PCOD - Symptoms, Causes & Conceiving with it

Fertility For Women Over 40 | Medicover Fertility

As a woman gets older, getting pregnant becomes harder. Moreover, as she crosses 40, she experiences many changes in her life. Advanced age comes with a fair share of hurdles and adjustments. Your eyesight suddenly begins to weaken. You don’t have the energy that you once used to have. You feel that your body is failing you. You become susceptible to medical conditions such as blood pressure, diabetes and heart problems. Your hair begins to grey at a more rapid pace. Moreover, to top it all your fertility reduces. However, the desire to have a baby becomes stronger.

• What is advanced maternal age (AMA)
• Why does fertility decrease with age
• The risk associated with AMA
• What can be done to increase the chances of pregnancy in older women
• What are the treatment options for advanced maternal age
• How can medicover fertility help women to conceive in their advanced age
• What is geriatric pregnancy
• What age is high risk to have a baby with a genetic problem
• Is advanced maternal age high risk

WHAT IS ADVANCED MATERNAL AGE?

Advanced maternal age (AMA) or advanced reproductive age is a term used to define women who conceive when they are 35 years or older. With advanced age, there is a trend of decreasing fertility, as the quality and quantity of eggs deteriorate. A woman not only finds it difficult to get pregnant, but the chances of miscarriage also increase. Moreover, if also she conceives, it would be a high-risk pregnancy.

As we know the ‘Reproductive Age’ of a woman starts with her first menstrual cycle at around the age of 12 or 13, and it continues until her last periods, i.e., until the onset of menopause. So, with advancing age, her fecundity (fertility) starts declining, that means she doesn’t remain fertile throughout her life. So, elders in the family always focus on saying that there is a right age to have a baby, and the best time to have a baby is 25 – 35 years.

However, nowadays, the concept of delayed parenthood is slowly increasing. More couples are pushing past the 35 years age mark before they start a family. Many women are planning a second pregnancy after 35. The number of women who are planning their first child after 40 has also significantly increased over the last decade. While getting pregnant at 40 has its own risk, but age does not appear to be a barrier to parenthood any longer. Older couples do not think twice when they decide to have a child past their prime. All thanks to advances in fertility treatment like IUI, IVF, ICSI, and they can also opt for egg freezing.

WHY DOES FERTILITY DECREASE WITH AGE?

Ageing of eggs–With age, according to female fertility age chart, the remaining eggs in a woman’s ovary also ages. Aged eggs are exposed to DNA damage, and hence they are not suitable for fertilisation, and if also they fertilise the resulting embryos won’t be able to implant in the uterine lining.

Gynaecological problems – It is common to find damaged fallopian tubes, uterine fibroids and endometrial polyps in older women which in a way can also affect a woman’s fertility.

A decrease in libido – With age libido or longing for sexual relations declines. Moreover, the male partner also advances in age and older men, the sperm quality declines.

RISKS ASSOCIATED WITH ADVANCED MATERNAL AGE

When a woman has reached advanced maternal age and is thinking to start a family, then the key to a healthy pregnancy will be to consult a doctor and have a thorough medical check-up, mainly if she has some underlying health conditions (hypertension, diabetes, thyroid problems), because conceiving with health issues will have a direct effect on the developing baby. If one is overweight, then it is time to follow a strict healthy diet and an exercise regime before planning a pregnancy.

Getting pregnant at 40 risks – There are some risks associated when a woman plans her pregnancy at an advanced age, which she needs to be aware of and consider minimising the risk factors. A female is born with a fixed number of eggs, and as she ages the quality and quantity of eggs available significantly decreases, thus reducing fertility. The incidence of medical conditions like diabetes and hypertension also increases, and this, in turn, increases pregnancy complications. The risks associated are:

• CHROMOSOMAL ABNORMALITIES There is an increased risk of having babies with genetic abnormalities like Down syndrome in advanced age because an older woman faces a high risk of having eggs with structural problems. Which means that the eggs have a defect in the way they are formed. These eggs may not fertilise easily. If even they do fertilise, the survival rate will be low and would result in a miscarriage. If the fertilised egg develops into a baby, then there is a risk of the baby suffering from some congenital disabilities which could be developmental, physical or mental.
• SPONTANEOUS ABORTION/MISCARRIAGE The risk of miscarriage increases as a woman ages, because of the presence of chromosomal abnormalities in the egg. Poor-quality eggs and chronic health conditions together like hypertension, diabetes increases the risk of miscarriage (Miscarriage Meaning in Hindi).
• PREGNANCY COMPLICATIONS With advanced age, the risk for pregnancy complications increases like:
  • Ectopic pregnancy Maternal age increases the risk of developing an ectopic pregnancy.
  • Preeclampsia High blood pressure during pregnancy can lead to a pregnancy complication called preeclampsia, which if not controlled, can lead to multi-organ failure.
  • Gestational diabetes This kind of diabetes only happens during pregnancy. And is characterised by the presence of high blood sugar during pregnancy, and results in birth of larger than average size babies. After delivery, this condition usually goes on its own.
• STILLBIRTH Due to pre-existing health conditions and pregnancy complications the risk of stillborn or loss of pregnancy increases in an older woman.
• PRE-TERM DELIVERY The risk of premature delivery increases in women of older age group. Because with age pregnancy complications increase like high blood pressure, and reduced blood supply to the uterus, thus restricting the growth of the baby. Therefore, early delivery may be required.
• CONCEIVING TWINS/TRIPLETS The risk of multiple pregnancies increases with age. As the ovarian reserve starts to decrease with age, the body signals the ovaries to release more eggs, so the chances to conceive with twins or more increases.

WHAT CAN BE DONE TO INCREASE THE CHANCES OF PREGNANCY IN OLDER WOMEN?

Advanced maternal age group women find it difficult to conceive or may take a longer time to get pregnant. So, there should be an advanced maternal age pregnancy guideline, where a woman is explained the do’s and don’ts before planning a pregnancy.

Fertility starts declining after the mid-’30s and plummets when a woman reaches 40 years. To know how to boost fertility in your 30's or 40's or to increase the chances of pregnancy in older women, we recommend them:

• To lead a healthy lifestyle, reduce stress and start with prenatal vitamins like folic acid and DHEA supplements. DHEA (Dehydroepiandrosterone) is a hormone that is known to improve the quantity and quality of eggs, thus reducing the chances of miscarriage.
• Counselling the patient on the awareness of the effect of age on fertility is essential.
• A woman who is older than 35 years should receive evaluation and treatment after six months of failed attempts to conceive.
• Also, in women older than 40 years, immediate evaluation and treatment are needed.
• A pre-conception check-up is necessary, and during the consultation, a detailed family history of the couple is taken. If during investigations chronic health conditions are found, they should be managed well medically as these can lead to a high-risk pregnancy.
• A woman above the age of 35 should have a genetic counselling to know the risk of having a baby with genetic abnormalities. With advanced maternal age, Down syndrome is the most common congenital disability, and a woman’s chance of having a baby with Down syndrome increases with age. At age 35 the risk is 1:350, at age 40 it is 1:100, and at age 45 it is 1:25. So in advanced maternal age mothers, genetic testing should be done to find out the odds of having a pregnancy with any genetic abnormality.

WHAT ARE THE TREATMENT OPTIONS FOR ADVANCED MATERNAL AGE?

Conceiving naturally – Fertility declines with age, but the rate at which it declines increases with age. So, a woman under 30 years have 25% chance of getting pregnant naturally in each cycle, above 30 years the chances come down to 20%, and by 40 years, the possibility of getting pregnant naturally each month comes down to 5%. The only drawback of trying to get pregnant naturally, or opting for the best fertility foods while trying to get pregnant, after 40 is that it can take a while, or not happen at all as fertility starts declining at a steady pace. So, if you have been trying for a while and have not been successful, it is advisable to visit a fertility consultant. Because with age, the ovarian reserve reduces, and the quality of eggs also becomes poor, which can lead to infertility.

