Dr. Irina Dey

Polycystic ovary syndrome (PCOS) and infertility are considered synonymous by most. However, the truth is that they are not and there are a lot of treatment options that can lead to pregnancy, even in a lady who is suffering from PCOS.

Reasons PCOS leads to infertility
Women with PCOS have different hormonal pathways than a normal woman without PCOS. It changes the system of how your body produces the eggs and prepares your uterus for pregnancy. Three reasons why women with PCOS do not get pregnant, or why it is difficult for them to maintain pregnancy are:

1. Women who are suffering with PCOS do not ovulate normally.
2. They have irregular periods and thus their monthly cycles are not predictable.
3. As they have irregular periods, their endometrium may not be prepared when the egg is released. Thus, it does not help in sustaining the pregnancy.

Symptoms of PCOS
There are a lot of symptoms that show the hormonal imbalance due to PCOS.

1. Ovarian cysts
2. Excessive amounts of male hormones
3. High levels of insulin
4. Fertility problems
5. Weight gain
6. Ovulation and menstrual problems
7. Excess body and facial hair
8. Acne
9. Anxiety and depression

As there is hormonal imbalance in a woman with PCOS, the eggs may not develop properly, and at the same time, they may not be ready to get fertilized, thus leading to infertility.

PCOS infertility treatment
The good news is that even if you are one of them with PCOS, there are treatments that can help you to get pregnant.

Here are the drugs that help patients with PCOS.
Metformin (Glucophage)
It helps in reducing the insulin levels and stabilizes the hormones. Thus, doctors often prescribe metformin that will help in making the ovulation cycles regular.

Clomid (Clomiphene citrate)
Another fertility drug that helps in conceiving is Clomid. It may be prescribed with or without metformin. When women with PCOS take these two drugs together, their chances of getting treated for PCOS and getting fertile become more. Many women may need a high dose of Clomid so that they can retain fertility.

Gonadotropins
This medication is necessary for helping you with ovulation as gonadotropins are hormones that stimulate your ovaries to release eggs. When someone is not responding to clomid then this medication may be tried.

If you too are trying to conceive and yet have not succeeded, and can find the symptoms mentioned above, visit your doctor and start the treatment.

Recurrent pregnancy loss refers to the situation when three consecutive pregnancy loss takes place. A pregnancy loss is a clinically defined pregnancy which ends before twenty weeks.

Causes of recurrent pregnancy loss

1. Major cases of pregnancy loss occur due to genetic abnormalities and chromosomal abnormalities. The abnormality may occur from the sperm, egg or the early developed embryo.
2. Recurrent pregnancy loss may occur in a woman due to ascending maternal age. This happens because of poor quality of the egg, which further leads to chromosomal abnormalities. In some cases, the pregnant mother or the father can have some gene irregularities. In such cases, the would-be-born infant is affected, and this causes pregnancy loss or miscarriage.
3. Uterus abnormalities also lead to recurrent pregnancy loss. This may happen because of poor supply of blood to the uterus. Abnormalities in the uterus are in-born in some women and in others these may develop over time.
4. Women having a poor immune system are likely to suffer pregnancy loss. Abnormalities in hormone secretion like thyroid or diabetes may also cause pregnancy loss in women.
5. If a woman suffers from abnormalities in blood clotting, the chances of miscarriage are enhanced.

Testing for recurrent pregnancy loss
Several tests and examinations should be carried out for detection of pregnancy loss. 

1. Karyotype analysis of the woman and her male partner has to be conducted. Karyotype refers to the genetic or chromosomal constituents of an individual and this test is carried out to detect abnormalities in genes and chromosomes of the parents, which cause miscarriage when passed on to the developing infant.
2. Another test includes the evaluation of the uterus and the uterine cavity. This is done by ultrasound, saline ultrasound, MRI, hysterosalpingogram X –ray or by hysteroscopy. These tests help to get information on the uterus shape, about fibroid presence, detect abnormalities within the uterus and observe the opening and closing of the tubes. Tests to detect the functioning of hormones are also carried out.

Treatment
The treatment for women with recurrent pregnancy loss depends upon the underlying causes of the pregnancy loss.

1. In case of patients with karyotypic abnormalities, genetic counselling is recommended, where a specialist is consulted to know about chromosomal abnormalities.
2. Prenatal genetic studies are carried out by some couples to know about the offspring’s genetic make-up. This is done with chorionic villus sampling or with amniocentesis. A process known as in vitro fertilization can be carried out.
3. In case of uterine abnormalities, a surgery may be performed and medications for reducing blood clot are used if anti-phospho-lipid antibody syndrome is detected.

