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If you’re looking into In-Vitro Fertilisation (IVF) as a choice for your family, no doubt you’ve been flooded with information on the process. Success stories, horror stories, scientific articles, opinion pieces, much of it conflicting with one another. It can be confusing and frustrating to sort through all the information. Dr Parul Agarwal, Senior Fertility & IVF Consultant & Gynaecologist, Cloudnine Hospital, Noida, simplifies it, “IVF treatment is an Assisted Reproductive Technology (ART) that involves the process of a woman’s egg being retrieved from her body and fertilised in a lab. Once the embryo grows, it is returned to the woman’s uterus or frozen for use in the future.”

The Procedure

Since IVF is a long and complicated procedure, it works differently for everyone considering age, health of the couple, and various other issues that doctors explain beforehand. “IVF is a highly evolved process where you meet with specialists and undergo tests, you get injections, your follicles are stimulated, eggs are collected and embryos are created. Thereafter, embryos are transferred in the womb for their implantation. It takes time, hopefully not too much, but it differs for every couple because there are variables to consider. A few variables when it comes to IVF, are hormones, medication, sperm quality, egg quality, age of mother (or age of donor), and more. Sometimes your doctor will tweak a few variables to yield a different result,” explains Dr Parul.

Dr Parul Agarwal

IVF Affects You And Your Partner

In a typical IVF protocol (if ‘typical’ exists in a procedure like this), a woman will have ultrasounds and injections. She’ll experience side effects that range from bloating to nausea to fatigue, not to mention all the changes that will come with pregnancy and birth. Dr Sanjay Makwana, Senior IVF & Endoscopic Surgeon, and Director, Vasundhara IVF Hospital, Jodhpur, adds, “What perhaps does not get said enough is the impact it has on the partner. They aren’t going through the physical experience, but they are affected emotionally and psychologically. They, too, experience the highs and lows of the process, and can feel drained, discouraged, inadequate, frustrated and anxious. Often partners want to fix the problem and want to be supportive and feel useful. Working through the peaks and valleys together can be tremendously helpful for both parents. After all, parenting begins the moment you make any conscious effort to care for your own health in preparation for enhancing your child’s conception.”

Dr Sanjay Makwana

Alcohol Can Greatly Reduce Your Chances of Success

Factors including age, health of parents/sperm/eggs, sleep, stress and caffeine can affect the IVF outcome. One of the biggest negative contributors is alcohol, and not just for women; men’s consumption can also seriously impact success too. While you’re undergoing IVF, and even for a few months before starting the procedure, it’s best to seriously limit your alcohol intake.

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Preconception Health Is For Men, Too

Women are given lots of information about preconception diet and health, be it through magazines, healthcare practitioners, friends and family. Men are typically not given the same information. Dr Haritha Rao, Director & HOD – Fertility & Reproductive Medicine, Ayaansh IVF Hospital, Bengaluru, says, “It is simply assumed that if a man can ejaculate, he can get a woman pregnant. But a single sperm makes up half of the embryo that develops into a baby. It makes sense that the man’s health is just as essential to IVF success as the woman’s.

And it helps to be a healthy man! Alcohol and smoking negatively impact sperm health, and so do stress, obesity, low exercise, heat exposure, and poor diet. In fact, many of the recommendations given to women for preconception can be applied to men. This includes stress management, moderate exercise, a nutrient-dense diet with supplementation where appropriate and abstaining from (or seriously limiting) smoking and alcohol.

Dr Haritha Rao

One May Need IVF Even After Having Conceived Naturally

Many people think that if they’ve conceived without assistance once, it will happen again. But that isn’t always the case. Secondary infertility can be traced to either partner or both partners. About 1/3rd of the cases originate in women and about 1/3rd originate in men. In the remaining 1/3rd, the cause is due to a combination of factors or isn’t known. Increased age, complications from prior pregnancy, increased weight, medications, sexually transmitted diseases, impaired sperm production, alcohol abuse and smoking are all examples of secondary infertility in men and women.

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Causes of secondary infertility in women include:

• Problems In The Quantity Or Quality Of Eggs

Women are born with a limited supply of eggs and are unable to create new eggs after birth. As women approach their 40s and beyond, the number of eggs in their ovaries decreases and the remaining eggs have higher chance of chromosomal problems. For women where age isn’t a concern, there are other reasons that they might have a low number of good quality eggs, including autoimmune or genetic conditions and prior surgery or radiation.

• Problem With Fallopian Tubes

The fallopian tubes which carry the eggs from the ovaries to the uterus can become blocked due to pelvic infections such as chlamydia or gonorrhoea.

• Problem With The Uterus

There are many conditions related to the uterus that can cause secondary infertility. Scarring can occur during a dilation and curettage (D&C) or caesarean delivery that can create adhesion inside the uterus interfering with future pregnancies.

• Fibroids Or Polyps

These are benign (non-cancerous) growths inside the uterus that can impair pregnancy. A retained placenta can cause infection and uterine scarring.

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• Endometriosis

Endometriosis is a condition where tissue that normally grows inside the uterus grows elsewhere in the body, such as on the ovaries or bowel surfaces. While endometriosis is common, not all endometriosis causes infertility.