Conceiving with ART (Assisted Reproductive Techniques) – At an advanced age, each day matters. So, resorting to assisted reproductive techniques may increase the chances of pregnancy. After a brief period of ovulation induction, IVF can make the optimal use of the limited eggs left in the ovary. Provided the matured egg retrieved in that specific cycle is of good quality. Moreover, for women for whom ovarian stimulation to retrieve good quality eggs have failed, then IVF with donor egg should be considered. A donor of younger age with a matching profile of the woman is selected. Donor egg/Donor embryo IVF treatment can also be helpful for women who have had their menopause to conceive successfully. If associated with medical comorbidity, Surrogacy can also be an option for advanced age group mothers.

HOW CAN MEDICOVER FERTILITY HELP WOMEN TO CONCEIVE IN THEIR ADVANCED AGE?

Medicover Fertility clinics are among the top fertility clinics in Europe now in India. With state-of-the-art technology and technical expertise of doctors, we have been helping older women in planning a pregnancy.

The concept of delayed parenthood is slowly increasing. Careers get preference and accumulation of assets is a priority. Family planning takes a back seat. The theory that most people follow now is about securing themselves financially before they have a child. That way, they can give the child all the comforts and necessities of life. So, this has resulted in couples to plan a pregnancy at an advanced age.

So, the cases of infertility are on the rise due to work-related stress, irregular eating habits, reduced ovarian reserve and ageing eggs. However, motherhood now does not have to be limited to younger women only. Advances in fertility treatments have helped many older women to conceive successfully.

PCOD - Symptoms, Causes & Conceiving With It

Polycystic Ovary Disease (PCOD full form) is a condition in which the ovaries develop cysts. These are not functional cysts which disappear over time but cysts that tend to occupy a large area of the ovary resulting in enlarged ovaries. These cysts also interfere with the way the ovaries function.

The cysts in the ovaries disrupt the menstrual cycle and cause fertility problems by hindering ovulation. Today a large number of young women are affected by cysts in the ovaries as well as hormonal imbalances resulting from the presence of cysts. This has led to infertility, and the growing concern for this condition stems from the difficulty of conceiving. At some point in their life, every woman wants to have a child, and this is when the condition of PCOD becomes an inconvenience. Thankfully today, fertility treatment offers solutions for women suffering from PCOD. Having a baby is no longer something impossible or a big challenge.

What Are Cysts?

Cysts are sacs filled with a fluid-like substance. There are different kinds of cysts, and most of them are non-cancerous. Cysts can be classified into two main types. The most common are functional cysts, and these usually appear around the menstrual cycle. Functional cysts are non-harmful and tend to disappear by themselves after a few months. They form during ovulation when the follicles, instead of disintegrating, close up again with some fluid inside them. If a woman has too many functional cysts, the doctor may recommend oral contraceptives for a few months to prevent ovulation and allow the cysts to disappear. The non-functional cysts do not disappear by themselves and may cause some irregularities in the normal reproductive cycle. Some no-functional cysts can even be cancerous.

Polycystic Ovaries

The term poly means many, and hence polycystic ovaries mean many cysts in the ovaries. Sometimes when there are many cysts in the ovaries, it can interfere with the normal functioning of the ovaries.

The presence of cysts in the ovaries causes it to malfunction in a number of ways. During the reproductive cycle, the ovaries produce oestrogen and progestogen. However, when there are many cysts in the ovaries, it encourages the production of higher levels of androgen instead of oestrogen. Oestrogen is the female hormone, and androgen is a male hormone. Androgen is found in very small quantities in the female body.

The increased amount of the male hormone androgen encourages certain changes in the female body. A woman may find that there is hair growth in unusual areas like the chest and face. This is very similar to that of a man.

The greatest fear and cause for concern among women diagnosed with PCOD is infertility that is associated with it. For an Indian woman, her fertility defines the woman that she is. It is her most prized possession. Considerably, the value of a woman on the marriage market reduces when she has fertility problems. In fact, she may have to compromise when settling for a groom.

