In vitro fertilization (IVF) Treatment

In vitro fertilization (IVF) Treatment

In vitro fertilization (IVF) helps with fertilization, embryo development, and implantation, so you can get pregnant.

IVF stands for in vitro fertilization. It’s one of the more widely known types of assisted reproductive technology (ART).  IVF works by using a combination of medicines and surgical procedures to help sperm fertilize an egg, and help the fertilized egg implant in your uterus.

First, you take medication that makes several of your eggs mature and ready for fertilization. Then the doctor takes the eggs out of your body and mixes them with sperm in a lab, to help the sperm fertilize the eggs. Then they put 1 or more fertilized eggs (embryos) directly into your uterus. Pregnancy happens if any of the embryos implant in the lining of your uterus.

During IVF, mature eggs are collected (retrieved) from your ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs are implanted in your uterus. One cycle of IVF takes about two weeks.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using your own eggs and your partner’s sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — a woman who has an embryo implanted in her uterus — might be used.

Why Should I Start IVF Treatment?

In Vitro Fertilization is typically used when couples have continuously failed in attempts to conceive and after other types of fertility treatments were not successful. IVF can be used to treat infertility caused by a number of reasons, including female ovulation disorders, premature ovarian failure, uterine fibroids, genetic disorders, blocked, damaged or removed fallopian tubes, and male infertility, such as decreased sperm count.

Women who have damaged or removed fallopian tubes can get pregnant through IVF treatment because the eggs are retrieved from the ovaries, and the embryos are transferred through the cervix — no direct need for open fallopian tubes.

For couples who hope to use an egg donor or surrogate, IVF treatment is a viable option.

Common IVF Terms You May Have Heard

Starting IVF treatment isn’t just about what happens at the doctor’s office — you’ve probably already realized that there’s a lot of research involved in the process. To help, here are a few common IVF terms that you may have heard, explained.

• Blastocyst: Going through the IVF process can seem clinical, especially when it comes to what reproductive tissues and matter are called. After an egg is fertilized by sperm, it develops into blastocyst. Within five to seven days, these cells then turn into an embryo, which can be transferred to the uterus during IVF.
• Clomid: Clomid is a commonly used fertility medication that a doctor may recommend during IVF. It encourages the body to ovulate and release an egg.
• HCG levels: Human Chorionic Gonadotropin (HCG) is a hormone created by the body after conception has occurred. HCG can be tested for from blood or urine, and is the hormone that pregnancy tests identify to determine if conception has occurred. After an IVF cycle, your HCG levels will be checked to determine if you are pregnant.
• IVF with PGS: Some couples choose to undergo IVF after determining they have a family or genetic history of particular diseases, syndromes or other traits. Preimplantation Genetic Screening (PGS) can be used to study each embryo and determine if it has genetic or chromosomal abnormalities before being transferred to the uterus.
• PCOS: Polycystic Ovarian Syndrome (PCOS) is an ovarian issue that can cause irregular menstrual cycles and make it difficult for women to ovulate — a crucial part to the conception and pregnancy process. Women with PCOS do not release eggs regularly, and their ovaries often have many small cysts within. IVF is a strong option for women with PCOS, since it can help their bodies ovulate to achieve pregnancy.

Steps involved in IVF treatment

There are five basic steps in the IVF and embryo transfer process:

Step 1: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. A trans-vaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.

You may need several different medications, such as:

• Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time.
• Medications for oocyte maturation. When the follicles are ready for egg retrieval — generally after eight to 14 days — you will take human chorionic gonadotropin (HCG) or other medications to help the eggs mature.
• Medications to prevent premature ovulation.These medications prevent your body from releasing the developing eggs too soon.
• Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation.

Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort.

Typically, you’ll need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, your doctor will likely perform:

• Vaginal ultrasound, an imaging exam of your ovaries to monitor the development of follicles — fluid-filled ovarian sacs where eggs mature
• Blood tests, to measure your response to ovarian stimulation medications — estrogen levels typically increase as follicles develop and progesterone levels remain low until after ovulation

Sometimes IVF cycles need to be canceled before egg retrieval for one of these reasons:

• Inadequate number of follicles developing
• Premature ovulation
• Too many follicles developing, creating a risk of ovarian hyperstimulation syndrome
• Other medical issues

Egg retrieval can be done in your doctor’s office or a clinic 34 to 36 hours after the final injection and before ovulation.

