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Battling PCOS: Here’s What You Should Know!

In our society, most of the time, married couples are expected to have children after one or two years of their marriage. Once we take out that expectation, most couples do want to produce offspring. But women who are affected by chronic health conditions such as Polycystic Ovary Syndrome (PCOS), often have concerns about their capacity for childbearing. These fear often include the doubts about their ability to become pregnant.

PCOS is a complex hormonal condition that affects one in every five women who are in their childbearing age. Although 40% of women affected by PCOS suffer from infertility, 90% can still conceive after proper management.

A woman may have polycystic ovary syndrome if she has any two of the three following characteristics:

  1. Irregular menstrual cycle or evidence of anovulation.
  2. Clinical or biochemical evidence of hyperandrogenaemia.

A condition in which a woman body shows symptoms of elevated male hormone production. The level of testosterone is assessed by a blood test. Another indication is hirsutism or hair growth issues – abnormal hair growth in hormone dependent areas, including the upper lip, the chin, the face, the breast, and the lower abdomen. The condition can be very mild to very severe depending on the amount of hormone production.

The presence of tiny cyst-like formations on transvaginal pelvic ultrasound. These  are eggs or follicles rimming the ovaries. They start to grow and then stop at a small follicle size of approximately 2-10 millimetres. The presence of these cyst-like formations is characteristic of PCOS and can be used for making the diagnosis.

While making the diagnosis for PCOS, other medical conditions that may look similar to PCOS must be eliminated. The following hormonal conditions must be ruled out before making the diagnosis of PCOS:

  • Thyroid disease.
  • Ovarian and/or adrenal tumours.
  • Adrenal enzyme deficiency.
  • Prolactin abnormalities.

How To Increase the Chances of Your Pregnancy?

The first tip is the obvious one. Being in the best possible health before planning pregnancy increases the chances of conceiving. According to the international evidence-based guideline for the assessment and management of PCO, adopting a healthy lifestyle – including being in the healthy weight range, not smoking, not having alcohol, eating a healthy diet, getting plenty of regular exercises, adequate sunlight exposure, and enough sleep – is the first thing to do to improve a woman’s chances of becoming pregnant and having a healthy baby. Women who plan to get pregnant must consider meeting with their infertility specialist to undergo a pre-conception health check, to get the right advice and support.

This is also an opportunity to discuss a plan of action, in case the PCOS causes fertility difficulties. For women with PCOS who are overweight or obese, modest weight loss sometimes results in more regular ovulation, which also increases the chances of pregnancy. For those who know they are ovulating, having sexual intercourse during the “fertile window” (before and during ovulation) boosts the chances of conception.

Let’s Have a Look at the Symptoms of PCO.

PCOS affects approximately 5 to 10 percent of the world’s population, and recent studies also suggest that it is rising among the women of Asian descent.

Clinical Features

  • Menstrual abnormalities – Irregular cycles.
  • Hyperandrogenism

Signs Include Acne, Seborrhoea, Alopecia, Frank Virilization

  • Metabolic abnormalities – Obesity, insulin resistance, risk of diabetes and cardiovascular disease.
  • Reproductive abnormalities – Infertility.

What Causes Polycystic Ovaries?

The main cause of PCOS is still unknown. Some select studies have found the possibility for a genetic. A person might have a disposition to PCO just as one might have a genetic predisposition to diabetes. Although the specific cause of PCOS is still unknown, the condition results in hormonal imbalances that curtail or prevent ovulation – the body’s process of producing and releasing eggs from the ovary.

It is common for women with PCOS to have an inappropriate production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). They may experience limited follicular development because of this (small, sac-like structures within the ovaries are called follicles and each follicle contains an egg). Egg development will not occur due to limited follicular development. Also, as we have already seen, women with PCOS have an increased level of testosterone and other male hormones (androgens) leading to symptoms like excessive facial hair, etc.

Irregular ovulation, or complete absence of ovulation – anovulation – can occur and may persist for months or even years due to limited development of egg. This ovulatory dysfunction is what causes infertility in these women. Also, the endometrial tissue in the uterus can get very thick and may result in heavy and/or irregular periods if anovulation is prolonged. It is also common for women with PCOS to have insulin insensitivity. This, many a times, can predispose them to have increased weight gain and obesity that places the patient at higher risk for diabetes and cardiovascular diseases.

Does PCO Affect Fertility?

Yes, PCOS causes infertility. In fact, PCOS induced infertility accounts for roughly 20-25% of all the cases of infertility. Many fertility procedures can take care of infertility due to PCOS, making it possible for most to get pregnant if started before age becomes a significant factor.

Common Fertility Treatments for Those with PCOS:

Ovulation Induction with Timed Intercourse or Intrauterine Insemination (IUI):

Since most women with PCOS do not ovulate, medication to help stimulate ovulation is recommended. Depending on the initial testing, a fertility specialist may recommend a patient to start ovulation induction medication with timed intercourse, or intrauterine insemination (IUI) scheduled around the time of ovulation.

For these treatments, it is important that her Fallopian tubes are opened and the partner’s sperm count is normal. This procedure is usually the first medical intervention done in a patient who suffers from PCOS and tries to get pregnant. Ovulation induction involves taking medication (oral medication and sometimes a trigger shot) to help stimulate ovulation. Couples are given dates for timed intercourse or intrauterine insemination accordingly.

Laparoscopic Ovarian Drilling:

This is done in women who have failed multiple ovulation induction cycles, or in women who have no response to ovulation induction medication. In this method, four punctures are made on the ovaries using an energy source. This procedure reduces the hormone imbalance and improves the pregnancy success rates. It is a simple yet effective day care procedure and the patient responds well to medication post-surgery.

In Vitro Fertilization (IVF):

IVF is the gold standard of fertility treatments, offering the quickest time to pregnancy per treatment cycle for anyone (including those with PCOS). Your specialist may advise IVF, if ovulation induction with timed intercourse or IUI has failed to achieve a pregnancy, or if other factors are contributing to infertility such as blocked fallopian tube/endometriosis/ fibroid uterus/male factor infertility, etc. In this process eggs are removed from the woman’s ovaries, fertilized in the lab with her partner’s sperm, embryos are cultured and grown in the lab, and frozen (by a process called vitrification). These frozen embryos are then transferred to the patient in her next cycle – Frozen embryo transfer.

PCOS is a number one cause for infertility owing to the number of people it affects and because of its negative impact in the disruption of normal hormonal balance that is critical to ovulation. Each case of PCOS is different and every woman responds differently to the same medication. Hence the right treatment from an infertility specialist at the right time is the key to overcome this condition. Consulting an infertility specialist at the right time helps to evaluate the condition and receive guidance according to your age and hormonal imbalance, which contributes to the quality of egg in women.

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