PCOS And Fertility-
PCOS- Polycystic Ovarian Syndrome- Imagine a woman being denied the most beautiful gift of life- childbirth! This medical problem called PCOS is the main culprit behind snatching away the boon of maternity from many women. It is a very painful and debilitating disease affecting the life of many adult women. There are many other sufferings closely associated with PCOS too.
PCOS Problems
PCOS brings with itself multiple abnormalities and difficulties that disturb the process pf pregnancy. The complications associated with this disease are the following-
● Oligovulation– Irregular menstrual cycles
● Anovulation– Complete absence of menstrual cycles.
● Excess Androgen Levels– Hyperandrogenism, or elevated levels of male hormones such as testosterone, is common in this. This can lead to symptoms like hirsutism (excessive hair growth), and alopecia (hair thinning). Medications eg Cliomine citrate and Letrozol have been found highly effective in this condition.
● Polycystic Ovaries: On ultrasound, the ovaries of women with PCOS often seem to be enlarged and contain many tiny, fluid-filled follicles. Despite this, these are not true cysts but rather immature follicles that fail to develop fully.
● Insulin resistance– The phenomenon of high blood glucose levels from the mother coupled with high insulin levels in the fetus results in large deposits of fat which causes the fetus to grow excessively large. Another issue that could be witnessed is Hypoglycemia which refers to low blood sugar in the baby immediately after delivery. Insulin resistance can impact pregnancy in several ways, including: • Fetal growth: Insulin resistance can affect the growth and metabolism of the fetus. When a mother is insulin resistant, the degree of glucose that passes from her to the fetus is also affected. This can lead to fetal ‘macrosomia’, which is a common and serious complication of pregnancy. • Gestational diabetes: Insulin resistance can contribute to gestational diabetes mellitus (GDM). • Hypertensive disorders: Insulin resistance has been linked to hypertensive disorders in pregnancy. • Adverse perinatal outcomes: Insulin resistance can contribute to adverse perinatal outcomes. • Birth injuries: Infants of diabetic mothers are more likely to experience birth injuries, such as shoulder dystocia and brachial plexus trauma.
During pregnancy, maternal tissues become less sensitive to insulin to ensure that the growing fetus receives enough nutrients However, hormonal changes during pregnancy can cause insulin resistance to increase.
● Weight Management– Obesity is a very common issue found in women with PCOS, and excess weight can negatively affect both natural fertility and IVF outcomes. Studies have shown that even modest weight loss (5-10% of body weight) can facilitate ovulation, hormonal balance, and total fertility in women with PCOS. For women undergoing IVF, achieving a healthy weight can increase the chances of success and reduce the risk of complications such as OHSS (Ovarian Hyper Stimulation Syndrome) and miscarriage.
● Lower egg quality– In addition to ovulatory dysfunction, women with PCOS may have lower egg quality, which can further hamper their capacity to conceive. This is where assisted reproductive technologies like IVF can be particularly beneficial. Processes such as “Intercytoplasmic Sperm Injection” could improve the quality drastically.
THE IVF IMPACT ON PCOS INFERTILITY
PCOS is a difficult demon to overcome but it’s possible with IVF, folks! Let’s have a look at HOW-
● Controlled Ovulation and Egg Collection: A wonderful aspect of IVF for women with PCOS is the ability to control ovulation. It gives you a leverage over mother nature! Unlike natural conception or other fertility treatments, IVF allows fertility specialists to stimulate the ovaries lulling them into a false feeling of menstruation and retrieve multiple mature eggs at once. This is like a dream come true, especially for women with PCOS, who may have irregular or absent ovulation. By retrieving multiple eggs, IVF maximizes the chances of successful fertilization and embryo development.
● Overcoming Anovulation: Women with PCOS often experience anovulatory cycles, where no egg is released. IVF bypasses this natural handicap of the need for natural ovulation by retrieving eggs directly from the ovaries after stimulation. The process is cut short and you are spared much hassle. This is particularly useful for poor women patients who do not respond to ovulation induction medications or IUI any longer.
● Greater Success Rates Compared to Other Treatments: Studies have shown that IVF is the champion and the ruler of the roster as it has higher success rates for women with PCOS compared to other fertility treatments, especially for those who have not responded to ovulation induction or IUI. IVF allows for much better control over the reproductive process in its entirety, from egg retrieval to embryo transfer, leading to a higher likelihood of pregnancy.
● Embryo Selection: A game-changing advantage of IVF is the ability to select the best-quality embryos for transfer. You get to decide the evolutionary conditions. Embryologists can assess the quality of the embryos based on their development and morphology, increasing the hopes of implantation and a healthy pregnancy. In some cases, preimplantation genetic testing (PGT) may be used to screen embryos for genetic abnormalities, further improving the chances of success. Any potential defects of the baby are nipped in the very bud!
CHALLENGES AND RISKS- HURDLES IN IVF FOR WOMEN WITH PCOS
IVF comes as a fantastic remedy and a marvel of modern science that offers many benefits, but challenges and risks associated with the procedure for women with PCOS:
● Ovarian Hyperstimulation Syndrome (OHSS): A main risk of IVF in women with PCOS is ovarian hyperstimulation syndrome (OHSS). This occurs when the ovaries are overstimulated during the ovarian stimulation phase, leading to swelling, fluid accumulation, and discomfort. In severe cases, OHSS can be life-threatening. Women with PCOS are more vulnerable to developing OHSS attributable to increased sensitivity to fertility medications. To mitigate this risk, fertility specialists closely monitor patients during the stimulation phase and adjust medication dosages as needed.
● Multiple Pregnancies: It’s a double-edged sword. While it is a good omen as it allows transferring multiple embryos increasing the chances of pregnancy, it also increases the risk of multiple gestations. To minimize this risk, fertility clinics often recommend transferring a single embryo (elective single embryo transfer or eSET), especially for younger women or those with high-quality embryos.
● Emotional and Financial Strain: IVF can be a double whammy by being emotionally and financially demanding for couples. The process puts you through multiple medical appointments, injections, and procedures, which can take a toll on the emotional well-being of the patient and her partner. Additionally, IVF is expensive, and not all insurance plans cover the costs of the procedure. This financial burden can add fuel to the fire of stress in an already challenging situation. Once parental dreams may suddenly become a nightmare and a black hole of financial chaos.
● Lower Egg Quality in Some Women with PCOS: It is good that women with PCOS often produce a large number of eggs during ovarian stimulation, however, the quality of these eggs may witness a decrease when compared to women without PCOS. Poor egg quality can result in lower fertilization rates, worse embryo quality, and curtailed chances of pregnancy. But fear not friends, as advancements in IVF technology, such as embryo culture and genetic screening, can help address this issue. Science has always got our back! Science makes us smile!