The polycystic ovary syndrome cause isn't well understood but may involve a combination of genetic and environmental factors. Symptoms of this polycystic ovary include menstrual irregularity, acne, excess hair growth and obesity.

Treatments usually include birth control pills to regularise periods, a medication called metformin to prevent diabetes, statins to control high cholesterol, hormones to increase fertility and procedures to remove excess hair.

What Is PCOD Problem?

Although, a uniform definition of PCOD does not exist because of the varied reasons behind its causes. However, the most commonly accepted definition of what is PCOD problem is is that it is a condition that is caused due to the imbalance of female sex hormones in women of reproductive age. The ovaries are part of the female reproductive system, along with the fallopian tubes, uterus and vagina. Ovaries contain a lifetime supply of eggs. These eggs are immature and are stored in tiny fluid-filled structures called follicles.

Our pituitary gland, located at the base of the brain, produces hormones that direct the functions of ovaries. Each month, the gland secretes Follicle Stimulating Hormone (FSH) and Luteinising Hormones (LH) into the bloodstream. After these hormones reach the ovaries, several hundred immature eggs start to mature, expanding the size of the follicles. As the eggs mature, the follicles secrete estrogen (the main female sex hormone). Once the amount of estrogen in the blood reaches the certain level, the pituitary gland sends a surge of Luteinising Hormones (LH) to the ovaries, causing the most mature follicle to open and release its egg in a process called ovulation.

The free egg travels through the fallopian tubes, where it awaits fertilisation. Eventually, the remaining immature follicles and eggs dissolve. If the egg is not fertilised, the egg and the lining of the uterus (endometrium) are shed during the next menstrual period.

In case of the PCOD problem in females, the pituitary gland may release an abnormally high amount of Luteinising Hormone into the bloodstream, disrupting the normal menstrual cycle. As a result, the follicles do not mature and ovulation does not occur, which can lead to infertility. Some of the immature follicles do not dissolve and remain as fluid-filled sacs called cysts.

Additionally, the doctor may also find increased insulin (a hormone produced by the pancreas) levels in women affected with PCOD. Too much insulin levels, combined with high levels of Luteinising Hormone (LH) can lead to the excess production of male sex hormone called testosterone in the ovaries, that prevents ovulation, lead to infertility and also cause many of the physical changes in women like abnormal facial hair growth, acne, etc.

Causes Of PCOD

There is not much information on the exact reason why women develop polycystic ovaries and the factors that induce it. To a large extent, polycystic ovaries have been linked to genetics. Researchers believe that if the mother has cysts in the ovaries, the daughter has a higher probability of suffering from a similar condition.

Conditions such as hormonal imbalance due to lifestyle factors can also lead to a disruption in the menstrual cycle, anovulation and malfunction of glands are also believed to be possible causes of PCOS. Other factors like obesity and an excess of fatty tissue can aggravate the hormonal balance by encouraging a higher production of oestrogen. Overactive adrenal glands result in the increased production of androgens. Androgens are the male hormone and disrupt ovulation.

What Is Ovulation?

Every cycle the female body undergoes a regular process of releasing the Follicle Stimulating Hormone (FSH) which encourages the maturation of an egg in the ovary. When the egg is mature, the LH hormone takes charge of the final step when the follicle opens, and the egg is released into the fallopian tube. Ovulation is the process of the egg being released into the fallopian tube and waiting there for male sperm to fertilise it. Ovulation is an important step for pregnancy to take place. While the egg is in the fallopian tube, it can be fertilised by the male sperm, which is the first step of pregnancy. In short, Ovulation refers to the release of an egg during menstruation in females. Part of the ovary called the ovarian follicle discharges an egg. The egg is also known as an ovum, oocyte, or female gamete.

Role Of Hormones In Ovulation

Your hormones play a very vital role in the process of ovulation. For ovulation to take place without a hitch, the hormones need to be perfectly balanced and work in sync. There are mainly 4 hormones that are very important for the maturation of the follicle and the final ovulation to take place. Follicle Stimulating Hormone (FSH): The FSH is released by the pituitary gland to stimulate the follicles to start maturing the egg it contains. This starts immediately after the menstrual cycle and marks the beginning of the next cycle.

