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Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age, ranging from adolescence through menopause. The prevalence of PCOS ranges between 10-13%.
PCOS is a common cause of anovulatory infertility and its incidence is high, between 70-80%. Therefore, fertility treatment for women suffering from PCOS mainly focuses on treating anovulation.
Fertility Treatment for Women Suffering from PCOS:
In an interview with HT Lifestyle, Dr Nandini Devi, gynecologist, obstetrician and infertility specialist and center head at Indira IVF in Chennai, revealed that fertility treatment options for women with PCOS include non-pharmacological, pharmacological interventions and assisted fertility treatments. Are. He explained in detail-
1. Non-pharmacological interventions: 40-60% of women with PCOS are overweight or obese. Obesity increases insulin resistance and ovarian hyperandrogenism, which increases the risk of hirsutism, anovulation, infertility, and metabolic disorders such as diabetes, hypertension, or cardiovascular disease. Therefore, lifestyle changes such as exercise and changes in diet are necessary. The new international PCOS guidelines recommend at least 150 minutes of moderate intensity physical activity per week or 75 minutes per week of vigorous intensity and muscle-strengthening activities on 2 non-consecutive days. A low-calorie diet with adequate nutritional intake and healthy food choices has been shown to improve fertility. Current recommendations for weight loss include achieving an energy deficit of 30% or 500–750 kcal/day.
2. Medicinal Treatment: The principle of this treatment is to treat anovulation as PCOS represents 80% of anovulatory infertility. Oral ovulation induction medications (such as clomiphene citrate and letrozole) and insulin sensitizers (such as metformin) are first-line medications. After unsuccessful treatment with first-line oral ovulogens, gonadotropins are used as second-line agents.
3. Assisted Reproductive Technology: Intrauterine insemination may be considered when ovulation induction with timely intercourse fails. In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) can be considered as a last resort option for anovulatory PCOS. PCOS is a multifaceted condition, therefore, multidisciplinary care is required to address anovulation and the metabolic syndrome and psychological issues associated with this condition.
Bringing her expertise, Dr. Nithya Rengraj of New Medical Center – Multispeciality Hospital in Pondicherry said that many women suffering from PCOS can still conceive with the right interventions. According to him, there are a variety of treatments available to help improve fertility –
1. Lifestyle Modification: Weight loss (5 to 7 percent) with a balanced diet and exercise is the initial recommendation for PCOS patients as it helps restore ovulation in more than 75 percent of women.
2. Medicines: Metformin is a common medication for people with PCOS and insulin resistance. Women who do not ovulate regularly may be given medications such as clomiphene citrate (Clomid) or letrozole to stimulate the ovaries to release an egg. These medications are often the first line of treatment for women with PCOS who are trying to conceive. In some patients, it may be necessary to add medications such as gonadotropins or dopamine agonists to achieve ovulation.
3. IUI: In case of unsuccessful conception despite ovulation for 3 cycles or combined male factor, artificial insemination can improve the pregnancy rate.
4. In Vitro Fertilization (IVF): For women who do not respond to ovulation-stimulating medications, IVF may be a more advanced option. In IVF, eggs are removed from the ovaries, fertilized in a laboratory, and then implanted in the uterus. Although it is a more invasive procedure, IVF has a high success rate for women with PCOS who experience fertility challenges.
5. Surgical Option: In some cases, a procedure called ovarian drilling may be considered. This laparoscopic surgery involves making small holes in the ovaries to reduce androgen production and stimulate regular ovulation. However, it is usually only considered when other treatments have failed or when AMH levels are very high. Tubal patency can be tested simultaneously.
What Can You Do to Improve Fertility with PCOS?
Dr. Nandini Devi replied, “PCOS is the most common cause of anovulatory infertility. Lifestyle modifications may help improve fertility. Lifestyle modifications such as exercise and dietary changes help reduce insulin resistance and restore spontaneous ovulation and thus clinical pregnancy and live birth rates. Supplements with inositol, such as myoinositol and delta chiro inositol, act as insulin sensitizers and improve ovulation.
She further added, “Vitamin D, calcium and vitamin B12 supplements promote follicular maturation and improve pregnancy rates. Thyroid supplements improve fertility in case of hypothyroidism. Adequate sleep is important, as it improves fertility. Poor sleep or disruption of the circadian clock contributes to menstrual and reproductive problems. Synbiotics and probiotics supplementation in women suffering from PCOS improves hormonal, oxidative and inflammatory indices of the condition.
Dr. Nitya Rengaraj advised –
- Maintain a healthy weight: Even modest weight loss can improve insulin resistance, reduce androgen levels, and restore ovulation. A balanced diet rich in whole grains, proteins, fruits and vegetables can aid in weight management and hormone regulation.
- Exercise regularly: Physical activity can help lower insulin levels and improve ovulation. Aim for at least 30 minutes of moderate exercise, a combination of aerobic exercise such as brisk walking, jogging or cycling, and flexibility exercises such as yoga or stretching.
- maintain a menstrual calendar To keep track of your cycles.
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Always seek the advice of your doctor with any questions you may have about a medical condition.
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