PCOS Treatments When Trying to Get Pregnant
PCOS or polycystic ovarian syndrome is a medical condition that can not only negatively affect the quality of your life, but it is also a known cause of infertility.
Fortunately, there are ways to treat PCOS, as well as treatments that will help you to fall pregnant even though you have PCOS.
Ovulation is the main issue to address when trying to fall pregnant when you have PCOS. You cannot fall pregnant naturally if you are not ovulating.
Treatments that help with ovulation
The treatment options available for PCOS that will also help you ovulate include specific medications available in tablet form, such as Femara and Clomid or Fertomid, which is medically known as Clomiphene citrate. Metformin tablets may also be used, and there are also injections available which might be prescribed with tablets or on its own. Beyond these treatments, artificial insemination, egg donation and IVF are examples of further options.
If you have PCOS and are taking medications to improve your chances of falling pregnant, it is crucial to rely on the expertise and experience of a qualified fertility specialist, who can monitor closely the effect of the tablets and/or injections. This is because women respond differently to the medications and injections.
Some women may not respond to a certain medication at all, or may just take longer to respond. Others may respond immediately and grow a healthy egg or two in the same cycle, ready to ovulate. Some women may over-respond, ovulating multiple follicles that could result in a multiple pregnancy. The aim is to ovulate one follicle, although two and maybe even three follicles might be accepted. There is also a risk of hyperstimulation, when the ovaries make too many follicles.
As a result, if you are taking meds or injections for ovulation, you should be monitored closely to ensure there is an adequate response and that this response is safe. If you’re not getting a good response from the medication, a different type of medication can be tried. If you’re getting an excessive response, and are at risk of having multiple pregnancies, a different treatment plan may be required. This is because a multiple pregnancy is very high-risk, with a much higher possibility of miscarriage and preterm babies.
Medications for ovulation
The tablets that are commonly prescribed for ovulation include Letrozole, which is commonly known by its trade name Femara. In the simplest terms, Femara is a medication that blocks the enzyme that tells the body to convert testosterone to estrogen. This triggers the body to produce a hormone called FSH, which is short for follicle stimulating hormone. This hormone tells the follicles (the little sacks containing the individual eggs) to grow and get ready to ovulate. Femara is more likely to stimulate the growth of one follicle versus multiple follicles. One of the very few side effects could be dizziness.
An alternative option might be Clomid, Fertomid or as it is called in medical terms, clomiphene citrate. In very simplified terms, this medication blocks the brain’s estrogen receptors, so it produces more follicle stimulating hormone (FSH), which stimulates more follicles to grow eggs. Clomid does tend to make more follicles grow, so there is a higher chance of having a multiple pregnancy. Some women also experience side effects such as hot flushes, headaches and moodiness.
Another medication that may be prescribed is Metformin, which is usually used to manage insulin levels. Metformin is not as effective as Clomid or Femara, but it may help with ovulation if you have PCOS. Your fertility specialist might also add Metformin in addition to Clomid or Fertomid.
Whether your fertility specialist prescribes Clomid or Femara for you, the tablets cannot be taken at any time – there is a window period during your cycle when it can be taken. Usually, for maximum benefit, a course of these tablets start on day 3 of your cycle, and is taken for five days. Usually on about day 11 of your cycle, an ultrasound will be arranged to monitor how you have responded and how many follicles (in which the little eggs grow) there are. The ideal is just one and certainly no more than three follicles should be acceptable to prevent the risk of multiple pregnancies.
If the response is acceptable, your fertility specialist will provide further medication to trigger ovulation. This medication starts maturing the egg/s and getting them ready to ovulate. The timing must be right, because if a follicle is still too small, the egg inside will be immature, and it may fail to ovulate and can also not be fertilized.
This process takes between 34 and 38 hours, so you will ovulate in around 36 hours. Because the time of ovulation is known, you will be able to have intercourse at the time you are ovulating, increasing your chances of falling pregnant significantly. Similarly, if an artificial insemination is required, it can be planned to fall within this time of ovulation.
If the response is not acceptable, your fertility specialist may recommend waiting a few more days, after which a new strategy may be implemented, such as adding in a few injections to boost the process, or to try again on the next cycle with only injections.
The injections are usually only a further step if the medication did not achieve the results. This is both because it is more expensive and time-intensive with self-administered injections and more scans, and also because it is very effective.
