38 FIT

In general infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Many physical & emotional factors can cause infertility. It many result from an issue with either you or your partner, or a combination of factors that interfere with pregnancy. The most common cause of female infertility is lack of or irregular ovulation. In premature ovarian failure the ovaries stop functioning before natural menopause. In Polycystic Ovarian Syndrome (PCOS) the ovaries may not release an egg regularly or they may not release a healthy egg. PCOS (Polycystic Ovarian Syndrome) is one of the most common Endocrine Disorder in women of reproductive age. Its prevalence may reach up to 18% of women of reproductive age. It usually presents with irregular menstrual cycles, signs of hyper androgenism &insulin resistance. Patients with PCOS are at increased risk of developing reproductive, metabolic & cardiovascular disorders, including infertility, insulin resistance, DM type II, hypertension & atherosclerosis. Moreover it may affect daily physical activities. The classic triad of this syndrome consists of chromic anovulation, hirsutism and obesity. If untreated it can cause rise in TSH level & insulin resistance. PCOS in usually diagnosed clinically in women who present with scanty menstruation, unwanted hair on body, acne, obesity after excluding other hormonal disorders. However, most women with PCOS do not exhibit all of these features and there is a considerable controversy about required criteria for the diagnosis. It's diagnosis can be established by USG. Early diagnosis and treatment of PCOS reduces chances of infertility in women, but if untreated/maltreated the patient may remain infertile until proper treatment. PCOS is primarily a clinical diagnosis, and laboratory findings should only be used to support the clinical testing and rule out other serious disorders. Longevity of a case may make it complicated as we have discussed above, it affect other body hormones as well.

PCOS & infertility

DR SIMI SOOD Infertility & Reproductive Medicine Specialist at Neelkanth Fertility & Women’s Care Hospital, Udaipur.

sYmPtoms of Pcos • irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods. • Too much hair on the face, chin, or parts of the body where men usually have hair. This is called "hirsutism." Hirsutism affects up to 70% of women with PCOS. • Acne on the face, chest, and upper back • Thinning hair or hair loss on the scalp; male-pattern baldness • Weight gain or difficulty losing weight • Darkening of skin, particularly along neck creases, in the groin, and underneath breasts • Skin tags, which are small excess flaps of skin in the armpits or neck area research on Pcos Some current studies focus on: • Genetics and PCOS • Environmental exposure & PCOS • Ethnic and racial differences in PCOS symptoms • Medicines and supplements to restart ovulation • Obesity and its link to PCOS • Health risks for children of women with PCOS [ [

associateD health risks There are several health risks associated with PCOS. These include: • type 2 diabetes • infertility • high cholesterol • elevated lipids • sleep apnea • liver disease • abnormal uterine bleeding • high blood pressure • obesity possibly leading to issues with low self-esteem and depression • metabolic syndrome • nonalcoholic fatty liver (steatohepatitis) • depression and anxiety • endometrial cancer • gestational diabetes • pregnancy-induced high blood pressure • heart attacks • miscarriage.

Sometimes we see patients come to us for infertility diagnosed with PCOS. So before starting treatment, infertility evaluation should include measurement of Thyroid Stimulating Hormone (TSH), prolactin. Insulin resistance can best be evaluated by a 2 hour glucose tolerance test (TTT) In HgbA1C. Apart from all above diagnosis, low birth weight babies, large for gestational age girls born to overweight mothers, obesity syndromes, insulin resistant features are all risk factors for development of PCOS. These tests are to be performed for initial diagnosis and every two years thereafter depending on risk factors and life style changes. Lifestyle & dietary modifications may help in management of PCOS to a certain level. Further management of PCOS aims to lower body weight & insulin levels, restore fertility, treat hirsutism or acne, restore regular menstruation and prevent complications. Weight reduction, diet & exercise are recommended for all women with PCOS where PCOS is associated with overweight or obesity. Successful weight reduction is the most effective method of restoring normal ovulation & menstruation. Some studies have also shown a 5- 10% loss in body weight, may result in a return of ovulatory cycles and a higher spontaneous pregnancy rate. Low carbohydrate diet and sustained regular exercise may help. Another option for these women is to use low dose oral contraceptive pills (OCP’S) to regulate menstrual cycle and provide contraception. In patients desiring pregnancy, ovulation induction in often required usually with clomiphene citrate. Insulin resistance has been implicated in the reproductive consequences of PCOS, namely infertility, miscarriage and gestational diabetes. Reducing insulin sensitivity through medications seemed to show effectiveness in lowering insulin and blood sugar levels in women with PCOS. Assisted reproductive technology procedures such as controlled ovarian hyper- stimulation with FSH injection followed by in vitro-fertilization (IVF) are used for patients who do not respond to clomiphene, diet and life style modifications. Though surgery is not commonly performed, the polycystic ovaries can be treated with a laparoscopic procedure with bilateral ovarian diathermy involves “drilling” in the ovary, which often results in either resumption of spontaneous ovulation or ovulation after adjuvant treatment. Offering psycho-social support to the female can be one of the most important aspect of managing PCOS depression. Early diagnosis & intervention of PCOS is important to treat symptoms and prevent long term consequences. There is no thumb rule in the treatment of infertility associated PCOS. It needs a combination of clinical expertise with use of Advance Reproductive Treatments.

