Polycystic Ovary Syndrome (PCOS) And Infertility

Hello,

Namaste, mera naam Dr. Prerna Gupta hai. Mein infertility aur IVF specialist hu. Meine apni padhai AIIMS se kari hai aur mein Delhi mein karyarat hu. Aaj hum PCOS(Polycystic Ovary Syndrome) aur infertility ke baare mein baat kareinge. Hum janege Polycystic Ovary Syndrome (PCOS) kya hai aur ye kaise infertility cause karta hai. Polycystic Ovary Syndrome bahut hi common decease hai. Ye almost 10 mein 2 patients ko hoti hai. Iska matlab meri OPD mein 10 patients aate hai toh unme se mein 2 Polycystic Ovary Syndrome disease ko dekhti hu. Polycystic Ovary Syndrome disease se infertility hona bahut common hai. Aur aaj hum kaise Polycystic Ovary Syndrome infertility cause karta hai aur iska treatment kya hai, iske baare mein baat kareinge.

Sabse pahle Polycystic Ovary Syndrome ki defination, hum Polycystic Ovary Syndrome ko diagnose kaise karte hai? Polycystic Ovary Syndrome ko janchane ke liye humare paas teen criteria hai. Agar apko irregular periods aate hai, agar aapko bahut der der se periods aate hai, mahine-dedh mahine mein periods aate hai, irregular periods hai. Secondly aapke symptoms hai jo dikhate hai ki apko male harmones jyada hai jaise ki apke shareer mein atyadhik baal hona ya apke paas acne jyada hona, apke hair fall hona ya fir thirdly apke ultra sound mein chote chote bahut saare 10mm se less follicles aaye huve hai ya cyst aaye huve hain. Toh inn teeno mein se irregular periods hona, male harmones jyada hona jaise ki atyadhik baal hona ya fir apke ultra sound mein PCOS oversize aana, inn teeno mein se do criteria apko hote hai tab apko hum Polycystic Ovary Syndrome disease mante hai ki haan aap Polycystic Ovary Syndrome se suffer karte hai aur Polycystic Ovary Syndrome kaaran ho sakta hai apko bachcha na thahrne ka. Polycystic Ovary Syndrome mein main problem ye hai ki apka egg bankar bada hokar release nahi hota. Polycystic Ovarian decease se unovelatry infertility hota hai matlab ovulation nahi ho pa raha hai, egg release nhi ho raha hai. Isliye bachcha nahi thahar raha hai. Agar egg hi release nahi hoga toh vo sperm se milega nahi aur bachcha nahi ho payega. Toh PCOS disease ka simple treatment hai ki humein apka jo ovulation mechanism hai vo wapas se start karna hai.

Jab bhi hum PCOS disease ka treatment shuru karte hai, most commonly ismein jo first line treatment hota hai vo hota hai weight loss. PCOS mein 70% women mein unka weight jo hota hai over weight hoti hai, unka normal BMI 25 ke upar hota hai. Toh first line of treatment hota hai ki aap apna wajan kam kariye, aap regular exercise kariye. Agar aap apna wajan even 10% kam kar lete hai, agar aap 75 ke hai aur aap 70 pe pahunch jaate hai, aap regular exercise karte hai, atleast 40 minutes a day, 5 days a week aap exercise karne lag jaate hai aur apna metabolism better kar lete hai toh humne dekha hai ki kai baar patients ko apne aap ovulation hone lag jaata hai, apne aap periods time se aane lag jaate hai, unko koi dawai ke bina hi bachcha thahar jaata hai. Agar apne ye weight loss kara hai, diet li hai uske baad bhi agar apko ovulation nahi ho raha hai, periods regularly nahi aa rahe hai toh second line of treatment hota hai drugs.

