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| IVF for
Polycystic ovarian disease - PCOD |
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.
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