IVF for Polycystic ovarian disease - PCOD
While many of us with polycystic ovarian disease will conceive with simpler treatment options, IVF still remains the fastest way of helping us to conceive quickly. However, IVF treatment for patients with PCOD is quite complicated and tricky but nothing is impossible.
While many patients with polycstic ovarian disease ( polycystic ovarian syndrome) PCOD will conceive with simpler treatment options, IVF still remains the fastest way of helping them to conceive quickly. However, IVF treatment for patients with PCOD is quite complicated and tricky, because superovulating PCOD patients can be quite difficult.
Because PCOD is not common in Caucasians, most IVF clinics in the US and UK do not have much experience in treating patients with PCOD. This often means that the pregnancy rates for IVF for these patients in these clinics is very low. This problem occurs because of two reasons: the difficulty in getting mature eggs; and the risk of ovarian hyperstimulation.
PCOD patients are hypersensitive to superovulation, which means that even though they do not grow eggs on their own, once they start growing eggs in response to the gonadotropin injections given in an IVF cycle, they grow too many. Many clinics monitor superovulation with E2 levels and ultrasound scans, and once the leading follicle reaches 18 mm, they trigger off ovulation. However, they often collect only immature eggs from patients with PCOD, because the majority of their follicles are still very small, with the result that they get very few embryos, and a disappointingly low pregnancy rate. Because they are very worried about the risk of OHSS ( ovarian hyperstimulation), they end up triggering off ovulation too early, as a result of which they collect only immature eggs, and achieve very low pregnancy rates.
Since PCOD is quite common in India, we have extensive experience in preventing OHSS, and have not needed to hospitalise a patient for this complication for the last 10 years. This is because we use a special technique during egg collection with a double lumen needle, which allows us to remove all the granulosa cells from each follicle at the time of egg retrieval, by flushing each follicle meticulously. Since these cells are the ones responsible for producing the chemicals which cause OHSS, by removing them we reduce the risk of our patients getting OHSS dramatically !
Many patients with PCOD will grow too many follicles (more than 25) , or have very high estradiol levels. Consequently, many clinics in the West are forced to cancel the IVF cycle, because of their fear of your developing ovarian hyperstimulation syndrome. (Remember that hyperstimulation cannot occur unless ovulation takes place. Thus, if the doctor withholds the HCG injection, there is no risk of developing hyperstimulation.) However, this means that your cycle gets cancelled and the treatment is wasted. Because of the special technique we use, we do not need to cancel these cycles, and can go ahead with egg collection, thus saving our patients a lot of money, and maximising their chances of conceiving.