Polycystic ovarian Syndrome (PCO, PCOS, PCOD)

Polycystic ovarian syndrome (also called Stein-Leventhal Syndrome) is a hormonal disorder that affects approximately six to ten percent of women in the child bearing age group and is the major cause of infertility. During ovulation, the ovaries receive hormones from the pituitary gland. These hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), help the egg reach maturity in preparation to be fertilized. In women with PCOS, there is an abnormal level of LH being secreted. The overproduction of LH causes the ovaries to overproduce androgens. Increased androgen production produces high LH levels and low FSH levels, so the follicles are prevented from producing a mature egg. Thus the ovulatory process is not allowed to complete itself.

The partially-developed egg (inside its follicle shell) dies. Without egg production, the follicles swell with fluid and form into cysts, and it is these cysts that create polycystic ovaries. Without ovulation, progesterone is no longer produced, whereas estrogen levels remain normal. Although Polycystic Ovarian Syndrome presents itself during adolescence or the early adult years, women often do not know they have the disorder until after they attempt to conceive. No two women affected by PCOS have the same symptoms. Common characteristics associated with PCOS are:

PCOS is of 2 Types - Obese PCOS & lean PCOS

In Obese PCOS one usually encounters hyperinsulinemia and these patients benefit from weight loss, life style changes and use of insulinsensitizing drugs. In the lean PCOS patients, the condition is due to a genetic disorder where in there is increased production of LH which in turn produces hyperandrogenism.

Endometriosis can cause conception difficulty due to organ damage, low levels of a molecule specific to enhancing implantation, increased presence of peritoneal white blood cells, and dysfunctional immune system. Unfortunately, there exists no simple blood or urine test to detect this common affection of the reproductive organs; the only true diagnosis is via Laparoscopy, a fortunately simple, yet still surgical procedure.

Pelvic Inflammatory Disease and Sexually Transmitted Diseases

Pelvic Inflammatory Disease (PID) is the major cause of infertility worldwide. PID includes a variety of infections caused by different bacteria that can affect the uterus, fallopian tubes, ovaries, appendix, parts of the intestine that lie in the pelvic area, or, in the worst case, the entire pelvic area (peritonitis). The sites of infection most often implicated in Infertility are in the fallopian tubes, a condition known as Salpingitis. Although PID can be a result of nonsterile abortions, use of an IUD, or a ruptured appendix, most infections are caused sexually. Chlamydia Trachomatis is an infectious organism that cause 75% of Salpingitis cases.A study suggests that Chlamydial infection of the upper genital tract, even without severe inflammation, may cause a higher proportion of fallopian ectopic pregnancies than previously thought. Gonorrhea is responsible for most of the remaining cases. Severe or frequent attacks of PID can eventually cause scarring, abscess formation, and tubal damage that result in Infertility. The severity of the infection, not the number of the infections, appears to pose the greater risk for Infertility. About 20% of women who develop symptomatic PID become infertile. PID also significantly increase the risk of ectopic pregnancy.

Ovulation and Hormonal Disorders:

Given the intricate interaction of the hormones necessary for ovulation, It is not surprising that about 33% of Infertility cases can be traced back to ovulation and hormonal problems. They may result in the failure of the ovarian follicle to grow, an empty follicle, or entrapment of the egg so that it isn't released. Various medical conditions, as well as lifestyle factors such as excessive weight, eating disorders, smoking, or stress can change normal hormonal rhythm. Even slight irregularities in the hormonal system can result in ovulation disorder.

Fibroid Tumors

Benign flbroid tumors in the uterus are extremely common in women over 30. In some cases, they can cause Infertility by interfering with the uterine cavity, blocking the fallopian tubes, or altering the position of the cervix and preventing sperm from reaching the uterus. High levels of estrogen seem to stimulate the growth of fibroid tumors; heredity may also play a role in their development. Only those fibroids interfering with fertility require removal before ART procedures.

Premature Ovarian Failure (POF)

Sometimes referred to as “premature menopause”, is a loss of ovarian function in women under 40 years of age. Periods stop, estrogen is low, and the follicle-stimulating hormone (FSH) level is elevated. Some women may experience premature ovarian failure because of adrenal, pituitary, or thyroid deficiencies. Radiation therapy and anti-cancer agents may achieve a cancer cure at the cost of fertility by causing premature ovarian failure. Women with Turner's Syndrome, a rare genetic disorder, do not develop functional ovaries at all. A new test to find out the ovarian reserves can also be done. This is done by finding the levels of AMH in blood. Patients with low level of AMH are prone to develop POF.