Watch out unwanted hairs and extra weight around your waist

“It could be Poly-Cystic Ovarian Syndrome”

By Dr. Shobha Gupta

• Women with infrequent menstrual periods, increased growth of hair on face, chest, stomach etc are likely to have PCOS

• Life style management and weight management can help manage PCOS

• IVF specialist is of utmost importance in controlling this syndrome in order to achieve pregnancy

PCOS

The Pleasure of mother hood and bringing a new life into existence is undoubtedly the greatest blessing to every woman.  Every mother trained their daughters in teens to beware of Polycystic Ovarian Syndrome which could get in the way of a pregnancy. Poly-Cystic Ovarian Syndrome (PCOS) is the most common total body endocrine disease that affects women of reproductive age from puberty to menopause. It affects approximately 10% of women in the reproductive age group.

Both males and females produce hormones called androgens, referred to as male hormones, which play a role in sexual functioning of the body. In girls with PCOS, the ovaries produce higher levels of androgens than normal, and this interferes with egg development and release. Some of the eggs develop into cysts which are little sacs filled with liquid and instead of being released during ovulation, these cysts build up in the ovaries and even get enlarged , hence the main polycystic ovaries or Poly-Cystic Ovarian Syndrome.

Women with infrequent menstrual periods or irregular bleeding are likely to have PCOS. Increased growth of hair on the face, chest, stomach, back, thumbs, or toes acne, oily skin, or dandruff may be some of the signs associated with PCOS. Infertility or inabilities to get pregnant because of not ovulating, weight gain or obesity, usually carrying extra weight around the waist are part of the Poly-Cystic Ovarian Syndrome.

Early diagnosis is very important; Infertility specialist is of utmost importance in controlling this syndrome. Most of these patients need help from an infertility/ IVF specialist in order to achieve pregnancy or regularize their periods.

If PCOS is not diagnosed early and treated properly it can lead to problems like type 2 diabetes , high cholesterol, high blood pressure, abnormal bleeding from the uterus, and very occasionally cancer too. The most important step is screening the condition and PCOS can be easily diagnosed through Blood tests and Ultrasound and therefore the chances of having serious side effects are reduced.

Fortunately today PCOS can be treated using various medications and other techniques like weight loss and exercise. These are very effective in lessening many of the health conditions associated with this disease, such as high blood pressure and diabetes. Apart from this medications are also available which counter the effects of excess androgens in a woman’s body.

Below are the methods commonly used to treat PCOS:

Life style management and weight optimization - Maintaining a healthy weight is another way women can help manage PCOS. Since obesity is common with PCOS, a healthy diet and physical activity help maintain a healthy weight. Even loss of 10% of body weight can help make a woman's cycle more regular and increase the chances of ovulation by 25%.

Birth control pills - For women who don’t want to become pregnant, birth control pills can regulate menstrual cycles, reduce male hormone levels, and help to clear acne.

Fertility Medications - The main fertility problem for women with PCOS is the lack of ovulation. Clomiphene (pills) and Gonadotropins (injectables) can be used to stimulate the ovary to ovulate. IVF is sometimes recommended to control the chance of having triplets or more. Metformin can be taken with fertility medications and helps to make PCOS women ovulate on lower doses of medication.

Medicine for increased hair growth - If a woman is not trying to get pregnant there are some other medicines that may reduce hair growth. Spironolactone is a blood pressure medicine that has been shown to decrease the testosterone effect on hair. Cyproterone acetate, is another medication that blocks this effect. Both of these medicines can affect the development of a male fetus and should not be taken if pregnancy is possible. Other non-medical treatments such as electrolysis or laser hair removal are effective at getting rid of hair. A woman with PCOS can also take hormonal treatment to keep new hair from growing.

Surgery - Although it is not recommended as the first course of treatment, surgery called ovarian drilling is available to induce ovulation. This is done via laparoscopy or key-hole surgery. The ovaries are punctured with a small needle carrying an electric current or using laser to voluntarily breech the ovarian capsule. This surgery can lower male hormone levels and help with ovulation.

Dr. Shobha Gupta

Some Frequently Asked Questions - FAQs

By Dr. Shobha Gupta

There are various issues and questions that came to our mind whenever we go for treatments like IVF, Surrogacy, ICSI etc. or even when you are unable to conceive then there are numerous questions which arises. Here are few:

Q.1 What is the success rate for IVF?

Ans. Success rate vary between 40 - 60% in IVF. Success rate depends on centre to centre from where the patient is taking the treatment and is more individualized depends on cause of infertility. Here at the Mothers Lap we have delivered 60% success rate which is still sustained and maintained.

Q.2 What should one expect from the IVF treatment?

Ans.  IVF is the combination of female’s egg and a male’s sperm and implanting the resulting embryos in woman’s uterus. IVF is more costly and persistent than other treatments but can be successful if other options fail. Try to relax and be positive throughout the process.

Q.3 What's the time taken to conceive and approximate cost?

Ans.  10 to 15 days for injection and after 2 or 3 days we do embryo transfer and then pregnancy test. So it takes roughly around 4 to 6 weeks. Cost for IVF is around 1.2 Lakhs to 1.7 Lakhs; but again it depends on centre to centre.

Q.4 What are the Precautions for late pregnancies?

Ans.  If a lady is pregnant in the late ages then she needs extra care as it is always risky to conceive after certain age.

She should be registered for close monitoring with a Gynecologist as risk of miscarriages is high, chances of growth restricted baby is also there. Ultrasound should be done regularly and she should be regularly monitored with blood pressure and blood sugar checkups too in 28th, 32nd and 36th week.