healthY Pcos Diet

• natural, unprocessed foods • high-fiber foods • fatty fish, including salmon, tuna, sardines, and mackerel • kale, spinach, and other dark, leafy greens • dark red fruits, such as red grapes, blueberries, blackberries, and cherries • broccoli and cauliflower • dried beans, lentils, and other legumes • healthful fats, such as olive oil, as well as avocados and coconuts nuts, including pine nuts, walnuts, almonds, and pistachios • dark chocolate in moderation • spices, such as turmeric and cinnamon

PCOS & homeopathy 6 DR MUKESH BATRA Padma Shri recipient and Founder & Chairman Emeritus, Dr Batra’s Group of Companies A SILENT DISORDER Polycystic Ovarian Syndrome (PCOS), is called a ‘Silent Disorder’, because 1 in every 4 women suffers from PCOS and yet half of these women go undiagnosed. The reason why this hormonal disorder, that affects over 10 million women globally, goes undiagnosed is because it doesn’t cause pain in most cases. Unfortunately, many women seek medical assistance only when pain starts affecting their routine life. They often neglect the other important PCOS symptoms like mood swings, anxiety, uncontrolled weight gain, increased acne, irregular periods and unwanted hair growth on face. This ignorance often leads to several health complications later including infertility. FACTORS THAT PUT YOU AT RISK OF GETTING PCOS The primary risk factor for PCOS is family history. There is a higher chance of developing PCOS if your mother or other women in your family have a history of irregular periods or diabetes. If a woman is diagnosed with PCOS, her sister has about a 40% chance of having it as well. Stress may be both a symptom and a possible cause of PCOS. Insulin resistance and PCOS are linked as well. However, what’s not known is if insulin resistance causes PCOS or if PCOS leads to insulin resistance. HOMEOPATHY EFFECTIVELY TREATS PCOS The conventional treatment for PCOS focuses on treating its visible and most troublesome symptoms. Medicines offered treat irregular periods, acne, excess hair, and elevated blood sugar. However, the root cause, which is hormonal imbalance, is left untreated. Homeopathy focuses on this root cause. Homeopathic remedies work on correcting the hormonal imbalance, regularizing ovulation as well as restoring menstrual normalcy. It also helps treat the associated symptoms of PCOS effectively. Also, long-term medicines that are conventionally recommended to suppress the cysts formation could lead to side-effects like cervical/uterine cancer. Homeopathy treats

case stuDY

A couple came to us for infertility treatment and the wife was diagnosed with PCOS. She complained feeling indolent, and had a tendency to put on weight. Besides, her monthly periods were regularly irregular. We gave her the homeopathic remedy Thuja Occidentalis 200C and recommended her ultrasonography (USG) after eight months. Not only did her monthly periods become regular, but within the 8 months timeline, her USG reports too revealed no abnormality, or any presence of the cysts. it did not take long, thereafter, for the couple to visit us with a positive pregnancy test report.

PCOS effectively with no side-effects. Moreover, homeopathy is an individualised treatment, which means, that no two women would be recommended the same medication despite presenting similar symptoms. Homeopathy does not recommend a one-suit-fits-all approach; each woman is given different medication, which is specific to her and effectively addresses the root cause of the ailment. Stress management, weight control, corrective lifestyle habits along with the medicines can be of considerable help. While the hormonal imbalances can be kept in check, homeopathy can also help to treat infertility in women who are planning for a pregnancy. Some homeopathic remedies for treating PCOS & associated complaints are: • Hair loss & PCOS: Weisbaden, Arnica, Thuja, Acid flour, China • Acne & PCOS: Berberis aquafolium, Phosphorus, Silicea, Sulphur, Calcariasulph, Borax, Hepar- sulph, Kali-brom • Infertility: Pulsatilla, sepia, terantula, apis, lycopodium, lachesis (Please do not self-medicate. Consult a homeopath for an appropriate dosage and duration of treatment). SELF-CARE TIPS In addition to medication, here are some self-care tips to deal with PCOS: • Exercise: It helps reduce excess fat. Excess fat can produce more estrogen, which leads to hormonal imbalances. Even reducing just 5-10% of body weight will help ease the symptoms and regularize menstrual cycle • Diet: Avoid processed sugar and white flour. Eat a balanced diet of healthy fats, protein, green vegetables, grains, nuts, seeds and legumes. • Avoid alcohol and smoking: Smoking and alcohol can cause hormonal imbalance which could make PCOS worse.