• Oestrogen : Oestrogen is known as the female hormone. At the start of the menstrual cycle, the level of oestrogen is low. The oestrogen level in the body increases as the time for ovulation nears. The increase of oestrogen informs the pituitary gland and the hypothalamus about the presence of a mature egg.
• Luteinizing hormone (LH) : As soon as the oestrogen informs the pituitary gland and the hypothalamus about the egg maturation, the LH is released. This is known as an LH surge, and this hormone causes the follicle to open and the egg to be released. It takes about 24 to 36 hours for the release of the egg from the follicle after the LH surge. Once the egg leaves the follicle, it travels straight to the fallopian tube where it will wait for fertilisation.
• Progesterone : As soon as ovulation takes place, and the egg is released into the fallopian tube, there is a rise in the progesterone hormone level. The follicle from which the egg was released is called the corpus luteum, and this is responsible for releasing the progesterone hormone. The function of the progesterone hormone is to prepare the uterus for the possibility of implantation. The endometrial lining thickens and gets ready to receive the embryo.

If the egg is fertilised and an embryo is formed the corpus luteum will continue to produce the progesterone hormone until implantation takes places and the placenta begins to perform its function.

Generally, the hormones work in harmony and ovulation takes place as scheduled. However, with altered lifestyle factors and the presence of other chemicals in the body, it can create a disruption in the proper functioning of the hormones, which in turn affects ovulation and fertility.

Symptoms Of PCOD

There are some characteristics of PCOD problem symptoms, which might bring about the awareness that smoothing is not quite right. The symptoms of PCOD usually appear gradually, and it is a while before a woman realises that things are not the way they should be, and she should visit the doctor. Some of the obvious PCOD symptoms are:

• Acne
• Irregular periods or absence of periods
• Excessive and unusual hair growth
• Weight gain
• Pelvic pain
• Mood swings
• Infertility – not able to get pregnant

Even though these are the symptoms of PCOD, it is not necessary that all women who have PCOD will suffer from the same symptoms. The symptoms vary from person to person and hence, it is difficult to tell at the onset of the problem that you might have PCOD. Some women may just have irregular periods and no other symptoms. Some women may have some of the other symptoms but no acne. It is not necessary that all women will have all the symptoms if they have PCOD.

Women with PCOD are insulin resistant. This is due to the fact that they have high levels of insulin in their blood. It also makes them susceptible to becoming diabetic.

The most common symptom of PCOD, which is obvious right from the start is an irregularity in the menstrual cycle. If your periods are getting delayed and sometimes do not come for 45 days or longer, you need to take note. Some women may experience exceptionally heavy bleeding. This could also be accompanied by severe abdominal cramps. Heavy bleeding occasionally, even with pain, is acceptable, but when it seems to be happening every cycle, this is a cause for concern and needs medical attention. Sometimes a woman may find that her period is very light. Scanty periods, if it seems to be happening continuously, means that there is something wrong with your menstrual cycle. Some women stop having their periods for several months at a stretch. Any problem with your periods should be reported to a doctor immediately.

Your periods are linked to your fertility. It is a sign of ovulation. Sometimes you can have your periods without ovulating. This happens if there is a problem with your ovaries, which is usually the case with women who have cysts in their ovaries. Keeping track of your menstrual cycle is important not just for getting pregnant but for your fertility health as well.

How Is PCOD Diagnosed?

There are several tests to diagnose PCOD. Some of the PCOD tests to diagnose it based on the symptoms of PCOD are:

Medical History: Menstrual periods, weight changes and other symptoms are observed by the doctors.

Physical Examination: The doctors measure blood pressure, body mass index (BMI), waist size, checking areas of hair growth, etc., in women with symptoms of PCOD.

Pelvic Exam: An examination for the enlargement or swelling of ovaries by the increased number of cysts is performed.

Blood Test: Blood test is done to check for hormone androgen and glucose levels.

Transvaginal Ultrasound: It is one of the main tools to diagnose PCOD in women.

