IVF Success in RegularVs Irregular Menstrual cycle

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