PCOS treatment At Lalbagh IVF Centre

No prizes for guessing which is the most common women’s fertility condition that I encounter in my practice at Lalbagh IVF Centre, Bangalore. Yes, you’re right ! PCOS or polycystic ovarian syndrome. PCOS easily ranks number one among the causes for infertility. The common symptoms of PCOS include scanty, irregular or absent periods, hirsuitism, obesity , increased insulin resistance, obesity and acne. I am constantly asked by young women as to the causes of PCOS and it most commonly due to a hormonal imbalance and in many cases hereditary. Failing to conceive is the primary reason why I am approached by so many young women with PCOS, but I make it a point to counsel them that by managing PCOS early, they also minimize the risk of developing Type 2 diabetes in their middle age.

So, how do I go about treating patients with PCOS. After detailed history taking, we do a trans-vaginal ultrasound scan to see whether the ovaries have features of PCOS. We correlate the scan findings with the patient’s body mass index (BMI) and other symptoms such as ovulation history, acne, hirsuitism etc.  I also ask the patient to get a blood test done to investigate serum insulin levels and other hormones. Once I’ve established that the patient does have PCOS, we can start the treatment.

PCOS requires a multi-pronged treatment approach, the first line of treatment being Metformin medication. This coupled with weight loss and exercise works for many women. At Lalbagh IVF Centre, Bangalore, PCOS patients have the benefit of the combined experience of myself, Dr. Priya Chinnappa, a noted endocrinologist, and Dr.Lalitha Priya, a Nutritionist & dietician. We put the patients through the paces with a rigorous diet plan and simultaneous exercise regime.  In more severe cases and for those wishing to conceive, Laparoscopic Ovarian drilling is a great option with excellent outcomes.

To summarise, losing weight is essential – an hour of slow walking daily is a good beginning. Reducing fatty and carbohydrate foods and replacing them with fibre and protein rich foods is something all PCOS patients would benefit from. Be positive and follow your doctors advice.

Trans-Abdominal Cerclage @ Lalbagh Nursing Home & IVF Centre.

I recently had a case of a couple with three previous failed IVF cycles and one mid-trimester abortion. Mrs.S, conceived twins in her fourth IVF attempt with donor oocytes at our centre.

Despite having a cervical stitch (McDonald’s suture) in her last pregnancy, she had a mid-trimester abortion in 2012. For her current twin pregnancy, I recommended that she try Transabdominal cerclage procedure to prevent a repeat abortion, especially after her multiple IVF attempts.

Laparoscopic abdominal cerclage is a viable option for women with bad obstetric histories such as recurrent pregnancy loss or with conditions like short /absent cervix.

While a traditional cervical stitch is put transvaginally, abdominal cerclage is performed higher up, close to the internal OS. The advantages are :

  • Abdominal cerclage is more secure than a cervical stitch, especially later in pregnancy and for twins/triplets.
  • It minimizes the risk of vaginal infections.
  • Since the cerclage is done abdominally, the patient can contemplate future pregnancies.

I performed the abdominal cerclage procedure with my colleague, Dr. Anil Magdum, who had flown down from Mumbai, especially for this. After the procedure, Mrs.S. was advised complete bed rest along with other supportive medication. She delivered her twins pre-term by ceasarean section at 36 -2 weeks and her babies were in the NICU for ten days. My entire team at Lalbagh Nursing Home and Mrs.S. and her family were elated at the outcome.

Following this case, we had another patient, Mrs.M., with three previous abortions and cervical stitch put in the last pregnancy. Mrs.M. however, decided to get the Abdominal cerclage procedure done in the United States. After the procedure, I delivered her baby by ceasarean section at 37 + weeks at Lalbagh Nursing Home.

We were able to perform the Laparoscopic abdominal cerclage for our first patient, Mrs.S. at 1/5th the cost of what it does in the United States with a favourable outcome. Not to mention the visa process, long travel and stay involved.