• During egg retrieval, you’ll be sedated and given pain medication.
• Transvaginal ultrasound aspiration is the usual retrieval method. An ultrasound probe is inserted into your vagina to identify follicles. Then a thin needle is inserted into an ultrasound guide to go through the vagina and into the follicles to retrieve the eggs.
• If your ovaries aren’t accessible through transvaginal ultrasound, an abdominal surgery or laparoscopy — a procedure in which a tiny incision is made near your navel and a slender viewing instrument (laparoscope) is inserted — may be used to guide the needle.
• The eggs are removed from the follicles through a needle connected to a suction device. Multiple eggs can be removed in about 20 minutes.
• After egg retrieval, you may experience cramping and feelings of fullness or pressure.
• Mature eggs are placed in a nutritive liquid (culture medium) and incubated. Eggs that appear healthy and mature will be mixed with sperm to attempt to create embryos. However, not all eggs may be successfully fertilized.

Step 3: The male is asked to produce a sample of sperm, which is prepared for combining with the eggs. Other methods, such as testicular aspiration — the use of a needle or surgical procedure to extract sperm directly from the testicle — are sometimes required. Donor sperm also can be used. Sperm are separated from the semen fluid in the lab.

Step 4: In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory dish to encourage fertilization. In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Fertilization can be attempted using two common methods:

• Insemination. During insemination, healthy sperm and mature eggs are mixed and incubated overnight.
• Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior IVF cycles failed.

In certain situations, your doctor may recommend other procedures before embryo transfer.

• Assisted hatching. About five to six days after fertilization, an embryo “hatches” from its surrounding membrane (zona pellucida), allowing it to implant into the lining of the uterus. If you’re an older woman, or if you have had multiple failed IVF attempts, your doctor might recommend assisted hatching — a technique in which a hole is made in the zona pellucida just before transfer to help the embryo hatch and implant.
• Preimplantation genetic testing. Embryos are allowed to develop in the incubator until they reach a stage where a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes, typically after five to six days of development. Embryos that don’t contain affected genes or chromosomes can be transferred to your uterus. While preimplantation genetic testing can reduce the likelihood that a parent will pass on a genetic problem, it can’t eliminate the risk. Prenatal testing may still be recommended.

Step 5: The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.

Embryo transfer is done at your doctor’s office or a clinic and usually takes place two to six days after egg retrieval.

• You might be given a mild sedative. The procedure is usually painless, although you might experience mild cramping.
• The doctor or nurse will insert a long, thin, flexible tube called a catheter into your vagina, through your cervix and into your uterus.
• A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter.
• Using the syringe, the doctor or nurse places the embryo or embryos into your uterus.

If successful, an embryo will implant in the lining of your uterus about six to 10 days after egg retrieval.

IVF Success Rate

The chances of giving birth to a healthy baby after using IVF depend on various factors, including:

• Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women age 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.
• Embryo status. Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or other care provider about your specific situation.
• Reproductive history. Women who’ve previously given birth are more likely to be able to get pregnant using IVF than are women who’ve never given birth. Success rates are lower for women who’ve previously used IVF multiple times but didn’t get pregnant.
• Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility.
• Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman’s chance of success using IVF by 50 percent. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine and certain medications also can be harmful.

The success rate of IVF clinics depends on a number of factors including reproductive history, maternal age, the cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not the same as live birth rates.

What are the side effects of IVF?

Like all medications and medical procedures, IVF has some risks and possible side effects. These include:

• bloating
• cramping
• breast tenderness
• mood swings
• headaches
• bruising from shots
• allergic reaction to medicines
• bleeding
• infection

