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PCOS, which stands for polycystic ovarian syndrome, is a condition affecting many women of reproductive age. It is, in fact, one of the main causes of infertility for women. A lot of women first discover that they have this condition upon seeking consultation with a fertility specialist if they are unable to become pregnant. Some estimate that fewer than a quarter of the women with the condition are unaware that they have it. This is often because a lot of the symptoms of the condition are attributed to other potential causes. It is not until women try to get pregnant, and cannot, that they seek medical consultation to determine the cause and find they have the condition.
Women who have PCOS produce a good deal of insulin, which may lead to the production of more male hormones called androgen. This can negatively affect the ability of the body to produce female hormones that are required for ovulation, so egg follicles do not mature. Instead, some follicles may contain cysts. With ovulation not present, progesterone, the hormone that causes the uterine lining to thicken for implantation of the embryo, does not get produced and the menstrual cycle may become irregular.
To treat the condition, many turn to fertility drugs such as Clomid, which block the estrogen receptors in the brain so the body thinks that estrogen is low and production of LH and FSH increase. The latter hormones are what lead the body to ovulate. Some patients with PCOS turn to injections of LH and FSH, which directly increase levels of those hormones in the body so that follicle production and ovulation is stimulated. Many will turn to these injections if they do not find success with Clomid or other treatment options.
But not all women with the condition turn to fertility drugs to become pregnant. Some may turn to procedures like in vitro fertilization, which extracts eggs from the ovaries and combines them with sperm inside of a dish in a laboratory setting. The eggs and sperm create embryos, which can be transferred to the uterus for implantation. Still, medication may be required to stimulate the production of mature eggs capable of creating embryos. Many other assisted reproductive technologies (ART) are used as well, but many of these also require the use of fertility drugs to stimulate the production of mature eggs. Make sure that you speak with your doctor regarding the potential side effects of these medications.
Infertility treatment plans are based on the origin or the many causes of infertility. It also depends on just how far you want to take the treatment. This is a very emotional time and can be financially stressful as well. You should consider all the alternatives and discuss and end point. Insurance will cover some of the cost but not all and then there are possible surgery and IVF treatments to consider. So, try and set the emotions a side and at least come up with a preliminary plan. You can always make adjustments to the plan along the way.
Low-tech and natural forms of treatments are being used widely all over the world. Natural remedies such as vitamins to help promote ovulation or increase semen, acupuncture is being used for males and females and treatments as simple as eliminating lifestyle issues that may be creating infertility issues.
Then there are the traditional fertility specialist forms of treatment such as medications and surgery that make up more than 85% of the treatments for couples dealing with infertility. This does not mean that all of these couples require medication or surgery this is just the method that they chose to improve fertility for them. However, 3% of infertile couples will resort to using Assisted Reproductive Technologies such as IVF. Couples that begin treatment for infertility are likely to improve their health condition and more than two-thirds of these couples are also likely to have a child.
Some of the common methods of infertility treatment are:
Drugs or Medications: Fertility medications are very usually prescribed to woman experiencing ovulation disorders. More than 25% of the reported cases of infertility worldwide are due to ovulation disorders and prescription drugs are considered to be the first line of treatment for this condition. Fertility medications are believed to have helped more than 80% of the women to ovulate on time. Some of the common drugs in this category are Clomid, Arimidex, Femara, Gonadotropuns and others. Taking prescription medication is not always enough. To help promote proper ovulation many times lifestyle changes are need as well so that the patient will respond well to the treatment.
Surgery: Fallopian tubes obstruction is the leading cause of infertility that requires surgery. In over 35% of the case of female infertility, the fallopian tubes are either blocked or are not functioning properly. There could also be problems with the abdomen and the pelvis as well. A test is conducted to see if the internal organs are functioning properly or not. If there is a blockage, a laparoscopic surgery may help in removing the obstruction and repair any damage within the tubes. This procedure will allow the patient to get back to a normal life very soon.
