Infertility- Not A Self Invited Health Issue

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Infertility has become a major problem not only in India but throughout the world and for this, more and more infertility specialists have come up with the best possible techniques to treat such patients.

Some women live with the guilt of becoming infertile assuming doing themselves wrong. However, this is not true. Infertility can happen to any women and even men due to some health factors like hormones, low sperms, uterus, fallopian tubes which lays beyond our control. A good gynaecologist doctor will be able to tell you the exact reason of infertility after some tests and provide the best possible treatment.

It is very important that once you find out the problem of infertility, it is essential to get the treatment done as soon as possible to lower the risks and increase the chances of fertility. The best IVFdoctor in Delhi would be able to help you to conceive a baby through various assisted reproductive techniques like fertility medications, IU, IVF and many more.

You might not be able to detect the problem at all by yourself as infertility may not show any signs until you actually try to conceive. However, some may face problems with menstruation or get lower abdomen pain signifying some problem. If you get these issues regularly, then seeing a gynaecologist doctor in Delhi is must.

So ladies, infertility is a very normal health problem now and happens to every 7 women out of 10. Nevertheless, once you get to know the problem, the best possible treatment is a must. 

The Importance of Seeing a Reproductive Endocrinologist for Fertility Issues

Having a child is probably the best thing that can happen to a woman. However, it is not always so easy for a woman to get pregnant. It is for this reason that a woman with fertility problems need to seek medical assistance from an infertility specialist who is also referred to as reproductive endocrinologist (RE). While your gynecologist may attend to your reproductive health on a general basis, she may refer you to a reproductive endocrinologist in case she suspects that the reason you are not getting pregnant is due to some fertility issues. Usually a gynecologist carries out a number of treatments for about 6 months to one year before considering it time for you to see a reproductive endocrinologist or fertility specialist.

A fertility specialist particularly deals with the diagnosis and treatment of male and female fertility issues. These medical experts have studied academically about subjects such as obstetrics/gynecology and urology (andrology). The reproductive endocrinologists are also board-certified for medically practicing in the areas of infertility and reproductive endocrinology. The fertility specialist carries out diagnostic tests to see and understand the probable causes of infertility that affect a particular person. For many women, natural conception may not work. This may happen due to increased age or other health problems. The best infertility specialist in Delhi can not only find the specific issue that is giving rise to infertility with ease but also help in curing it. Some of the infertility problems that may affect a woman include the following:

•         Endometriosis
•         Polycystic ovarian syndrome (PCOS)
•         Problems with ovulation
• ·    Abnormalities with the fallopian tubes, ovaries and/or the uterus  

Many women try to get pregnant but experience repeated miscarriages. In such cases, the fertility specialist can diagnose the actual cause of such miscarriages. He or she then can guide the woman in choosing procedures through which further miscarriages can be avoided. If a woman has been recently diagnosed with cancer, then an infertility specialist can present with fertility consultancy for explaining all fertility treatment options that she may have. Such medical advice can increase the chances for a woman to have a healthy baby. For women who are above the age of 35 years and may find it difficult to get pregnant naturally, there is an option to get pregnant through assisted reproductive technologies or ART, such as IVF or in vitro fertilization. The fertility specialist can offer reliable guidance about all aspects of ART process and also provide information about other high end procedures.

In order to find a reliable fertility specialist, you can ask your regular gynecologist to refer you to one. The best gynecologist in Punjabi Bagh area of Delhi can direct you to a reliable fertility specialist who can take care of all your fertility health issues. If you are not sure whether the infertility problem is with you or your partner, you can ask your male partner to visit the fertility specialist as well to see if there are any issues with sperm production or sperm count.          

Process and risk of ICSI treatment! A blog by Dr. Ruby Sehra

Many of the infertile couples in current era don't know the process , advantage and disadvantage of the fertility treatments. Do consult Dr. ruby Sehra for any problem since she is the best Gynecologist in west Delhi.

Lets us talk about conventional medicine as it plays an important role and most of the time is the first treatment for a couple who for what ever reason cam not conceive after 1 year of unprotected sexual intercourse or can not carry the pregnancy to full term. Artificial insemination is defined as placing sperm of the male partner by using medical advance technological instrument into the female reproductive tract through a method other than sexual intercourse. It is used when the male partner is diagnosed with low sperm count and motility or when a woman is diagnosed with ovulation or cervical mucus problems. In this article, we will discuss Intra cytoplasmic sperm injection (ICSI) : definition, effects, and risks of conventional treatment.