Recurrent pregnancy loss may happen due to various reasons and proper tests, and treatment procedures should be carried out for curing pregnancy loss. This phenomenon affects a woman and her partner deeply.

Menstruation is the monthly discharge of blood from the vagina, which lasts for about 5 to 6 days. It is the shedding of the inner lining of the uterus, when pregnancy does not occur after the release of egg from the ovary. Menstrual periods are generally often accompanied by painful cramps in the lower abdomen, heavy bleeding, weakness, water retention, irritability and malaise.

What is Menorrhagia?

Very heavy or prolonged periods are medically termed as menorrhagia. It is abnormally heavy bleeding if there is a requirement to change sanitary napkins or tampons several times within a very short span of time. Passing large blood clots, night time bleeding, bleeding for over 7 -8 days, are other symptoms that one might be suffering from menorrhagia.

Common Causes Behind It

1. Menorrhagia is mostly a cause of hormonal imbalance, particularly in the levels of estrogens and progesterone.

2. Fibroids, cysts or polyps in the organs of the reproductive system, which includes the uterus, ovaries or fallopian tubes.

3. History of miscarriage or failed pregnancies.

4. Use of contraceptives

How can you treat heavy bleeding during menses

1. Change of diet: You must include more minerals, iron, magnesium and calcium in your diet. Your diet must comprise a lot of green vegetables, fresh fruits and dairy products.

2. Some non steroidal anti inflammatory drugs such as ibuprofen may be prescribed to reduce the blood loss.

3. Certain hormonal therapies to regulate the hormonal imbalances and menstrual irregularities.

4. Home remedies such as intake of certain herbs, ginger and coriander seeds help to control heavy bleeding.

5. Increasing magnesium intake to balance out levels of oestrogen.

6. It is best to stick to natural remedies, as it generally does not create complications in other bodily functions.

If the bleeding cannot be controlled even after a change of diet and home remedies, you must visit the gynaecologist as soon as possible. Heavy bleeding is a serious problem, especially if accompanied by dizziness, fluctuations in the blood pressure, nausea and weight loss. Severe cramps and constant bleeding can hinder daily routine, therefore, the earlier you receive medical attention, the quicker you will get relief.

Menopause is characterized by the absence of menstrual periods for 12 months. It is the time in a woman’s life when the ovaries stop functioning. The periods then stop forever. Menopause can occur anytime between 45 years to 55 years age group, however, menopause may happen as ahead of schedule as the 40s or as late as the 60s. There is no solid lab test to determine when a lady will encounter menopause. Early menopause usually starts at the age of 45 and this is called premature menopause. Nevertheless, premature or early menopause is not that common with only about one percent of the women going through early menopause before the age of 40.

The signs and symptoms of early menopause are like the usual menopause. Some basic side effects include:

1. Irregular periods (amenorrhea)
2. Hot flashes
3. Night sweats
4. Vaginal dryness
5. Mood shifts
6. Mental fogginess
7. Diminished sex drive

Your specialist will suggest a treatment depending on your individual circumstances. Some common ways to deal with premature or early menopause are as follows:

Hormone Replacement Therapy
Supplements containing estrogen and progestin can help and replace some of your reproductive hormones in the body that can no longer make it all alone. They are frequently taken until the normal period of menopause (around 50) to help avoid bone loss. This treatment is not suggested for all ladies since it expands the danger of:

• Heart issues
• Stroke
• Blood clots
• Breast cancer

Supplemental Calcium and Vitamin D

Supplementary calcium and vitamin D can help in preventing osteoporosis in case you are not getting enough of these supplements from your normal diet. Women between ages 19 to 50 need to consume 1,000 milligrams of calcium for each day through food or supplements. Ladies over age 51 need to consume 1,200 milligrams for each day. A prescribed day-to-day measure of vitamin D has not yet been built up. For grown-up females, most specialists prescribe 600 to 800 global units through food or supplements. One should get a prescription from a doctor before ingesting the medication.

Other strategies to deal with Infertility
A few ladies with untimely menopause can at present get pregnant with no treatment. Ladies who want to have children, however, tend to become infertile after early or untimely menopause, need to consider in-vitro treatment, fertilization or even adoption.

Talk Therapy
Numerous ladies discover that having a conversation with a therapist can be supportive to adapt to their anxiety. It helps them release their pent up emotions and gives the clarity and satisfaction about their problems. Talk therapies like cognitive behavioral therapy are always beneficial since they help in addressing the symptoms and side effects that a woman may be going through emotionally when it comes to early menopause. In case you have a concern or query you can always consult an expert & get answers to your questions!