Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 151

1  Q1 What are polycystic ovaries? A1. Polycystic ovaries are ovaries in which there are more than the usual number of small cystic structures that contain eggs, otherwise commonly known as follicles. It is normal for there to be several follicles that are developing each month in a woman’s ovaries. In women with polycystic ovaries there are more than the usual number, and usually more than 20 in each ovary. Polycystic ovaries are detected by ultrasound which can be performed either with a probe in the vagina or a probe on the lower part of the abdomen.

2  Q2 What is polycystic ovary syndrome? A2. Polycystic ovary syndrome (PCOS) is a common condition in which women with polycystic ovaries also have other symptoms usually of irregular or absent menstrual cycles and also signs of excess androgen hormones leading to unwanted hair growth on the face and body, sometimes acne and occasionally thinning of the hair on the head. Women with polycystic ovaries often have an imbalance of the natural hormones that are produced by the ovaries with an excess of the androgen hormone testosterone, which is a naturally occurring hormone in all ovaries. Some women with PCOS have a tendency to gain weight in which case there is a concurrent elevation of insulin levels which has additional metabolic effects. Women with polycystic ovaries also have high levels of anti‐Müllerian hormone (AMH) as this correlates with the number of small follicles.

3  Q3 Can I have polycystic ovaries without polycystic ovary syndrome? A3. Approximately 20–25% of women have polycystic ovaries as detected by ultrasound scan; of these, three quarters have symptoms consistent with polycystic ovary syndrome. Therefore, it is possible to have polycystic ovaries without any symptoms of the syndrome. Symptoms can sometimes develop over time particularly in those who gain weight.

4  Q4 What are the implications of having polycystic ovaries if I am due to have IVF treatment? A4. Women with polycystic ovaries have a tendency to respond excessively to the drugs that are used to stimulate the ovaries and therefore there is an increased risk of ovarian hyperstimulation syndrome (OHSS). For this reason, a low dose of the stimulation drugs is used in a protocol that is designed to minimize the risk. However, if ovarian hyperstimulation does occur the treatment cycle is either discontinued or alternatively the eggs can be collected and fertilized and then the resultant embryos frozen for future use but not transferred in a fresh cycle. This enables the ovaries to settle down, minimizes the risks and also increases the chance of having a pregnancy.

5  Q5 Is IVF the only treatment for PCOS? A5. If you are wishing to get pregnant and have polycystic ovary syndrome it is important first to optimize your heath, body weight and nutritional status. If you are having irregular periods and therefore not ovulating regularly, we usually advocate the use of medication to stimulate ovulation, which has to be monitored carefully by ultrasound. It is only if this treatment doesn’t work that IVF might be considered as an option. IVF is sometimes required for women with PCOS or polycystic ovaries alone, if there are other fertility problems such as damaged or blocked fallopian tubes.