Yadav Hospital Nandanee IVF & Fertility Centre

Hi,

I am Dr. Shalini Yadav Consultant Obstretician & Gynaecologist. I think there are a lot of videos which are been put and it has to be very accessible for a common person to understand. So today I am going to talk about a very common problem which is a Polycystic Ovarian Syndrome. What is this? Lots of patients every second patient is coming and walking into our OPD and is having a PCOS. What do you think is it a problem only of infertile couples? No infertility is a later consequence of a PCOS but PCOS is a problem of young girls. It starts off a very early age girl. And what is the common symptom for which the patients come to us when they are not married they are young? It is the common problem is that they don’t get irregular cycles. So irregular menstrual cycle is the most common symptom with the patient comes and walk into our OPD and is of major concern.

Now PCOS is a polycystic ovarian syndrome and we have to understand it is not a single syndrome which constitutes the syndrome. It carries an irregular menstrual cycle one which is very common. The patient can menstruate in once in 2 months 3 months or absolute Amenorrhea for 6 months also. Subsequent it leads to high level of androgens. Androgens are those hormones they are most common in the male hormones. And that leads to obesity so the absolutely there in such females and hirsutism. Hirsutism is the abnormal hair growth in the body parts. So what the patient has – acne for that reason. The third and most common symptom of the polycystic ovarian syndrome is that the patient has very bulky ovaries. They have a necklace pattern. There are lots of eggs in the ovaries but they do not ovulate. Ovulate means the egg does not rupture from the ovary and that’s how anovulatory cycles for such females that is the major concern which leads to infertility in their future age group when they grow young and they get married. Now, what do you think is the common cause of PCOS and what has to be done to treat a PCOS patient.

One and the foremost is our lifestyle basically. We have started more on corporate work we do lots of jobs gets more into professionalism and they don’t have enough time to cook food. So we are mostly into junk food. We take lots of carbohydrates to eat junk food outside we don’t do any exercises so it's our lifestyle which worsens the PCOS. PCOS is a progressive disease and to control PCOS and make your cycles regular the most foremost common thing is to do weight reduction. Weight reduction is not only by not eating that’s a wrong concept. You have to have your regular exercise walk and a low carbohydrate diet. I have never said any carbs but a low carbohydrate diet and a high protein content. There are lots of foods which has to be avoided in a PCOS patient and trust me on that and as soon as the patient starts reducing weight mostly if you reduce 5 kg of weight in a span of 3 months also the cycles become regular and you do not require any hormonal treatment for that reason.

Now if a lady has come to us for infertility which is a very common cause of infertility nowadays it is easy to treat such patients but first and foremost as I have already mentioned is your lifestyle modification you have to cut down your carbs you have to exercise regularly it is not one day thing it takes a lot of time and the PCOS which I classified there is no such classification but broadly for the clinical aspect there are lean PCOS there are obese PCOS. Lean PCOS who are thin whose BMI is under a normal age they are easy to treat. They mostly have regular cycles as they are not overweight. The common problem in a Lean PCOS can be anovulatory cycles or there are problems with high androgens for that reason. So with simple injection with simple medication and follicular studies lean PCOS patients are easy to treat because they resume ovulation very easily. In compare to an obese PCOS who has already a high level of androgens they are really the BMI is more than 30 35 they are very hard to treat because it is very hard to break the threshold of all those follicles which are sitting in the PCOS in the ovaries and it really becomes challenging for any doctor to treat such patients but then the mystery of the treatment still remains tight you have to lose weight and once you start to lose weight whatever management may be in form of clomiphene citrate which is a drug which is used to make follicles eggs and subsequent ovulation in a PCOS patients.

If you start ovulating there are chances with the subsequent cycles in 6 to 7 cycles become 80 to 90% if you are really ovulating with clomiphene citrate. But in some people PCOS they are non-responding. They do not respond to drugs conventional drugs and they do not ovulate no matter what dose of clomiphene citrate we give. For such kind of patients, motivation is to reduce weight that is the first and the foremost thing and second comes is the gonadotropins. We have to start induction with most of the injectables and we see how you respond. So the second classification is the responding PCOS and the non responding PCOS the responding PCOS we still have a hope right whatever management we are going to give you are going to respond you are going to give us some result you are going to give some follicles and eggs we have a hope that we can have pregnancy in the cycles in which your eggs are forming and you are ovulating but no matter what we do sometimes with the gonadotropins also the eggs really do not pick up the BMI is too thick for obesity the BMI is too high sometimes with good amount of gonadotropins also a patient sometimes do not really responds.