• Polycystic Ovary Syndrome

This is a hormonal disorder characterised by longer-than-normal or infrequent menstrual periods. A woman with this condition has an excessive number of male hormones, and the ovaries fail to release eggs regularly.

• Weight Gain Or Other Lifestyle Changes

Weight gain can lead to ovary dysfunction in some patients. Certain diets or medications may affect fertility.

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Causes of secondary infertility in men include reduced levels of testosterone, which plays a key role in sperm production. Testosterone levels can decline due to ageing, injury to urinary or genital organs, or certain medical conditions like genital infections, thyroid diseases, or diabetes.
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Polycystic ovary syndrome (PCOS) is a disorder that doctors associate with an imbalance in female sex hormones. The imbalance can lead to a variety of symptoms and may affect a woman’s fertility.

What Is PCOS?

Every month, in women of childbearing age, tiny fluid-filled cysts known as follicles, develop on the surface of the ovary. Female sex hormones, including estrogen, cause one of the follicles to produce a mature egg. The ovary then releases this egg, and it breaks out of the follicle.

In women who have PCOS, there is an imbalance in female sex hormones. The imbalance may prevent the development and release of mature eggs. Without a mature egg, neither ovulation or pregnancy can occur. This hormone imbalance may also include an abnormal increase in testosterone, which is primarily a male sex hormone. Note that women also produce testosterone, although it is usually in small amounts.

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Causes Of PCOS

Experts do not know exactly what causes PCOS, but it may involve genetic factors. If a woman’s mother or sister has the condition, she has a higher chance than others of developing it.

Additionally, excess insulin in the body also increases a woman’s risk of developing PCOS. Insulin is a hormone produced by the pancreas, and it is used by the body to convert sugar present in food into energy. Notably, women with PCOS often have insulin resistance. Insulin resistance is the body’s inability to lower blood sugar levels correctly. Blood sugar levels can become too high, which causes more insulin production.

Too much insulin further increases testosterone production, which leads to some of the symptoms of PCOS.

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Symptoms Of PCOS

Not everyone with PCOS will have the same signs or symptoms. Also, PCOS symptoms can occur at any age or time during a person’s reproductive years. Symptoms can also change over time. Some of the most common symptoms of PCOS include:

• Abnormal hair growth on the face, chest, or back
• Acne or a darkening of the skin
• Weight gain
• Thinning hair on the head
• Infertility
• Irregular periods
• Ovarian cysts
• Depression
• Increased skin tags

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How PCOS Affects Fertility

Dr. Dakshayani Ravikumar, Clinical Director, Art Fertility Clinics, Chennai, says that the effects of PCOS on fertility can be different from person to person.

• Ovulation problems are usually the primary cause of infertility in women with PCOS. Ovulation may not occur due to an increase in testosterone production or because follicles on the ovaries do not mature.
• Even if ovulation occurs, an imbalance in hormones may prevent the lining of the uterus from developing properly to allow for the implantation of the mature egg.
• Due to unbalanced hormones, ovulation and menstruation can be irregular. Unpredictable menstrual cycles can also make it difficult to get pregnant.

Dr Dakshayani Ravikumar

Other Complications Of PCOS

Infertility is often one of the main complications of PCOS, but it is not the only one. Dr. Dakshayani lists the health conditions that women with PCOS are at a greater risk for than others:

• High cholesterol levels
• High blood pressure
• Heart disease
• Diabetes
• Weight gain
• Sleep apnea
• Depression and anxiety
• Poor body self-image
• Endometrial cancer

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When To See A Doctor?

“Anyone who is having difficulty becoming pregnant should speak to a doctor, who will be able to explain the various treatment options. Anyone who is concerned that they are unable to become pregnant or who has symptoms that may indicate PCOS, should see a doctor,” advises Dr. Dakshayani.

Even if a woman does not wish to become pregnant, getting an early diagnosis of PCOS can help prevent complications. Assessment for PCOS can help target treatment and improve the chances of conceiving. “If a woman does become pregnant, it is also essential to know if PCOS is present, as studies have found a higher risk of pregnancy complications with PCOS, such as gestational diabetes, premature delivery, and high blood pressure,” adds Dr. Dakshayani.

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PCOS Diagnosis And Treatment

There is no specific test to diagnose PCOS; doctors make a diagnosis based on several factors. Tests may include a physical exam, knowing medical history, blood tests for hormone levels and glucose levels, and an ultrasound scan.

PCOS treatment can increase the chances of conceiving in those who wish to become pregnant. It can also help people manage their symptoms. Since symptoms vary from individual to individual, treatment is not always the same. Options also depend on whether or not the woman wishes to become pregnant.

