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PCOD/PCOS

PCOD/PCOS also called as Polycystic ovarian disease/ syndrome is a hormonal disorder which leads to menstrual irregularity, enlarged ovaries and excessive androgens in the body with increased acne/ facial hair in some women. It is multifactorial in origin and affects around 5-10% women in the reproductive age group. This is mainly caused due to imbalance of reproductive hormones and can cause difficulty in conceiving. PCOS can easily be controlled with exercise, diet modifications and with certain medications. The main goal is to restore fertility by regularization of menses and inducing timely ovulation using ovulation induction medications, treatment of acne and hirsutism, controlling blood sugar levels and maintaining the right BMI. Normally PCOS is treated by ovulation inducing agents such as letrozole or clomiphene in combination with insulin sensitizers such as metformin, myoinositol or D chiro inositol. Sometimes if this fails to achieve pregnancy, one can go for ovulation induction with low dose gonadotrophins either alone or in combination with letrozole/ clomiphene. Very rarely, in special circumstances, one may subject patient to laparoscopy with ovarian drilling (very few drills < 4 per ovary, so as to not damage the ovarian reserve). If all else fails these patients are subjected to IVF. In recent times our unit would do ivf and instead of using HCG, use Gnrh injection for triggering oocyte maturity. After the pick up the resultant embryos are all frozen (freeze all). The embryos are transferred back into the womb, one or two months later. By this segmentation approach, the dreaded side effect of Ovarian Hyperstimulation Syndrome OHSS is totally avoided. In our unit almost all PCOS patients become pregnant in three attempts. Most of them get enough embryos in the first round of oocyte retrieval. Hence, they don’t need extra oocyte retrieval attempts. In about 5 to 10 % of patients , despite of repeated attempts , the egg number is very low , or the egg quality is very poor with resultant very poor fertilisation rates . These patients may be subjected to repeated attempts with embryo pooling and PGTa. If despite of all this the patient fails to conceive, she can opt for egg donation. In the future such patients may be good candidates for MIST (Mitochondrial Spindle transfer )