1. Definition

Intra cytoplasmic sperm injection (ICSI) : definition, effects, and risks of conventional treatment. is defined as a fertility medical technique which uses a small needle to inject a sperm into the center of the egg.

2. What exactly is Intra cytoplasmic sperm injection (ICSI)?

It is only suggested to the infertile couple, if the male partner have low quality sperm including sperm count, motility, shape and inability of sperm in egg penetration or blockage in his reproductive tract. Under the microscope, the reproductive specialist withdraws a sperm and guides it to an mature egg by using a medical instrument called pipette, then injects the sperm into the egg. From there, the fertilized egg is allowed to develop in a laboratory for one to five days, before placing in the female partner uterus. The chance of fertility of Intra cytoplasmic sperm injection (ICSI) : definition, effects, and risks of conventional treatment. is as high as 50%

4. Risk

Althrough the ICSI has a success rate 50% to 80% for eggs fertilizing, it also increases the risk of
poor eggs or low quality of sperm.
a) Birth defect is around 1.5% to 3%
b) Miscarriage
c) Chromosome abnormality

Dr. Ruby Sehra has the best success rate. No doubt she is the best gynecologist in West Delhi.

Why you should chose best clicnic for ICSI treatment!

At the point when you guys know why ICSI is utilized for effective Infertility treatments. as a part of this example, it is to endeavor to deliver a higher measure of eggs that will get to be prepared. Do consult Dr. ruby sehra the best ICSI specialist in West delhi.

 The achievement rate for in vitro treatment techniques that incorporate intracytoplasmic sperm infusion have appeared, in a few studies, to be higher than that of IVF utilized alone. In the simple language it means  ICSI has better success rates if you fulfill a few factors.The ordinary purpose behind this is most times the ladies included were youthful and considered ripe.

A low quality or volume of egg creation is another reason that IVF ICSI techniques can be utilized. The achievement rate when managing this specific infertility issue is ordinarily lower. The fundamental deciding component on account of IVF methods is the feasibility and nature of the embryos that are exchanged.

The practicality and nature of these embryos relies on upon the nature of the eggs that are created. Whether the infertility issue is the generation of value eggs or the nature of the sperm, IVF and ICSI systems can build the odds of a couple having the capacity to consider a kid, much of the time.

You may be shocked to know that most of the clinics are way to smart than you may think. They will rip you apart while providing with bills. This is not it some of them even change the embryo with a different one if you have many failure's. While this not the case with Dr. Ruby Sehra's Cilainic. She is running the place with transparency since 22 years. That is quite an achievement if you ask me !  She is for sure the best ICSI specialist in West delhi.

A quick look on how exactly Embryo Cryopreservation works ?

World is changing rapidly so is Medical science. Humans have brilliantly analyzed their body by successful tests. The most advancing field is the Reproductive medical field. Times are gone when there where couples who had no child. Many specialist like Dr. ruby Sehra has quite impressive achievements in this field. She is one of the most experienced doctor in West Delhi. She handles her clients and patient with genuine care. I can guarantee she has the most transparent procedures available in Delhi.

Well let me tell you about how exactly Embryo Cryopreservation works ?

During the time spent during various IVF treatments , various developing Embryo might be made for better preceding implantation to guarantee that there are sufficient suitable ones. These are accessible at the season of exchange basically if the first attempt fails. Be that as it may, to stay away from the difficulty of high request different pregnancies, just such a variety of them can be embedded at one time. Alternate incipient embryo might be cryopreserved for future IVF medicines. The procedure includes these strides: 

Embryo Cryopreservation works

- The hearty Embryo is arranged and blended with a cryoprotectant which shields the inner Embryo from harm in the solidifying procedure.

- The blend is then put away in a dainty tube made of glass and set in a machine at a low temperature loaded with fluid nitrogen. Just suitable enough to freeze it.

- If the couple needs to utilize the remaining Healthy embryo for another IVF treatment, the tube is expelled from the fluid nitrogen and defrosted again .

- The Embryo is defrosted, the defensive liquid is evacuated, and the Embryo is then re-arranged for transfer.

This is exactly what it is ! Just see how simple and now you understand it pretty well.

In any case, I just want to remind you if you need any advice just consult Dr. Ruby Sehra the best gynecologist in West Delhi.