Dr. Dakshayani shares treatment options for PCOS symptoms:

• Birth control pills to help correct hormonal imbalances
• Insulin-sensitising drugs to improve the body’s use of insulin and testosterone production
• In the case of diabetes, medication to control blood sugar levels
• Exercise and healthful eating to help boost overall well-being and control weight
• Maintaining a healthy weight can help reduce insulin and testosterone levels and improve symptoms

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Fertility Treatment For PCOS

If a woman with PCOS wishes to become pregnant, the doctor may prescribe medications to regulate menstrual periods and encourage ovulation. “Surgery may be an option if the medication does not improve fertility. One surgical procedure is laparoscopic ovarian drilling, in which the surgeon makes small cuts in the abdomen and inserts a needle. Electric current is used to destroy a small amount of tissue that produces testosterone in the ovary. Decreasing testosterone levels may allow regular ovulation to occur,” explains Dr. Dakshayani.

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Tips For Increasing Fertility

Below are some lifestyle tips that can help increase fertility.

• Weight Management

Losing excess weight may help balance hormone production and increase the chances of ovulation and pregnancy. People with a low weight who have difficulty conceiving may want to see their doctor as well, as this may be another risk factor for infertility.

• Stress Management

Long-term stress can affect hormones. For example, ongoing stress can increase cortisol in the body, which may trigger a rise in insulin production. High insulin levels can lead to an imbalance in female sex hormones and infertility. Finding healthful ways to manage stress may also boost fertility. Tips for managing stress include getting regular exercise, balancing work and home life, spending time with friends and family, and getting enough sleep.

• Dietary Changes

For some people with PCOS, a low glycaemic diet may improve symptoms and fertility. This type of diet involves eating fewer foods that cause a spike in blood sugar levels, resulting in lower insulin levels and less testosterone production.

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Other Factors That Affect Female Fertility

PCOS is only one of the many possible causes of female infertility. Some other common reasons include the following.

• Endometriosis: A growth of uterine tissue outside of the uterus can also lead to infertility, especially when it develops in the fallopian tubes.
• Structural Problems: A problem with the structure of the fallopian tubes or other parts of the reproductive system can make it difficult to become pregnant.
• Fibroids: These noncancerous tumors in the uterus can cause fertility problems by preventing implantation.

However, many women with fertility problems, including PCOS, can become pregnant with medical help. The first step to take to increase the chances of pregnancy is for an individual to see a doctor and get an accurate diagnosis. By doing this, they can start treatment as soon as possible.

Couples whose attempts at parenthood do not succeed are already stressed and PCOS can only add to it. Our experts today are here to assure couples that there is no reason to despair as there is a way forward. In today’s discussion with our four medical experts, we take a look at an issue that affects almost 20% of the women in India – polycystic ovarian syndrome or as we know it, PCOS – and how it affects those couples who are looking at becoming parents via IVF. They help us understand the causes of this syndrome, how to identify it, the need to seek medical help and the lifestyle changes that will help.

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As we started learning about PCOS, Dr Shital Punjabi, Founding Director at Shashwat IVF & Women’s Hospital, Ahmedabad, shed light on how it is a syndrome and affects the woman’s body from head to toe. Some of the symptoms she mentions are crankiness, irregular and scanty periods, and weight gain among other things. At a later stage, she says, the girl might face problems in conceiving if PCOS is not addressed in time. A revelation she has is that it is not necessary all girls suffer from this syndrome or that all who do experience all the symptoms, these are just indicative of the fact that medical intervention is needed.  

Moving forward Dr Krithika Devi, Senior Consultant at NOVA IVF Fertility MRC Nagar, Chennai, clears the fact that women who have PCOS need not worry about becoming mothers, since it is possible. Couples often conceive naturally too, if the woman has PCOS. Even with IVF, the success rate is fairly good. “The most common medical issue seen with women with PCOS during an IVF treatment is ovarian hyperstimulation. That is, the body produces a lot of eggs, which might lead to abdomen pain and discomfort. The positive part is there are many eggs to work with, based on their quality,” she elaborates.

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Half the battle is won when the woman is already aware of the condition is getting it treated. Dr Kalyanai Shrimali, Senior Consultant Reproductive Medicine at NOVA IVF, Indore, points out that awareness is a wonderful way to start. “The IVF treatment is always teamwork between the couples and the consulting doctor. We always counsel the couple for lifestyle changes that will help. Of course, these can’t happen overnight, but the willingness and drive to do it will improve the chances of success,” she says. She also mentions that PCOS increases the stress hormones, so any positive lifestyle changes will help reduce stress levels and improve the ability to conceive.

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As is understood, counselling of the couples who are already stressed about becoming parents, is extremely crucial in such cases. Dr Hitendra Somani, Director at Nirmal IVF & Test Tube Baby Centre, Bhavnagar, says that he advises couples to address basic issues life stress, diet, lifestyle and addiction issues, if any. “Eventually, couples do become pregnant, but the ride is a bit bumpier than usual, due to PCOS, so they have to be very careful in avoiding complications and adhering to the medication schedule,” he says. In this entire journey, the most important person who needs to be by the side of the woman is the life partner. “The partner and family members must understand that the lady is not only going through physical stress but also a lot of emotional upheaval, and she needs support most at this time.”All the doctors agreed on the fact that PCOS can be treated and will not form a major hindrance if it is caught young, and addressed properly. They also suggested that the best way to address it is with the help of a medical practitioner and appropriate lifestyle changes for the long term.

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