PCOS and Fertility Issues

WHAT IS PCOS/ PCOD?

Polycystic ovary syndrome (PCOS) or Polycystic ovary disease (PCOD) represents same disorder and is commonly found women between 15 – 45 years of age. It affects approximately 10- 15% of women with reproductive age group and may manifest as difficulty in getting pregnant.Women with PCOS may exhibit a variety of symptoms like irregular and delayed menstrual cycles, excessivebody hair growth, acne, hair fall, weight gain. An ultrasound scan shows ovaries contain multiple small cysts arranged in a necklace pattern. The word cyst is a misnomer, as these are actually small antral follicles, which are present in all women in reproductive age group but in women with PCOS, the number of these antral follicles is more than normal. These excessive follicles produce unwanted hormones which interfere with egg formation leading to delayed cycles and infertility.

RELATION BETWEEN PCOS AND INFERTILITY

PCOS interferes with fertility as women with the condition either do not ovulateat all or ovulate very less. Even if ovulation happens, it gets difficult to estimate the fertile window as the cycles are irregular. Normally, ovulation or release of eggs from ovaries happens around 14 days before expected periods in regular cycles. Asthere are high levels of hormones such asestrogens and testosterone there is excessive hair growth, acne, insulin resistance. High hormone level also negatively affects egg quality.

GETTING PREGNANT WITH PCOS?

If a women is aware of having PCOS or she has delayed periods, she should consult a good fertility specialist for her baseline check up. This preconceptional management helps a lady get prepared for her pregnancy. Since, these women are predisposed to diabetes also, getting a preliminary testing helps avoid pregnancy complications too. If all the tests are normal, couple may try on their own. If already 6 months have passed, ovulation induction needs to be given.

STEPWISE APPROACH FOR PCOS MANAGEMENT

Women looking for the Best PCOS clinic in Jaipur must visit Vansh IVF centre Jaipur, which is the Best Fertility Centre in Jaipur. The key is early diagnosis and specific treatment. Random treatments or ovulation medicines, given without monitoring along with a battery of investigations are both physically and financially draining. We must follow the step wise approach for women suffering from PCOS and trying to conceive.

LIFESTYLE MANAGEMENT

The first and foremost step is lifestyle management which includes a good diet control and regular exercise.

The goal of a 10% WEIGHT REDUCTION OVER 6 MONTHS in itself helps majority of patients conceive faster.The options are brisk walk, streching exercises, yoga, outdoor games, swimming, etc.

According to recent ESHRE guidelines, 2019, the recommendations are:

For prevention of weight gain and maintenance of health, a minimum of 150 min/week of moderate intensity physical activity or 75 min/week of vigorous intensities or an equivalent combination of both, including muscle strengthening activities on 2 non-consecutive days/week is recommended.

For weight reduction, a minimum of 250 min/week of moderate intensity activities or 150 min/week of vigorous intensity or an equivalent combination of both, and muscle strengthening activities involving major muscle groups on 2 non-consecutive days/ week is required.

Along with this, minimised sedentary, screen or sitting time is desirable.

Physical activity includes leisure time physical activity, transportation such as walking or cycling, occupational work, household chores, games, sports or planned exercise, in the context of daily, family and community activities. Daily, 10000 steps are ideal, including activities of daily living and 30 minutes of structured physical activity or around 3000 steps. Structuring of recommended activities need to consider women’s and family routines as well as cultural preferences.

PCOS DIET: The diets shown to give best results in PCOS patients include those with lower carbohydrates, avoidance of potatoes, rice, sweets, processed foods, cheese,bakery items. Taking antioxidant rich diet as tomatoes, guava, fresh fruits, green vegetables, nuts, sprouts and plenty of water might help maintain good hormone levels.

OVULATION INDUCTION

Women who still fail to ovulate despite lifestyle modifications may require ovulation inductionby medicines foregg formation. Initially, tablets are prescribed for the same. The response to medicines is assessed by follicular monitoring done by ultrasound. The couple is advised to have intercourse on the days of ovulation that can be accurately found out in an ultrasound.

There are cases where despite ovulation induction by tablets, eggs fail to develop. In such cases, woman is given gonadotrophin injections. Follicular monitoring is done to find out the response.

In selected cases laparoscopy and ovarian drilling is done.This reduces the excessive number of eggs and may help achieve hormonal balance in few cases. Through this process, a detailed evaluation of female reproductive system can be done. Fallopian tubes can also be checked for patency.

When all the above strategies fail, woman needs Assisted Reproductive Techniques like  In Vitro Fertilisation (IVF). This procedure is the last option for women with PCOS but at the same time the most effective treatment that gives best success rates in minimum time. If done in safe and experienced hands, IVF promises a reasonably good pregnancy rates with minimum adverse effects.

Although PCOS management looks easy, but one needs to be very specific for every patient’s needs as PCOS also has variable symptoms. For the best and personalised PCOS Treatment in Jaipur, you may visit Vansh IVF centre, Jaipur. We  have gynaecologists trained in reproductive endocrinology who take you through a stepwise approach in PCOS management, which is the key to management.

When visiting a doctor you must always discuss about the stepwise approach for PCOS and the options that you have. IVF is undoubtedly the best solution to almost all the infertility related problems in terms of success rates but there are other options too that should be explored before resorting on to IVF.

LONG TERM HEALTH RISKS IN PCOS

Long term health risks and the precautions needed should be discussed at the time of PCOS detection. PCOS may show a variety of symptoms. Risk spectrum includes cardiovascular disease, gestational diabetes, type 2 diabetes, Obstructive sleep apnoea, obesity, endometrial cancer, depressive and anxiety symptoms, mood swings, psychosexual dysfunction. These risks can be avoided with good lifestyle modification and timely intervention.

Dr. Suchika Mangal is a regular speaker at various state and national conferences. Passionate about writing blogs and articles on general health, infertility, PCOS, healthy lifestyle and food. She has always believed in helping infertile couples by creating awareness and involves her patients in the decision making process to better manage and tailor the treatment.