Polycystic ovarian disease (PCOD) is one of the most common hormonal disorders found in women of reproductive age. It is a condition characterized by irregularities in menstrual cycles, high levels of male hormones (androgens), and enlarged ovaries with multiple small cysts.
“Most women diagnosed with PCOD usually face fertility issues; for such cases, assisted reproductive technologies, wherein In Vitro Fertilization (IVF) is one of them, can be sought. Unique hormonal abnormalities found in PCOD cases require specific adjustments in IVF protocols, thereby optimizing the outcomes along with minimising the risk,” Dr. Nishi Singh, Head of Fertility, Prime IVF told Financial Express.com.
Understanding PCOD and Fertility Challenges
PCOD negatively affects the normal functioning of the ovaries and usually causes ovulatory problems. According to Dr. Singh, most women with PCOD undergo irregular ovulations that cause them to have irregular periods and difficulty achieving pregnancy.
“Increased levels of androgen in PCOD tend to have symptoms like excessive hair growth, acne, and thinning hair on the scalp. Hormonal imbalance has also disturbed the usual regulation of follicular development, which ends with immature follicles (cysts) forming instead of uniting and releasing mature eggs during ovulation,” he said.
Based on these conditions, women facing PCOD suffer from both anovulation as well as the risk of experiencing ovarian hyperstimulation syndrome (OHSS) related to receiving IVF treatment. Hence the IVF protocols required for a woman afflicted with PCOD need to be tailored to such specificities, he said.
Tailoring IVF Protocols for Women with PCOD
Ovarian Stimulation
Stimulation of the ovaries is one of the most crucial steps in IVF cycles. This medication stimulates both active ovaries to produce more than one egg. It is difficult to promote because women with PCOD often have hyper-responsive ovaries to hormones. Conventional stimulation invariably leads to hyper-response and also causes ovarian hyperstimulation syndrome (OHSS); which is when the ovaries are swollen and painful, and there is leakage into the abdomen, which is potentially life-threatening in some cases.
To mitigate the risk of OHSS, doctors often use a milder stimulation protocol, including:
- Low-dose Gonadotropins: Compared with the high-stimulation drugs for women without PCOD, the dose of gonadotropins, i.e. FSH and LH, is lower for ovarian response regulation.
- GnRH Antagonists: GnRH antagonists are used to avoid premature ovulation during stimulation which makes it possible to better manage the timing of egg retrieval.
- Monitoring Ovarian Response: Monitoring is done closely by ultrasound and blood tests to follow follicular growth and conduct dose adjustments if required.
Triggering Ovulation
Once the eggs have matured to an optimal size, a trigger shot of hCG (human chorionic gonadotropin) or sometimes a GnRH agonist is given to induce final egg maturation. In women with PCOD, precise timing is critical to prevent premature ovulation and ensure the eggs are retrieved at the right time.
Controlling Insulin Resistance
It has been reported that many of the women suffering from PCOD generally suffer from insulin resistance, which means that the body has a poor utilization of insulin. This effect can cause havoc within the ovarian microenvironment and aggravate the hormonal imbalance. Most of these women may be put on medications by their physicians, which results in lowered amounts of insulin and better ovulation. On the other hand, medicines are used before and during an IVF cycle for better response in egg quality and ovarian development.
Managing the Risk of OHSS
To avoid the development of OHSS, certain IVF centers may employ a dual trigger procedure, which involves the use of hCG and a GnRH agonist in triggering ovulation. This approach may help mitigate the risk of OHSS by favoring a more controlled and less stimulating ovarian response.
Moreover, the freeze-all strategy is one other method employed among women who have polycystic ovary disease (PCOD). Eggs are retrieved, and instead of immediately transferring embryos, they are frozen first before going for a frozen embryo transfer (FET) after which the ovaries are allowed enough time for recuperation as well as a minimized risk of OHSS.
Egg Retrieval and Embryo Transfer
Egg retrieval generally involves performing the procedure under sedation, after which fertilization of eggs is carried out in the lab. However in women with PCOD, the issue is the quality, not quantity, of eggs; hence, specific attention is given to selecting the healthiest embryos. After fertilization, embryos must undergo a few days of culture, after which the best embryos will be selected for transfer.
“Women suffering from PCOD are confronted with unique problems during IVF, ranging from ovarian hyperstimulation to issues of quality of oocytes and ovulation. For this reason, IVF protocols must be individually tailored to these considerations. Through the fine-tuning of ovarian stimulation dose, the selection of oral agents, the careful monitoring of ovarian response, and the adoption of these methods as dual triggers or freeze-all cycles, fertility professionals can contribute to minimizing the risks associated with the high rates of failure in PCOD patients to achieve success rates,” she told Financial Express.com.