Polycystic Ovarian Syndrome & Infertility

Fertility is the capacity to produce posterity and conceive. Human fertility depends upon various elements .A woman’s most fertile time is during ovulation. Ovulation occurs within 11th to 21st day of a woman’s cycle.  Infertility is a condition which is found in both men and women, and both of them are affected almost equally. Infertility in men and lady can likewise be treated with ARTs.

Women's health has been a long concern but nowadays it has reached an extreme point of concern. Normally women and men share similar health challenges the only difference is that the health of women deserves particular attention. There are biological processes such as childbirth and pregnancy that carry health risks and are the principal cause of death in young women between 15 and 19 years old in developing countries. The leading cause of death among women of reproductive age is HIV/AIDS which is due to biological factors and limitation of women’s knowledge about HIV and unsafe sex. Lack of contraception results in unwanted pregnancies, unsafe abortions, sexually transmitted infections, etc.

Gynecology and Obstetrics is the medical specialty that includes the two subspecialties of obstetrics and gynecology that is covering the health of the female reproductive systems (i.e.,vagina) and ovaries. Gynecology is the sub branch of medicine dealing with the administration of health care to women, especially the analysis and treatment of disorders affecting the women’s reproductive organs and it also deals with the study of diseases of the female reproductive surgery, including and issues related to reproductive hormones.

Polycystic ovary syndrome (PCOS) is a typical reason of ovulatory dysfunction. This disorder involves anovulation dysfunction and androgen excess of unclear etiology. Estrogen levels are raised, increasing risk of endometrial hyperplasia and, eventually, endometrial cancer. Androgen levels are regularly raised, increasing the risk of metabolic syndrome and causing hirsutism. Hyperinsulinemia occurs due to insulin resistance may be present and may contribute to increased ovarian production of androgens. The risk of cardiovascular disorders, including hypertension and hyperlipidemia. Polycystic ovary syndrome (PCOS) is a typical reason of ovulatory dysfunction. This disorder involves anovulation dysfunction and androgen excess of unclear etiology. Estrogen levels are raised, increasing risk of endometrial hyperplasia and, eventually, endometrial cancer. Androgen levels are regularly raised, growing the risk of metabolic syndrome and causing hirsutism.

Hypertension is the major medical problem comes upon during pregnancy, complicating up to 15% of pregnancies. Hypertensive disorders during pregnancy can be classified into 4 types such as Chronic Hypertension, Gestational Hypertension, Preeclampsia and Eclampsia. Hypertensive pregnancy disorders represent the important complications of pregnancy and contribute significantly to maternal , perinatal morbidity and mortality. The main aim of treatment is to prevent significant cerebrovascular and cardiovascular events in the mother, without compromising fetal well-being.

Reproductive Endocrinology and Infertility is belongs to the Department of Obstetrics and Gynecology. The research area is related to human reproduction including female and male infertility, assisted reproductive technologies. Those include reproductive surgery, endometriosis, uterine fibroids, polycystic ovary syndrome, developmental problems, and issues related to reproductive hormones. In vitro fertilization is also type of assisted reproductive technology which is used in infertility treatment.

Women face lots of health problems during pregnancy. These problems can involve the mother's health, the fetus's health, or both. Even women who were healthy before getting pregnant can face complications. These difficulties may make the Complications during pregnancy.

Some common complications of pregnancy listed the following.

Immune infertility has become a severe health issue involving 2 in 10 women under normal conditions; moreover, a woman with the polycystic ovarian syndrome has become very frequent. Semen that is known as the composite fluid which contains sperm, cellular vesicles, and other cell components, this semen could be a reason for sensitization of female genital tract. Iso-immunization is also associated with infertility. Numerous specific components of the regenerative system which do not represent in other body systems those many of are immunogenic efforts. The major advantage involved in the immunological approach of fertility is very effective or potential for women who are infrequent administration by a specialist's trained people who could deliver antifertility services.

