PCOS AN ANCIENT FOE, AND LATEST MENANCE TO FEMALE FERTILITY, THAT HAS STOPPED MANY WOMEN FROM GETTING PREGNANT
You need to see her, she was very pretty, but also very large. I was surprised when she told me that she is only 24 years old, I was thinking she should be 32, but her size made my judgement wrong.
Tinu [not her real name] is a great gal, very jovial and lively person to be with, however she is suffering from infertility. She has been married very early in her life, at age 20.
Of course coming from an affluent family, no body associated her obesity with any medical condition, it was thought to be an evidence of good living. However when she tried getting pregnant and remained infertile for long, she decided to go for a fertility check up.
One of those reasons brought her to me. After undergoing a Transvaginal Scan, I immediately noticed she has a peculiar ovarian problem called Polycystic Ovarian Syndrome [PCOS].
Polycystic Ovarian Syndrome is a problem in which a woman,s hormones are out of balance.
Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinizing hormone (LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus.
PCOS is surprisingly a very common condition affecting as many as 1 in 15 women, often symptoms begin early in their teen years. The good thing is that treatment can help control the symptoms and prevent long-term problems.
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CAUSE:
The exact cause of PCOS is not known, but it is thought to be hereditary and in the genes. That is why we cannot talk about prevention , because we cannot really isolate the cause.
The principal features of PCOS are obesity, anovulation, irregular or absent menstruation, infertility, hirsutism, acne, and excessive amount of androgenic hormones [masculinisation]
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DIAGNOSIS
Not all women with PCOS have polycystic ovaries (PCO), nor do all women with ovarian cysts have PCOS, although pelvic ultrasound especially Transvaginal Ultrasound is a major diagnostic tool, it is not the only one. The diagnosis is straightforward using the Rotterdam criteria, even when the syndrome is associated with a wide range of symptoms.
Standard diagnostic assessments:
[1] History-taking, specifically for menstrual pattern, obesity, hirsutism, and the absence of breast development. A clinical prediction rule found that these four questions can diagnose PCOS with a sensitivity of 77.1% (95% confidence interval [CI] 62.7%–88.0%) and a specificity of 93.8% (95% CI 82.8%–98.7%)
[2] Gynaecologic ultrasonography especially Transvaginal Ultrasound, specifically looking for small ovarian follicles . These are believed to be the result of disturbed ovarian function with failed ovulation, reflected by the infrequent or absent menstruation that is typical of the condition.
In normal menstrual cycle, one egg is released from a dominant follicle - essentially a cyst that bursts to release the egg. After ovulation the follicle remnant is transformed into aprogesterone producing corpus luteum, which shrinks and disappears after approximately 12–14 days. In PCOS, there is a so called "follicular arrest", i.e., several follicles develop to a size of 5–7 mm, but not further. No single follicle reach the preovulatory size (16 mm or more). According to the Rotterdam criteria, 12 or more small follicles should be seen in a ovary on ultrasound examination. The follicles may be oriented in the periphery, giving the appearance of a 'string of pearls'. The numerous follicles contribute to the increased size of the ovaries, that is, 1.5 to 3 times larger than normal.
[3] Laparoscopic examination may reveal a thickened, smooth, pearl-white outer surface of the ovary. (This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the ovaries in this way to confirm a diagnosis of PCOS).
[4] Serum (blood) levels of androgens (male hormones), including androstenedione, testosterone and Dehydroepiandrosterone sulfate may be elevated The free testosterone level is thought to be the best measure, with approximately 60% of PCOS patients demonstrating supranormal levels. The Free androgen index of the ratio of testosterone to sex hormone-binding globulin (SHBG), is meant to be a predictor of free testosterone, but is a poor parameter for this and is no better than testosterone alone as a marker for PCOS, possibly because FAI is correlated with the degree of obesity.
[5] Some other blood tests are suggestive but not diagnostic. The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone) is greater than 1:1, as tested on Day 3 of the menstrual cycle. The pattern is not very specific and was present in less than 50% in one study. There are often low levels of sex hormone binding globulin, particularly among obese women.
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Common assessments for associated conditions or risks
[1] Fasting biochemical screen and lipid profile
[2] 2-hour oral glucose tolerance test (GTT) in patients with risk factors (obesity, family history, history of gestational diabetes) and may indicate impaired glucose tolerance (insulin resistance) in 15-30% of women with PCOS. Frank diabetes can be seen in 65–68% of women with this condition. Insulin resistance can be observed in both normal weight and overweight patients.
For exclusion of other disorders that may cause similar symptoms:
[1] Prolactin to rule out hyperprolactinemia
[2] TSH to rule out hypothyroidism
[3] 17-hydroxyprogesterone to rule out 21-hydroxylase deficiency (congenital adrenal hyperplasia). Many such women may appear similar to PCOS and be made worse by insulin resistance or obesity, but they can be greatly helped by adrenal suppression with low-dose glucocorticoid therapy.
[4] Fasting insulin level or GTT with insulin levels (also called IGTT). Elevated insulin levels have been helpful to predict response to medication and may indicate women who will need higher dosages of metformin or the use of a second medication to significantly lower insulin levels. Elevated blood sugar and insulin values do not predict who responds to an insulin-lowering medication, low-glycemic diet, and exercise. Many women with normal levels may benefit from combination therapy. A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is consistent with insulin resistance. A mathematical derivation known as the HOMAI, calculated from the fasting values in glucose and insulin concentrations, allows a direct and moderately accurate measure of insulin sensitivity (glucose-level x insulin-level/22.5).
[5] Glucose tolerance testing (GTT) instead of fasting glucose can increase diagnosis of increased glucose tolerance and frank diabetes among patients with PCOS according to a prospective controlled trial .While fasting glucose levels may remain within normal limits, oral glucose tests revealed that up to 38% of asymptomatic women with PCOS (versus 8.5% in the general population) actually had impaired glucose tolerance, 7.5% of those with frank diabetes according to ADA guidelines.
TREATMENT OPTIONS
Since the cause of PCOS is not know, the treatment options becomes complex.
However taking care of the symptoms have always been the best way to go. For instance obese patients with PCOS are advised to lose weight , this will help with insulin resistance and diabetes symptoms, including improving fertility hormones.
Other medical treatments such as using hormones or ovulation inducing drugs including ovarian drilling have assisted PCOS sufferers who are usually infertile to get pregnant.
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JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria, offer comprehensive infertility screening tests for both couples like Transvaginal Scan for uterine and ovarian functions,Ovulation/follicular tracking, HSG to evaluate the fallopian tubes, blood tests for hormone check, semen analysis etc. We also offer a simple assisted reproductive procedure like INTRAUTERINE INSEMINATION [IUI].
For accurate assessment of your fertility situation, contact us at JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria.
For FREE Consultation and FREE Counseling. Also for Quality and Accurate Medical Diagnostic Tests Contact
JOAS MEDICAL DIAGNOSTIX
JOAS MEDICAL DIAGNOSTIX-------WE ARE AN ULTRAMODERN MEDICAL IMAGING CENTER. WE ARE EXPERTS IN ULTRASOUND SCAN SERVICES, 3D/4D COLOUR DOPPLER SCAN SERVICES, X-RAY/RADIOLOGY SERVICES, ECG SERVICES, INFERTILITY SERVICES, HSG SERVICES, LABORATORY SERVICES,BLOOD BANKING SERVICES , DNA SERVICES, AND HEALTH CONSULTANCY/COUNSELLING SERVICES.
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Bolorunpelu, Ikotun, Lagos
Postcode: 100265
Nigeria.
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