Polycystic ovarian syndrome and Polycystic Ovarian disease (PCOD)

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder, affecting 1 in every 10 women of reproductive age in India. It has recently been on the rise with increased incidence among teenage girls. PCOS affects a woman’s menstrual cycles, her ability to conceive, physical and mental health.

WHAT CAUSES PCOS?

Although the exact causes of PCOS are not known, it is thought to be of multifactorial in origin with a   strong   genetic association. It primarily arises from an imbalance of sex hormones with increased male hormones, excess insulin levels, obesity, oxidative stress, sedentary lifestyle and unhealthy eating habits leading to weight gain.

Uterine Fibroids( Leiomyoma or Myoma)

Fibroids are benign tumors of the uterine  smooth muscle cells.  It is estimated that 70-80% of women will develop fibroids some time  in their lifetime—however, not everyone will develop symptoms or require treatment.

Fibroids vary in size from small  seedlings measuring few mm to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones.

Endometriosis

Endometriosis is defined as the presence of normal endometrial (uterine lining) tissue in an abnormal ( extra-uterine sites)  place. Once implanted elsewhere,   the endometrium grows under the influence of the major female hormone oestrogen Like the lining of the uterus. The most common sites in the pelvis are ovaries, Fallopian  tubes and deep in the pelvis behind the uterus, called the Pouch of Douglas. It also may grow on the Ligaments that support the uterus (uterosacral ligaments),The anterior cul-de-sac, i.e., the space between the uterus and bladder, the outer surface of the uterus and the lining of the pelvic cavity.

 

Adenomyosis

Adenomyosis is a benign gynaecological condition of the uterus  where the endometrial tissue i.e the lining of the uterus invades the muscular wall of the uterus.It is  prevalent in 10 to 18 percent of the female population.  A woman could complain of severe menstrual  pain (dysmenorrhea) , (menorrhagia) heavy bleeding and or prolonged bleeding, pain during intercourse and chronic pelvic pain.  Adenomyosis can commonly co-exist with  an other benign condition of the uterus called uterine fibroids. It can sometimes be associated with endometriosis as well.

Risk factors for developing adenomyosis – advanced age, previous uterine surgery, smoking, previous pregnancy, tamoxifen drug use or it could be developmentally acquired.

 

Sperm Freezing

Sperm freezing – the sperm samples are washed and stored in liquid nitrogen for later use.For who? – 

sperm pooling  for IUI  in case of  mild OLIGO ASTHENOTERATOZOOSPERMIA OR   transient azoospermia (A transient state of azoospermia may occur due to toxic, environmental, infectious or iatrogenic conditions)  or severe oligo astheno teratozoospermia  where the stored samples are used for icsi later,  as part of fertility preservation or prior to chemotherapy.

 

 

Embryo Freezing

This is a procedure where The embryos  obtained from ivf procedure  are cultured for 2-5 days and then they are frozen and stored in liquid nitrogen tanks for later use.

For who? – Women at risk of developing OHSS ( ovarian hyper-stimulation syndrome) in a fresh embryo transfer cycle, poor endometrial thickness(inner  lining of the uterus),  storage of surplus embryos ( extra embryos left after a fresh embryo transfer cycle)

Oocyte Freezing

The oocytes (eggs) obtained through ovum pickup procedure are frozen and stored in liquid nitrogen. When an embryo transfer cycle is planned, these oocytes are thawed and subjected to icsi (intracytoplasmic sperm injection) and  cultured in an incubator for 2-5 days and  transferred into the uterus ( embryo transfer)

For who? women opting for social egg freezing (a procedure of non-essential egg freezing for the purpose of preserving fertility for delayed child-bearing when natural conception becomes more problematic  or when pregnancy planning  is delayed), women undergoing chemotherapy ( cancer treatment ), donor oocytes obtained through a registered donor oocyte bank.

Blastocyst Culture

A blastocyst is an embryo that has been developed in laboratory for 5-6 days after insemination where as in a conventional IVF/ICSI cycle, the embryo transfer is usually done after culturing for 2 to 3 days.

Advantages of blastocyst culture – extended culture of the embryos to blastocyst stage for transfer has several advantages over transfer of  cleavage stage embryos. These include a higher implantation rate and live birth rates, the potential decrease in the number of  embryos transferred thus decreasing the risk of multiple pregnancy significantly,

Frozen Embryo Transfer

Frozen embryo transfer – When the embryos after 2-5 days of culture are frozen with the help of liquid nitrogen to be transferred back in to the uterus in one of the later months and not the same cycle as that of ovum pickup is called a frozen embryo transfer.

For who? – women at risk of developing OHSS ( ovarian hyper-stimulation syndrome) in a fresh embryo transfer cycle, for women who produce 15 or more eggs after hormone stimulation, poor endometrial thickness(inner  lining of the uterus),  storage of surplus embryos ( extra embryos left after a fresh embryo transfer cycle) which can be used if the woman fails to conceive in a fresh cycle.

 

Fresh Embryo Transfer

Once the inseminated oocytes are fertilised, they are cultured in an incubator for a period of 2 to 5 days and 1- 3  of these embryos are transferred to the recipient’s uterus in the same cycle between  day 2 to day 5 which is called a fresh embryo transfer.

Pros and Cons of Fresh Cycles

Pros:

Fresh cycles have been used for decades in IVF treatment and have a long history of success. Another advantage is that, if you are successful with your first, fresh cycle you don’t have to go through the intensive hormone injection treatment again unless you want to have another child later on and use your frozen embryos.