Assisted Reproductive Technologies (ART): ART refers to the infertility treatments involving the embryos or the eggs. This technology includes different treatment options like GIFT, ZIFT and IVF. IVF is a very common infertility treatment and is one of the most successful as well. IVF is most effective when a woman is under the age of 35; the success rate is 35% during this stage. However, as a woman ages the success rate of this method declines.
Intrauterine Insemination (IUI): Also known as artificial insemination, this procedure involves the placing of sperm into the female uterus directly. This method is commonly used in treating unexplained infertility, problems with male infertility and cervical mucus in woman. The success rate of this infertility treatment has been quite high. However, this treatment also requires adequate care.
Infertility treatments vary from patient to patient. Many natural forms of therapy are available, however in some more severe cases couples may require medical treatment and possibly even surgery. As always a patient needs to consult a doctor for his or her proper diagnosis and treatment.
Many women have abnormal or irregular periods. If infertility becomes an issue, then these irregular periods may be a sign that you are not ovulating normally. If you are not ovulating at all, it is referred to as anovulation.
Many things can affect your ovulation ability. Certain diseases such as diabetes and liver disease can stop you from ovulating. There are also a number of glandular disorders that can halt ovulation. There may be adhesions or other complications with the ovaries themselves. Whatever the reason, it is important to work closely with an infertility specialist to rule out certain disorders before continuing with hormonal treatments for anovulation.
Fertility drugs such as clomid are fairly effective in stimulating ovulation. The purpose of fertility drugs like clomid is to block the effects of estrogen in the body. When estrogen is blocked, it simulates the natural drop in estrogen that should be occurring, but may not be, in your body. When estrogen drops, your body produces luteinizing hormone (LH) and follicle stimulating hormone (FSH). These hormones stimulate the ovaries into ovulating.
Multiple ovulations are common and sometimes multiple births can be expected. Your doctor will monitor the effects of the fertility drugs and adjust the dosage to best suit your needs. Generally, you will start out low and increase over six months until you become pregnant. Different medications may be prescribed if the first one does not seem to be effective.
Some fertility drugs stimulate the ovaries and others actually mature the egg so that it can be released. When given in combination with each other, these can be very effective. Most fertility drugs are administered by injection, sometimes daily, and some are taken orally. Your infertility doctor will take regular blood tests and perform many ultrasounds to monitor your egg development.
Some problems that can occur include bloating and fatigue, irritability and headaches. Sometimes infertility drugs can alter cervical mucus and actually make it a hostile environment for sperm. In this case, artificial insemination can be used to bypass the cervix and fertilize the egg in utero. Intrauterine Insemination, IUI, is the most common form of artificial insemination. This is where sperm is introduced directly into the uterine cavity or fallopian tubes, bypassing any cervical problems that may be present.
In the case of polycystic ovary syndrome, the body produces too much testosterone and develops an insulin resistance. This causes ovulation not to happen. Your doctor may provide fertility drugs to combat these effects and start ovulation again.
The goal of using fertility drugs to combat anovulation is to get your cycle back on track and get ovulation started. Talk to your infertility specialist about what options may be available to you.
PCOS or polycystic ovarian syndrome is a complex condition that has a direct impact on the ovaries. This condition is considered complex due to the fact that there are some very particular appearances of the ovaries that give the condition its name, but these traits do not have to be present for a woman to be suffering from PCOS. Specifically, PCOS can impact the woman’s ability to become pregnant.
PCOS is a common cause for anovulation, a condition in which a woman’s body does not release eggs at all or on a regular basis causing irregular periods and difficulty conceiving. Polycystic ovarian syndrome is very common, affecting ten percent of all women between the ages of 15 and 50 making them infertile. For the population at large, PCOS affects twenty five percent of all women.
While PCOS makes getting pregnant difficult, there are a number of very good treatment options available. A rather newer treatment option that has been shown to be very effective is metformin. Metformin is a medication that typically has been used to treat and control diabetes. Metformin is effective in treating PCOS on its own, but not 100 percent of the time.
There are times when metformin is used in conjunction with other medications that treat PCOS such as clomid. This combination has been shown to be effective in helping those women that do not respond to metformin alone to ovulate. Should the combination of metformin and clomid not be effective, metformin can also be used in conjunction with letrozole, injectable FSH hormone, and in vitro fertilization.
