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Polycystic ovaries
The diagnosis of poly cystic ovaries is usually made by taking into account some clinical features like irregular menses, obesity , excess facial hair, acne and also sonological findings that are typical ‘cyst’ like spaces in the ovaries. A hormone
test may reveal excess androgens and high levels of insulin in the blood.
No. This is a clinical problem that is probably inherited, genetically. Hence a cure is not possible, although a
worsening can be prevented.
Yes. Weight loss reduces Insulin resistance and improves the chances of spontaneous ovulation in women with PCOS. Even a weight loss of just 10% can help women to get pregnant faster.
Different treatment plans help different women. As a rule life style changes, weight loss through healthy eating habits
and a regimented exercise programme are the starting points of therapy. Some women need simple medications
to induce ovulation while some others need hormone injections.
Laparoscopic ovarian Drilling is a minimally invasive surgical method of inducing ovulation. The laparoscopic surgeon “drills” 5 to 6 holes in the substance of each ovary using a special needle like instrument. We are not entirely sure how this mechanism helps induce ovulation. It may do so by destroying excess amount of androgen secreting ovarian tissue. Most women become ovulatory following surgery and about 50% of these women conceive naturally within a year of undergoing the surgery.
Extra caution is mandatory. Smaller doses of hormones need to be used. Risks of ovarian hyper stimulation
syndrome (OHSS) is much greater in women with PCOS.
In Vitro Maturation or (IVM) is the answer to these situations. Here small doses of hormone injections are given for short period of time. The oocytes are removed form the ovaries and matured in the laboratory. These oocytes are used for IVF or ICSI using your partner’s sperm.
The risk of severe ovarian hyper stimulation increases many fold when embryos are implanted in the same cycle as the one that yielded very high number of oocytes. Also the chances of implantation are reduced during that cycle due to the very high levels of circulating hormones.

Hence it is a good idea to freeze the embryos and transfer them after 2 cycles.This is safer and enjoys good pregnancy rates with low risks of abortions.
IVF and the older women
At the present moment we do not have any evidence backed method of improving ovarian reserve. Medications like DHEA require approval from medical authorities and is hence not a routine prescription. Donor egg IVF program may be the best solution for women with very low ovarian reserve.
Yes. It is a good idea to complete a clinical evaluation at the earliest. At 35 years of age, there is a rather rapid decline in ovarian reserve and it may be a good idea to use active measures to attempt pregnancy.
Most centers maintain a donor registry. However, it is still rare for young, educated girls to volunteer as egg donors.
Hence most of our donors are women who are married and have children of their own.

You can choose a donor who will be as close a match as possible. However, we do prefer to keep donors anonymous.
We will need to short list a donor for you. Once this is done we will try and co-ordinate your menstrual cycle with her’s using birth control pills.

You will need to come to our centre about a week before your (pill – induced) period is due. We will complete investigations like diagnostic hysteroscopy and begin certain medications and GnRh agonist injections. You will need to be in India for a further 3 weeks after that.

In countries where there is access to some Pre – IVF medications and diagnostic tests, the stay in India can be shortened by a week or so.
Ovarian and Tubal Abnormalities
Cysts less than 5cm in size, filled with clear fluid are often seen in the early Part of the menstrual cycle. They are called “functional” or “retention” cysts. They are harmless and disappear spontaneously. Usually they are ignored and fertility
treatment is continued in that cycle, (with the exception of IVF treatment where the cyst may need to be ‘aspirated’).
A pelvic ultrasound scan showed a “Chocolate cyst” in both ovaries. My doctor says they are small and should not matter. How do I proceed ?

A “chocolate cyst” is a blood filled cyst within the ovarian tissue. They may grow over time and cause discomfort. They could also make the ovaries “sticky” and result in their getting adherent to the uterus or bowels.

However, as the cysts are small in your case, the correct approach would be to go through 4 or 5 cycles of ovulation induction combined with intra uterine insemination as this would offer you the best chance to get pregnant quickly.
Yes. Hydrosalpinges are non – functioning fallopian tubes that usually are diseased due to infections or inflammations. The fluid in the hydosalpinges can drain into the uterine cavity and reduce the chances of embryo implantation at IVF. It is hence a good idea to get it removed surgically through laparoscopy.
Pelvic tuber culosis can be diagnosed by a laboratory test using samples of tissue from the uterus. It is also possible to take tissue samples from fallopian tubes during Laparoscopy.
The following women are considered high risk for having the infection and hence are tested.
Women with previous tubal pregnancies.
Women with hydrosalpinges as seen on HSG or at Laparoscopy.
Women with previous repeated, early pregnancy losses.
Women who are exposed to the infection in any way.
Yes Results show consistently better implantation rates after treatment for TB.
Psychology of infertility
This is not an altogether uncommon situation that we see in Fertility clinics. In the larger interest of the couple’s life together every attempt needs to be made to put sexual intimacy on the right track. Psycho sexual counseling helps.
Sometimes a small surgical procedure may make penetrative sex easier for the women.

However, all these can be worked at alongside to active fertility treatment measures. In a large group of these couples, short and simple treatment gives very good results.