Polycystic ovarian syndrome (PCOS) is a health condition that affects women of childbearing age. In this condition, the ovaries tend to produce excess androgens, a male sex hormone that is usually present in small amounts in women. The name, polycystic ovarian syndrome, describes numerous small cysts (fluid-filled sacs) in the ovaries. However, these are different from the other ovarian cysts which require surgery. PCOS can have an impact on a woman’s overall health as well as their physical appearance. Although common, PCOS is often a treatable condition.

&nbsp;

<strong>Impact of PCOS on Fertility</strong>
<img src="https://www.nufertility.com/blog/wp-content/uploads/2023/11/Shutterstock_1835827393.png">

Hormonal imbalances in women may result in excessive amounts of androgens, the formation of cysts in the ovaries, the thickening of the outer well of the ovaries, and insulin resistance. All these changes can interfere with the process of ovulation in women. One of the common signs to understand this is missed or irregular periods.

<strong>Signs and symptoms</strong>
<img src="https://www.nufertility.com/blog/wp-content/uploads/2023/11/Shutterstock_1835827393.png">
The symptoms of PCOS may include:
<ul>
<li>Missed or irregular periods
</li>
<li>Infertility
</li>
<li>Skin tags 
</li>
<li>Acne or oily skin
</li>
<li>Ovaries that are large or have several cysts
</li>
<li>Excess body hair (hirsutism)
</li>
<li>Male pattern baldness or thinning of hair
</li>
<li>Dark or thick skin patches at the back of the neck, in the armpits, and under the breast
</li>
</ul>


<strong>Diagnosis</strong>
<img src="https://www.nufertility.com/blog/wp-content/uploads/2023/11/Shutterstock_1835827393.png">

PCOS is diagnosed in the following ways:
To begin with, your healthcare provider will take your complete medical history along with your symptoms. Following that, you will have to undergo a thorough physical examination, especially of the pelvic region. This includes checking the reproductive organs closely. 
A few additional tests may also be ordered to confirm the diagnosis. These include:
Pelvic ultrasound: This test creates images of blood arteries, tissues, and organs using sound waves and a computer. It examines the size of the ovaries as well as the presence of cysts in them. It also provides information on the thickness of the endometrium (inner lining of the uterus). 
Blood tests: These tests provide information on the levels of androgen and other hormones in women. Additionally, it may provide information on blood glucose, cholesterol, and thyroid levels.


<strong>Treatment
</strong>
<img src="https://www.nufertility.com/blog/wp-content/uploads/2023/11/Shutterstock_1835827393.png">

There is no treatment available for PCOS as such. However, the symptoms can be treated and managed well. Infertility treatment caused by PCOS involves correcting ovulation issues and tackling metabolic problems, such as insulin resistance. If you have a BMI of 30 or above, your healthcare professional may advise you to lose weight by adopting a healthy eating pattern and regular exercise. 
If you don’t wish to become pregnant, hormonal birth control pills may be helpful. However, a few treatments that may help you ovulate and conceive include:
Medicines that stimulate ovulation (releasing an egg)
These medications work by stimulating the ovary to grow eggs. These are taken once a day for five days at the start of your menstrual cycle.
These drugs work quite effectively in helping women with PCOS to ovulate. However, these are started at the lowest possible dose and increased as needed, by your healthcare practitioner.
Insulin-sensitizing drugs
These medications are effective in women with insulin resistance - a condition where insulin fails to act in the body. These drugs aren’t first-line treatments for PCOS but can be used to encourage regular periods and ovulation. They may not be as effective as other treatments of PCOS in helping women to become pregnant but can stimulate ovulation. 
Hormone injections
These are injectable hormones that facilitate ovarian stimulation and ovulation. This treatment may require frequent doctor visits to monitor your body’s response to the drug.
Surgery
Surgery in the form of laparoscopic ovarian drilling is recommended for patients who do not respond to medications. Although rare, it may be an option.

<strong>Complications of PCOS</strong>
If left untreated, women with PCOS may be likely to develop serious health conditions such as
<ul>
<li>Type 2 diabetes mellitus</li>
<li>High blood pressure
</li>
<li>Heart diseases
</li>
<li>Sleep disorders
</li>
<li>Depression and anxiety
</li>
<li>Infertility
</li>
<li>Uterine cancer
</li>

</ul>

PCOS is a common hormonal problem in women of childbearing age these days. It affects the menstrual cycle and causes many symptoms. It is best to speak with a healthcare provider if you believe you are experiencing any PCOS-related symptoms. You can control the symptoms, reduce risk factors, and increase your chances of getting pregnant with the help of medical interventions and lifestyle modifications.
NU Hospitals located in Bangalore, India provides special effective treatment for PCOS by well-trained doctors to handle even the most delicate cases with expertise. If you are suffering from PCOS, or have any queries related to infertility, consult the specialist at NU Hospitals today!





