Polly came to visit me again 3 years after she got married. She was experiencing difficulty in conceiving and her ultrasound showed that each ovary contained about twenty fluid-filled sacs, arranged like a pearl necklace all the way across the ovarian surface. This was very typical of polycystic ovaries. Now, the challenge was to get Polly to produce good eggs. We started by answering her questions.
Although there is no known singular cause for PCOD, we know that raised insulin levels play a pivotal role in causing anovulation. Most commonly, women with PCOD experience insulin resistance. It is the sensitivity of the ovaries to insulin as well as raised testosterone and luteinising hormones that prevent the follicles from producing mature healthy eggs.
Women with PCOD have a very good chance at conception. Patience and dedication may be necessary to allow lifestyle modifications to enhance fertility naturally. It is also a good idea to be proactive in seeking medical therapy if natural conception over an extended period does not prove fruitful. With proper treatment, PCOD can be managed for the long-term and patients can live relatively symptom-free.
Recently, improvement in ovulation rates, circulating androgens, pregnancy rates and perhaps even improvements in first-trimester miscarriage rates have been observed when insulin sensitisers like metformin are used to correct underlying insulin resistance. For young women with PCOD, oral clomiphene can work as an effective medication. Those who require more aggressive treatments through injectable medications and in vitro fertilisation (IVF) probably represent a subset of PCOD patients with severe ovarian problems.
In general, two of the main risks of IVF are multiple births and hyperstimulation. The issue of multiple births can be minimised if a limited number of embryos is transferred. Hyperstimulation, on the other hand, needs to be taken very seriously in a woman with PCOD. Ovarian hyperstimulation is when the ovaries become very large with fluid building up in a woman’s belly. In a mild form, a woman may feel bloated with some discomfort in her belly. In a more severe form, it can put a woman at significant health risk. The best way to avoid this complication is to follow a segmented approach, with stimulation via injections performed in the first month and embryo transfer undertaken at a later stage. While these embryos wait to be transferred, they are frozen through a rapid freezing procedure called vitrification.
It is an undeniable fact that women with PCOD undergoing IVF are commonly found to have poorly developed (dysmorphic) eggs with reduced fertilisation potential, thus yielding poor quality embryos.
So our dear Polly had to finally undergo IVF in order to conceive. During the IVF procedure, 2 frozen blastocysts were transferred, and Polly “became pregnant and delivered” a lovely baby girl. Polly and her husband promised to guide her to lead an active life to help her stay away from PCOD.- Dr. Vaishali Choudhary