PCOD(polycystic ovarian disease)

Is one of the commonest causes of infertility. Patients have multiple small cysts in their ovaries that occur when the regular changes of a normal menstrual cycle are disrupted. The ovary is enlarged, and it produces excessive amounts of androgen and estrogenic hormones.

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Polycystic ovary syndrome (PCOS), also called hyper-androgenic anovulation (HA), or Stein–Leventhal syndrome, is a set of symptoms due to a hormone imbalance in women. Signs and symptoms of PCOS include irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, trouble getting pregnant, and patches of thick, darker, velvety skin. Associated conditions also include type 2 Diabetes, Obesity, Obstructive Sleep Apnea, Heart Diseases, Mood Disorders, and Endometrial Cancer.

PCOS is due to a combination of genetic and environmental factors. Risk factors for PCOS include obesity, not enough physical exercise, and a family history of someone of this condition. Diagnosis is based on two of the following three findings: no ovulation, high androgen levels, and ovarian cysts. Cysts are detectable by ultrasound. Other conditions that produce similar symptoms include adrenal hyperplasia, hypothyroidism, and hyperprolactinemia.

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PCOS has no permanent cure. Treatment for PCOS involves lifestyle changes such as weight loss and exercise. Birth control pills are used to help in regularizing periods, excess hair, and acne. Metformin and anti-androgens are also useful. Efforts to improve fertility include weight loss for obese patients, and administration of clomiphene, or metformin. In vitro fertilization is used in few caseswherein the treatment is not effective.

PCOS is the most common endocrinal disorder among women between the ages of 18 and 44. It affects approximately 5% to 10% of this age group. It is one of the leading causes of poor fertility.

Diagnosis

Not everyone with PCOS has polycystic ovaries (PCO), nor does everyone with ovarian cysts have PCOS;

Pelvic ultrasound is a major diagnostic tool, but it is not the only one. The diagnosis is straightforward using the Rotterdam criteria, even when the syndrome is associated with a wide range of symptoms.

Management

The primary treatments for PCOS include lifestyle changes, medications, and surgery.

Diet

Where PCOS is associated with overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation, but many women find it very difficult to achieve and sustain significant weight loss.

Medications

Medications for PCOS include oral contraceptives and metformin. The oral contraceptives increase sex hormone binding globulin production, which increases binding of free testosterone. This reduces the symptoms of hirsutism caused by high testosterone and regulates return to normal menstrual periods. Metformin is a drug commonly used in type-2 Diabetes to reduce insulin resistance and is also used to treat insulin resistance seen in PCOS. In many cases, metformin also supports ovarian function and return to normal ovulation.

Not all women with PCOS have difficulty in becoming pregnant. For those that do, anovulation or infrequent ovulation is a common cause. Other factors include changed levels of gonadotropins, hyperandrogenemia and hyperinsulinemia. Like women without PCOS, women with PCOS that are ovulating may be infertile also due to other causes such as tubal blockages due to a history of sexually transmitted diseases.

For women not responsive to clomiphene and diet and lifestyle modification, there are options available including ART Procedures such as controlled ovarian hyper-stimulation with follicle-stimulating hormone (FSH) injections followed by in vitro fertilization (IVF).

Surgery is not commonly performed for treating this syndrome, but polycystic ovaries can be treated with a laparoscopic procedure called “ovarian drilling” (involves puncture of 4–10 small follicles with electrocautery, laser, or biopsy needles), which often results in either resumption of spontaneous ovulations or ovulations after adjuvant treatment with clomiphene or FSH.

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