 Hello, my name is Dr. Arpit Mahajan. The paper presentation title is color Doppler sonographic evaluation of women with polycystic ovarian disease and compare with normal women with normal ovaries. Name of the study to assess the ovarian estomal blood flow pattern in women with ECOS and compare with normal ovulatory women using color Doppler analysis. Introduction polycystic ovarian syndrome is the most common cause of an ovulatory infertility accounting for more than 70% cases. Over 16-25% of the normal population has polycystic ovarian on ultrason, the presence of polycystic ovaries was considered to be suggestive but not diagnostic of PCOS. However, the Rotatum PCOS consensus workshop group requires the existence of two of the voluntary criteria to make the diagnosis of PCOS. First, olivobulation or anovilation second is the clinical or biochemical science of hyperendogenism, that is the PCOS on ultrasonography. The intra-ovarian vascularity in cases of PCOS is localized mainly within the hyper-ecosin ovarian estomal. Waveform obtained from ovarian tissue showed a mean resistance index of 0.54 without cyclical changes between the subsequent examination. Therefore, high resistance to chlorinates maintain value with no cyclical changes in the established characteristic of an anovilatory cycle. Color Doppler studies have shown that in patients with PCOS important changes in ovarian vasculature occur at the level of intra-ovarian arteries. Although intra-ovarian vascularization is usually not seen before the 8-10 of the 28-day cycles. In this cross-sectional study, we took 110 patients from the OPD of the Ops Guinean Department from the Indian Institute of Medical Sciences, in the Uttar Pradesh. When patients come to ultrasonography, we look for the ovarian estoma, ovarian volume and the number of follicles. If the number of follicles is more than 10, ovarian volume is more than 10 CC and equal to ovarian estoma, then we took the Doppler parameter. Now, we have the peak systole velocity, endostasis velocity, falsitivity index and resistive index. If peak systole velocity is more than 10, it may go towards the PCOS. If less than 10, it may be normal. If endostasis velocity is more than 8, it may go towards PCOS when less than 8, it may be normal. If falsitivity index is more than 2, it may go towards normal ovarian volume. If less than 2, it may go towards PCOS ovarian volume. If putting any resistive index, it may go towards normal ovarian volume. If it is less than 6, it may go towards PCOS ovarian volume. Now, we see the mean How in my study, woman is 25 plus minus 5.8 and men burden between the 15 to 30 year of the age group. The BMI of the PCOS patient in my studies is more than 25 in 33 PCOS woman out of 55 whereas for normal one it is between 18.5 to 24.9. The volume of the PCOS patient of the ovary is more than 10 in 54 woman out of 55 where is normal one it is less than 10 and the number of follicle in PCOS woman is more than 10 in 54 patient out of 55 and there is an echogenic stroma in the ovaries of the PCOS patient as compared to the normal woman. Pre-cystralic velocity if we do the cutoff value of 10 then 52 patient out of 55 times the velocity of more than 10 and if we take the cutoff value of 20 then 44 patient out of 55 in PCOS woman have more than 20 cm per second velocity in 20 cm per second the specificity is 85.45 and it increased to 98% if we do the cutoff value of 30 cm per second but sensitivity drops to 19%. Similarly end diastolic velocity in PCOS woman is more than 10 whereas in normal one is less than 10 and if we do the cutoff value of 8 cm per second then it is the best compromise between the sensitivity and specificity in this case sensitivity is 90% and specificity is also 90%. That is in PCOS woman end diastolic velocity is more than 8 whereas in normal one it is less than 8. Resistive index in PCOS woman is generally less than 0.6 whereas in normal one it is more than 0.6. Similarly pulsative index in PCOS woman is less than 2 that is decreased as compared to the normal one increase in pulsative index it is more than 2. SG systolic diastolic ratio in PCOS woman is less than 3 whereas in normal one it is more than 3. Discussion color of the ultrasound is a non-invasive assessment of the blood flow. Different studies show conflict in the value of the average resistive index and pulsatory index of ovarian artery in diagnosis of PCOS. The mean age in our study is 25 plus minus 5.9 the mean burden of the age group between 15-30 years. Obvious women are more likely to have menstrual irregularity and ovulatory inverting than normal wet women. In reproductive age women the relative risk of an ovulatory infertility increases at BMI of 24 kg per square meter and continues to rise in increased BMI. The mean BMI of PCOS woman in my study is 24 plus minus 2.4 and for normal it was 22.4. Number of follicles varying in sizes in PCOS however different studies have different value for minimum number of follicles. In my study the mean number of follicles in PCOS woman was 14.7 plus minus 2 and normal one it was 4.8 plus minus 2. In previous studies and the mean number of follicles were 13 plus minus 4 whereas in normal one it is 5 plus minus 2. Increase in estomol ecogenicity in PCOS due to the combination of rest estomol ovarian volume and the significantly lower mean ecogenicity of the entire ovary in this woman. In my study the ecogenicity was seen in 54 out of 55 patients of PCOS ovary in volume increase in ovary in volume is an essential criteria for PCOS according to previous studies in the criteria fulfillment sufficiently specificity and sensitivity to define PCOS at least one of the following either dual or more follicles measured to 9 mm diameter or increased ovary in volume. In our study all patient have more than 10 volume it was one of the inclusion criteria but only four of normal patient have volume above the maximum bulk of the patient were in between 10 to 19 cc. In my study mean ovary in volume of PCOS woman was 17 plus minus 4 whereas for normal one it is it was 7 plus minus 1.9. Peaks estomol ecogenicity ovary in vessel are engorged and dilated in patient with PCOS and resulting in increased viscosity and has increased PSV. In my study average PSV of PCOS woman was 24 plus minus 6 and for normal woman it was 15 plus minus 5. That is there is increase in estomol ecogenicity reduced PI and RI in PCOS woman. End estomol velocity since the viscosity of ovary is increased in PCOS there is increased in end estomol velocity out of proportion to peaks estomol velocity which result in decreasing resistive index pulsated to index estomol dashed with ratio. In my study end estomol velocity of PCOS woman was 11 plus minus 2 and normal woman 5 plus minus 2 sensitivity was 54 percent and specificity 98 percent. In my study the best sensitivity is 90 and specificity is also 90. The impedance in the blood flow of the ovary in RT was significantly lower in patient with PCOS that is ovary in RI, resistive index was significantly lower in PCOS group. In my study resistive index was significantly lower that is 0.52 then in normal woman. Setting the cut of 0.6 the best sensitivity is 83 percent and specificity is 92 percent. In the study the pulsativity index of the ovary in estomol RT is significantly lower 1.35 plus minus 0.5 in PCOS woman 4 plus minus 0.8 in normal woman that is the blood flow in ovary in estomol artery higher in patient with PCOS is compared with the normal woman. The low pulsativity index value indicates that the ovary in vessel are probably interrelated and involved more evidently in the ovary of woman with PCOS. Sensitivity of PI less than 2 is diagnosis of PCOS was 89 percent and specificity was 98 percent. If cut of value was taken to less than 1 then sensitivity was reduced to 60 percent and specificity was 98.21 percent. In an SD ratio there is significant decrease in SD ratio in PCOS woman as compared to normal woman in my study SD ratio of PCOS woman is less than 3 in 80 percent of PCOS woman. Overall best indicator is pulsativity index followed by the end acetyl velocity and the combination of above indicator will help in diagnosis of hemodynamic alteration in PCOS in early stages and with more pieces and then grayscale alone. These are my references. Thank you.