Fertility care in women diagnosed with polycystic ovarian syndrome
Polycystic ovarian syndrome is a general endocrine disorder that mainly manifests in female reproduction. It is diagnosed when two of the following conditions exist
1. High male hormone testosterone, which is detected by blood levels or the presence of excessive hair hirsutism or acne.
2. Anovulation - No ovulation in most of a woman's cycles
3. Polycystic appearance of the ovary. On ultrasound, there are many small follicles under the outer capsule of the ovary.
No further test is required for diagnosis. Because only a few diseases can be classified as PCOS, doctors sometimes measure other hormones to distinguish PCOS from other diseases. Because of its general effects on insulin, blood sugar and lipids, many doctors also measure glucose, insulin, cholesterol and other lipids.
Women who do not want to get pregnant immediately should take oral contraceptive pills or synthetic progesterone drugs to combat the effects of estrogen. Continued exposure to estrogen, such as PCOS, can cause proliferation of endometrial hyperplasia, which can lead to endometrial cancer.
Women who want to become pregnant should be examined for male, tubal and uterine factors. The male factor is assessed through a thorough medical history and semen analysis. The tube factor is assessed using a hysterosalpingography test, a dye from the uterine cavity and the fallopian tubes. As soon as other factors are excluded - the patented fallopian tubes, the normal uterine cavity and the analysis of normal sperm - attention is drawn to the induction of ovulation. The initiation of ovulation is usually associated with a timed intrauterine insemination. This ensures that there is a sufficient amount of active sperm in the fallopian tube at the time of ovulation.
Induction of ovulation. Before you recommend treatment, you should consider the diet. Obese women should be encouraged to lose weight and start an appropriate exercise program. Weight loss can cause ovulation to start again. The goal of the subsequent induction of ovulation is to produce a small number of follicles (one or two) to reduce the risk of multiple pregnancies. Multiple pregnancies pose risks to maternal health and premature labor and sometimes have long-term consequences for the fetus. For this reason, the use of all these drugs should be monitored with ultrasound and sometimes with blood tests. Do not take any of these drugs unsupervised to avoid multiple ovulations and multiple pregnancies.
1. Clomiphene Citrate Clomid. An oral medication used to increase the release of a signal hormone from the brain's main gland and induce the development of follicles in the ovaries - the pouch that contains the egg. The risk for twins is 8% and for triplets or more 1%. The risk of pregnancy is approximately 10% per treatment cycle. Many doctors prescribe metformin with Clomid. This medication has no proven additional benefits in terms of ovulation and should therefore not be used alone.
2. Aromatase inhibitors - letrozole and anastrozole. These are oral medications that also cause the signaling hormone to be released from the main gland, which then stimulates follicular growth in the ovaries. Some women who do not respond to Clomid respond to these drugs. Letrozole was accused of an increase in birth defects, which was later refuted.
3. surgery. This is achieved through laparoscopic procedures with minimal access. The inner part of the ovary is burned with electricity to reduce the production of androgens. Risks include scarring and a decrease in the number of follicles remaining in the ovary. Their use is reserved for some selected cases.
4. Gonadotropins - "injectable" drugs. These are synthetic hormones that are similar to the signal hormones produced by the master glands. They are much stronger than oral medication. It is associated with a pregnancy rate of around 15% per treatment cycle, but also with a higher risk of multiple pregnancies - around 30% twins and 1 to 3% or more triplets. The risk of ovarian overstimulation syndrome is also much higher. In this state, the ovaries expand and the fluid flows into the abdominal cavity, making the blood thicker and more likely to clot. Their use should be closely monitored by a reproductive endocrinologist and fertility specialist.
5. In Vitro Fertilization IVF. The ovaries are stimulated with gonadotropins. The eggs are collected using a needle and vaginal ultrasound. The eggs are fertilized in the laboratory. Embryos are observed and the best one or two embryos are transferred to the uterus. Although more complicated than ovulation induction and IUI, it has the advantage that the pregnancy rate is 30-50% higher depending on age and that the number of embryos transferred is controlled, which prevents multiple pregnancies from freezing excess embryos for use in later years , IVF allows placement of an embryo in the uterus, virtually eliminating higher triplets and multiple pregnancies and reducing twins to approximately 1%.
A large study compared a step-by-step approach to oral medication, followed by injectable medication, followed by IVF and oral medication, followed by IVF when pregnancy does not occur. progressive approach.
Acupuncture - For infertility
Acupuncture is the insertion of very fine needles (not much thicker than a hair) into certain acupuncture points along the meridians or channels that are connected to the various organs of Chinese medicine. The idea is that by needling these specific points, you can influence the flow of qi (pronounced chee) or the energy that flows to the organs and improve the functioning of the organs. Research in western medicine has shown that acupuncture can alter the production of various brain chemicals, including neurotransmitters, endorphins, encephalins, pain relievers, mood enhancers, natural anti-inflammatories, etc. The meridians and points are also often near blood vessels, nerves, and lymphatic channels or certain organs.
Is Acupuncture Safe?
Absolutely, if it is practiced by a qualified and competent practitioner. After practicing acupuncture for 12 years, I found that the worst thing that happened was mild to moderate bruising in some patients and sometimes a persistent feeling that the needle remained a day after. The acupuncture needles we use are sterile and intended for single use, so there is no risk of infection.
Does acupuncture hurt?
Since needles are not much thicker than a hair, penetrating the skin is very uncomfortable, sometimes a small pin prick. When the needle reaches its destination, you may experience a tingling sensation, an electrical sensation, or a feeling of deep pressure, but usually not much more, and the feeling generally disappears within a minute or two of inserting the needle. Needle. After that, you may know that the needle is there, but you don't really feel much of it.
What does an acupuncture treatment look like?
A total of 35 to 40 minutes of treatment. I start by marking where the needles go by pressing on your skin, cleaning this area with alcohol and inserting the needle. Once they're all in, they stay for about 20 minutes and are then removed and thrown away. Each treatment consists of 8 to 18 needles. Afterwards, most people report that they feel excited or relaxed.
How Can Acupuncture Help Infertility?
Studies have shown that acupuncture is useful for regulating ovarian function in polycystic ovary syndrome (PCOS). There is evidence that acupuncture relieves pain during egg retrieval, improves pregnancy outcomes in in-vitro fertilization (IVF), reduces fallopian tube pregnancies and miscarriages. Manage ovulation disorders, male fertility, primary dysmenorrhea, endometriosis and menopause symptoms. From the perspective of traditional Chinese medicine (TCM) you improve the function of the organs by improving the energy flow also and from the organ. From the perspective of Western medicine, you increase the activity of the immune system in and around the reproductive organs in order to promote healing and optimal function. They also directly stimulate the nerve endings that cause the organ to stimulate the brain to increase the cytokines and neurotransmitters that increase repair activity.
As a naturopath, I combine acupuncture with my other healing methods, including diet and nutrition, natural supplements, herbs, lifestyle advice, and stress reduction to achieve maximum effects, reversing infertility and helping women achieve healthy pregnancies and produce healthy babies.