PCOS and infertility in women
What exactly is ovulation?
Ovulation happens once a month on average. The ovum (egg) develops within a follicle in the ovary. Several follicles begin to form each month, but only one matures and is discharged from the ovary into the Fallopian tubes. It can then move to the uterus to be fertilized, and pregnancy can occur at this point (if sexual intercourse has taken place).
How does PCOS influence ovulation?
Because of elevated quantities of male-type hormones in the ovaries, such as testosterone, follicle growth generally ceases early in women with PCOS. This results in a large number of immature, tiny follicles within the ovaries. These appear as black circles on the ovaries on ultrasonography.
Anovulation occurs when an egg is not released on a regular basis. An egg may or may not be released each month in women with PCOS. Ovulation might occur irregularly or cease entirely. This can make it more difficult for women with PCOS to conceive on their own. Pregnancy can still occur, and contraception is still required if pregnancy is avoided.
Fertility and PCOS
Approximately 70% of women with PCOS have some difficulty getting pregnant. PCOS-related variables such as elevated hormone levels, obesity (BMI more than 31), and lifestyle impacts may all reduce fertility. Medical and lifestyle management, on the other hand, can improve the chances of a successful pregnancy.
It’s reassuring to know that women with PCOS have the same number of children as women without PCOS (with or without treatment). If it is desirable and attainable, it is advised to start thinking about starting a family as soon as possible. If you are having difficulty conceiving, you will have more time to examine a variety of fertility treatment options before the chance of age-related infertility increases (around the age of 35).
Alternatives for management
Some women with PCOS may have reduced fertility or ‘sub fertility’ , which means it may take longer to conceive, or they may require more medical aid to produce a pregnancy.
There are various things you may do to boost your chances of getting pregnant. A healthy lifestyle has been demonstrated to be the most effective treatment for increasing the likelihood of a successful pregnancy.
Some women with PCOS will require further medical assistance in addition to lifestyle adjustments. It is possible that a referral to a fertility specialist will be required. A variety of drugs can be highly useful in enabling people with PCOS to become pregnant. If these are ineffective, various medical procedures may be of assistance.
Because there are numerous reasons why a woman may struggle to conceive, consult your doctor to check if PCOS is interfering with your fertility
A healthy lifestyle (diet and exercise) has been demonstrated to significantly increase one’s chances of becoming pregnant. Small weight loss can help, so if you are overweight, weight control and physical activity should be your first therapy option. A 5-10% reduction in your starting body weight has been demonstrated to help restore normal ovulation and considerably boost your chances of becoming pregnant.
Before beginning any other form of treatment, your doctor may advise you to undertake lifestyle modifications. Evidence suggests that if fertility treatments are required, they are more likely to be effective if lifestyle changes have already been implemented.
The current international suggestion is to achieve a healthy weight or lose a moderate amount of weight before becoming pregnant. This reduces the likelihood of difficulties during pregnancy.
Fertility enhancement surgery
Infertility in women with PCOS can potentially be treated surgically.
Laparoscopic ovarian surgery/ovarian drilling
This is a surgical treatment that can improve ovarian function and increase or restore ovulation.
A laparoscope is used to do ovarian drilling (a small telescope-like instrument). It is a minimally invasive treatment that involves making an incision in the abdomen while under general anesthesia. Small holes are bored in the ovary’s surface to remove tissue that produces too much androgen (‘male’ hormones like testosterone). Ovulation is frequently maintained after ovarian drilling for up to 6–12 months.
After alternative lifestyle or medical treatments have proven futile, this procedure may be explored. Consult your doctor to see if it is a good option for you.
Scar development around the ovaries, as well as injury to the bladder, bowel, or blood arteries, are possible side effects of ovarian drilling.
Weight loss promotes fertility and lowers the risk of pregnancy and birth difficulties. When aiming to lose weight or avoid weight gain, the first approach to try is lifestyle changes.
Bariatric surgery should be undertaken only after all other weight-loss treatments have been exhausted.
There are various dangers associated with bariatric surgery. Before choosing if this procedure is right for you, you should talk to your doctor about all of your options.
It is also crucial to understand that this surgery is not a quick fix for boosting fertility because a woman’s weight must be stable for at least 12 months after the operation before she attempts to conceive.
There are still many concerns concerning the hazards of bariatric surgery. The benefits of bariatric surgery for women with PCOS who desire to improve their fertility and pregnancy outcomes are still too ambiguous to advocate it as a therapy approach for infertility for these people. Your doctor will be able to advise you on this.
ART stands for assisted reproductive technology.
Women who have been unable to conceive naturally or via the use of medications or lifestyle changes to increase their fertility have another option: assisted reproductive technology. This includes IVF therapies (in vitro fertilisation). These treatments require a referral to a fertility expert.
Assisted reproductive technology is best used when less intense procedures have failed. These treatments are costly and time-consuming, and they are less effective in women who are older or obese. The technology works better in women who have already made lifestyle modifications, even if these adjustments do not boost fertility on their own.
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