1. Cramping and abdominal pain: Period-like cramps are common during the IVF process, along with minor abdominal pain that feels similar to your menstrual cycle. You can combat general cramps with over-the-counter pain relievers or a heat pad to reduce discomfort.
2. Bloating: Fertility medications can heavily impact how your body retains water, leading to the dreaded side effect of bloating. This is especially common in your midsection, where fluid can build up near the ovaries (creating abdominal tenderness, too). You can combat bloating by increasing your fluid intake, and participating in light exercise such as walking.
3. Breast tenderness: Tenderness is often felt throughout your menstrual cycle, and can be amplified by IVF medications. You can help ease this discomfort by using warm or cold compresses on your breasts (whichever feels best) or by taking a warm or cool shower. Wearing a supportive but non-restricting bra can also help.
4. Constipation: Constipation is an unfortunate side effect that can be remedied by eating more fiber, increasing your water intake, and avoiding dehydrating beverages such as coffee and soda.
5. Headaches and mood swings: Headaches and mood swings are common IVF treatment side effects. Over-the-counter medications can ease headaches, and while no medication can help with mood swings, knowing that they’re a normal part of IVF treatment helps. If you find mood swings are disrupting your day, be sure to seek out self-care practices such as enjoying alone time, reading a book, taking a nice bath, or sharing feelings with a friend or loved one.
6. Hot flashes: If you suddenly feel very warm, have a flushed face, or find yourself randomly sweating, you may be experiencing a hot flash. They can appear at random during the IVF treatment process, but you can help prevent them by reducing stress, avoiding spicy foods and warm environments, and cutting back on alcohol or caffeine intake.

Your doctor can talk with you about any questions or concerns you have about IVF risks and side effects.

IVF can also be difficult emotionally, both for the person having the procedures and for their partner and/or family. Many people doing IVF treatments struggle with depression and anxiety throughout the process.

IVF Cost

The cost of IVF can vary greatly depending on your location, Doctor and Hospital you choose. Many couples prefer to travel to other cities with more affordable IVF treatment plans.

Other Important factors are

• Women’s Age
• Medical Condition of Wife
• Medical Condition of Husband

Understanding the cost of fertility treatments can be difficult, simply because there are so many factors that impact the final bill.

Special Scenarios That Can Impact IVF Costs

Only you and your reproductive specialist can determine the best ways to utilize IVF treatments. Sometimes, that means using donor eggs or sperm, or with the help of a surrogate.

IVF Cost With Donor Eggs

In some fertility cases, it is necessary to use donor eggs. Depending on the region and clinic, this can either decrease or increase the bill for IVF treatment. Some IVF clinics claim that IVF costs with donor eggs can be dropped by up to 50 percent, partially because of the reduced medication cost and the fact that donor eggs remove the need for egg retrieval. But, how the eggs are collected and stored can make a cost difference. IVF costs with egg donation can be impacted based the clinic or donor egg bank you select.

IVF Cost With Frozen Embryos

Choosing to undergo an IVF cycle utilizing frozen embryos can reduce the IVF price tag. This is because multiple eggs are fertilized at one time, developing into embryos that can either be implanted or frozen for later use. IVF costs with frozen embryos are reduced because there is no need to retrieve more eggs, speeding up the IVF process and cutting out parts of a complete cycle.

IVF Cost With a Surrogate

Contrary to popular believe, utilizing a surrogate is common among more people than just celebrities. Surrogates allow women who are unable to carry a baby to still have children. Though, the IVF cost with a surrogate can go far beyond other kinds of fertility treatments.

IVF Cost With PGD

PGD, short for Preimplantation Genetic Diagnosis, is a form of testing done on embryos created during the IVF process to ensure there are no genetic abnormalities. PGD testing is done before embryos are transferred to the uterus, allowing doctors to select the healthiest embryos possible. Because this is an additional service, the IVF cost with PDG can increase. Some clinics will include this cost in your total cycle price, while others charge separately.

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5 years ago Infertility Treatment

Unexplained Infertility Explained

Unexplained Infertility Explained

The term, Unexplained Infertility is used when the sperm quality meets normal standards, the woman is likely to be ovulating regularly with a good ovarian reserve/egg supply, and a “dye test” (hysterosalpingogram) proves that the fallopian tubes are open.  Also, if the doctor suspects the answer may be within the women’s pelvis, then a surgical procedure known as laparoscopy is performed.

Approximately 30% of couples struggling to get pregnant are told that they have “unexplained infertility“. After examinations and tests, the doctor states there is no known medical reason to explain why they haven’t conceived.

An unexplained infertility diagnosis may be justified if it has been shown that,

1. You are ovulating regularly
2. Your ovarian reserves are good. (Evaluated with blood work and/or an antral follicle count.)
3. Your fallopian tubes are open and healthy. (Evaluated with an HSG.)
4. Your partner’s semen analysis is normal (including total count, sperm movement, and sperm shape.)
5. There are no serious uterine fertility issues. (Evaluated with a hysteroscopy.)

