What is PCOS or PCOD?
Polycystic Ovarian Syndrome (PCOS) is a condition that results from hormonal imbalances and metabolic alterations that results in symptoms like irregular periods, weight gain, abnormal hair growth and most importantly infertility. Hear from the best IVF clinic in Delhi, PCOS causes difficulty to conceive because the process of monthly release of an egg (ovulation) is impaired in these patients. The condition, also called as Polycystic Ovarian disease or PCOD affects 10-15% of all women and is one of the most common causes of Infertility in the female.
Janini IVF excels in the individualised treatment that PCOS patients require. Through customised tailor-made solutions for each PCOS patient deepening on the age, severity and other factors, Dr. Dalal, the best infertility specialist doctor in Delhi, ensures each PCOS patient walks home with a baby. Indeed, in our expert hands PCOS patients have a very high success rates and hardly anyone faces failure in getting pregnant.
Cause of PCOS?
It is believed to be multi-factorial. In simple words, a combination of your genes and the environment you are in - both contribute to the development of this condition. It is common to see a PCOS patient having many relatives who are also suffering from PCOS.
How does PCOS hinder my efforts to get pregnant?
There are various mechanisms and causes of impaired fertility in PCOS patients.
- Altered hormonal balance - PCOS patients fail to ovulate because there is elevation of male hormones like Testosterone in their blood. Again, FSH/LH ratio is altered and very high LH prevents normal ovulation.
- What happens in a normal menstrual cycle is at around day 12 a single egg is release out of the dominant follicle and this egg then rests in the Fallopian tube waiting for sperm. In PCOS patients this process does not happen in spite of the fact that there are many small follicles in these patients. In other words, these patients have many small follicles, but they remain small and never ovulate.
- There is elevation of serum Insulin and these patients run a high risk of developing diabetes later in life.
- Elevation of the free form of male hormones like Testosterone and DHEA
Symptoms and Diagnosis of Polycystic Ovarian Syndrome
If you are having problems in getting pregnancy in spite of regular, frequent intercourse you could be a patient of PCOS. Some symptoms are :
- Inability to get pregnant (infertility)
- Absent ovulation means the hormonal cascade that happens every month normally is disturbed in these patients. So they would suffer from irregular menses. Sometimes it is so severe that periods won’t come unless medicines are taken.
- Abnormal weight gain
- Visible hormonal changes like acne / abnormal hair growth like facial or body hair
- Appearance of ovaries in ultrasound scan is typically polycystic (more than 12 small antral follicles in each ovary, may be lying in a ‘necklace’ pattern)
- Depression / anxiety / decreased sex drive
Diagnosis - we follow the Internationally accepted Rotterdam criteria for diagnosing PCOS. Any two of the three conditions of (i) Polycystic ovaries on Ultrasound (ii) Clinical or biochemical an-ovulation (eg irregular periods) and (iii) Clinical or biochemical hyper-androgenism (eg high Testosterone levels in blood)
These days there is a lot of scientific attention given to the role of AMH blood test in diagnosing PCOS. Although no strict cut-off is accepted, an AMH level of more than 6 ng/ml usually points towards PCOS.
Once a diagnosis of PCOS is confirmed the fertility specialist at Janini IVF will highlight the effective treatment options available and work with you to determine the best option suited to your individual situation and fertility goals. PCOS is a lifelong syndrome and there is no permanent ‘cure’ to it. Best treatment strategy is to try and control it by targeted therapy, weight loss, ovulation inducing agents and finally most effective is IVF or ICSI. Timely and proper treatment of PCOS is important for achieving faster results.
What are the treatment options for PCOS?
- First you will be advised to lose weight. Although we understand it is easier said than done, we at Janini IVF will help you in the weight loss process by providing you an expert dietician and counsellor. Even a modest 5% weight loss can be really helpful.
- For simple cases with no other Infertility factor and completely normal male investigations, we can try simple treatment like Ovulation induction or IUI. IUI is an effective treatment option with reasonably good success rates.
- Laparoscopic Ovarian Drilling (LOD) surgery used to be popular in the past but is almost outdated now. Reason being LOD can sometimes cause harm by destroying healthy ovarian follicles. Indeed, it has been seen that patients who undergo LOD end up with very low AMH levels and sometime require IVF with donor eggs! If done judiciously and with constraint, LOD is a good effective option for those who can wait for longer periods and do not wish to undergo assisted conception.
- IVF or ICSI is the most effective and successful treatment option for PCOS patients. We offer this option for PCOS patients in the following categories
- Long standing severe PCOS
- PCOS along with other factor in the female like endometriosis, blocked tubes, thyroid, etc.
- Abnormal semen parameters or low sperm count
- Those who’ve tried IUI three times and failed
- Age of the wife more than 37 and trying for many years
- Those who conceive with IUI treatment but unfortunately end up with abortions
- Sometimes we may start a tablet called Metformin which is meant to correct some of the hormonal imbalances. This is the same medicine that diabetes patients take because many of the disturbances in PCOS patients match those with Diabetes. Metformin also helps while doing IVF because it reduces Ovarian Hyper-stimulation Syndrome (OHSS). However Metformin alone is not enough to help you conceive.
