clomifene citrate. The baseline serum cut-off level for free testosterone to predict clinical pregnancy was 1.94 pg/ml with 75% sensitivity and 67% specificity rates. CONCLUSION: Lower or higher levels of androgenic milieu within the ovaries result in defective folliculogenesis and ovulation failure. Increased serum levels of free testosterone which is a proxy for ovarian androgen production might be a detrimental factor for clinical pregnancy rates of women with polycystic ovary syndrome by impairing proper folliculogenesis.

A-21 year-old woman diagnosed with Meyer Rokitamsky Kuster Hauser syndrome has presented with a complaint of amenorrhea and failure to have vaginal penetration during coitus. On magnetic resonance imaging, bilateral rudimentary uterine remnants next to normal appearing ovaries with absence of uterus have been detected. Laparoscopically, a 3 cm transverse incision was made pelvic peritoneum and vaginal apex to create a two finger width opening to the blind vagina. Anterior and posterior visceral peritoneal edges have been grasped and sutured vaginally to the vaginal epithelial border. A continuous purse string stitch technique has been utilized to close the proximal part of the neovagina. Postoperative course of the patient was uneventful. The patient kept using a vaginal silicone dilatator every night for 3 months and she was allowed to have regular coital activity after then. Modified Davydov procedure is an efficient surgical technique with lower complication rates and vaginal stenosis rates.