Abstract
The most frequently diagnosed condition in women at the age of reproduction is the polycystic ovarian syndrome (PCOS).it could be related to a complex endocrine condition, due to its heterogeneity and uncertainty about its etiology, as the clinical highlights of PCOS incorporate those related to reproductive signs such as decreased frequency of ovulation, irregular menstrual cycles, decreased fertility. Carnitine plays a substantial role in weight loss, glucose tolerance, insulin function and fatty acid metabolism. Thus carnitine plays a crucial role in controlling obesity, insulin resistance, oxidative stress that are associated with PCOS .While, AGEs are a diverse group of reactive molecules that are formed endogenously by non-enzymatic reactions of carbonyl group of carbohydrates with free amino groups of proteins, nucleic acids or lipids. The soluble form of receptors of AGE (sRAGE) could play an important role in management obesity, insulin resistance, hyperandrogenism, oxidative stress which could be related to PCOS. This study was aimed to investigate serum levels of carnitine & soluble receptors for advanced glycation end products (sRAGE) in clomiphene resistant PCOS .Besides assessing the correlation between serum levels of carnitine ,as well as, soluble receptors of AGE with hormonal ( LH, FSH& Testosterone) and metabolic ( serum glucose , serum insulin & HOMA-IR) markers in these patients .
 The study included thirty women with clomiphene resistant PCOS and thirty apparently healthy women, as a control .In order to measure serum total carnitine and serum soluble receptor of advance glycation end product (sRAGE in PCOS and control groups.
 The results of our study have shown a decreased serum levels of total carnitine in PCOS group in comparison with control group (48.05 and 59.73 nmol/ml, respectively), but there was no significant elevation in serum levels of sRAGE in patients group as compared with control group .In addition to a significant correlation between serum total carnitine and serum sRAGE levels (r=0.45, P-value=0.03). 
 In conclusion serum total carnitine level was low in Clomiphene resistant-PCOS patients in comparison with control group. Although, sRAGE levels in clomiphene resistant- PCOS patients were not significantly different from the age and BMI-matching controls, but a significant correlation between serum total carnitine and sRAGE was detected.
 Key words: Poly cystic ovarian syndrome, soluble receptor of advance glycation end products (sRAGE) , SerumTotal Carnitine
Highlights
The most frequently diagnosed condition in women at the age of reproduction is the polycystic ovarian syndrome (PCOS) [1]
The results of our study have shown a decreased serum levels of total carnitine in PCOS group in comparison with control group (48.05 and 59.73 nmol/ml, respectively), but there was no significant elevation in serum levels of soluble receptors for advanced glycation end products (sRAGE) in patients group as compared with control group
The chosen PCOS patients were under supervision, based on the changed Rotterdam criteria, which require, two of the following three appearances: [1] oligo-and/or anovulation, [2] clinical and/or biochemical hyperandrogenism (clinically by evaluation of the hair development based on the altered Ferriman-Gallwey score and/or biochemically based on raised add up to testosterone, raised serum dehydroepiandrosterone sulfate (DHEAS), and androstenedione) and [3] polycystic ovaries on ultrasound (PCO was characterized as the presence of 12 or more follicles in each ovary, each measuring 2-9 mm in diameter, and/or expanded ovarian volume > 10 ml) [27]
Summary
The most frequently diagnosed condition in women at the age of reproduction is the polycystic ovarian syndrome (PCOS) [1]. Clinical highlights of PCOS incorporate those related to reproductive signs like decreased ovulation frequency, menstrual irregularities, decreased fertility, ultrasound polycystic ovaries, and elevated male hormone concentrations such as testosterone, which can contribute to excessive body and facial hair development and acne. Clomiphene citrate competes with endogenous estrogen at hypothalamus and pituitary gland receptors, interfering with natural estrogen's negative feedback signaling. The elevated levels of FSH induce ovarian hyperstimulation and the potential to grow multiple follicles; 15-20% of the patients fail to ovulate (CC resistance) and from 6070% of the patients fail to conceive (CC failure) after 6 cycles of treatment with CC and require alternative treatments. Part of the insulin resistance appears to be independent of obesity and related to PCOS, with abnormalities of cellular mechanisms of insulin action and insulin receptor function having been documented [4]
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