If any of the above has not been evaluated, a diagnosis of unexplained infertility may be premature.

Reasons for unexplained infertility

1. Autoimmune Disorders

Inflammation and autoimmunity are distinct processes, though they share a common tactic: They cause the immune system to target any perceived invader, including an embryo.

Researchers have identified upward of a hundred autoimmune disorders that cause the body to mistake its own tissues for intruders. Some of the more familiar varieties — Hashimoto’s thyroiditis, rheumatoid arthritis, and celiac disease — may be linked to conception failure and recurrent miscarriage.

Some 75 percent of autoimmune sufferers are women, so an early diagnosis is key for those seeking to get pregnant. Diagnostic results, however, can take some time — an average of four years and four doctors, according to the American Autoimmune Related Diseases Association.

2. Thyroid Malfunction

Autoimmune issues involving the thyroid exert an especially potent effect on fertility. Hashimoto’s, an inflammatory response in which the body attacks the thyroid glands, accounts for 90 percent of hypothyroidism, and a 2014 study published in the International Journal of Endocrinology found that 47 percent of patients with Hashimoto’s had difficulties becoming pregnant.

Thyroid malfunction puts a woman at greater risk for anovulatory cycles, in which no egg is released, though she may still regularly get her period. Additionally, lower thyroid levels are associated with decreased sex hormone binding globulin, which can “interfere with growth and development of follicles and get in the way of proper FSH and LH [hormone] surges associated with ovulation,” according to Dana Trentini and Mary Shomon, authors of Your Healthy Pregnancy With Thyroid Disease.

3. Food Sensitivities or Intolerances

Food sensitivities trigger low-level inflammation, making them potential suspects in any case of infertility. The same is true of food intolerances, which can occur when the body is deficient in an enzyme necessary to break down certain food substances, like lactose in dairy or gluten in wheat. If you have a food intolerance, eating even a small amount of the offending food can trigger systemic immune activation, causing widespread inflammation.

4. Toxic Exposure

We’re products of our environment, and it has an impact on fertility. A 2005 study by the Environmental Working Group found 287 industrial chemicals, pollutants, and pesticides in the umbilical-cord blood of 10 U.S. newborns chosen at random. Many toxins have been shown to trigger inflammation, suppress the immune system, impair fertility, or result in pregnancy complications and birth defects.

One research study found higher blood concentrations of mercury in infertile couples. Another observed significantly higher levels of lead in the blood of infertile women. Experts posit that heavy metals damage the immune system’s ability to distinguish between the body’s own tissues and hostile invaders, creating the conditions for an autoimmune attack.

5. Chronic Stress

Chronic stress is “anything that overwhelms your body’s capacity to respond effectively to the challenges you’re exposed to,” explains Romm, and it can affect fertility by keeping the nervous system activated, triggering low-grade inflammation, and interfering with hormone production.

The pressures of infertility, of course, also contribute to overall stress loads. “The diagnosis [of] ‘unexplained infertility’ can leave people devastated and heartbroken,” says Grunewald. “It adds to the stress that could be preventing conception in the first place. There may be peace of mind in knowing what is behind your infertility, even if the news is not what you’d hoped.”

Treatment for unexplained infertility

1. Lifestyle changes recommended (like weight loss, quitting smoking)
2. Continue to try on your own (if you’re young and willing) for six months to a year
3. Clomid or gonadotropins along with IUI for three to six cycles
4. IVF treatment for three to six cycles
5. Third-party IVF treatments (like using an egg donor or surrogate)

 

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5 years ago Infertility Treatment

Blocked Fallopian Tubes: Symptoms, Causes and Treatment for Fertility

Blocked Fallopian Tubes: Symptoms, Causes and Treatment for Fertility

 

Fallopian tubes connect a woman’s ovaries to her uterus, allowing an egg to travel through the fallopian tubes to the uterus. Most women have two ovaries (left and right) where your egg follicles are stored. Each month a follicle matures and it is releases an egg into the fallopian tubes. Fallopian tubes are two thin tubes, one linking to each ovary to help move the mature egg from the ovaries to the uterus. When there is an obstruction in one or both of the fallopian tubes the condition is known as blocked fallopian tubes or tubal factor infertility. This can occur on one or both tubes and is one of the main causes of female infertility.

