It’s a general concept even in layman that for pregnancy one needs to have regular and timely menstrual periods. But in certain patients periods may not come regularly ever since menarche. Besides, they may have a history of weight gain, acne, excessive hairs on the skin of the face, may need to go for threading/waxing more often than required and may have cousins, sisters or even mother having same issues.
Such symptoms and signs point towards:
- PCOS – as the first most diagnosed
- Hormonal imbalance-FSH, LH ratio change with high LH levels
- Insulin resistance
- May have add-on Thyroid/prolactin derangements
These patients generally have high body mass Index(BMI)but some fall into the category of lean with periods regular.
What all these lead to is a situation called Chronic anovulation, a common cause of infertility. Most of such PCOS patients have normal FSH but high LH levels. It's a multifactorial condition with lifelong implications
What can we do about it?
Yes we can do major part especially if weight is more then Lifestyle modifications alone will help to keep things on track but it needs constant action in a well-planned manner.
So tips to keep a check on PCOS:
- Weight loss- at a rate of 5-10% over a period of 5-6 months.If you have 80 kg then you should lose between 4 to max 8 kg only slowly with crash courses/diets or shortcuts
- Daily brisk walking at least for 30 minutes to burn extra calories
- Moderate exercise on a regular basis
- Joining a structured programme like Gym
- Take healthy balanced food(if possible with help of a dietitian)
- Cut down carbohydrates like banana, rice, rice products with a check on milk and milk products and less of fats
- Keep proper hydration (3-4 LITRES of water daily)
- Avoid junk foods with empty calories
Dear readers all these need to be followed as part of life and not till you have pregnancy as PCOS has more of chronic effects also later on due to the tendency to gain weight due to hormonal disturbances
Polycystic ovary syndrome (PCOS) is diagnosed in approximately 60–70% of women with such features.
How to plan pregnancy in PCOS?
Singleton live birth rates of up to 71% in 2 years can be achieved in such patients with –
1) Induction of ovulation - It can be by clomiphene citrate as the first line of treatment and Injectables gonadotropins as second-line of treatment with success rate varies from 2 to 3%
2) IUI - combined induction with IUI increases success rate from 8 -13% to 15-20%
3) IVF - not used as the first-line therapy in these patients, except for subgroups with a poor prognosis like:
- Advanced age group
- Longer duration of infertility
- Higher insulin: glucose ratio
- Other indications of an IVF-tubal factor, male factor, unexplained/idiopathic infertility
The outcome of IVF In PCOS:
The outcome of IVF in women with PCOS shows variable outcome as Response to Medicines is the main issue- erratic(resistant to hyper) which is generally unpredictable
- More oocytes obtained-with more of immature
- Less fertilization rate-both mature and immature oocytes of PCOS patients show reduced fertilization rates, presumably due to endogenous hormonal imbalance
- More chances to have poor quality eggs
- Chances of abnormal(aneuploidy)embryos are high
- Increased chances to form endometrial polyp with recurrence
- Increased chances of cancellation of cycle/use of high dose of medicines
- High chances of first-trimester miscarriage
- But the good part is despite reduced overall fertilization, IVF pregnancy rates in PCOS patients appeared to be comparable to normal-ovulatory women
- Also, live birth rates are comparable