There are side effects that are worth noting when using metformin to treat PCOS. Twenty five percent of women that use metformin experience some side effects such as: cramping, nausea, diarrhea and abdominal discomfort. While these side effects are not life threatening, they can become severe enough for a woman to stop using metformin.
If metformin is a treatment option for you, your doctor may order some lab work to make sure metformin is safe for you to use. These lab tests can include a fasting blood sugar and insulin levels, LH, FSH, DHEAS, testosterone, 17-OHP, TSH, kidney function and liver function as well as estradiol. These tests are important because some women may be insulin resistant and these tests can help determine that. Women that are insulin resistant should not take metformin.
There is also patient education that needs to be addressed before a woman takes metformin. For example, knowing when to have intercourse is important. Women will need to know the possibility of ovulating; this means regular intercourse is ideal to increase the chances of a woman becoming pregnant. Regular intercourse is defined as intercourse every two to three days. It is also important that the woman keep a menstrual calendar or journal. Keeping track of the days that there is bleeding and the days that she has intercourse.
Typically metformin will be prescribed at the dosage the woman can tolerate. For most women this is going to be a 500 mg tablet taken three times a day, this dose is built up to gradually. The starting dose is 500 mg once a day for the first week, the second week is 500 mg twice a day, and the third week is a 500 mg tablet three times a day. If taking metformin three times a day cannot be tolerated that woman will be kept on the twice daily regimen, noting that the most effective dose is 500 mg three times a day.
Making a baby isn’t always easy. Even if neither of you have fertility problems, you have only a 25% chance of falling pregnant each cycle.
Many doctors will not consider a couple has a fertility problem until they have been trying for a baby for at least one year. But one in every seven couples needs some kind of medical help to conceive.
Causes of infertility
One cause of fertility problems for women is Endometriosis – a gynaecological condition where tissue, similar to the lining of the womb, grows in other areas of the body, most commonly on the ovaries, causing inflammation, scarring and adhesions.
Another cause is PCOS (Polycystic Ovary Syndrome) when a hormone imbalance prevents eggs from maturing in the ovaries. Pelvic inflammatory disease (PID); fibroids, STDs, chronic illnesses like diabetes, cancer and thyroid disease can also interfere with fertility.
As many as 25% of couples with fertility problems have a sperm allergy. It can occur in both men and women when an immune reaction makes sperm immobile and unable to swim towards the egg.
Fertility can also be affected by being overweight or underweight, smoking (cannabis or cigarettes). Stress and too much alcohol can also seriously affect your fertility.
The male to female infertility ratio is about 40/60. A man’s health and lifestyle are factors, but medical problems can be to blame, like a blockage in the sperm-carrying tubes – possibly caused by a sporting injury to the testicles, STDs or hernia repairs. Only one in ten of men with blocked tubes are born that way.
Genetic disorders exist, but are rare. Chromosome irregularities can disrupt cell division and sperm production.
Men can also have hormone irregularities. For example the over-production of the female hormone prolactin in men has an affect on fertility.
• Fertility drugs (clomid or gonadotrophins) to stimulate the ovaries to produce more mature eggs each month, increasing the odds of conceiving. Multiple pregnancies are a risk.
• IVF (in vitro fertilisation). Fertility drugs stimulate egg production. These are removed and put into a Petri dish with a fresh sample of sperm. If healthy embryos develop one or two are returned to the woman’s uterus. Remaining embryos can be frozen for the future. If the man’s sperm is unviable a donor can be used.
What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is one of the main causes of infertility in women, and is believed to affect approximately 5% of the female population. It is in fact the most common hormonal disorder (hormone infertility) among women of a reproductive age. PCOS is associated with increased levels of insulin in the blood. Insulin regulates blood glucose levels, and is produced by specialized cells within the pancreas. When blood glucose levels rise (eg. after eating), these cells produce insulin to help the body use glucose for energy.