 

Causes for Blocked Fallopian Tubes

There are a number of reasons why your fallopian tubes can be blocked:

• Pelvic inflammation
  Pelvic inflammation is the most common cause of blocked tubes. The inflammation usually happens inside your fallopian tubes which is usually the case with sexually transmitted infections (STIs) such as gonorrhea or chlamydia. The inflammation can also occur outside your tubes due to an infection from another organ such as the appendix.
• Blocked from birth (congenital tubal obstruction)
  A very rare condition which is present from birth.
• Accidental damage following other surgery
  It is possible for your fallopian tubes to be blocked by excessive scar tissue from previous surgery
• Severe endometriosis
  Fallopian tubes can become damaged or blocked in severe cases of endometriosis due to adhesions or scar tissue.
• Endometriosis. Endometrial tissue can build up in the fallopian tubes and cause a blockage, or endometrial tissue on the outside of other organs can cause adhesions that block the fallopian tubes.
• Certain sexually transmitted infections. Chlamydia and gonorrhea can cause scarring and lead to pelvic inflammatory disease.
• Past ectopic pregnancy. This can scar the fallopian tubes.
• Fibroids. These growths can block the fallopian tube, particularly where they attach to the uterus.
  Past abdominal surgery.
• Past surgery, especially on the fallopian tubes themselves, can lead to pelvic adhesions that block the tubes.

 

Diagnosing a blocked fallopian tube

Hysterosalpingogram (HSG)

Hysterosalpingography (HSG) is a type of X-ray used to examine the inside of fallopian tubes to help diagnose blockages. During HSG, your doctor introduces a dye into your uterus and fallopian tubes. The dye helps your doctor see more of the inner fallopian tubes on the X-ray. An HSG can usually be done in your doctor’s office and should take place within the first half of your menstrual cycle. Side effects are rare, but false positive results are possible.

If the HSG doesn’t help your doctor make a definitive diagnosis, they can use laparoscopy for further evaluation. If the doctor finds a blockage during the procedure, they might remove it, if possible.

Sonohysterography

Sonohysterography is a non-invasive procedure where ultrasound imaging is used instead of the potentially more damaging x-rays. Similar to the HSG, a thin tube is placed through the vagina and into the uterus to see if there is a blockage in the tubes. The ultrasound examination can also diagnose a hydrosalpinx and other issues such as ovarian cysts, endometrial polyps and uterine fibroids. It can be carried out without a general anesthetic.

Chromotubation

Chromotubation is performed during a laparoscopy so that your specialist can see the dye spilling from the fallopian tube. The dye for this procedure is different from a HSG as it cannot be seen on an X-ray. This test is considered the most reliable way to determine if you have blocked tubes but does require surgery and a general anesthetic.

 

Blocked fallopian tubes Treatment

If your fallopian tubes are blocked by small amounts of scar tissue or adhesions, your doctor can use laparoscopic surgery to remove the blockage and open the tubes. If your fallopian tubes are blocked by large amounts of scar tissue or adhesions, treatment to remove the blockages may not be possible.

If you only have one tube that is blocked, your fertility specialist may recommend continuing trying to conceive naturally as it is still possible to conceive. If both tubes are blocked then laparoscopic surgery or microsurgery [4] may be an option to try and open one or both of the fallopian tubes. If there are only a few adhesions between your tubes and your ovaries then your chance of conceiving naturally after the surgery is good.

In some cases, if surgery is ineffective, then IVF may be an option. IVF bypasses the need for fertilization to occur in the fallopian tubes by placing an embryo directly into the uterus.

Surgery to repair tubes damaged by ectopic pregnancy or infection may be an option. If a blockage is caused because part of the fallopian tube is damaged, a surgeon can remove the damaged part and connect the two healthy parts.

Complications of blocked fallopian tubes

The most common complication of blocked fallopian tubes and treatment is ectopic pregnancy. If a fallopian tube is partially blocked, an egg may be able to be fertilized, but may get stuck in the tube. This results in an ectopic pregnancy, which is a medical emergency.