Q.5 What are the reasons of low fertility in female with age?

Ans.  Fertility starts declining for women at the age of 30, dropping down more abruptly at the age of 35. As women grow older the chances of getting pregnant rapidly falls down resulting in infertility. 

As the age raises the number of eggs in female decreases and at the same time quality also decreases. The ageing process effects the rate of fertility and catching power of fallopian tube also falls down. As a woman ages it is more likely that she may have had longer exposure to a condition that has not been treated. An untreated Chlamydia infection, for example, can develop into pelvic inflammatory disease, blocking your fallopian tubes resulted in inability to conceive and infertility

Q.6 What are some age and lifestyle related diseases which lead to decreased fertility in women. How? 

Ans.  Lifestyle plays a very vital role in fertility. Most common disease due to lifestyle choices that could affect your fertility is PID- Pelvic Inflammatory disease. PID mostly affects sexually active women between the ages of 15 and 24. It is common in females and is gradually growing in India especially in metropolitan cities because of so much exposure to sex.

Apart from it sometimes these things are a result of lifestyle choices that include smoking, drinking, thyroid or auto immune diseases, exposure to radiation like chemotherapy or radiotherapy, poor nutrition etc. 

Hormonal imbalance is also one of the causes of infertility.  If your female hormones fail to transmit their chemical signals at precisely the right time, ovulation may be irregular, infrequent or fail to occur. Periods will likely be erratic and unpredictable. Female hormonal imbalances can often be treated with fertility drugs.

Q. 7 What are the risks of planning late pregnancies. And what are the risks to both mother and child?

Ans. There is trend of becoming moms at the age of 30 or more. Planning late pregnancies are mainly due to work pressure or most girls these days get married post 26 as a result they plan late pregnancies. The later you plan pregnancies, chances of high blood pressure, diabetes and stress are high. It is true that the risks of having a baby after 30 tend to multiply, but it is also true that the vast majority of working women all over the globe today are having their first babies in their mid thirties.

Risks:

Your chance of having a baby with Down’s syndrome is 1 in 1000 at the age of 30. However the same risks increase to 1 in 400 if you are planning to have a baby at age 35. So, its better if you plan baby as soon as possible.

For an average woman below 30 the risk of having a miscarriage in the first 20 weeks of pregnancy is between 12% to 15%. For a woman over 35 years of age the same risk increases to 20%. 

During the second and third trimester, a mother's diabetes can lead to over-nutrition and excess growth of the baby. Having a large baby increases risks during labor and delivery. For example, large babies often require caesarean deliveries and if he or she is delivered vaginally, they are at increased risk for trauma to their shoulder.

Dr. Shobha Gupta

LOOSING WEIGHT BEFORE INFERTILITY TREATMENT IMPROVES IVF SUCCESS

By Dr. Shobha Gupta

Some facts about obesity:

Obese woman checking her weight

• 2 billion people worldwide are officially classified as overweight
• 70% of India's urban population is obese
• 10% of couples in the country get affected by infertility due to obesity
• Women who are obese are also at a greater risk for pregnancy complications 

Losing excess weight before undergoing in vitro fertilization (IVF) treatment can improve pregnancy and birth outcome. The women with normal weight (BMI below 20) had higher live birth rates (38.6 percent) and embryo implantation (40.4 percent) compared to obese women (BMI above 30 -27.7 percent and 30.9 percent respectively).

A body mass index (BMI) of 19 to 25 is considered to be the ideal weight for conceiving. A healthy body and optimum weight during pregnancy is crucial for having a smooth pregnancy and delivering a healthy child.

According to the WHO 1.2 billion people worldwide are officially classified as overweight. According to recent study 70% of India's urban population is obese and comes under overweight category.

Both underweight and overweight women and men suffer from a higher incidence of infertility. I see at least 10 patients in a day coming to me for infertility out of which 3 to 4% are obese. Women who are obese are also at a greater risk for pregnancy complications like having a C-section, giving birth to a large baby or even developing gestational diabetes and hypertension.

When going for infertility treatment

There are numerous potential complications for obese women trying to get pregnant. Some of these include:

Lower response to medication used to regulate or initiate ovulation.

Greater need for carefully titrated dosing of medication, especially in patients with polycystic ovaries (PCO).

Greater frequency of over-response and the risk of over-stimulation and / or multiple pregnancies in response to medications used to induce ovulation. And if a multiple pregnancy is conceived, there are greater obstetrical complications in patients with excessive BMI than in multiple pregnancies in patients with a normal BMI.

More complicated IVF cycles (besides those complications listed above) including: 

• Fewer eggs retrieved
• Greater technical difficulty retrieving eggs with greater risk of bleeding or injury
• Greater anesthesia risk at the egg retrieval, including maintaining adequate airway, hypertension and     aspiration
• Greater difficulty with embryo transfer in visualizing the uterus and accomplishing the embryo transfer    effectively
• Lower embryo implantation rates
• Lower IVF success rates

LIFESTYLE CHANGES TO GET RID OF OBESITY WHICH AUTOMATICALLY INCREASES YOUR CHANCES TO GET PREGNANT FASTER.

Obesity needs to be managed long-term with a combination of diet, increased activity and lifestyle changes.

1.      Balanced diet

2.      Regular physical exercise and relaxation exercise

3.      Eat three meals everyday breakfast, lunch and dinner

4.      Reduce your intake of food or drinks that contain high level of sugar and fat

5.      Eat more fruits, green leafy vegetables and salads

6.      Quit smoking and drinking

7.      Go for brisk walking twice in a day for 30 minutes

Stay healthy and obesity free..!!

Dr. Shobha Gupta