For such kinds of resistant patients there is an insulin resistance that why sometimes we have to adopt the metformin lifestyle weight reduction and the last and the most important thing what we recommend not for the obese it really does not work yes you have to reduce weight come to a normal BMI and then the ovarian drilling really works which is a surgical way of treating PCOS in which we drill in each ovary laparoscopically and we really coagulate Tromax which converts your PCOS ovary into a normal looking ovary. But then still with the medication and the supportive treatment, we ask the patient you know to try naturally for 3 to 6 months and with the regular natural cycle for your tracking but If you are tracking your cycles and you are ovulating yes then the chances of pregnancy really becomes much higher.

So what my advice to all parents are rather than letting your daughters landing up with infertility once they get married if they have an irregular cycle get your check-ups done and if your daughter is a PCOS patient it is very important to take care of her diet cut down the carbs, cut down the junk food let her not eat outside food have high protein content for your daughters make them indulge into exercises aerobics gyming swimming dancing whichever way of exercise they are comfortable with you to know to try them to get involved with more of exercises so that they do not put on a lot of weight.

Once they are not gaining weight then the chances of controlling PCOS and landing up with the future complications really decreases to an extent rather than going to doctors again and again putting them on hormones depending on hormones for their cycles and it is a really depressive thing for most of the young females because there is nothing you can do about it because for some it is hereditary it is there in the body and they try very hard and they do not reduce weight so my advice to all of you is to control of your diet make sure you do not gain much weight and detect PCOS as early as possible. So that we can treat it in time.

Thank you.

Hi! 

I am Dr. Shalini Yadav, consultant obs and gynae fertility specialist. I will be talking about a very simple and common question, Why IVF? Is IVF for all and how it works? What is the success rate in actual? How a lady gets ovulated and gets pregnant naturally? In the natural cycle and in an average female who has a menstrual cycle of 28 days, there is the production of the hormone from the brain which also causes the follicular production. As follicular grows, they do produce a hormone which is an estrogen. One follicle dominates and starts producing estrogen. Now sperm travels from your vagina and meets the egg released from the tube. There fertilisation occurs.

And embryo travels all the way to uterine and that is how the implantation occurs. If the lady is pregnant, she does not get cycle otherwise on 14th day, she will get her menstrual cycle. So, the patient asks that IVF is for all? My answer is No. IVF is for those who have undergone any tubal surgeries or any related problems. It depends on pathology and morphology of the sperm. Sperm count also matters for the same. Because it can make difficult for you to conceive. So, IVF is not for all. So, only 5% of couple require this treatment. Doctor needs to check whether the problem is, in female or male. If the problem is with male, then IVF is required. In female, there are 2 major causes - 1st is tubal pathology like you may have tubal blockage, infection in the tubes, tuberculosis or any previous surgery in the tubes.

We encounter lots of patient with premature ovarian failure. Now how IVF works and what is the success rate? The success rate does not depend on the doctor or the centre. It is all about the couple success rate. In IVF, we stimulate the ovary but it is a controlled ovarian stimulation. Under anesthesia, we take out all the eggs under ultrasound guidance. Then we fertlise them with sperm. Or we do ICSI. Where one sperm is injected in one egg. If the lady has 10 eggs, she might not have 10 embryos. We check fertilisation on the gap of 48-72 hours. So, the success depends that in how much of the good amount a couple will make the embryos. And in IVF, the success rate is not more than 40-60%. So, a couple should understand that they are dealing with their own eggs and sperm. If there is the uterine abnormality then we go for surrogacy. Or if the eggs are really poor then we only go for the donor cycle. But we prefer natural IVF cycle. We are getting lots of success rate. We just discuss with the patient, if there is any such problem.

Thank You.