Various types of Infertility treatment - A blog by Dr. Ruby Sehra

Firstly, every infertile couple on this planet need to realize that this is 21st century. Science and technology has advanced drastically. This has led to various inventions which made impossible things possible. Times are gone when your in laws could curse you for not having a child. Times are gone when couples need to sit in front of T.v and parks watching other kids play. Yes you read it right! Times are gone. Every problem has a solution you just need to KNOCK THE RIGHT DOOR! Just like i did!

Now, Various types of treatments are available for curing any type of infertility issues. And Kudos to the Doctors and specialist like Dr. Ruby Sehra who has more than 22 years of experience in this field.

Let us talk about what exactly Cryopreservation is? It a technique of freezing tissues or cells that can be preserved to be used at a later on. These Cells are typically kept at essentially  ultra-low temperatures below - 1960C or 77K . The reason being at this very low temperature, any type of biological activities are restricted, including the biochemical reactions that would cause cell death, is effectively stopped. Hence the tissues can be stored for several years seriously like many years. This preservation can only be created by the use of cryoprotectants.

The cryoprotectants are normally used to shield the biological tissues from freezing so that the it wont get damaged from ice formation. They are just like cover withing a layer to protect the inner most part of the cell.They act like antifreeze by lowering the freezing temperature of the cell  and increasing the viscosity of the cell afterwards. A very few people know the procedure of the cryopreservation and you are one of them.

If you have any concern about infertility and you want have a genuine advice. Just , DONT THINK TWICE CALL Dr. Ruby Sehra, the best infertility doctor in Delhi.

How about doing exercise during pregnancy?

Why do we workout? To stay fit, active and immune against ailments. But some people have a common belief that they cannot stretch their body during pregnancy. It’s not true though. Working out always helps your body in any case, it’s just that the set of exercises differs according to situations. Pregnant ladies are asked to stick to bed and just ask for whatever they need. Due to this they get used to it and may find it difficult to come back to their normal form after giving birth to their child. It is very necessary for the body to be in motion.  

Exercises come with a nice package of benefits for you and your baby. But you can consume those benefits only if you continue to exercise throughout your pregnancy. Usually, only 5 to 10 percent of pregnant ladies exercise during pregnancy. Some couple of exercises is perfectly safe for both mother and her baby. Pregnant ladies should be given motivation to exercise more often throughout their pregnancy period. 

You don’t have to exercise rigorously being pregnant. Exercises are not hard to perform and the strength required is specific. You can train at a gym or with a personal trainer but make sure they are experienced enough with pregnant ladies. In fact you can search videos online and try it by yourself.

Some of the common benefits explained in brief:

Exercises reduce your stress and spike your energy levels. It helps you in lifting your body weight more efficiently. Your body gets prepared enough to meet the demands of labour. You will not get into pregnancy sickness and will be immune against other ailments. It also prepares your body for breast feeding and improves blood supply in your body and the baby’s too. Usually women gain weight after pregnancy but if you are regularly exercising, then you won’t get extra weight gains. You will also get into your normal body shape early. Exercises boost up recovery process; hence you will recover fast after giving birth, letting you get in with the daily routine as earlier. 

In case of any problem related to pregnancy you can consult to Dr. Ruby Sehra, a highly experienced and bona fide renowned gynecologist in Delhi.

Pregnancy should always be natural – a myth! A blog by Dr. Ruby Sehra

Humans have the tendency to give birth to children in order to continue the legacy of the family. We live in a country where some people have a developed false perception that after marriage, pregnancy is natural. They don’t know what it takes to be a pregnant lady. A lot of hurdles come in the path of pregnancy which is known by the mother itself. Giving birth to a baby is one of the most cumbersome jobs of womankind. 

It’s not always true that a woman conceive a child naturally. Inability to conceive is also like other ailments which can be cured, plain and simple. There is no need to get embarrassed over such a problem because lots of people are traveling in the same bus. IVF (in vitro fertilization) is a benefaction to lots of people who are suffering from the same problem. Assisted reproduction to let a woman conceive a child without any problem is termed as IVF. It includes medications, egg production and various other things which can let you have your own baby child. 

Eggs are harvested surgically in the lab and later they are combined with the sperm collected from the male partner. It takes three to five days for the embryos to grow. Then the viable ones are implanted into the uterus. The selection of viable embryos is a part of this process where the experienced doctors never fail. This is one of the reasons why you should always consult an experienced gynecologist. 

Pregnancy may occur in the first cycle depending on the success rate. More than one cycle can be needed to result in pregnancy. There is a plethora of gynecologists in India however a few of them are the genuine and highly experienced. I would personally suggest you to visit a highly experienced gynecologist for best results.