Surgery that removes part of the fallopian tube also increases the risk of ectopic pregnancy. Because of these risks, doctors often recommend IVF instead of surgery for women with blocked fallopian tubes who are otherwise healthy.

 

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Who is Best Specialist for Blocked Fallopian Tubes Treatment?

Blocked Fallopian Tubes can be unblocked through Laparoscopic procedure. Find all required details here

What is Cost of Laparoscopic Fallopian Tubes surgery?

Laparoscopic Fallopian Tubes surgery cost depends on various medical factors. Contact us for cost estimate

What is Laparoscopic Fallopian Tubes surgery success Rate?

Laparoscopic Fallopian Tubes surgery is common procedure and has high success rate. Find Best Laparoscopic surgeon based on Rating and Reviews from past clients

5 years ago Infertility Treatment

Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment

Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.

 

PCOS Symptoms

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain.

Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:

• Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.
• Excess androgen. Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
• Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

You’ll tend to gain weight, especially around the waist, and have a hard time losing it. You’ll often grow extra hair or have thinning hair. You may get acne or dark patches of skin. Pelvic pain and depression are also possible symptoms

PCOS signs and symptoms are typically more severe if you’re obese.

 

PCOS Causes

Doctors don’t know exactly why you get it, but some researchers think high levels of insulin are at the root of the illness. If you’re overweight, your chances of developing it are greater.

Your genes play a role, too. If your mother or sister has PCOS, you’re more likely to have it. Most women are diagnosed in their 20s or 30s. But even girls as young as 11, who haven’t gotten their period yet, can have it.

The exact cause of PCOS isn’t known. Factors that might play a role include:

• Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation.
• Low-grade inflammation. This term is used to describe white blood cells’ production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.
• Heredity. Research suggests that certain genes might be linked to PCOS.
• Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.

 

PCOS Complications

Complications of PCOS can include:

Obesity is associated with PCOS and can worsen complications of the disorder.

• Infertility
• Gestational diabetes or pregnancy-induced high blood pressure
• Miscarriage or premature birth
• Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver
• Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
• Type 2 diabetes or prediabetes
• Sleep apnea
• Depression, anxiety and eating disorders
• Abnormal uterine bleeding
• Cancer of the uterine lining (endometrial cancer)

 

PCOS Diagnosis

There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of your symptoms, your doctor may talk to you about your medical history and do a physical exam and different tests:

Physical exam:Your doctor will measure your blood pressure, body mass index (BMI), and waist size. They will also look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).

Pelvic exam: Your doctor may do a pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.
Pelvic ultrasound (sonogram). This test uses sound waves to examine your ovaries for cysts and check the endometrium (lining of the uterus or womb).
Blood tests. Blood tests check your androgen hormone levels, sometimes called “male hormones.” Your doctor will also check for other hormones related to other common health problems that can be mistaken for PCOS, such as thyroid disease. Your doctor may also test your cholesterol levels and test you for diabetes.

Once other conditions are ruled out, you may be diagnosed with PCOS if you have at least two of the following symptoms:

1. Irregular periods, including periods that come too often, not often enough, or not at all
2. Signs that you have high levels of androgens:
   Extra hair growth on your face, chin, and body (hirsutism)
   Acne
   Thinning of scalp hair
3. Higher than normal blood levels of androgens
4. Multiple cysts on one or both ovaries

 

PCOS Treatment

PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.

Lifestyle changes

Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for example, losing 5 percent of your body weight — might improve your condition. Losing weight may also increase the effectiveness of medications your doctor recommends for PCOS, and can help with infertility.

Medications

To regulate your menstrual cycle, your doctor might recommend:

• Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.
• Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn’t improve androgen levels and won’t prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.

To help you ovulate, your doctor might recommend:

• Clomiphene (Clomid). This oral anti-estrogen medication is taken during the first part of your menstrual cycle.
• Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.
• Metformin (Glucophage, Fortamet, others). This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don’t become pregnant using clomiphene, your doctor might recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.
• Gonadotropins. These hormone medications are given by injection.

To reduce excessive hair growth, your doctor might recommend:

• Birth control pills. These pills decrease androgen production that can cause excessive hair growth.
• Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defect, so effective contraception is required while taking this medication. It isn’t recommended if you’re pregnant or planning to become pregnant.
• Eflornithine (Vaniqa). This cream can slow facial hair growth in women.
• Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.

 

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