IVF Success in Regular
Vs Irregular Menstrual cycles
Author- Dr Richa
Sharma(IVF Consultant Mumbai)
It’s
a general concept even in layman that for pregnancy one needs to have regular
and timely menstrual periods.But in certain patients periods may not come
regularly ever since menarche.Besides they may have history of weight
gain,acne, excessive hairs on skin of face, may need to go for threading more
often than required and may have cousins, sisters or evn mother having same
issues.Such symptoms and signs point towards –
· PCOS – as the first most
diagnosis
· Hormonal imbalance-
FSH,LH ratio change with high LH levels
· Insulin resistance
· May have add on
Thryoid/prolactin derrangements
These
patients generally have high body mass Index(BMI)but some fall into category of
lean with periods regular.
What
all these lead to is a situation called-Chronic anovulation- a common cause of
infertility.
Most of such PCOS patients have normal FSH but
high LH levels.Its a multifactorial condition with life long implications
What we can do about it
?
Yes
we can do major part especially if weight is more then Lifestyle modifications
alone will help to keep things on track but it needs constant action in a well
planned manner.So tips to keep a check on PCOS-
· Weight loss- at rate of
5-10% over a period of 5-6 months.If you have 80 kg then you should loose
between 4 to max 8 kg only slowly with crash courses/diets or short cuts
· Daily brisk walking at
least for 30 minutes to burn extra calories
· Moderate exercise on
regular basis
· Joining a structured
programme like Gym
· Take healthy balanced
food(if possible with help of dietitician)
· Cut down carbohydrates
like banana,rice,rice products with a check on milk and milk products and less
of fats
· Keep proper
hydration(3-4 LITRES of water daily)
· Avoid junk foods with
empty calories
Dear
readers all these need to be followed as part of life and not till you have
pregnancy as PCOS has more of chronic affects also later on due to tendency to
gain weight due to hormonal disturbances
Polycystic
ovary syndrome (PCOS) is diagnosed in
approximately
60–70%of women with such features.
How to plan pregnancy in
PCOS?
Singleton
live birth rates of up to 71% in 2 years can be
achieved
in such patients with –
1)
Induction of ovulation- it can be by clomiphene citrate as first line of
treatment and Injectables gonadotropins
as second-line
treatment
with success rate varies from 2 to 3%
2)IUI-
combined induction with IUI increases success rate from 8 -13% to 15-20%
3)
IVF- not used as first-line therapy in
these
patients,
except for subgroups with a poor prognosis like-
§ Advanced age group
§ Longer duration of
infertility
§ Higher insulin:glucose
ratio
§ Failed ovulation
induction
§ Other indications of
IVF-tubal factor,male factor,unexplained/idiopathic infertility
Outcome of IVF In PCOS-
The
outcome of IVF in women with PCOS shows
variable outcome as-
Response
to Medicines is the main issue- erratic(resistant to hyper) which is generally
unpredictable
· More oocytes
obtained-with more of immature
· Less fertilization rate-
both mature and immature oocytes
of
PCOS patients show reduced fertilization rates, presumably due to endogenous
hormonal imbalance
· More chances to have
poor quality eggs
· Chances of
abnormal(aneuploidy)embryos is high
· Inc chances to form endometrial
polyp with recurrence
· Inc chances of
cancellation of cycle/use of high dose of medicines
· High chances of first
trimester miscarriage
· But good part is despite
reduced overall fertilization, IVF pregnancy rates in PCOS patients appeared to
be comparable to normo-ovulatory women
· Also live birth rates are comparable
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