How to chose best IVF specialist in India - Dr Ruby Sehra

India is known as the temple of best medical facilities. India as well as is the cheapest and the most efficient IVF Treatment country in the world. This is not what I am saying this is what the statistics are saying. When we compare it internationally Indian IVF treatment Clinics offer you the same exact treatment at very lower cost.

Numerous couples would love to have an infant yet for various reasons, they have very difficult time to conceive a baby. Likewise, you realize that it will turn out worst for  you and your spouse. After a long chat with your partner, when both of you have made up your mind for IVF treatment you must consult the Best IVF Specialist like Dr. Ruby Sehra.

I would love to tell you a few things her IVF Clinic has which should be a necessity if you want best results. The first inspection that you need to do is check if that doctor is having valid amount of experience. We all know that Con Doctors are everywhere.

Then you need to check that the treatment you are going through is completely transparent. Transparency in this case means the egg embryos or the sperm cell would not be altered in any case. This is the best quality about Dr. Ruby Sehra keeping the procedures transparent every time.

Now lets us take a look at what exactly IVF is? Well, In -vitro preparation(IVF) procedure is sensibly straight forward treatment which includes an IVF specialist that will separate a lady's egg and will prepare it in a lab. The IVF specialists then place the Fetus into the lady's uterus as she will experience an ordinary full term pregnancy. In vitro preparation might be fruitful and most effective when every other technique have fizzled or failed.

The success rate though plays a major role in categorizing the best IVF specialist. So chose your doctor wisely ! For best results consult the best IVF specialist in India - Dr. Ruby Sehra

A Brief view on Genuine IVF treatment

First of all, let us take a look at what exactly IVF is.IVF is an abbreviation used for In Vitro  Fertilization. Infertility is named as a failure to conceive after various months of making an attempt for pregnancy without using any contraceptives. When you have been diagnosed with infertility, then the primary factor you wish to search out the reason behind this infertility. You exactly want to know what is the reason behind the inability to conceive.  This treatment is pursued once alternative treatments have failed to accomplish pregnancy. Initial IVF treatment is an exciting but a kind of troublesome experience. This is the very first treatment tried when an egg donor is being used. While there are several cases of male infertility or when a woman's Fallopian tubes are blocked completely.

IVF treatment is most successful and in fact has a good success rate when compared with other methods, though, it may take more than one attempt. Studies show that the potential for success with IVF treatment is a better option. IVF treatment is quite stressful. just looking over the schedule of blood work, injections, then checking your ultrasound reports and so on can make you feel fragile. Even the fertility medication may change your moods.

Infertility and IVF is pretty nerve-racking and at times you might feel unhappy and worried; you and your partner may even struggle during that treatment, but it works fine once you have both made up your mind.

Now, let us take a look at what this treatment involves? 

Treatment involves taking hormones to stimulate the ovaries to provide eggs. Eggs are collected from the ovaries using an advanced ultrasound-guided trans-vaginal authentic needle aspiration. These eggs are placed in a dish with a large number of sperm cell, allowing fertilisation to occur, and some of those eggs go on to create embryos. They are placed in the incubator for fertilization. These embryos can be transferred into the womb using a small plastic tube and some can be frozen and keep for future transfer. The embryo, then implants itself in the womb. Then a normal procedure of pregnancy starts completely natural.

26 years exp. Gynecologist Doctor in Delhi - Dr. Ruby Sehra

Gynaecology is a study that deals with the health of the feminine reproductive organs. This is immensely delicate and important part of the human body. This is the only organ that requires immense amount of knowledge and study. There are various elements that are looked into by gynecologist like cancer, urine problems, menstruation problems, IVF issues etc. This is a vast field which can only be performed by professionals. Let's take a view at a few things you should take a glance at when choosing your gynecologist.

Do you need a Gynecologist who is a practising Obstetrician or who is a specialist in this field as well?

Well now need to worry we got you covered here. Well there are many renowned gynecologist in this world but only a few have time for their patients. Well Dr. Ruby is one of the best Gynecologist present in Delhi right now. She has splendid success rate in the procedures performed by her team.

I can surely tell you a few thing a professional gynecologist like her has .

Firstly, Do check that the gynecologist you are visiting has  a valid experience and qualification. They should have a good success rate since you don't want to waste your money and emotions.

