Fertility Treatment for PCOS/PCOD in Mumbai, India

What is PCOS/PCOD?

PCOD/PCOS, also called polycystic ovarian disease/ syndrome, is a widespread endocrine condition in the reproductive-aged woman. It is multifactorial in origin  and affects around 5 to 10% of women in the reproductive age group. It is mainly caused due to imbalance of reproductive hormones and can cause difficulty in conceiving.

PCOS/PCOD is a hormonal disorder that leads to:

• menstrual irregularity
• enlarged ovaries
• excessive androgens in the body
•  increased acne
•  abnormal hair growth on face and body

PCOS and Infertility

• PCOS negatively impacts fertility. Woman with PCOS does not produce an egg per month. It happens due to excessive production of estrogen by the ovaries.
•  It results in irregular periods and increased levels of hormones such as testosterone.
•  Elevated hormonal levels can affect egg quality and inhibit ovulation, leading to insulin resistance. It raises the risk for conditions such as gestational diabetes.

Is It Possible To Conceive With PCOS?

While some patients with PCOS can get pregnant independently, but some may need fertility treatment.

Fertility Treatment For PCOS/PCOD

Exercise, diet modifications, and certain medications can easily control PCOS.
The main goal of the treatment is:

•  To restore fertility by regularization of menses
• Inducing timely ovulation using ovulation induction medications
• Treatment of acne and hirsutism
•  Controlling blood sugar levels
•  Maintaining the right BMI

1. Lifestyle and Diet Modification

•  For a woman trying to get pregnant, the first step in managing PCOS is to change the lifestyle, including maintaining a balanced diet and exercising regularly.
• Low carbohydrate and glycemic diets are the most effective for a PCOS woman. PCOS patients can exercise for at least 30 minutes three days a week.

2. Medications

• Woman who continues to have infrequent ovulation after making lifestyle changes may need fertility medicine to help them release an egg from the ovary.
• Initial treatment for PCOS patients who do not ovulate and are trying to conceive is administering certain fertility medications. These medicines are selective estrogen receptor modulators.
• Sometimes, if this fails to achieve pregnancy, the patient can opt for ovulation induction with low-dose gonadotrophins either alone or letrozole/clomiphene.
• Very rarely, in exceptional cases, we may subject the patient to laparoscopy with ovarian drilling (very few drills < 4 per ovary, to avoid damage to the ovarian reserve).

3. Fertility Injections

• Fertility tablets do not cause ovulation or pregnancy in some PCOS patients. Thus, fertility injections are needed to release an egg. Fertility injections such as Follistim®, Gonal-F®, Bravelle®, and Menopur® contain the same hormones released by the brain. It signals the ovary to start producing eggs.
• Many patients on fertility injections can produce two or three eggs each month, rather than just one. This procedure necessitates more frequent transvaginal ultrasounds and several blood tests to assess the patient’s
  estradiol level. It is a hormone produced in the ovary.

4. Assisted Reproductive Techniques

• If all else fails, these patients are subjected to IVF to achieve a healthy pregnancy. Our IVF Doctor in Mumbai would do IVF; instead of using HCG and GnRH injection for triggering oocyte maturity

• Regular fertility injections are used to stimulate the ovaries to develop multiple eggs in this case. Further, these ovaries are harvested in a minor procedure.
• In the lab, the eggs are fertilized. The embryo (fertilized egg) would then be transferred into the woman’s uterus by the Doctor. Extra embryos can be preserved (cryopreservation) for further use.

• If the first IVF cycle fails, the embryologist will transfer frozen embryos back into the womb one or  two months later. This segmentation
  approach can entirely avoid the dreaded side-effects of Ovarian Hyperstimulation Syndrome (OHSS).

• In our IVF Centre in Mumbai, almost all PCOS patients become pregnant in three attempts. Most of them get enough embryos in the first round of oocyte retrieval. Hence, they don’t need extra oocyte retrieval attempts.
•  In about 5 to 10% of patients, the egg number is deficient despite repeated attempts, or the egg quality is inferior with resultant poor fertilization rates.
•  Fertility experts may subject these patients to repeated attempts with embryo pooling and PGT-A.
• If despite all this, the patient fails to conceive, she can opt for egg donation. In the future, such patients may be good candidates for MIST (Mitochondrial Spindle transfer).

What Are PCOS Health Risks?

• Diabetes:
  Insulin resistance can develop in a woman with PCOS. A blood test can detect if a person is insulin resistant. If the test shows insulin resistance, a woman with PCOS may be treated with a medicine called metformin.
• Hyperlipidemia:
  Hyperlipidemia, or high cholesterol or triglycerides, can also occur in a woman with PCOS. A fasting blood sample can be used to test a woman for this condition. Screening for hyperlipidemia is essential since this condition can lead
  to cardiovascular disease later in life.
• Risk of Endometrial Cancer:A woman with PCOS is at higher risk of developing endometrial (uterine) cancer later in life due to persistently higher estrogen levels. Since menstrual cycles are irregular, the uterine lining may grow abnormally, contributing to malignancy in
  some cases.

Book an appointment with Dr. Hrishikesh Pai to seek the most effective fertility treatment.