With the injection option, the treatment should start off at a low dose. You inject yourself every day for a few days, and your fertility specialist will also give you injections before beginning the scans.
The self-administered injections are designed to allow you to set the dose and has a tiny needle that is really not painful.
The other risk is that these injections are very effective and might see you with five or six growing follicles. In that case, switching over to IVF treatment should be considered seriously. If that is not an option, abandoning the cycle is highly recommended because the risk of having a multiple pregnancy is three times higher.
Further treatment options
These treatments are very effective to address ovulation as a crucial aspect of achieving a natural pregnancy. However, even with healthy ovulation, pregnancy is not guaranteed.
It is also important to remember that PCOS may not be the only fertility issue you may have as a couple. In as many as a third of fertility cases, there are more than one contributing factor.
As such, your fertility specialist will also check for other potential problems such as sperm quality, endometriosis or blocked fallopian tubes among many others possible contributing factors. Fortunately, all of these can be addressed through the range of fertility treatments available today.
We offer all these latest and most effective fertility treatments at Cape Fertility, and we believe in making quality fertility treatment affordable, while always striving for higher success rates.
Your next step to getting the right treatment for you for PCOS when trying to fall pregnant is simply to contact our team of fertility specialists by clicking here…
At Cape Fertility, we value each individual patient and we look forward to providing you with our signature individualised and personalised care!
A Step By Step Overview of the In Vitro Fertilisation (IVF) Process
“In vitro fertilization” or IVF treatments refers to a medical process that has helped millions of couples around the world to experience the joy of having their own babies. Practiced for more than three decades across the world, IVF is a safe and trusted medical treatment, and its success rate is impressive.
In the simplest terms, IVF can be described as a woman’s eggs being extracted, fertilized in a laboratory and returned to the uterus. However, such as simple description obscures the fact that IVF treatment is not a single procedure, but rather a process that involves a number of steps that span over a time period of 28 days.
This can be quite a daunting journey! However, however, when you undertake your IVF journey at Cape Fertility, you will enjoy truly individualised and personalised care from a team of fertility experts who will guide and support you every step of the way.
The Steps in the IVF Process
In short, we can summarise the steps during IVF treatment as follows:
* The first step is a course of fertility medications to stimulate egg growth, followed by careful monitoring.
* Next, the eggs are surgically removed from the ovary.
* In the lab, the eggs are mixed with sperm to be fertilized.
* Three to five days later, the fertilized eggs, called embryos, are transferred into the women’s uterus.
* The last step is a blood test to establish if a pregnancy has been achieved.
* Below is a full overview of the steps involved in a typical IVF treatment cycle at Cape Fertility and provides a realistic picture of the steps in the IVF process.
Step 1 – Fertility medications
The first step in IVF treatment is taking fertility medications to stimulate egg growth within the first two to three days of your cycle. These medications may include tablets or fertility injections containing FSH (Follicle Stimulating Hormone), which you can easily administer yourself.
During this time, you will also take medication to suppress normal pituitary function and prevent the eggs from being ovulated before it is time for egg collection.
Most women have no or minimal side effects. Possible side effects of fertility drugs are headaches, nausea, painful breasts, mood swings, bloated feeling and increased vaginal discharge. Serious side effects are rare, but the most common is enlarged ovaries. Fortunately, with modern medicine, this can be avoided in most cases.
Step 2 – Monitoring
The next step is carefully monitoring your IVF treatment cycle through blood tests and ultrasound scans, usually starting on Day 8 of your cycle.
On Day 8, you will have the first scan with your fertility specialist. Using an ultrasound scan, your specialist will be able to see the follicles containing eggs.
On Day 10 of your cycle, you will have a second scan to closely monitor the development of the follicles and any reactions you may have to the medication.
A third scan will be done on Day 12. If the eggs are ready for collection, you will have a trigger injection in the evening. The eggs are triggered for ovulation through an injection 36 hours prior to the egg collection.
Step 3 – Egg collection
Step 3 is an important milestone – this is when the eggs are retrieved. It usually happens on Day 14.
At Cape Fertility, the egg collection procedure is performed safely under sedation in our custom-designed procedure room. Under anaesthetic, you will not feel anything.
A transvaginal ultrasound is performed, and the eggs are extracted with a fine needle attached to the ultrasound.
