Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. It is characterised by a combination of hyperandrogenism (either clinical or biochemical), chronic oligo/anovulation, and polycystic ovaries. It is frequently associated with insulin resistance and obesity. PCOS receives considerable attention because of its high prevalence and possible reproductive, metabolic, and cardiovascular consequences.
Women with PCOS have concerns about fertility and childbearing mainly because they believe that it will be difficult for them to conceive, and identify a need for evidence-based information and preconception care so that they can make informed decisions about having children and achieve their reproductive goals. Preconception care, including counselling and information about appropriate interventions and self-management strategies to optimise health and improve chances of conception, may be of particular assistance to women with PCOS.
Every month, in women of childbearing age, tiny fluid-filled cysts known as follicles develop on the surface of the ovary. Female sex hormones, including estrogen, cause one of the follicles to produce a mature egg. The ovary then releases this egg, and it breaks out of the follicle.
In women who have polycystic ovary syndrome, or PCOS, there is an imbalance in female sex hormones. The imbalance may prevent the development and release of mature eggs. Without a mature egg, neither ovulation or pregnancy can occur.
Tips for increasing fertility
Below are some lifestyle tips that can help increase fertility.
For people carrying excess weight, losing weight may help balance hormonal production and increase the chances of ovulation and pregnancy.
Finding healthful ways to manage stress may also boost fertility.
Long-term stress can affect hormones. For example, ongoing stress can increase cortisol in the body, which may trigger a rise in insulin production. High insulin levels can lead to an imbalance in female sex hormones and infertility.
For some people with PCOS, a low glycemic diet may improve symptoms and fertility.
A low glycemic diet involves eating fewer foods that cause a spike in blood sugar levels.
Avoiding spikes means that blood sugar levels become more stable, resulting in lower insulin levels and less testosterone production.
If a woman wishes to become pregnant, a doctor may prescribe medications to regulate menstrual periods and encourage ovulation. Doctors don’t automatically suggest IVF for PCOS.
Women who have PCOS do not ovulate regularly. The following are the medicines commonly used for ovulation induction Clomiphene citrate is a common fertility treatment for women with PCOS. This fertility medication causes the ovaries to produce and release eggs.
Metformin is often used as an insulin-sensitizing drug to treat diabetes. However, it can also be used alone or with an ovulation-inducing medication to improve or regulate ovulation.
Letrozole is a fertility medication, like Clomiphene citrate, that helps the ovaries to produce and release eggs. Letrozole is as effective as clomiphene citrate at increasing ovulation although they work in different manners.
If a patient does not get pregnant while using hormone-regulating medications alone, they can be prescribed Gonadotropins or recommend IVF for PCOS.
Gonadotropins are hormones that are given as injections to cause ovulation. However, women who take these medications require frequent monitoring via blood tests and ultrasounds to see how their body is responding to treatment.
When a woman is taking one or more of these medications, she should perform timed intercourse with her partner to achieve pregnancy. If a patient does not get pregnant from this method, she may be suggested intrauterine insemination, IUI, or more advanced fertility methods like IVF.
In vitro fertilization, IVF is an advanced fertility treatment that involves several steps. A woman begins by taking one or more of the fertility medications listed above and when the time is right, we retrieve the eggs. Then the embryologist combines the eggs with sperm. Finally, the embryos one or two are placed into the patient’s uterus and the rest are frozen. With PCOS, we carefully manage the cycle to avoid ovarian hyperstimulation syndrome (OHSS)
Surgery may be an option if the medication does not improve fertility. Laparoscopic ovarian drilling is a surgical option.
Infertility is very common in women with PCOS. However, it is important to highlight that women with PCOS have a very good chance at conception. Patience and dedication may be necessary to allow an adequate amount of time for lifestyle modifications to enhance fertility naturally. When appropriate, being proactive about the initiation of medical therapy in these patients frequently results in a successful pregnancy. With the proper treatment, PCOS can be managed for the long-term and patients can live relatively symptom
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