PCOS

What are the symptoms of PCOS?

• The symptoms of PCOS may vary from one woman to another, it is commonly related to either the absence of a menstrual period or an irregular menstrual cycle. Most women with PCOS have a longer time interval between two periods. Among the symptoms of PCOS areexcessive hair growth in the face and body

• obesity

• irregular and infrequent periods or absent periods

• infrequent or absent ovulation

• miscarriage

• infertility.

• high insulin level or type two diabetes

Statistics bear that five to ten percent of women of childbearing age have PCOS without their knowledge that they do have it. Some are even fortunate to conceive despite their irregular menstrual period.

There are long-term risks of developing type 2 diabetes, cardiovascular disease and cancer of the womb. Women diagnosed as having PCOS before pregnancy have an increased risk of developing gestational diabetes.

What is the cause of PCOS?

The cause of PCOS is not fully understood. It involves a complex interplay between the female hormones, the male hormones and the hormones controlling the sugar metabolism.

What is the incidence of Polycystic Ovarian Syndrome?

Polycystic ovarian syndrome (PCOS) accounts for 90% of women with oligomenorrhoea (infrequent periods) and 30% of women with amenorrhoea (absent of periods) and over 70% of women with anovulation.

How is PCOS diagnosed?

Diagnosis of Polycystic Ovarian Syndrome is done by

1. Blood hormone levels of LH, FSH, androgens and SHBG Ideally, these tests should be performed during the first four days of the cycle. If the women has no period, then the test can be performed anytime, and repeated if the results do not provide a clear picture. FSH levels are low or normal, LH levels are often raised. However, a normal level does not exclude diagnosis of polycystic ovarian syndrome (PCOS). The levels of androgens and testosterone may be raised.

2. Vaginal ultrasound scan (better than abdominal) The vaginal ultrasound may show the typical PCOS appearance but reliability varies with expertise. It shows enlarged ovaries with thickened stroma and a characteristic ‘ring of pearls’ appearance of immature follicles in the periphery of the ovary.

3. Laparoscopy: Laparoscopy allows direct inspection of the ovaries; the ovaries are enlarged and polycystic. However, polycystic ovaries may appear normal at laparoscopy.

What is the treatment of Polycystic Ovarian Syndrome?

Treatment of Polycystic Ovarian Syndrome in women who wish to conceive involves

1. Weight loss (if she is over weight) is a simple treatment because loss of weight can help improve hormonal imbalance. This simple measure may restore menstruation and ovulation in patients with polycystic ovarian syndrome. Exercise and weight control also reduce the likelihood of developing type 2 diabetes in later life.

2. Ovulation induction with clomiphene (clomid) tablets. Induction of ovulation with clomiphene tablets is the first choice and is an effective treatment of polycystic ovarian syndrome (PCOS). It results in restoring menstruation and ovulation in about 70% of women and some 30% will conceive within three months of treatment. Clomiphene tablets maybe combined with steroid tablets to suppress androgen production.

3. Controlled ovarian stimulation with FSH or hMG combined with hCG. Because the polycystic ovaries are usually sensitive to stimulation by hormones, it is important to start with a low dose and adjust the dose according to the response. Monitoring of treatment is essential because these patients are susceptible to develop ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.

4. Metformin is a drug that improves the body’s ability to utilize insulin. It is normally used for the treatment of type 2 diabetes but it is safe for women who do not have diabetes too. Metformin helps in correcting the Insulin imbalance in PCOS, but the beneficial effects of Metformin are apparent only after at least 3 months of therapy.

5. Surgery (Laparoscopic Ovarian Drilling) Surgery is recommended should the medical treatment fail and for women who have experienced OHSS. In Laparoscopic Ovarian Drilling, multiple small punctures are made in both the ovaries with a needle. This helps in correcting the hormonal imbalance of PCOS. After surgery, ovulation occurs spontaneously in 70-90% of women and the probability of pregnancy after one year is in the region of 40-60%. There is no increased risk of multiple pregnancy or OHSS. If ovulatory cycles fail to restore after the surgery, the doctor may restart ovulation induction. A recent study up to 20 years after laparoscopic drilling has shown persistence of ovulation over many years. Compared with medical treatment, it need only be performed once and intensive monitoring is not required.

6. IVF (In vitro fertilization)

7. In-vitro Maturation is helpful for women who do not respond to drug therapy. IVM is a process where undeveloped eggs are collected and made to mature in a laboratory, to be used afterwards in fertilization.

Letters to Dr. Richa Katiyar

Dear Dr. Richa,

The reason for contacting you is b'cos me & my wife are trying to get our first baby from more than 2 years now however without any succes. We got your reference from the weblink: https://www.facebook.com/ivfclinicdelhi/info.

We would appreciate if you can kindly go through an overview of our case details mentioned below and guide us.I have a low sperm count along with poor morphology & motility. My wife is

suffering from PCOS and had taken Clomid 100 and 150 mg during her cycles however not much joy was noted in the follicular study reports or while checking the ovulation through home testing strips (urine samples) - we found out that she did not ovulate.

We have been informed by some Doctors that we would have to take help of assisted reproductive technology to get our baby. Also, are being informed that IUI won't be a success considering our reports hence and ICSI/IMSI would be the best technology to move ahead with.

What can be the best line of treatment (IVF, ICSI/IMSI) considering our reports to get the highest success rates.

Regards,

Atul

Hello Mr.Atul,

Sorry to learn that you and your wife are having difficulty in having a baby.

You are welcome to come to New Delhi to get IVF-ISCI treatment done. After perusal of the reports which you have sent to me, this appears to be the best course of action as we will overcome the problem of poor growth of eggs as well as the poor morphology and motility of sperms.

Feel free to contact me for further queries.

Dr. Richa

Dear Maa'm,

I am Shweta, 28, Kanpur, UP, Suffering from infertility from last four years. i have gone through four cycles for ovulation study, and once for IUI. But i was not able to conceive. Findings of the test made it clear that my eggs were weak and they were made only with the help of clofert-50 tablet. HSG (tube test) is normal. I have diagnosed PCOS and Thyroid from last 2 years. I am taking Thyronome 50mcg daily and glyciphage 500mg twice after meal.

Last three months my treatment was undergoing in Rockland Hospital. Dr. had advised me for a laparscopic surgery and drilling of ovaries.

I wanted to know that would it give me positive results after surgery or there is any other way of treatment, by which i would conceive without surgery.

Kindly advised me asap so that i would be able to take any decision

in this regard.

Thanks and in waiting for your response.

Shweta

Dear Shweta,

Sorry to learn that you are having problems in conceiving. If you are making eggs after taking the medicine Clofert, then there is no need for you to go for this operation called Laparoscopic ovarian drilling as this is done only for those patients who are not able to make eggs with Clofert. It is done for medicine resistant patients while you are already responding to it, that too with the lowest dose of 50 mg, so there is no benefit to be gained.

Feel free to contact me for further queries.

Best regards,

Dr Richa Katiyar