Dr. Shiwani Agarwal

Polycystic ovarian syndrome is one of the biggest issues around the world. Most women with polycystic ovary syndrome can expect to gain excess weight, facial hair growth, pimple on face and irregular periods. Obese and overweight females are more prone to it. It can be cured with a healthy diet and exercise. You should include more fibre-rich foods in your diet.

PCOS or polycystic ovary syndrome is an endocrine disorder in women, in which the female hormones, progesterone and estrogen, are imbalanced. This imbalance leads to the formation of cysts (benign masses) in the ovaries. PCOS tends to affect your heart functions, fertility, menstrual cycle and appearance.

There are certain symptoms, which can be indicative of PCOS; these symptoms tend to begin as a woman's menstrual cycle starts. In certain cases, however, PCOS may also affect a woman in her mid age. PCOS can also cause excessive hair growth in unwanted places like above the upper lip,chin,arms and chest like a male.

The symptoms are:

• Increase in the production of male hormone, leads to development of male characteristics
• The size of the breasts may reduce
• The tone and the texture of the voice may change and become similar to a man's voice
• Hair may start to fall
• You may suffer from acne and pimple breakouts on your face
• It can lead to sudden weight gain
• It may affect a woman's fertility
• It may lead to pain in the pelvis

Other symptoms: Apart from these symptoms, a woman may also experience other health complications such as high levels of bad cholesterol, high blood pressure and diabetes.

Causes: The causes of PCOS are not well known, however, the likely causes are genetics and hormonal complications. If someone in the family has PCOS, then the risk of being affected by PCOS rises significantly. The other likely cause is the overproduction of the male hormone androgen in the female body. Although androgen is a male hormone, the female body also produces it in trace amounts. However, in some cases, when it is overproduced, it might impair the ovulation process.

Diagnosis and Treatment: Once the condition is diagnosed, there are certain treatments, which are recommended for the patient. The condition in itself does not have a cure, but the symptoms can only be controlled. Medications to control the androgen levels in the female body may be administered if you have androgen hormone complication. A balanced diet and an exercise regimen can be chalked out to control body weight and regulate blood sugar levels. If PCOS leads to ovulation problems, then medications to facilitate ovulation may be advised.

The inability to conceive after indulging in unprotected sex is known as infertility. It can also be referred to the biological incapability of a male to cause the conception or a woman being unable to carry the pregnancy for full-term. Research has shown that female problems contribute to over half of all the infertility cases while a majority of the other causes include sperm disorders.

Treatment of infertility depends on:

1. Cause of Infertility
2. Duration of Infertility
3. Age of both partners
4. Personal preferences

Causes:
Causes of infertility in women include:
1. Ovulation disorders: This is regarded as the most common cause of infertility in women. The disorders can be caused due to the following

• Premature ovarian failure
• PCOS (polycystic ovary syndrome)
• Poor egg quality
• Hyperprolactinemia
• Overactive or Underactive thyroid gland
• Chronic conditions like cancer or AIDS.

2. Problems in fallopian tubes or uterus: Abnormalities in the uterus or fallopian tubes render the woman incapable of conceiving naturally. This might be due to:

• Submucosal fibroids
• Surgery
• Endometriosis
• Previous sterilization treatment

3. Medications: There is a possibility that treatment will cure infertility. Examples include NSAIDs (non-steroidal anti-inflammatory drugs), Chemotherapy and Radiotherapy. Treatment of infertility might involve a significant amount of psychological, physical, temporal and financial commitments. In men, treatment is done to treat lack of healthy sperm or general sexual problems. The treatments include:

1. Medications
2. Surgery
3. Change in lifestyle
4. Sperm retrieval

Even though it is possible to restore fertility in women using only one or two therapies, a number of treatments might be required before conception is possible. Some of these treatments include:

1. Intrauterine insemination (IUI)
2. Stimulation of ovulation with fertility drugs
3. Surgery to restore fertility

In situations where pregnancy does not happen spontaneously, Assisted Reproductive Technology (ART) can be used by couples to achieve pregnancy. It is a form of fertility treatment which involves the handling of sperm and egg. The entire ART team consists of psychologists, physicians, embryologists, nurses and lab technicians.

One common ART technique is In vitro fertilization (IVF). It is a process where an egg and sperms are manually combined in a laboratory dish, followed by transfer of embryo to the uterus. Some aspects involved in an IVF cycle are:

1. Intracytoplasmic sperm injection (ICSI)
2. Assisted hatching
3. Donor eggs or sperm
4. Gestational carrier

Some complications that may occur during the treatment of infertility are:

1. Multiple pregnancy
2. Ovarian hyperstimulation syndrome (OHSS)

Dilation and curettage is a surgical procedure where the cervix (the lower part of uterus) is dilated and tissues are removed from the inside of the uterus. The procedure is usually done to treat heavy menstrual bleeding or clean the lining of the uterus after an abortion or miscarriage.