Progesterone hormone is given after the egg collection to prepare the lining of the uterus (womb) for the embryo transfer. This may be given as a vaginal gel, pills inserted vaginally, vaginal pessaries, an injection or oral tablets.
Step 4 – Embryo development
In our laboratory, right next to our procedure room, the fluid collected is examined under a microscope to check how many eggs were retrieved. The eggs are then fertilized by mixing it with sperm.
For the next three to five days, the fertilized eggs – called embryos – are nurtured under controlled conditions in the laboratory. Thanks to new techniques of embryo culture, embryos can now be grown in the laboratory longer until they reach the blastocyst stage (on day 5 in the lab). These better quality embryos can be chosen for transfer into the uterus.
This means that fewer embryos – usually one or two – can be transferred with excellent success rates, while the chance of a multiple pregnancy is reduced. If there are more than two quality embryos, the others can be frozen (cryopreserved) and stored in liquid nitrogen to be used in future treatment cycles.
Step 5 – Embryo Transfer
The next step is a special occasion – the day the fertilised eggs (embryos) are transferred into the womb!
This embryo transfer is a painless procedure performed in our special procedure room at Cape Fertility. A speculum inserted into the vagina allows the specialist to visualize the cervix and a thin plastic tube is used to transfer the embryos directly into the uterine cavity. An ultrasound scan is performed to make sure the embryos are transferred into the correct place.
Step 6 – The pregnancy test
In a final step in the IVF cycle, a pregnancy test can be done around Day 28. It is a blood test and is done 14 days after the egg collection.
Support on Each Step of your IVF Journey
So many steps and procedures over so many days may seem a long and difficult journey.
However, at Cape Fertility you will find a team of world-leading fertility experts to support you every step of the way. This includes your highly qualified and well-experienced reproductive specialist and your own IVF co-ordinator, with a 4-year University Degree as Bachelor of Nursing (or equivalent) and many years of experience in fertility and IVF treatment. Your IVF co-ordinator will guide you through every one of the various steps of the IVF process, plan your treatment dates and monitoring, show you exactly how the medications should be taken and answer the practical questions you may have while offering advice and support.
All the procedures in the IVF process are done at our purpose-built premises in Claremont, in the beautiful City of Cape Town. Adjacent to our Main Reception and Staff Offices, we have an IVF Procedure Room, a modern, sophisticated Laboratory and an Embryo Transfer room. These facilities, along with our experienced team, ensure all the latest Assisted Conception Techniques, including IVF, are used with great success at Cape Fertility.
At Cape Fertility you will also find patient-friendly protocols, and your own customised step-by-step cycle sheet, describing exactly what happens during each step, and when and how each step must be completed – from the medications that should be taken to when the monitoring and pregnancy test needs to be done.
Your next step to IVF treatment is simply to contact us by clicking here…
At Cape Fertility, we value each individual patient and we look forward to providing you with our signature individualised and personalised care during every step of your IVF journey!
Treatment Options for PCOS
If you have been diagnosed with polycystic ovarian syndrome or PCOS as it is known, you will be glad to hear that there are a number of options available to treat this medical condition.
In this article we take a look at the treatment options ranging from lifestyle changes to specialised medicines and find out how to know which treatment is right for you.
What treatment options are available for PCOS
PCOS is actually an endocrine disease of the ovaries. It is also a chronic medical condition for which there is no known cure. However, like other chronic medical problems such as asthma or diabetes, it can be well managed over the long term.
The cornerstone of treatment for those with PCOS is weight loss. This treatment is prescribed for all women diagnosed with PCOS, whether they are simply managing their condition or if they are treating PCOS with the objective of falling pregnant.
The reason is simple: excess weight not only contributes to metabolic syndrome, it also adversely affects other crucial health factors, such as cholesterol, insulin levels and blood pressure. Furthermore, PCOS can also interfere with ovulation.
It is crucial to lose some weight to improve all these adverse health conditions associated with PCOS.
One way to know where you are at right now in terms of a healthy weight is the body mass index or BMI. The formula is BMI = kg/m2 where kg is your weight in kilograms and m2 is their height in metres squared. You can use an online calculator to work out your BMI.
A BMI between 18 and 25 is considered normal. A BMI above 25 is considered overweight while a BMI over 30 is considered obese, and above 35 – morbidly obese. The objective of knowing your BMI is to provide a starting point from which to improve over the long term.
