All about Polycystic Ovaries ,Dr. Rita Modi

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Know About polycystic ovary and its consequences on fertility. So as an expert, I am going to give you a few tricks and tips on how to handle conception, how to prepare yourself for conception when you are having polycystic ovaries.

So basically, the name has been given because it’s a condition characterized by collection of fluid-filled small, small spaces that is why the ovary looks like maybe, classically, it is called a string of pearl appearance. So, the ovary contains multiple fluid-filled spaces, that is why it is called polycystic ovaries. What it does to the hormonal system is it makes ovulation or the release of egg infrequent or absent, so there may be periods of several months where no ovulation happens and that leads to symptoms like delayed periods, irregular periods, infrequent periods. And for women who are trying to conceive, it’s difficult for them to conceive. There are also long-term health hazards because of polycystic ovary like higher chances of diabetes mellitus, then heart disease, people with polycystic ovary are going to have it in more severity or even at a relatively younger age. It can also lead to endometrial cancer or the cancer of the womb, if it goes untreated.

Now, this is a condition where exact reason is not known, why it happens, exact pinpointing the cause is not possible. So, all that can be done is to prevent, that prevention can be primary and secondary prevention. Now, about people with polycystic ovary, lifestyle is shown to play a great role in the pathogenesis of the disease and that is why if we want to reverse or control the disease process, lifestyle is something that we have to focus a lot upon. So, about half of women who are suffering from polycystic ovary are known to have higher body weight, high BMI, obesity, higher percentage of fat especially concentrated in the abdominal area and around the internal body organs. And this is the most obstinate fat and this is what we will call bad fat, bad fat because it will bring about negative metabolic changes. So for women who are on the overweight side, they need to look very seriously at their lifestyle, try to lose weight.

Good news is that if you are able to lose about 5-10% of body weight, whatever is your existing body weight, at least 5-10% if you are able to lose over a periods of say 3 months, you are going to see good effects, your cycle may become more regular, your insulin levels may become more normal, may go back towards normal, and ovulation may resume on its own without requiring any medication. Now, for that you have to avoid the crash dieting or those type of short-cut methods, so it has to be a combination of a good diet and good lifestyle changes like regular exercise, which is a combination of aerobic exercise then isometric exercise, then at least 30 to 40 minutes of exercise, minimum 5 days a week, that’s considered the minimum to maintain your body weight. So if you want a negative metabolic balance, you will have to organize your activities accordingly, you can take the help of an expert for this. Regarding your diet, you need to avoid simple sugars, simple carbohydrates, focus more on whole grains, complex carbohydrates apart from vegetables and all, low calorie food. But very important is to not skip meals so that your insulin level fluctuations are very less.

Now apart from a good body weight, another thing that you need to consider is whether you are taking, I mean this is going to give you negative body image or you are feeling not so good about yourself. If that is the case, please work upon it because mental and psychological health is also equally important. If those issues are there, you may think of getting professional help, that’s really going to take you a long way.

Now apart from that, if you are used to having alcohol or smoking, you know it is very very bad for ovarian function, so please avoid, cut down on it. Then, if you are having hormonal changes then there are medications, whatever can be naturally reversed, you need to do the best for it. Apart from that, a lot of medical help is available in the form of hormonal medication. Now, most commonly used medication are like Clomiphene citrate, letrozole, these are the ones which will try to change the hormonal environment of the body towards a more suitable one, so that the ovary starts producing follicles, which will ultimately mature and give you an egg, and those are the days when the egg is available in the system, as in just before ovulation and after ovulation, that is the period that you need to try naturally. Of course, it goes without saying that your partner will also have to maintain good general health and good reproductive health, so that you are able to fulfill your dream of having a baby.

Now apart from that, medication will help you but they must be taken under strict medical supervision. Please do not try to self-medicate yourself because this kind of treatment maybe potentially harmful, if it is not being monitored by an expert. So, usually what is done is with these type of medication, follicle studies are advised which is nothing but internal sonographies which are done at regular intervals to monitor and see when the follicle is growing and when ovulation is likely, so that is the day when a couple can try naturally. And those are the days if a couple has been trying for very long or if ovulation has become very difficult, in those situations, this can be combined with other form of therapies like assisted-reproductive technologies like IUI (intrauterine insemination). So on the day the lady is expected to ovulate, if on the same day, husband semen sample is taken to the lab and prepared and put inside the womb of the lady with the help of a very narrow, soft tube, this will improve their chances of conception. So what we can expect in terms of pregnancy rates with this, about 15% per attempt, per cycle. So if one cycle does not work, maybe we can look at getting another cycle done. So these are the simpler form of treatment.

Apart from that, for people who are obese or whose blood sugars are not so good, who are having diabetes or they are pre-diabetic, sometimes diabetic medication like Metformin also helps. And there are reports that if this category of women, they are taking this medication, chances of complications, some of the complications during pregnancy can also be avoided, like pregnancy-induced diabetes.

Now, there will always be a subset of women who are not going to respond to this simple medication, simple treatment, then there are more advanced form of treatments like hormonal injections, but again word of caution, they must be taken under medical supervision because their dosing and their timing are of extreme importance. Now, if there is a situation that women or the couples are not conceiving even with this or the follicles are not developing even with this then there is a surgical treatment which is called laparoscopic ovarian drilling. Now, this form of treatment is useful for making women responsive when they are not responding to usual medication or the hormonal medication. As I said, again and again, I am going to emphasize on this that these are to be decided upon by experts, to be conducted by experts. There are methods where you would do the needful without damaging the ovaries further because there has to be a very fine balance in making the lady ovulate but not damage ovarian cortex at all, so that has to be observed.

There will be some cases where none of these treatments work, then IVF is the most modern form of treatment for this, wherein basically, daily injections are given for roughly 10 days to try and develop multiple eggs in the ovary and those eggs are taken out, fertilized with the partner semen, and the ready embryos are put in the womb of the woman, so then the chances of conception are to the tune of 40-45% per attempt. Now, this again is not without its risk and complication, so that is why it requires medical supervision. There is an entity which is called hyperstimulation, which is a condition where ovaries may become enlarged in size, too large in size, there may be a little fluid accumulation in the abdomen and the chest. So, those are the situations which require maybe sometimes inpatient monitoring, fluid and electrolyte balance has to be corrected and then the ovarian size has to come down before an embryo is put inside the woman’s body. So basically, one has to prevent and manage complications and do the needful, create follicles, and help the woman in conceiving. Before you take medical treatment, there is a lot that you can do yourself for making conception possible.

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