<strong>After IVF failure: What next?</strong>
<img src="https://www.nufertility.com/blog/wp-content/uploads/2023/11/Shutterstock_1470930050.png">
If your first IVF cycle has failed, it may be useful to find out the reason behind its failure. It may have been due to the woman’s maternal age, cause and duration of infertility, history of previous pregnancies, male factor (sperm count and quality), and lifestyle influence. The younger the age of the woman, the greater is the possibility of an IVF to succeed. A woman in her 20s has 60-70% higher chances of conceiving in the very first in-vitro cycle. In case of a first-time IVF failure, your fertility specialist would generally recommend you to undergo another cycle because with every cycle, the chances of a woman to conceive become more. 
In case of two failed in-vitro cycles, the couple needs to undergo another cycle, after determining the cause of failure during the previous two cycles. However, a third-time IVF failure can only mean an underlying condition that is disrupting the in-vitro implantation, leading to repeated failure. In such cases, it is advisable to opt for a more specific and advanced pregnancy treatment.

<strong>Advanced treatments after multiple IVF failures</strong>
<img src="https://www.nufertility.com/blog/wp-content/uploads/2023/11/Shutterstock_1303695934.png">

Despite having recurrent IVF failures, there is still hope of conceiving with the other advanced treatment options now available. These pregnancy procedures can be carried out once your fertility specialist has analyzed your previous cycles to rule out the reason behind the IVF failure. 
<ul>
<li>Frozen embryo transfer:</li> FET is a procedure in which healthy embryos (blastocysts) from a previous in-vitro cycle are frozen and preserved for use at a later time. This technique is fast gaining popularity over conventional in-vitro cycles. 
<li>Intracytoplasmic sperm injection: </li>Often abbreviated as ICSI, this is an advancement in the conventional IVF procedure. During this procedure, the egg is directly fertilized by injecting with a single live sperm. ICSI is a good option for couples where the male suffers from male factor infertility. 
<li>Intracytoplasmic morphologically-selected sperm injection: </li>IMSI is another advancement in the traditional IVF procedure. It is similar to ICSI except that in IMSI, the sperm is first analyzed under high magnification to select only the sperm which has the best morphology. This procedure is helpful in case the male partner’s sperm has quality issues. 
Treatment of immunological causes of infertility before proceeding with the next cycle.
Preimplantation genetic testing of embryos for chromosomal abnormalities before embryo transfer.

With the latest medical advancements in the field of fertility treatment, it is now possible for a woman to conceive in spite of multiple IVF failures. However, it is important to let your fertility specialist run a battery of tests on you and your partner to ascertain the cause behind IVF failure. Your desire to become parents is no longer a dream!
NU Fertility at NU hospitals is the best place for IVF failure treatment in Bangalore, India. The fertility specialists here not only make it possible for you to conceive using IVF, but also rule out IVF failure reasons. Once the reason is known, they take you through the best possible treatment so that your wish of becoming a parent turns true. Visit NU Fertility in case you have any issues in conceiving through IVF as this is the best place for infertility treatment in Bangalore. 


<strong>Diagnosis of vaginismus</strong>

Your healthcare provider will ask you questions about your symptoms, medical, and sexual history. A pelvic examination can help determine if there are any other issues or the presence of muscle spasms. A topical numbing cream may be applied on the outside of your vagina prior to the pelvic exam to reduce discomfort.

&nbsp;

<strong>References:</strong>

1. Failed IVF Cycles: Reasons, What to Do Next, and Tips for Success. Grace Fertility. https://gracefertility.in/3-failed-ivf-cycles-what-next/. Accessed on 5 October 2023.
2. IVF Failure- Why Did My IVF Fail? The Fertility Foundation. https://fertilityfoundation.org/ivf-failure-why-did-my-ivf-cycle-fail/. Accessed on 5 October 2023.
3. Weathering the Storm: What to Do After Your First Failed IVF-When and How to Try Again? India IVF. https://www.indiaivf.in/blog/first-ivf-failed-what-next-when-to-try-again/. Accessed on 5 October 2023.
4. WHY DOES IVF FAIL? The Fertility & Gynaecology Academy. https://www.fertility-academy.co.uk/blog/why-does-ivf-fail/. Accessed on 5 October 2023.

Author: Dr. Sneha J
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