If you name a hormone disorder in young females, PCOS comes first. In addition to its common occurrence, the syndrome is surrounded by controversies, often these are regarding its evaluation and treatment. IVF for PCOS women need special care and monitoring as they have the tendency of hyperstimulation. GnRH agonists are one of the most appraising discoveries for IVF treatment. The pretty latest addition of GnRH antagonist in clinical practice has supplemented the ovarian stimulation in IVF.
What is PCOS?
It is a hormonal imbalance as a result of the ovaries secreting male hormones. Ovaries generate and release excessive levels of androgens. These hormones create imbalance in reproductive status of female. As a result, Women with PCOS regularly have erratic menstrual cycles, missed periods and unpredictable ovulation. Small cysts might also additionally broaden the problems. Regardless of the name ‘polycystic’ ovulation doesn’t happen. It is one of the reasons of woman infertility. It also is a risk factor for different health conditions.
What do hormones have to do with PCO?
Reproductive hormones are out of balance in PCO Women; this may cause hassle with ovaries. Situations like no longer having periods on time or no longer getting it at all are common. Body makes hormones to make various things happen. Some have an effect on menstrual cycle and are related to reproduction.
The hormone that plays function in PCOS include;
1. Androgens: It is a male hormone; however, women have them too. Women with PCOS have a tendency to have higher levels.
2. Insulin: This hormone controls blood sugar. If you have PCOS, body may not react to insulin the manner it should.
3. Progesterone: Body needs sufficient of this hormone to maintain pregnancy. There is a threat for early pregnancy loss with deficiency of progesterone.
What are the symptoms of polycystic ovarian syndrome?
The most common signs of PCOS:
Irregular periods: Abnormal menstruation includes missing periods or now no longer having periods.
Abnormal hair growth: Excess facial hair and heavy hair growth at the arms, chest and abdomen. This impact as much as 70% of girls with PCOS
Acne: PCOS can reason acne, specifically at the back, chest and face. This acne may maintain the teenage years and can be difficult to treat.
Obesity: About 80% of women with PCOS are obese or have obesity, and feature problem losing weight.
Darkening of the skin: Patches of darkish skin, specifically within side the folds of neck, armpits, and groin and below the breasts. This is known as acanthosis nigricans.
Cysts: Many girls with PCOS have small pockets of fluid of their ovaries
Skin tags: They are little flaps of extra skin. They are frequently determined within side the armpits or at the neck in girls with PCOS.
Thinning hair: People with PCOS many lose patches of hair on their heads or begin to move bald.
Infertility: PCOS is the maximum common reasons of woman infertility. Decreased frequency or loss of ovulation can bring about now no longer being capable of conceive.
IVF for PCOS – Antagonist v/s agonist protocols
Oligo-anovulation, hyperandrogenism/hyperandrogenemia, and polycystic ovaries visible at ultrasound are features of PCOS. It is a substantial reason of infertility and affected women look for assisted reproductive method for conception. As it occurs in 4-12% of the overall population their number is high in fertility centers. Evaluation of protocol is mandatory to avoid ovarian hyper stimulation syndrome (OHSS) in particular group of PCO patients.
Advantage of antagonists:
- Antagonists are the shorter duration therapy
- The shorter length of stimulation with Follicle stimulating hormone (FSH)
- Decreased chance of developing ovarian hyperstimulation syndrome (OHSS).
- The opportunity of triggering ovulation with a brief endogenous luteinizing hormone (LH) surge brought on with a GnRH agonist in place of HCG
- Long agonist protocol about 25 each day subcutaneous injections are wanted while antagonist calls for round five each day subcutaneous injections
Compared with recognized protocols, lengthy agonist and a couple of dose antagonists, for IVF in PCOS aim at reduction of OHSS prevalence. This reduces the cost of ICSI treatment. Number of oocytes retrieved, fertilization, implantation and being pregnant costs in are comparable in both protocols.
The use of GnRH antagonists in IVF for PCOS prevents of untimely LH boom, simpler and takes much less time. GnRH antagonist act inside some hours after their management, and that they may be administered in which simplest while there’s a chance for an LH surge. This is in contrast to GnRH agonist in which pituitary down regulation happens after 7-10 days.
Preference of Protocol in IVF for PCOS Women
Women with polycystic ovary syndrome are at high risk for growing ovarian hyperstimulation with exogenous gonadotropin. Both agonist and antagonist can suppress increased circulating LH concentration; however, the smaller follicular cohorts in antagonist cycles lessen the chance of ovarian hyperstimulation in girls with polycystic ovary syndrome who have a tendency to be excessive responders.
The lengthy GnRH agonist protocol is a traditional protocol, likely the maximum broadly used thru the sector even now. It has few cancellation cycles due to premature LH surge unlike in antagonist cycle. However, the chances of ovarian hyperstimulation are high due to recruitment of a larger cohort. Antagonist in the other hand, restricts the cohort size with exogenous ovarian stimulation.
Women receiving antagonist had been proven to have a decrease prevalence of ovarian hyperstimulation syndrome (OHSS). Assuming similar scientific results for the antagonist and agonist protocols, those advantages might justify an antagonist regimens. It ought to additionally be mentioned that the dose of HCG used for triggering very last oocytes maturation in 5000IU. Regarding OHSS incidence, the realization drawn within side the subject matter may not relevant in sufferers with PCOS in whom 10,000IU HCG is used for triggering very last oocyte maturation.
The antagonist protocol can be the favored stimulation protocol for PCOS affected person. Stimulation with antagonist protocol with ICSI treatment has less OHSS prevalence without compromising the the pregnancy outcome.