Effective study about the PCOS gives that it is caused by abnormal functioning of hormones and by the metabolic endocrinological disorder. There are more research works are process on the investigation to find the exact a rise of the disorder and the partial way to sustain the further action worsened by the PCOS. The recent research work on plant product called Resveratrol- product obtained from the plant synthesis. Resveratrol has a property of Anti-oxidant most of the plants contain a type of phenol called phytoalenin  which obtained from plant tissues in response to invading fungus and stress and it also had a clinical feature of inflammatory properties it involves in the reduction of coronary heart diseases and it shows an effective work of fighting against cancer. Resveratrol drug is administrated into the systemic circulation of the women fighting with PCOS that may show an effective work against the hormonal imbalances. Evaluation can be done by taking the blood sample of the patient after 3 months of treatment for the determination of testosterone levels and other androgen hormone levels in the blood that which shows the development/ implementation of the syndrome. This defines the alteration of the implement. Taking natural diet like almonds, milk, and veggies can help to improve fertility and makes normal hormonal function.

Obstetrics is generally known as the branch that which deals with the study of pregnancy, childbirth and the postpartum period. Based on the consequent changes in the surgical methods it is combined with the Gynaecological department and it is fairly known as Obstetrics and Gynaecology as a surgical field. This field of obstetrics is correlated with gynaecological conditions like Polycystic ovarian syndrome (PCOS) which has a vast and varied relation with the women bearing pregnancy this PCOS consequence has an utmost effect on reproductive women. Women with PCOS can experience Gestational Diabetes, Preeclampsia. This leads to the maternal mortality the main causes of the maternal mortality are maternal bleeding maternal sepsis. There is no difference between symptoms and complication /Discomfort of pregnancy.

Polycystic ovary syndrome is the common endocrinopathy among reproductive-aged females in the all over the world, affecting approximately 6% of female patients. The pathophysiology of the disease is complex and there is no single defect from which it is known to result, it is hypothesized that insulin resistance is a key factors from asymptomatic to having multiple gynecologic, dermatologic, or metabolic manifestations. Advices from the Endocrine Society mentioned using the Rotterdam criteria for diagnosis, which mandate the presence of two of the following three findings—hyperandrogenism, ovulatory dysfunction, and polycystic ovaries and plus the exclusion of other diagnoses that could result in ovulatory dysfunction.

Stem cells are homogeneous cells which are capable of self-renewal (reproducing themselves) and distinguishing into different types of cells. The two main properties of stem cells are self-renewal and potency which allow them to differentiate into any kind of cells. As of late in 2004, two investigations demonstrated that ovaries do contain stem cells which form oocytes in grown-ups and that can be cultured in vitro into develop ones. Another investigation gave novel confirmation of endometrial recovery by stem cells in women who got bone marrow transplants. This finding has potential for the utilization in treatment of uterine disorders and has a potential for the use in treatment of uterine disorders. It also supports a new theory for the cause of endometriosis, which is a condition in which cells similar to those in the endometrium grows outside of it.

In vitro fertilization is a type of assisted reproductive technology which is used in infertility treatment or genetic problems and assist with the conception of a child. In IVF an egg is fertilized with sperm outside the body in a liquid medium in a specialized lab. The zygote goes through embryo culture for a period of 2–6 days, and then the specialist re-implants the embryos back into the woman’s uterus. This process intends to initiate a successful pregnancy.

Pregnancy is a special physiological condition where treatment of drug is an important concern as the physiology of pregnancy affects the pharmacokinetics of treatment used some medications can reach the fetus and harms them. Treatment for pregnant woman cannot be totally avoided since some may have chronic pathological situations that require continuous or interrupted treatment like asthma, epilepsy and hypertension.  New medical environments can develop, and old ones get worsen during pregnancy requiring drug therapy, which becomes a major problem for child bearing women to take medication whether prescription, over-the counter, or herbal medication.

Epidemiology

Epidemiology is the study and analysis of the distribution and factors of health and disease conditions in defined populations. It is in the basis of public health, shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare. Epidemiology has assisted to develop procedures which are used in clinical research, public health studies, and, to a lesser extent, basic research in the biological sciences.

Metabolic syndrome is most common in patients with polycystic ovary syndrome when it is compared with the overall population, and patients with polycystic ovary syndrome are four times more likely than the general population to develop type 2 diabetes mellitus.

Treatment of PCOS is individualized based on the patient's presentation and desire for pregnancy. For patients who are having overweight for them weight loss is recommended. Clomiphene and letrozole are first-line medications for infertility. Metformin is the first-line medication for metabolic manifestations, such as hyperglycemia. Hormonal contraceptives are the best treatment for irregular menses and dermatologic manifestations.