Tuesday, January 10, 2023

Treating PCOS in infertile women


PCOD (Polycystic Ovarian Disease, PCOS or Polycystic Ovarian Syndrome) is one of the commoner causes of infertility in young women. The problem is there is a lot of confusion about this disease , because everyone seems to make this diagnosis at the drop of a hat – the nutritionist , the beautician , the neighbourhood aunt  , the sonographer, and the GP.

This is why infertile women with PCOD often end up getting poor quality treatment

Step number one is first deciding what your priority is . Do you just want to regularise your periods ( if your periods are irregular )? Or do you want to have a baby now ?

If you just want to get regular your periods , then all you need to take are inexpensive birth control pills, and these are very effective and efficient, and will ensure you will get regular periods as long as you take them regularly.

However, if you want to have a baby , your treatment options are very different – and birth control pills will not help !

The first line of treatment is lifestyle changes , especially for those who are overweight. Losing weight helps, but this is easier said than done, and will not work for all patients. 

The next step is medical therapy using medicines such as metformin and myoinositol to improve the abnormal insulin resistance which is so common in women . If this doesn’t work , then the next step is ovulation Induction with medicines such as clomiphene and letrozole. This may require follicle monitoring as well , to document that you are ovulating after taking these, as the dose varies from patient to patient.

If these simple treatment options do not work , then you might have to consider treatment by an infertility specialist . The simplest treatment option is IUI ; and if this fails , then the next step would be IVF . The success rates are a good clinic are excellent , but you should also remember that treating patients with PCO can be quite challenging , because when they don't grow eggs they don't grow any at all , but when they grow eggs , they often end up growing too many . This means you have an increase risk of multiple pregnancy when doing IUI , and an increased risk of ovarian hyperstimulation syndrome ( OHSS) when doing IVF , so that finding a good IVF clinic is extremely important

Another very effective treatment option for patients with PCOD is laparoscopic ovarian drilling ( a newer option is vaginal ultrasound guided ovarian cauterization) , to ablate the increased ovarian stroma which disrupts the hormonal balance by producing too much androgen.

This is specially useful for young women who have large ovaries , with increased ovarian volume , as well as increased stroma because we can then surgically correct the underlying problem . This means that your hormonal profile will go back to normal, and you can get pregnant without any further medical intervention ( provided your husband’s semen analysis is normal, and your fallopian tubes are open).

If you have more questions, please email me at [email protected] 

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