The Close Association Of PCOS And Infertility

Polycystic Ovarian Syndrome (PCOS) induces irregular menstruation and small cysts on the ovaries and therefore is one of the primary causes of infertility in women. Approximately 8-10% of women of reproductive age are assessed to have PCOS. PCOS may sometimes be called by other names, including PCO (polycystic ovaries) or PCOD (polycystic ovarian disease).

Talking About An Irregular Cycle

During a regular menstrual cycle for women without PCOS, a mature follicle develops that ultimately releases an egg. Those follicles are typically anywhere from 18 to 28 millimeters in diameter. Polycystic ovaries contain many small follicles (usually from 2 to 9 millimeters in diameter) with eggs in them. However, these small follicles do not develop and mature properly and never release an egg.

The reason behind this failure to produce the mature follicles necessary for ovulation appears to be excessive insulin production. A woman's body will react to high levels of insulin by producing more male hormones (androgens), including testosterone and androstenedione. It is the imbalance between the high levels of androgens and lower levels of female hormones that create infertility problems for women with PCOS.

Often women with PCOS experience pelvic pain. Other symptoms, attributable to the increased production of androgens, include increased hair growth on the back, chest or face, acne, and thinning hair.

These symptoms often emerge as early as in the teens and typically worsen with age. Additionally, women who are obese or have type two diabetes (and therefore high insulin levels) are at risk for PCOS. Some women with PCOS have amenorrhea, or a lack of menstruation altogether, whereas others may experience irregular menstrual cycles, called oligomenorrhea.

Some Treatment Options

Because obesity is a contributing factor for PCOS, getting weight under control is an important part of any treatment program. Some women who have been able to reduce their weight themselves through diet and exercise have even eliminated PCOS. Many women with PCOS will make use of fertility drugs to increase the chances of ovulation. Clomiphene citrate ("Clomid") is among the most common of the fertility drugs. Clomid blocks estrogen receptors in the brain, "tricking" the body to believe that it needs to produce more of the hormones necessary for ovulation (in particular FSH and LH) to combat low estrogen levels. If Clomid doesn't appear to be helping after 6-12 cycles discuss with your doctor whether it's best to move to a different treatment. There is at least some evidence that suggests extended use of Clomid may increase the risk of ovarian cancer. If a woman is not responding well to Clomid, other medications such as injectable HCG (human chorionic gonadotrophin) and/or HMG (human menopausal gonadotrophin) might be better alternatives. In vitro Maturation (IVM) may be another practical treatment option, particularly for women who are not responsive to drug therapies aimed at increasing ovulation. IVM allows the immature eggs produced by women with PCOS to be harvested early in a woman's cycle so that they may mature further in laboratory conditions where they are not affected by hormonal imbalances. Those properly matured eggs may then be used for fertilization.

Reference

Dr. RK Sharma is the best-known infertility specialist, who has been treating infertility treatment in women in Delhi-NCR for many years.




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