Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder, it accounts for as high as 80% of women with ovulatory dysfunction such as f ovarian cysts, anovulation, and endocrine variation affecting women.
About 40% of the women diagnosed with PCOS have associated metabolic syndrome which has severe health implications. Women with PCOS should have a lipid profile, oral glucose tolerance test, waist circumference, and blood pressure measurement to rule out metabolic syndrome. They should be counseled regarding long term health implications of the same.
Lifestyle interventions
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Diet:- is recommended for all women with PCOS to optimize their health. Weight loss of 5-10% yields significant clinical improvements and these women should consume a hypocaloric diet (500 kcal deficit) with a reduced glycaemic load.
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Physical activity:_Regular moderate-intensity physical activity at least 150 minutes /week is an important component of weight loss programs and enhances the overall health benefit.
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Bariatric surgery can be offered to morbidly obese women or in presence of comorbidities.
A. Treatment :
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At present, the International consensus of all major societies is to use Letrozole as a first-line pharmacological agent for ovulation induction (OI) in PCOS.
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Clomiphene citrate (CC) alone can also be used for OI in these women. About 70 – 80% of PCOS females have difficulty in conception and require ovulation-inducing drugs like letrozole or clomiphene citrate.
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Metformin which is a hypoglycemic drug (a medicine used in diabetic patients) is the most commonly used drug for the metabolic control of these patients. The therapeutic effects of metformin as an insulin-sensitizing and hypoglycemic agent have been well confirmed in women with PCOS as PCOS females have insulin resistance. Also, metformin is known to have anti-hirsute properties.
B. Surgery :
LOS (laparoscopic ovarian surgery ) can be preferred as first-line in women with other indications for laparoscopy or the second line in CC resistant women.
The choice between LOS and Gonadotropins depends on surgical expertise, cost, monitoring, and potential side effects.
In our clinic, the therapeutic plan is tailored to the patient’s phenotype, complaints, and reproductive desire. Here at Renew Healthcare patients undergoing laparoscopic ovarian drilling by our experts in this field have had successful results. With the support of our expert team, we have delivered smiles to thousands and lakhs of our PCOS patients.
C. IVF
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IVF is usually the third-line treatment in women with PCOS where the first-line or second-line therapies have failed unless there is another absolute indication for IVF.
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Problems faced in these women include risk of hyperstimulation and subsequent OHSS, poor oocyte quality, and altered endometrial receptivity
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Due to the increased incidence of fertilization failure in these women some advocate ICSI to improve the fertilization rates.