Trying to conceive with PCOS? Learn about fertility treatment for PCOS and infertility treatments in this article by Mumbai-based gynaecologist, Dr Duru Shah.
Polycystic Ovarian Syndrome (PCOS) is one of the prominent causes of infertility, in which normal ovulation is disrupted. This article will answer frequently asked questions on PCOS and infertility and fertility treatment for PCOS.
What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is a gynaecological hormonal disorder, which affects one out of ten women, from puberty to menopause.
The presenting complaints may differ from cosmetic issues like facial hair, acne, irregular periods, inability to conceive, and chronic diseases like diabetes mellitus, high blood pressure, high cholesterol, and uterine cancer.
80% of girls or women are overweight and obesity increases the problems of PCOS, which is one of the prominent causes of infertility, in which ovulation does not occur or occurs irregularly.
It is possible to assist women having difficulty in getting pregnant with various forms of medications that help ovulation. As a matter of fact, at our centre, we see a maximum of infertile women with PCOS, who have ovulation disorders, which can be easily managed successfully.
Prevalence of PCOS in India
An estimated 1 in 5 Indian women suffer from PCOS. The incidence of this condition has been increasing every year with increasing obesity, unhealthy diets and sedentary lifestyles.
Hence urban Indian women have been found to have a higher prevalence of PCOS in comparison to rural women (almost 22.5%). Recent studies have estimated an overall prevalence of PCOS ranging from 3.7 to 22.5 %. (Ref. M. Ghanie, Epidemiology of, Nov. 2019)
Due to the different definitions used in the detection of PCOS, there has been a discrepancy in the prevalence rates globally. Other international studies have reported a prevalence of PCOS worldwide between 4 to 10 % in women of reproductive age.
Symptoms of PCOS
PCOS is associated with menstrual, cosmetic, fertility and metabolic issues, irregular or delayed periods and sometimes no periods. Women with PCOS may get hardly 3 to 4 periods in a year! Sometimes, periods are induced by medications in order to avoid heavy bleeding after 3 to 4 months of no periods.
Acne and excess facial hair (hirsutism), hair loss from the scalp are cosmetic concerns occurring due to raised male hormone levels, which can be quite disturbing for women especially young girls.
Weight gain and craving for sweet foodstuffs can occur due to Insulin Resistance, a relative lack of insulin hormone causing diabetes in the body. This is mainly associated with fat accumulating around the waist due to Insulin Resistance.
PCOS symptoms can be clinically visible as pigmentation in the nape of the neck, underarms and groin area. On an ultrasound, multiple tiny cysts, more than 12 in number in each ovary or enlarged ovaries twice their normal size are seen, making the ovaries look “polycystic”.
As young girls with PCOS get older, get married and plan their family, they may face fertility issues due to their irregular periods or hormonal imbalance and require treatment for the same.
What are the causes of PCOS?
As of today, the cause for PCOS to occur is not known, but a lot of research is ongoing and hopefully, we should have an answer in the near future. But we do know that PCOS is a hormonal disorder that is genetically determined, with insulin resistance and increased male hormones adding to the problem.
It occurs due to an interaction of genetic and environmental factors such as obesity. It is a life-long condition that cannot be completely cured today, as we still do not know the cause but can definitely be kept under check.
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How does PCOS affect fertility?
PCOS is one of the prominent causes of infertility. This occurs due to irregular menstrual cycles and lack of ovulation. PCOS can also lead to imbalances in the reproductive hormones and a rise in the androgen (male hormone) levels.
Along with this, there is also a rise in the insulin levels in the body (a hormone that regulates glucose secretion in the body) leading to Insulin resistance. All these parameters have an effect on the ovaries causing ovulatory dysfunction and hence infertility.
Women with PCOS who become pregnant are also at an increased risk of developing Diabetes or Hypertension in pregnancy or suffering from spontaneous abortion.
As they reach 40+ age, they can develop abnormal uterine bleeding, diabetes, high blood pressure, increased cholesterol, obesity, increased risk of cardiovascular disease and cancer of the uterus.
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What is the protocol for PCOS infertility treatment?
The commonest cause for Infertility in PCOS women is irregular periods leading to the irregular release of an egg which is needed every month in order to have a baby.
It is possible to help women with PCOS conceive with the help of excellent medications, both oral and injectable fertility treatments, which help in ovulation. These include tablets like Clomiphene and Letrozole and hormonal injections like FSH & LH.
These medicines are given from the 2nd/3rd day period. After taking these medicines, ovulation is usually monitored by serial ultrasound to assess the follicular growth and to avoid problems like too many eggs getting mature (hyper-stimulation).
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Some patients may require assisted reproduction such as IVF or ICSI if they do not get pregnant with simple ovulation induction and intrauterine insemination.
Those who do not respond to simple measures such as medication for ovulation induction, and weight loss, also require further interventions such as Intrauterine Insemination (IUI) or In-Vitro Fertilization (IVF).
