PCOS affects fertility by disturbance of ovulation and excess of male hormones or insulin

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Polycystic Ovaries & Fertility
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AN ONLINE EDUCATION INITIATIVE OF PCOS CLINIC
• Does PCOS affect fertility & how?
• What are the home remedies I can do to manage PCOS?
• Medical Treatment options – insulin sensitizers, OVI
• Surgical Treatment options – ovarian drilling
• Will I be needing IVF for conception?
Dr Anju Yadav
Dr Nupur
Gupta
Fertility Consultant
Gynecologis
t
9818077238

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The Mother of all Lifestyle
Disorders in Women
Polycystic Ovarian
Syndrome/ PCOS
Dr Nupur Gupta
MBBS, MS, MICOG (Ex AIIMS)
DIRECTOR,
Dept of Obstetrics & Gynecology
Fortis Memorial Research Institute, Gurgaon

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DIFFICULT DIAGNOSIS
 Collection of signs and symptoms
 May be difficult to diagnose
- Heterogeneous presentation
- Features change with age
 No single test or feature is diagnostic of PCOS

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INCIDENCE
 Affects 10 to 20% of females
 20 to 30% have ultrasound appearance
Most common hormonal disorder in
women of reproductive age

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WHAT IS PCOS?
A health problem that can affect a woman’s
 Menstrual cycle,
 Ability to have children
 Hormones
 Heart
 Blood Vessels &
 Appearance

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AGE GROUP
 Adolescent age (pubertal)
 Reproductive age

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Clinical Presentation

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SYMPTOMS
Vary from woman to woman
 Irregular menstrual cycles (amenorrhoea 25%,
oligomenorrhoea 85%, hypomenorrhoea)
 Difficulty in conception 50%
 Weight gain 40%
 Unwanted hair growth
 Acne

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PCOD & INSULIN RESISTANCE
 High insulin levels – high androgens
 Hyperinsulinemia
 Insulin resistance
IR (body cells do not respond
normally to insulin)

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DIAGNOSIS
 CLINICAL
 ULTRASOUND – multiple tiny ovarian cysts (STRING OF
PEARLS)
 BIOCHEMICAL (blood tests) – hormones (LH FSH,
Testosterone, DHEAS, Glucose tolerance test)
 ASSOCIATED TESTS - thyroid, prolactin, lipid profile

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PCOD & WEIGHT GAIN
 Increase in abdominal fat as in males
 Apple figure (waist hip ratio)
 Rise in BMI

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ANOVULATION
Prevents release of eggs from the ovaries

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LIFESTYLE MANAGEMENT: First
Line
 Weight control
 Healthy Diet
 Regular exercise & physical activity

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WEIGHT LOSS & MENSTRUAL CYCLES
If 7% weight loss & 30 to 60
min of moderate physical
activity
 Spontaneous menses
Free androgen
Free insulin
Free testosterone
SHBG

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WEIGHT LOSS & FERTILITY
 In overweight anovulatory women
 Weight loss 6 Kg
 Resumption of ovulation 92%
 Pregnancy rate 65%
 Decrease in insulin & testosterone levels

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MEDICAL TREATMENT
 Metformin - metabolic/glycemic
abnormalities & menstrual irregularities
 Clomiphene, Letrazole, HMG - infertility
 IUI

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SURICAL TREATMENT
 LAPAROSCOPIC OVARIAN DRILLING
 ADHESIOLYSIS
 ENDMETRIOSIS

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HOW TO COPE WITH
EMOTIONAL ASPECTS OF PCOS?
Don’t feel embarrassed
Don’t be depressed

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Early diagnosis & treatment helps prevent long-term
complications, such as infertility, metabolic
syndrome, obesity, diabetes & heart disease
Lifestyle management (weight loss & exercise)
Metformin
IS THERE A CURE FOR PCOS?
CAN IT BE PREVENTED?

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