At Cape Fertility, we usually aim for an initial target of losing 5% of your body weight and to reach a healthy BMI. So, if for example you weigh 100kgs, you might start off with an initial target of losing 5% of your body weight, or 5kgs.
Studies have shown that even losing just 5% of body weight is often enough to make a significant difference to PCOS symptoms. It will also be extremely helpful in terms of improving your cholesterol, your insulin levels and blood pressure, and its also potentially going to help you ovulate on your own, which will also increase the chance of conception.
Lifestyle changes to lose weight sustainably is the treatment prescribed for all women diagnosed with PCOS, whether they are simply managing their condition or if they are treating PCOS with the objective of falling pregnant.
It is particularly important for moms-to-be, not only to assist them to fall pregnant, but also to ensure that they go into a pregnancy in good health – with a normal BMI, and insulin levels, cholesterol and blood pressure all well controlled – improving the chances of a healthy pregnancy and a healthy baby.
Because weight loss is mostly achieved through eating correctly, you might want to consult a dietician. It is also important to find a form of exercise that you enjoy.
At Cape Fertility, we follow the recommendations provided by the European Society of Human Reproduction and Embryology or ESHRE.
ESHRE recommends decreasing your calorie intake by about 30%. Some of our patients use one of the many apps online to assist them in keeping track of what they are eating and understanding their intake of daily calories, so they can make improvements.
When it comes to exercising, one commonly cited goal is 10,000 steps a day. For women with PCOS who are reducing their weight, ESHRE recommends 250 minutes of moderate intensity exercise a week, which is about 50 minutes of moderate intensity exercise, five times a week. If you do more vigorous exercise, such as running or high intensity interval training, five sessions of 30 minutes each per week is recommended.
The next step is to bring your blood pressure and your cholesterol under control, and managing your insulin levels to avoid insulin resistance and Type 2 diabetes.
Losing weight and exercising, will definitely contribute to improving these health factors, further intervention – perhaps in the form of medication – may be required.
This is because there is another symptom of PCOS many women experience and that often requires treatment: prolonged and painful periods. With PCOS women often do not have regular periods – sometimes with two to three months between cycles. During this time, a thick lining builds up in the uterus, which means that the delayed period is heavy with lots of clots and extended – anywhere from 10 days to three weeks, before disappearing again for two to three months.
There are different options for treating irregular periods and the right option here will also depend on whether or not you are trying to fall pregnant.
Contraceptive pills, Provera, or a Mirena are among the first line treatment options for those who are not trying to fall pregnant.
There is a wide selection of contraceptive pills available and not every kind of pill will fit every woman. Some contraceptive pills will also reduce the level of androgens in the body, which will help clear up acne and decrease the rate of growth of excess body hair associated with PCOS. So, it’s important to talk to your doctor about this to find the one that works for you.
Provera, a form of progesterone, can be taken for about 12 days every month and is another possible treatment to ensure a regular period every month.
The Mirena is an intrauterine contraceptive device that is also used to treat abnormal bleeding. It can be fitted in a doctor’s room and it can stay for up to five years. Most women will actually stop having a period with a Mirena.
It is important to realise that these treatment options are not quick fixes – it is usually recommended that the prescribed treatment is followed for six months before adding further medication. This might include adding specific medication that decreases testosterone levels, blood pressure medication, or medicines to reduce insulin levels such as Metformin or Glucophage.
Fertility drugs are also effective, but this treatment should only be offered by qualified and registered fertility specialists and must be monitored very carefully.
Which treatment is right for you?
It is important to know that not all women with PCOS display all the symptoms, or even the same intensity of symptoms. In addition, some of the symptoms may be caused by a condition other than PCOS.
The only way to know for certain which PCOS treatment is right for you is to undergo the necessary tests and investigations at an accredited and recognised clinic, where a fertility specialist with state-of-the-art equipment and years of experience will be able to make a professional determination and provide you with the best advice for the right treatment to manage this chronic medical condition and even to achieve a pregnancy.
If you have been diagnosed with PCOS or suspect that you have PCOS, we would like to invite you to come and meet one of our specialists by clicking here…
At Cape Fertility, we value each individual person and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises in the beautiful city of Cape Town.