How PCOS is treated?
Unfortunately, there is no cure for PCOS. However, it can be kept under control. Majority of the women can keep the disease under control with lifestyle changes (diet and exercise), rather than medicines. These can also help to prevent the long-term consequences. You should aim to keep your weight to a level that is normal. Losing only a small portion of weight will improve regularity of your periods, ovulation and also the chance of pregnancy. Some women are prescribed “Insulin sensitizers” like inositol and metformin. Treatment of fertility depends on your age, duration of infertility and other fertility factors.
Usually the first line of treatment is OI (Ovulation Induction). The next lines are IUI (Intrauterine Insemination) and IVF (In Vitro fertilization) respectively.
What is Ovulation Induction?
Medicines (tablets and/ or injection) are given to help your eggs grow and rupture. In the first cycle, it is important to see (by ultrasound) whether eggs are growing or not. If the eggs rupture, the chance of pregnancy per cycle is 15% and after 4-6 cycles of OI, it is nearly 50-60%. That means, out of 100 women who had ovulation, 15 can conceive after one month.
How IUI is done?
IUI is one step ahead of OI. Here along with medicines given for OI, husband’s sperm is collected, processed (“preparation”) and then inserted inside the uterus. The success rate is 15-20% per cycle.
When IVF is advised?
If a woman fails to conceive after 4-6 cycles of IUI, if the age is on higher side, there is long duration of infertility or additional problems like sperm defects or tubal blocks, IVF is advised. The success rate is 40-50% per cycle. But caution should be taken as these women are at risk of developing OHSS (Ovarian hyperstimulation syndrome- excessive response by ovaries) and twin pregnancy. Frozen embryo transfer reduces the risk.
Is there any role of laparoscopy?
Only very few women who fail to ovulate with any medicines, sometimes laparoscopy is done where some cysts are punctured using electric current (laparoscopic ovarian drilling- LOD). Additionally, LOD can be done for women requiring laparoscopy for other purposes (like pain, testing the tubes). However, LOD carries risk of ovarian damage and therefore, should be done in selective patients.
Is any special precaution required in pregnancy?
Women with PCOS are at higher risk of developing miscarriage, diabetes (gestational diabetes mellitus- GDM), high blood pressure (preeclampsia), growth problems, premature delivery during pregnancy. Therefore, screening for GDM should be done along with regular scan under specialist supervision throughout pregnancy.
Conclusion
PCOS is common but majority of the women can do well with lifestyle changes. The chance of pregnancy after treatment is higher for women with PCOS than for other women. Proper care should be taken before and during pregnancy.