PCOS & Fertility Treatments

Hi!

This is Dr Manu, senior consultant in reproductive medicine and I have a specialized interest in dealing with PCOS.

Much of my lives work has been spend around helping people with PCOS conceive naturally & also reverse this disease with simple treatments

In this awesome round up article we are going to discuss about the various fertility treatment options available for PCOS.

So PCOS can be pretty darn frustrating as it severely interferes with the ability of a women to conceive naturally. 

Women diagnosed with PCOS do not have regular menstrual cycles due to hormonal imbalance. Cycle regularity is a sign that ovulation is occurring normally once a month.

On the hand, when the individual’s cycles are irregular, it becomes difficult to predict when ovulation is actually occurring. 

In the absence of knowing or predicting ovulation, achieving a pregnancy definitely becomes challenging!

Given below are some the of the well accepted fertility treatments for PCOS

A. LOSING WEIGHT & OPTIMIZING BMI:

What is the best weight to treat PCOS naturally?.

Simple, lose weight

Losing weight especially helps in normalizing the bodies hormones resulting in cycles getting back its normal regularity.

When your cycles become regular, your chances of conception soars through the roof!

Limitations: Most patients find it difficult to adhere to weight loss programs & lose motivation

losing weight to treat PCOS


B. OVULATION INDUCTION MEDICATION:

One of the most well researched and clinically established treatment for PCOS is the use of drugs like Clomiphene citrate. 

Clomiphene citrate is has the ability to induce ovulation in over 70% of patients with PCOS.

This medication is widely used in treating PCOS very successfully

The dose per patient of course needs to be individualized and standardized.

Most well published studies recommend a dose anywhere between 50 mg to 100 mg. 

Patients are usually put on these medications between Day 2 to Day 6 of their menstrual bleeding day and are asked to try intercourse naturally at a frequency of 3/week from the time bleeding stops.

Moreover, before monitoring growth of the follicle (sac that holds the egg) by ultrasound and also the thickness of the endometrium is also routinely done

A good proportion of patients conceive naturally by the above mentioned treatment strategy.

Limitation: Their is a small risk of multiple pregnancy when using clomiphene citrate based treatment cycles.

Furthermore, no clinical benefit is seen beyond the 6 cycles of clomiphene treatment.

C. GONADOTROPHIN INJECTIONS FOR PCOS: 

Sadly, not all women respond uniformly to clomiphene citrate.

In these scenarios, injectable preparation called gonadotrophins are used to stimulate the growth of the egg. 

The female body produces 2 gonadotrophins naturally, they are namely FSH and LH.

Both these hormones are produced in the brain and play a key role in the growth of the egg in a women. 

In women with PCOS, this very delicate hormone balance is upset. 

Gonadotrophins are are nothing but synthetic derivatives of the naturally produced hormones and when given externally, they trigger egg growth in a dose dependant fashion. 

When on gonadotrophin therapy, strict monitoring of egg growth with ultrasound is routinely done. 

In most clinics, clomiphene citrate treatment cycles are combined with gonadotrophin therapy as well.

Here again, treatments/doses of medications are highly individualized to the patient.

LIMITATIONS: Here again , their is a risk of multiple pregnancy when too much medication is used.

Also not all patients enjoy getting injected frequently!

gonadotrophin in PCOS treatment


D. INTRAUTERINE INSEMINATION FOR PCOS: 

Also popularly called as IUI, and IUI treatment cycle involves giving medications for egg growth & closely monitoring egg growth with a series of scans.

Once the follicle (sac containing the egg) reaches a critical size (>18 mm), an injection called HcG is given to trigger egg release. 

Next, the husbands semen is collected and processed to isolate the motile sperm fraction.

The motile sperm fraction is then loaded in a specialized catheter and then injected into the uterus. 

The objective of an IUI treatment cycle is to place a high density of sperm close to egg at the time of ovulation.

Thereby, the chances of the sperm fertilizing the egg increases. 

IUI treatment for PCOS


D. IVF (ART) FOR PCOS:

IVF stands for in-vitro fertilization, which simply means fertilization takes place outside the human body. 

On an average over 3.5 million babies are born throughout the world using IVF based technology. 

For some patients with PCOS, multiple failed past conservative fertility treatments, combined with lost time, family pressure and increasing age are a dominant reason for choosing IVF.

IVF involves the following steps –

Ovarian stimulation:- Here depending on the patients clinical profile gonadotrophins combines with GnRH analogues are given serially to allow a controlled growth of multiple eggs

Egg Aspiration:-Next, the eggs are aspirated with ultrasound guidance using a needle. The aspirated eggs are then suitably prepared and are kept ready for fertilization in dish

Fertilization: Then using a device called the micromanipulator, prepared sperm from the husband are then injected into egg.

Culture: The injected eggs are then placed in a device called the incubator overnight. In the next day, the fertilized egg (now called zygote), is then allowed to grow under specialized culture conditions over the next three to five days.

The embryos, thus formed are either transferred to the patient or are frozen for transfer at a later date.

The diagram below should briefly explain the various steps of the IVF process!

IVF steps

Phew!!

That was one long article!

Hope you found it informative. Please do share the above info with all your friend’s and loved ones.

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Dr Manu Lakshmi, MB, DA, MRCOG ( UK) FIMSA, FUSG. FRM.

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