Drugs hoti hai vo oral bhi hoti hai aur injectable bhi hoti hai. Initially aapko oral drugs shuru kari jaati hai. Jo most commonly drugs use kari jaati hai PCOS treatment mein, vo hoti hai clomiphene citrate ya fir letrozole tablets. Inn dono drugs ka ek hi kaam hai ki vo apke eggs banana aur unko time se release karna. Ye periods ke 2nd day to 6th day di jaati hai aur fir apka ultra sound hoti hai 10th ya 12th day, ye dekhne ke liye ki haan apke eggs ban rahe hai ya nahi ban rahe hai. Agar apko initial doses se eggs nahi badte hai toh apke doses badaye jate hai. Jaise ki clomiphene ko 50 se 100, 150 ya 200 bhi kara jaata hai. Agar apke inn dawaiyo se egg ban rahe hai toh inn dawaiyo per apko 3 se 6 mahine rakha jata hai aur hum kahte hai aapke ovalution ho raha hai ya eggs ban rahe hai toh 60 to 70% patients PCOS ke sirf simple ovalution drugs se hi conceive kar jaate hai. Fir aapne ye dawaiya li, 3 se 6 mahine li toh do cheeje ho sakti hai, ek hua ki humare ande ban hi nahi rahe hai isko hum kahte hai clomiphene resistance ki aapke eggs inn dawaiyo se nahi ban rahe hai. Dusra, ki apne li ye dawaiya, eggs bane, ovalution bhi hua, lekin conception nahi hua toh hum isko clomiphene failure kahte hai. Agar apko resistance ya failure hai toh hum second line of treatment pe ja sakte hai jo ya toh laparoscopic ovarian drilling ho sakta hai jisme hum ek operation karke apke ovaries mein chhed kar diye jaaye taaki vo apne aap ovalute kar jaaye ya fir hum second line of drugs, like injections, use kar sakte hai. Inn injections ke madhyam se bhi hum try kar sakte hai ki aapke eggs bane aur release karein.

Agar injectables se apke eggs bante hai toh ye bhi aap 3 se 6 mahine try kar sakte hai. Aapko ye baat jan na jaroori hai ki PCOS mein, kyuki aapke eggs nahi ban rahe the isliye apko bachcha nahi thahar raha tha, toh ismein duration of treatment se mat dariye ki 3 mahine, 6 mahine kyu wait karna padega? Agar mera anda ban raha hai toh mujhe pregnancy honi chaiye. Jaise marraige ke baad 6 mahine wait karte hai ki har mahine anda ban raha hai, release ho raha hai, hum try kar rahe hai par bachcha nahi thahar raha hai. Waise hi PCOS mein jaise hi ovalution shuru ho jaaye, iss treatment ko 5-6 mahine dijiye. Within 5 to 6 cycles hum kahte hai 80-90% patients inhi treatment se conceive kar jaate hai. Higher treatments like IVF and IUI bahut hi kam patients, sirf 10-15% patients ko jaroorat padti hai. PCOS mein success rate bahut high hoti hai. PCOS mein treatment easy hota hai agar aap sahi doctor ke paas pahunche. PCOS mein kaafi drugs bhi use kari jaati hai jaise metformin use kari jaati hai. Jaise ovaries ke number of eggs ko achche karne ke liye kai type ke adjuvins use kare jaate hai. Jitna evidence batata hai, metphomin jaisi dawaiya tabhi use kari jaati hai agar aap over weight hai aur apke sugar ke tests mein problem aayi hai. Iske alawa agar aap lean hai, apki sugar ki test normal hai toh metformin apki pregnancy rate nahi batata. Bahut saare drugs market mein available hai jo kahte hai ki agar aap ye drugs lenge toh apke quality of eggs hai PCOS mein vo improve kar jaati hai. Aisa koi bhi studies mein nahi dekha gaya hai. Jaroori hai ki aap apni lifestyle pe, apni diet pe dhyan dijiye. Saare vitamins, minerals, saari sabjiya khayein vo jyada jaroori hai rather than ye ye mehangi dawaiya khayein. Agar hum PCOS mein ovalution kar paate hai toh 90% patients waise hi conceive kar jaate hai. Vo ovulation chahe weight reduction se ho ya balanced diet se ho ya dawaiyo se ho. Sirf 10% patients jinme nahi conception ho pata unmein IVF treatment ki jarurat hoti hai. IVF treatment PCOS patients mein bahut successful hota hai, kyunki ismein bahut saare ande milte hai, toh freezing milti hai. Hum day 5 andro transfer tak pahunch jaate hai. Toh isme chances of conceptions achche hi rahte hai. Aisa nahi hai ki PCOS mein quality of eggs poor hoti hai, usme quality of eggs achchi hi milti hai. Toh agar apko PCOS hai toh ghabaraiye nah. Apke paas bahut saare options hai jisse aap apni fertility ko achieve kar sakti hai, conception achieve sakti hai. Hopefully, apko ye information informative mili hogi, apne koi nayi information gain kari hogi. Dhanyawad.

Thank You!