Managing Infertility

Often infertility can be the result of treatable conditions or lifestyle issues. Listed below are some health issues that, if managed effectively, would result in conception.

Fibroids and Pregnancy

Because fibroids can grow back, those women planning to become pregnant in the future must try to conceive as early as possible after the myomectomy procedure. However, following surgery, Dr Turner will advise you to wait for 4 to 6 months until the uterus heals.

Before undergoing any infertility treatment, Dr Turner may recommend a hysterosalpingogram and an X-ray test to check the uterus and fallopian tubes.

The incisions made in the uterine wall of the uterus to remove fibroids may cause placental problems, and improper functioning of the uterus during labour may need a caesarean delivery.

In rare cases, a hysterectomy may be needed if the uterus has grown too large with fibroids.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder and one of the common causes of infertility among women. 

It is characterised by an ovulation dysfunction or impedance to the normal growth and release of eggs from the ovaries. It is commonly seen in women of childbearing age and is rare after menopause.

The hormonal imbalance results in enlarged ovaries containing several small cysts (fluid-filled sacs less than or equal to 8mm in diameter).

Causes of Polycystic Ovarian Syndrome (PCOS)

The exact cause of polycystic ovarian syndrome is unknown. However, several factors, including genetics, have been implicated in playing a role in developing PCOS.

Women with a family history of polycystic ovarian syndrome are at a higher risk of developing this condition.

Researchers have also found an association between excessive insulin production and the development of PCOS. Insulin hormone regulates blood sugar levels, and any disorder affecting the insulin mechanism may result in excessive insulin secretion, which triggers androgen secretion from the ovaries.

Low-grade inflammation, in response to ingestion of certain foods, may lead to the release of substances that can cause insulin resistance and cholesterol accumulation in the blood vessels or atherosclerosis.

Clinical studies have demonstrated the presence of low-grade inflammation in women with PCOS. Excessive exposure to the male hormone during the foetal period may disrupt the function of normal genes and increase the risk of insulin resistance and low-grade inflammation for the foetus later in life.

Symptoms of Polycystic ovarian syndrome (PCOS)

The symptoms of polycystic ovarian syndrome vary from person to person and depend upon the nature and severity of the condition.

Some symptoms of PCOS include

• infertility,
• absent or irregular menstrual cycle, and
• obesity or accumulation of fat, usually around the waist.
• Abnormal facial and body hair,
• adult acne
• male pattern baldness or hair thinning may develop due to excessive androgen secretion.

In some patients, black or dark brown patches are seen around the skin of the neck, arm, breasts or thighs. Patients often experience anxiety or depression.

Diagnosis of Polycystic ovarian syndrome (PCOS)

The diagnosis of polycystic ovarian syndrome is based on the medical history along with a physical and pelvic examination and blood test to evaluate the patient's condition and help identify the underlying cause. Test conducted could include:

• Blood tests are conducted to determine the level of various hormones.
• Glucose tolerance test and
• Evaluation of blood cholesterol may also be conducted.
• Pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining.

Treatments for Polycystic Ovarian Syndrome (PCOS)

The treatment of polycystic ovarian syndrome is based on the symptoms and individual concerns such as infertility, irregular menstrual cycle, acne or obesity.

Both medications and surgical treatment can be used for the management of PCOS. Infertility may be treated by fertility therapy with ovulation-inducing drugs.

• Drug Therapy: Clomiphene citrate may be prescribed to patients; the drug 25mg-100mg dose can be given day2 to day 6 of your cycle; it can also be given day 5 to day 9. In some patients, the doctor may add metformin to clomiphene to enhance the function of the drug and help induce ovulation. Another oral drug superior to Clomid is Letrozole, the usual dose of 2.5-5 mg and given on day 2 to day 6 of the cycle. Dr Turner will do an ultrasound to check the growth of follicles and determine the time of ovulation around day 12 of your cycle.

In patients not responding to clomiphene and metformin, gonadotropins, namely, follicle-stimulating hormone (FSH) can be administered by injection.

• Lifestyle Modifications and anti-diabetic medications may be prescribed for the management or prevention of obesity and diabetes mellitus.
• Surgery may be recommended in patients who do not respond to medications. Laparoscopic ovarian drilling is a day surgical procedure that may be used to treat the condition and induce ovulation.

If PCOS is Not Treated

Patients with polycystic ovarian syndrome frequently develop other serious medical conditions such as

• diabetes mellitus,
• cardiovascular diseases,
• high blood pressure,
• Precancerous and cancerous conditions of the lining of the uterus
• miscarriage 

These patients are also at risk of anxiety or depression.

Cancer Related issues for Women

The treatment of cancer may pose temporary or permanent fertility problems in both men and women. The effects may be immediate or show up much later in life.

Various factors, such as the type of cancer, treatment and age, determine the chances of infertility following treatment.

Any cancer therapy would involve one or more of the three general techniques:

• chemotherapy 
• radiotherapy, which is the use of high-energy radiation and
• surgery to destroy and remove cancer cells.

The higher the dose of chemo and radiation therapy, and the older the patient, the greater its effect on fertility.

Cancer therapy can damage the endocrine glands (glands that release hormones essential for puberty and fertility.

Fertility Preservation Options for Women

The options for women may include:

• Embryo freezing: involves the collection of mature eggs and fertilisation with sperm in the laboratory. The resulting fertilised embryos are frozen and preserved until the woman is ready to become pregnant.
• Oocyte freezing: involves the collection of mature eggs and freezing them (without fertilisation with sperm).
• Oophoropexy: Involves surgically moving the ovaries away from the path of radiation and bringing them back to their original position after treatment, with an intention of protecting the ovaries from radiation therapy.
• Ovarian tissue cryopreservation: In girls who have not yet entered puberty, or if post puberty and not enough time or too unwell to undergo ovarian stimulation ovarian tissue preservation is performed, which involves the surgical removal of ovarian tissue and preserving it by freezing. The tissue may be transplanted back into the pelvis after the cancer treatment.

Fertility-preserving procedures may vary for each individual and each condition. You can discuss with Dr Turner in detail before you decide.