During the procedure, the cervix is dilated with medication and a thin surgical instrument is inserted through the vagina. This instrument is then used to scrape (curettage) the uterine tissues.

Reasons for Conducting the Procedure

Dilation and curettage is mostly done to either treat or diagnose certain uterine disorders. Dilation and curettage is recommended if your doctor needs to diagnose conditions such as:

1. Irregular uterine bleeding

2. Postmenopausal bleeding

3. Discovery of unnatural endometrial cells while conducting a common test for cervical cancer

Sometimes, the doctor can take a sample tissue from the uterus and perform tests on it to check for the following conditions:

1. Uterine cancer

2. Uterine polyps (abnormal tissue growth)

3. Endometrial hyperplasia (precancerous thickening of the uterine lining)

Dilation and curettage, when used for therapeutic purposes, is used in the treatment of the following conditions:

1. To clear away molar pregnancy; which is characterized by formation of tumours.

2. To treat heavy bleeding after childbirth; any remaining placenta in the uterus is removed.

3. To remove benign uterine or cervical polyps.

4. To clear away fibroids (benign tumours which form on the uterine wall)

5. To remove any tissue that could have been left behind after an abortion or miscarriage to prevent heavy bleeding or infection

What needs to be considered before opting for it?

The procedure of dilation and curettage is mostly safe. Complications from this procedure are rare, but some factors should always be taken care off.

1. The surgical instrument can perforate or poke a hole in the uterus. Sometimes, perforations can heal on their own; but if any organ or blood vessel gets damaged, then another surgery will be required.

2. The cervix can be damaged during the procedure. The doctor can stitch the wound close, or apply pressure on the wound to stop the bleeding.

3. Sometimes, there might be scar tissues on the wall of the uterus. This can cause irregular, painful or absent menstrual cycles, augment risks of infertility and future miscarriages.

Pregnancy and childbirth is one of the most important time in the life of a woman. It is a time to celebrate and yet be cautious as well, so that all goes well and the end of the pregnancy is a beginning of life for a baby. There are numerous ways of monitoring the health of the foetus during pregnancy. The non-stress test is one of the ways. Let us find out more about this: 

Heart rate monitoring: The non-stress test is basically concerned with the monitoring of the heart rate of the foetus. This is a prenatal test that is very commonly used in order to check the overall health and vitals of the baby while it is still in the womb. The test is essentially carried out to check how well the heart rate responds to the other movements carried out by the baby inside the womb. It is called a non-stress test because there is no external stimulation that may put pressure on either the heart rate or the movements of the baby.

Why: This test is usually recommended by the doctor when there is an increased risk of losing the foetus due to complications. This test is conducted from 36th week of the pregnancy and onwards till delivery. It is also done even when the patient is in labour.This test will usually show whether or not the baby needs extra test, monitoring or care. This test is essentially conducted to check the oxygen supply and is a non-invasive procedure that does not pose any serious physical risks or harm.
Fetal Hypoxia: This test will also show whether or not the baby is suffering from fetal hypoxia, which is a condition where the heart beat is disrupted, if the passage of oxygen is blocked due to some reason.

Conditions for non-stress test: The non-stress test may be conducted if the lady in question has lost or had complication in previous pregnancy. Also, if the mother has any other medical condition like diabetes or cardiovascular conditions, then this test is imperative. Decreased movement of the foetus may also prompt the doctors to take action and conduct this test as a cautionary measure.

Procedure: During the procedure, you will be asked to lie down on a reclining chair and two belts with monitors will be attached to your abdomen. The heart rate of the baby, as well as the movements, will then be studied once the monitors are switched on. These monitors are in turn attached to a screen, in order to take the reading. This test will take no more than twenty minutes. However, if there is no movement in the baby, then the test may continue for a little longer until the baby becomes more active.

• This is especially for the youngsters. Now a days, many young couples randomly use  Emergency Contraceptive Pills without understanding the implications.
• Using cyclical pills is a much better and safer option.
• These cyclical pills if taken methodically can actually be beneficial in many other ways in addition to providing contraception.
• Cyclical pills keep the menstrual cycles regular, the amount of bleeding is lesser, pain is reduced significantly and these pills also help in protecting from STDs to some extent.