 |
Polycystic Ovarian Syndrome (PCOS)
affects 1 in 10 women of childbearing age and have important metabolic and
reproductive repercussion.[1]
The treatment approach varies per the age of the patient, desire for pregnancy
and the presenting symptoms.
Approximately
80% of women who suffer from anovulatory infertility have PCOS. The treatment
approaches towards ovulation induction varies per efficacy, patient BMI and
other associated metabolic abnormalities.
A recent
paper published in the December issue of Human Reproduction Update summarizes
the evidence based recommendations for the management of anovulatoryinfertility in PCOS patients.[2]
The evidence will form the basis for WHO
to develop global guidelines. Management includes lifestyle changes,
pharmacotherapy, bariatric surgery and laparoscopic surgery.
Lifestyle
management, weight loss and exercise is recommended as the first line of treatment
to improve general health and decrease insulin resistance. Morbidly obsess women
should seek expert advice. At present, there is no evidence supporting the role
of bariatric surgery in PCOS associated infertility. [3]
 |
| courtesy: iconfinder.com |
Clomiphene
citrate is recommended as primary agent to bring about ovulation. It is simple,
inexpensive and induces ovulation in 75% of the patients.[4]
Letrozole, an aromatase inhibitor is fast catching on clomiphene citrate as
first place option.[5]
Metformin
alone is not very effective in improving the live birth rates. It is added to
clomiphene citrate regimen in older women with visceral obesity.
Gonadotrophins
and laparoscopic ovarian drilling are reserved as second line of treatment in
patients who do not respond to lifestyle modification and oral therapies. Gonadotropin
releasing hormone (GnRH) antagonist protocol is safe and combined with IVF.
When GnRH agonist is the choice for treatment, metformin should be used as an adjunct
to reduce the risk of ovarian hyperstimulation syndrome(OHSS).
Laparoscopic
ovarian drilling is specifically used when there are other indications for laparoscopic
surgery. It should not be used as first line of treatment. Concerns about long
term effect of drilling on ovarian functions are still unanswered. [6]
IVF can be
of use in those patients who do not respond to lifestyle modifications and oral
ovulation induction drugs. It is specifically useful in those patients who also
have additional causes for infertility.
No evidence supported
the use of acupuncture or herbal remedies in ovulation induction.
[1] https://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html
[2] https://humupd.oxfordjournals.org/content/22/6/687.abstract
[3] https://www.ncbi.nlm.nih.gov/pubmed/27965894
[4] https://www.ncbi.nlm.nih.gov/pubmed/27151490
[5] https://www.ncbi.nlm.nih.gov/pubmed/27866938
[6] https://www.ncbi.nlm.nih.gov/pubmed/22696324
No mention of myo inositol ....
ReplyDeleteMyoinsoital has shown initial promise. Few observational studies have shown its beneficial effect in ameliorating insulin sensitivity, but these are few and we need more data before it can be incorporated in global guidelines
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It was my last hope of having a child and Dr Obodo made my dreams come true. I asked for the spells, but didn’t tell my husband. We carried on trying to get pregnant as normal. I had a really good feeling about Obodo. I felt pregnant or like pregnancy was coming very about a week after the spells were cast. I began to vomit in the morning from morning sickness. I thought it was the toast. I’ve never felt like that before. And it was true! I went and grabbed the pee stick to show my husband. I went to my doctors at the earliest possible time to have a test and it came back positive. I immediately rang up my husband to let him know that the pee stick was not a false positive. He asked me how it was possible. He was certain that the pee stick was passed the expiry date. I told him all about Obodo, the fertility spells and he was amazed. We now have a very beautiful baby boy on the way and we are expecting to use Obodo in hope that I can have my baby girl. you can get in touch with doc via info ___ templeofanswer@hotmail . co . uk , call 234 8155 425481 for help
Thank you,
The Messer Family
It was my last hope of having a child and Dr Obodo made my dreams come true. I asked for the spells, but didn’t tell my husband. We carried on trying to get pregnant as normal. I had a really good feeling about Obodo. I felt pregnant or like pregnancy was coming very about a week after the spells were cast. I began to vomit in the morning from morning sickness. I thought it was the toast. I’ve never felt like that before. And it was true! I went and grabbed the pee stick to show my husband. I went to my doctors at the earliest possible time to have a test and it came back positive. I immediately rang up my husband to let him know that the pee stick was not a false positive. He asked me how it was possible. He was certain that the pee stick was passed the expiry date. I told him all about Obodo, the fertility spells and he was amazed. We now have a very beautiful baby boy on the way and we are expecting to use Obodo in hope that I can have my baby girl. you can get in touch with doc via info ___ templeofanswer@hotmail . co . uk , call 234 8155 425481 for help
Thank you,
The Messer Family
Myo inositol has not enough evidence at present
ReplyDeleteSome RCts in progress I guess... have to wait till then
But as of now no role
Thanks, Dr. Kulkarni.Very true.
DeleteTHanks. DR. S K Pal, KOlkata.
DeleteWell this blog was good. Would like to share some of my insights about OHSS.
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Lots of hopeless couple are now see hope on PCOS. PCOS would be great fertility option for couple.
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You need to know about PCOS very well. You can rid from this easily with proper treatment.
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