At our fertility centre in Mumbai, we see a large number of women with PCOS and infertility, who have ovulation disorders. They have been easily treated with successful outcomes.
Does PCOS treatment require diet and lifestyle changes?
Lifestyle modification is the first-line treatment for PCOS and infertility. The principle treatment involves maintaining normal weight through lifestyle changes via a healthy diet and regular exercise. A low-calorie diet and regular exercise is the key to weight loss.
Weight loss can improve fertility, regularize periods, reduce insulin resistance and lower androgen levels. A weight control program with regular aerobic exercises, preferably under a nutritionist’s guidance, is highly recommended.
Exercise helps lose all the extra kilos and thus leads to better ovulation rates and pregnancy rates in both, the natural or IVF cycles. Aerobic exercises, moderate-intensity exercises and cardio at least 5 times a week goes a long way in controlling PCOS.
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What PCOS diet do you recommend?
There have been many diets propagated today, claiming to cure PCOS. Unfortunately, PCOS cannot be cured, can be only kept under control.
Research has very clearly shown that a low-glycemic index diet (low sugar) with more saturated, trans-fatty acids (good fat) helps in reducing insulin levels. A caloric deficit diet accompanied by a healthy dose of exercise can also help reduce obesity in PCOS.
Omega-3 fatty acids and Vitamin D are some dietary supplements that have also been shown to modify the hormonal imbalance in PCOS patients. Thus a balanced diet with limited calories low carbohydrates, fibre-rich and average amounts of saturated fats is recommended.
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Is ayurvedic medicine effective for PCOS?
Ayurveda aims at a more holistic approach and believes in a normal balanced state of Doshas. This forms the basis of a healthy person. Ayurvedic treatment regimens are supported to help Insulin Resistance, obesity and hormonal imbalance associated with PCOS.
There have been a few scientific studies to establish the benefits of Ayurvedic drugs in PCOS. Since I am not an Ayurvedic physician I cannot comment on how well it works, especially because we believe in solid scientific data before we get convinced to use a drug.
Does yoga help in treating PCOS?
Studies have shown that Yoga for PCOS helps in fine-tuning hormonal issues. Yoga is known to align the hormonal imbalance in PCOS by reducing mental stress and thus balancing the axis between the brain and the ovaries.
Studies have found that yoga reduces androgen levels and also facilitates the excretion of cortisol (stress hormone) from the body. PCOS is also accompanied by anxiety due to its symptoms.
Yoga helps to decrease anxiety symptoms and depression in overweight women. There have been a few studies that suggest that Yoga can prevent long term sequelae of diabetes mellitus and cardiovascular disease in PCOS women.
Is acupuncture treatment for PCOS effective?
Acupuncture has become quite popular worldwide due to its feasibility and low cost. Though it has not yet been proved that acupuncture helps to increase pregnancy rates, new studies have suggested that acupuncture can help regularize menstrual periods by decreasing androgen levels in PCOS patients.
So acupuncture has been shown to help in regularizing menstrual cycles. But we need much more research done to determine the effectiveness of acupuncture in the treatment of infertility. A consistent and long treatment period combined with proper medications assist in getting successful results.
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Is homoeopathy or Siddha effective in treating PCOS?
There are very few scientific studies to establish the usefulness of Homeopathy in PCOS patients. It has been suggested that Homeopathy balances the hormonal disturbances and reduces androgen levels thus tackling hirsutism and acne.
Homoeopathy works on the psychosomatic aspect of PCOS, thus assisting in balancing hormones with a holistic approach. Thus, even though homoeopathy is more cost-effective and easily available, its potency in controlling PCOS and treating infertility due to PCOS is still limited.
How and where can women get fertility treatment for PCOS?
Visit Gynaecworld to know more about PCOS and fertility treatments options. For fertility counselling and information about fertility treatment in India, contact our fertility centre in Mumbai.
Book your appointment today at Gynaecworld at Kemps Corner, Mumbai:
Call: +91-22-23802584
Email: durushah@gmail.com
About the author:
Dr Duru Shah is Director, Gynaecworld, the Center for Women’s Health & Fertility in Mumbai, India and a prominent and well-known gynaecologist in India. She is not only known to be one of the best gynaecologists, but also a prominent social activist.
Through her profession, she has contributed towards the girl child and rural women in society. She is the voice of the gynaecological community for propagating the best practices in her field and championing multiple social causes pertaining to women’s health.
A consultant to Breach Candy Hospital and Jaslok Hospital, even at the age of 70, Dr Shah is intrinsically engaged in setting new benchmarks in her profession and unflinchingly lends support to an array of social causes through various professional and social organisations.
For fertility counselling and information about fertility treatment in India, contact her fertility centre in Mumbai. Book your appointment with Gynaecworld at Kemps Corner, Mumbai. Call: +91-22-23802584 | Email: durushah@gmail.com
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