If glucose levels do not respond to normal levels of insulin, the pancreas produces more insulin. An over-production of insulin leads the body to respond by producing high levels of male hormones, or androgens. The elevated androgen levels can sometimes cause excessive facial hair growth, acne, and/or male-pattern hair thinning. There is unfortunately no single test for diagnosing PCOS. It will be diagnosed using blood tests, and checking for all the common symptoms. PCOS can also lead to irregular menstrual periods. If blood glucose levels continue to rise despite increased insulin levels, the person could develop Type 2 diabetes.
PCOS and The Menstrual Cycle
Although PCOS is not completely reversible, there are a number of treatments that can reduce or minimize bothersome symptoms. And women with PCOS are able to lead a normal life without significant complications.
During a women’s normal menstrual cycle, the brain (including the pituitary gland), ovaries, and uterus normally follow a sequence of events which prepare the body for pregnancy – whereby several follicles develop within the ovaries. Each follicle contains an egg. Two hormones, follicle stimulating hormone (FSH) and luteinizing hormone (LH), are made by the pituitary gland. Two other hormones, progesterone and estrogen, are made by the ovaries.
As the menstrual cycle continues, only one follicle will remain which will produce the egg during ovulation. After the egg has matured, LH levels will surge, causing the egg to burst from the follicle thus causing ovulation. After ovulation, the ovary produces both estrogen and progesterone, which prepare the uterus for possible implantation and pregnancy.
During the menstrual cycle in women with PCOS, multiple follicles may develop (4 to 9 mm in diameter) and accumulate in the ovary, hence the term polycystic ovaries. In short, the hormones are imbalanced, and the follicles are unable to grow to a size that would trigger ovulation; indeed some may later develop into cysts.
PCOS may show up on an ultra sound as a “string of pearls” within the ovary. This “string of pearls” represents the follicles that have not developed. And because ovulation does not occur, progesterone is not produced, which is what causes the lining of the uterus to thicken. Most women are unaware that they have PCOS. Some women may be lucky enough to conceive during an irregular ovulation cycle. Symptoms for PCOS vary with each woman – some women only have an irregular period as a symptom.
What Can You Do – Naturally?
There are several immediate steps that can be taken to begin to address the problem.
Eat a healthy, low GI diet – there are certain components in common foods that can actually make your symptoms worse. Some of these you may be eating every day, unaware that they are contributing to the problem. Your diet is the first place to start if you want to beat PCOS.
Some women can simply treat their PCOS by losing weight, which in turn can help to improve hormone imbalances. Weight loss is one of the simplest, yet most effective, approaches for managing insulin abnormalities, irregular menstrual periods, and other symptoms of PCOS. For example, many overweight women with PCOS who lose 5 to 10 percent of their body weight notice that their periods become more regular. Weight loss can often be achieved with a program of diet and exercise.
Reduce the amount of toxic substances coming into your body, and speed up elimination of the ones that do get in. We are living in a toxic world now, and our bodies are suffering because of it. People who have greater health have several lifestyle factors in common – quality sufficient sleep, a good social exercise regime, and, very crucially, a positive attitude about their health.
What Can You Do – Medically?
Metformin is a drug that improves the body’s ability to absorb insulin. It is considered safe to use on women who do not have diabetes, because it affects insulin levels and does not actually lower blood sugar directly. Clomid or other fertility drugs are often used in the treatment of infertility relating to PCOS.
Clomid blocks estrogen receptors in the brain, so it thinks there are low estrogen levels. Low estrogen levels trigger the body to produce more FSH and LH which signal the body to ovulate.
In Vitro Maturation (IVM) is an option for women with PCOS – where immature eggs are harvested early in a woman’s cycle. The eggs are then matured in a laboratory and afterwards can be used for fertilization. IVM is helpful for women who do not respond to drug therapy.
In Vitro Fertilization (IVF) harvests the eggs after they are already mature. The eggs are then fertilized and implanted in the woman’s uterus. IVF treatments also include medications that help the eggs develop.
Oral contraceptives (OCs) are the most commonly used treatment for regulating menstrual periods in women with PCOS. They decrease the body’s production of androgens, and anti-androgen drugs (such as spironolactone) decrease the effect of androgens. These treatments can be used in combination to reduce and slow hair growth.