Tag: Dr. Ritu Hinduja

Getting Pregnant With PCOS By Dr. Ritu Hinduja, Fertility Consultant, Nova IVF Fertility, Mumbai

Polycystic Ovarian Syndrome, also known as PCOS, is a reproductive metabolic syndrome and imbalance or an endocrine metabolic problem. Women having PCOS may have infrequent or prolonged menstrual periods Women with PCOS produce higher-than-normal amounts of male hormones. This hormone imbalance causes them to skip menstrual periods, as no egg is released from the ovary and this makes it harder for them to conceive.

In PCOS, many small, fluid-filled sacs grow inside the ovaries. The word “polycystic” means “many cysts.” These sacs are actually follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation. The lack of ovulation alters levels of estrogen, progesterone, FSH, and LH. Estrogen and progesterone levels are lower than usual, while androgen levels are higher than usual. Extra male hormones disrupt the menstrual cycle, so women with PCOS get fewer periods than usual.

Doctors don’t know exactly what causes PCOS. They believe that high levels of male hormones prevent the ovaries from producing hormones and making eggs normally. Genetics, insulin resistance, and inflammation have all been linked to excess androgen production. Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy. When cells can’t use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones, which not only disrupts ovulation but also causes hirsutism and acne. Women having PCOS also tend to experience a low-grade inflammation that stimulates polycystic ovaries to produce androgen, which can invite heart and blood vessel problems in the future.

Know how PCOS affects your fertility?

It is a well-established fact that women suffering from PCOS take a longer time to get pregnant. The reason can be due to irregular periods which means they don’t ovulate every month. PCOS patients tend to have a poor quality of the egg, compared to that of a non-PCOS woman. This could imply that a PCOS patient has a lower pregnancy potential compared to a non-PCOS patient of the same age. Also, being overweight reduces fertility and can contribute to women with PCOS taking longer to conceive. This is how women with PCOS improve their chance of pregnancy. One needs to adhere to a healthy lifestyle and medications in order to increase the chances of getting pregnant. Here are some healthy lifestyle changes that should be opted for:

• Adding fiber to your diet helps lower the insulin levels and enhance the health of your gut. Eat seeds, berries, legumes, flax seeds, and whole grains.
• Eat more of lean protein but speak to your expert about the quantity in which you should eat. Include grilled chicken, salmon, fish, beans, tofu, shrimp, and tuna.
• Eat antioxidant-rich foods by opting for olive oil, avocado, quinoa, brown rice, kale, and spinach to stay healthy.
• Women with PCOS are at a higher risk of type-2 diabetes. A low-GI diet can help in weight loss as well as improve insulin sensitivity. Eat nuts, seeds, fruits, starchy vegetables, and other unprocessed, low-carbohydrate foods.
• Say no to white bread, pizza, pasta, and white rice. Too much sugar intake is linked to weight gain. So, do not eat sweets or pastries or drink juice, aerated drinks, or smoothies.
• Processed foods contain harmful chemicals, not only are poor for weight loss but can also destroy the gut microbiome. Bid adieu to ice creams, candies, and cookies.
• Saturated fats can be pro-inflammatory so don’t eat fast food and red meat. Avoid eating doughnuts, French fries, frozen pizza, junk, oily and spicy food.
• Similarly, smoking and alcohol is a strict no-no.

Fertility treatment can also be helpful: IVF is the most common treatment for women with PCOS who are not able to conceive naturally. In severe cases of PCOS, even after incorporating lifestyle changes, some women still experience infrequent ovulation, making it difficult for them to conceive. In these cases, women may choose to undergo IVF treatments to help with conception. In Vitro Fertilization (IVF) is one of the types of assisted reproductive technology (ART) that works using a combination of medicines and surgical procedures in order to help sperm fertilize an egg after which the fertilized egg is implanted in the uterus. First, a woman is prescribed medication to make her eggs mature and ready for fertilization. Next, the doctor performs a procedure called egg retrieval, post which, the sperms and the eggs are fertilized in the IVF lab. After that 1 fertilized eggs (embryos) of good quality is transferred into a woman’s uterus and the woman may become pregnant if the embryo implants itself in the lining of the uterus.

Why pre-marital counseling is essential and how does AMH Test play a role By Dr. Ritu Hinduja, Fertility Consultant, Nova IVF Fertility Mumbai

It may be the right time that couples should think about both, pre and post-marital counselling. Though the couple may think that the counselling is unnecessary, the outcome could make them feel otherwise. Counselling is a good way to resolve all your relationship issues along with planning your timeline of steps towards starting a family. Yes, you have heard it right!

Chalking out a roadmap for when to plan a child makes you feel empowered as a couple, and it is easier than you think. Two very simple tests can help you plan your parenthood and that is a blood AMH (Anti-Mullerian Hormone) level in women and semen analysis in men.

Everything about the Anti-Mullerian Hormone Test:

In women egg reserves decline with age, this is known as their biological clock. AMH testing is a way for couples to get a sense of the reproductive span, thus helping in smart planning of conception

AMH Test is a test that is an indicator of a woman’s ovarian reserve. The level of AMH gives insights into the remaining quantity of eggs and where a woman stands on her fertility graph. AMH testing involves a simple blood test that can be done at any time of the month, as the levels of AMH do not change with the menstrual cycle.

Did you know? The AMH blood test can be done even if you are using oral contraceptives.

Why pre-marital counselling is essential and how does AMH Test plays a role:

Many couples seek pre-marital counselling to test their compatibility. For couples, today fertility parameters are as important as emotional factors before tying the knot and thus AMH along with a semen analysis can be the perfect test. Understanding your AMH levels can help to assess your ovarian egg reserve and therefore your fertility. However, we know fertility declines as we age so it’s important that women understand their fertility and what the current tests and treatments can and can’t do for them. Considering we now live in a society where late marriages are a norm which ultimately translates into a delay in starting a family, AMH Testing helps in providing information on reproductive years left for the couple.

Career-oriented women tend to delay many aspects of their personal life while chasing their professional dreams. Increasing age means a decrease in ovarian reserve, this can prove to be a roadblock in attaining motherhood. A simple blood test lets a woman know her ovarian reserve within a matter of hours. Therefore, if you get your AMH levels tested at a younger age, you will have a better idea of your reproductive health. An AMH test can also help couples decide if they want to put their embryos on ice while they pursue other achievements on their timelines. It can also guide women who do not have a steady partner or are not married to decide to freeze their eggs thereby freezing their fertility in time so that when they do find a partner they can use their frozen eggs and plan a pregnancy thereby breaking free of the deleterious effects of ageing on reproductive outcomes.

When to opt for the AMH test?

AMH can be done at any time in the menstrual cycle, as your AMH levels are stable throughout the cycle. It is a marker for ovarian (egg) reserve and is assessed via an AMH blood test. It is imperative to understand that AMH is just an indicator of a woman’s fertility and does not guarantee a pregnancy. Women opting for AMH testing should consult with her fertility expert or gynaecologist to discuss the way forward.

Take-home message: AMH does not guarantee pregnancy in the future. However, it does make a woman more educated about her fertility. If your AMH levels are low and do not meet the mentioned criteria, then you need to speak to your doctor and act accordingly. Your doctor will then suggest a suitable way forward for you.