The images found on the ultrasound, along with the result of blood tests, medical, physical and pelvic examination, and thorough patient history is analysed for the diagnosis of PCOD.

Treatment Of PCOD

There are different kinds of PCOD problem treatments, depending on the symptoms. Even though it can be treated, it is not curable.

The main aim of treating Polycystic Ovaries Disease is to

• Regulate the insulin levels
• Reduce androgen levels
• Balance the hormone levels

PCOD problem solution can be regulated through medication and by controlling the diet. Losing weight through exercise and a healthy diet is an essential initial step for PCOD treatment. Weight regulation helps to restore the insulin levels, hormonal balance and reduce the fatty tissue in the body. Weight loss is recommended through a regimental exercise routine and strict diet control.

Medication to induce ovulation is prescribed by the doctor. This medication is hormone-based and increases the required hormone levels in the body, which will help the ovaries to mature the follicles. This overcomes the problem of lack of ovulation faced by women with PCOD. Anti-androgen medication is prescribed for women who have a very high level of androgen production. This helps to reduce the hirsutism and limit the excessive hair growth on the face and body.

Most women who suffer from PCOD also experience irregular periods. The menstrual cycle can be regulated through medication, which also induces ovulation. Birth control pills are recommended to some women to regulate the menstrual cycle. This is okay for women who are not keen on an immediate pregnancy. For those women who are trying to get pregnant taking birth control pills is not advisable as it takes a few months for the effect of the contraceptive to wear out from the body.

Getting Pregnant With PCOD

Women who have polycystic ovarian disease face difficulties in getting pregnant with PCOD or PCOD pregnancy after 30 due to a number of factors. But the most prevalent one is that it hinders conception due to the lack of ovulation. Women with PCOD usually do not ovulate. The lack of ovulation means there is no mature egg released by the ovaries, which can be fertilised by the sperm.

IVF is the best and most highly recommended fertility treatment for ovulation disorders. The treatment comprises of inducing ovulation to mature the eggs. These eggs are retrieved directly from the ovaries through an egg aspiration procedure.

The egg and sperm are fertilised in the lab to avoid any risk of conception, not taking place. After a few days, the best embryo is selected and transferred to the mother uterus in a procedure called embryo transfer.

Geeta and Anuj were devastated to learn that she had PCOD problem after marriage and would not be able to conceive naturally. Anuj was very fond of children and was looking forward to having some of his own. A friend told Geeta about fertility treatment. Anuj was very excited. They booked an appointment, went for the prescribed tests and started treatment as soon as they could. Excitement turned to disappointment when Geeta’s IVF cycle failed. They were not ready to give up. After several tries and failures, they came to Medicover Fertility the IVF speciality clinic. They learnt about Medicover from a newspaper article in the Navbharat Times which raved about the high quality of fertility treatment. Treatment at Medicover was a wonderful experience, and they were happy to have a nice doctor who apprised them of the progress at each stage. They felt good to be involved in the treatment decision making and know what was happening. Finally, Geeta was pregnant, and this was a period of true excitement for them.

PCOD Fertility Treatment At Medicover Fertility

Medicover is a leading fertility clinic in Delhi and has a number of centres around North India. Medicover is a specialised fertility clinic with a very high success rate. It uses advanced technology fertility treatment to ensure that women with all kinds of severe fertility problems like PCOD and many other conditions are able to conceive successfully.

Medicover Fertility imbibes European standards and offers patients an international level of treatment and facilities. Each Medicover Fertility Clinic in India is equipped with the latest technology facilities and infrastructure. Medicover has a team of highly qualified in-house fertility doctors.

Conclusion

Although PCOD is a condition of hormonal imbalance and has no exact cure, still the patient’s life can be normalised by managing its symptoms and causes. Today with the advanced technology, modern diagnostics and treatment processes, women with PCOD have even successfully conceived. If a woman is suffering from PCOD problems and is unable to conceive due to it, even after several attempts, contacting Medicover Fertility by calling us at +917862800700 can help her improve her conception chances and deal with PCOD as well.

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