Secondly, check the facilities provided during the procedures. The sanitation facilities should be best as most of the accidents happen by carelessness.

Finally, you should check the team of the Gynecologist you are choosing. As most of the famous specialist are busy to provide time to the patient so most of the time you are spending is with the team of doctors. So you should also check that those valuable members of the clinic are qualified and experienced enough to take care of you.

Most women face difficulties like they say your doctor is unavailable for any reason then there are other doctors to oversee your case. For example, lets Say your gynecologist is on vacation and your labour starts it could be an serious issue. So Now you know what things you should check while choosing a specialized Gynecologist.

Now you can easily find a Gem Gynecologist Specialist in Delhi.

Polycystic ovarian disease- Dilemma of modern women

        Introduction and background epidemiology

PCOS is a common disorder often complicated by chronic an ovulatory infertility and hyperandrogenism with the clinical manifestations of oligomenorrhoea, hirsutism and acne. Many women with this condition are obese and have a higher prevalence of impaired glucose tolerance, type ll diabetes and sleep apnoea than is observed in the general population . They exhibit an adverse cardiovascular risk profile, characteristic of the cardiometabolic syndrome as suggested by a higher reported incidence of hypertension, dyslipidemia, visceral obesity, insulin resistance and hyperinsulinaemia. PCOS is frequently diagnosed by gynecologists and it is therefore important that there is good understanding of the long-term implication of the diagnosis on order to offer a holistic approach to the disorder.

PCOS is one of the most common endocrine disorder on women of reproductive age. Because of differences in the diagnostic criteria employed, prevalence estimates vary widely, ranging from 2.2% to as high as 26% . The prevalence of PCOS when diagnosed by the Rotterdam criteria was over twice that found when the National institute of Health (NIH) criteria were used to diagnose PCOS.

The prevalence of PCOS may be different according to ethnic background . for example, compared to Caucasians, a higher prevalence is noted among women of south Asian origin, where it presents at a younger age and has more severe symptoms . 

   Q.1 How is PCOS diagnosed ? 

  PCOS should be diagnosed according to the Rotterdam  Consensus criteria.  With two or three of the following criteria being diagnostic Of    the    condition.

• Polycystic ovaries ( either 12 or more follicles or increased ovarian volume [ >10 cm ] )
• Oligo-ovulation  or anovulation
• Clinical and / or biochemical signs of hyperandrogenism .

The recommended baseline test for hyperandrogenism os free androgen index (total testosterone divided by sex hormone binding globulin {SHBG x 100 } ). If there are signs of virilisation (e.g. deep voice , reduced breast size , increased muscle bulk , clitoral hypertrophy ), rapidly progressing hirsutism ( less than 1 year between hirsutism  being noticed and seeking medical advice) or high total testosterone levels (greater then 5 nmol/1 or more than twice the upper limit of normal reference range), androgen – secreting tumour and late onset/nonclassical congenital adrenal hyperplasia (CAH) should be excluded. 17 hydroxyprogesterone should be measured in the follicular phase and will be raised in CAH . as Ashkenazi jews or those with a family history of CAH, since the management of CAH is different than that of PCOS. If 17-hydroxyprogesterone is borderline , it will be have confirmed by an ACTH stimulation test to diagnose CAH .

Q.2   What is the risk of developing gestational diabetes in women with PCOS ?

        Clinicians may consider offering screening for gestational diabetes to women who have been diagnosed as having PCOS before pregnancy . This should be performed at 24-28 weeks of gestation , with referral to a specialist obstetric service if abnormalities are detected . the prevalence of gestational diabetes mellitus is twice as high among with PCOS compared to control women . Clinicians may consider offering a 2-hour post 75 g oral glucose tolerance test to all pregnant women with PCOS , similar as for screening in women with any other risk factors for gestational diabetes . 

Q.3 How should women with PCOS be screened for type ll diabetes.

      Women presenting with PCOS who are overweight ( body mass index [BMI] > 25KG/M) and women with PCOS who are not overweight (BMI <25KG/M ), BUT who have additional risk factors  such as advanced age (>40 years), personal history of gestational diabetes or family history of type ll diabetes , should have a 2-hour post 75 g oral glucose tolerance test performed . 

      In women with impaired fasting glucose ( fasting plasma level from 6.1 mmol/l) or ompaired glucose tolerance (plasma glucose of 7.8 mmol/l or m ore but less then 11.1 mmol/l after a 2-hour oral glucose tolerance test) an oral glucose tolerance test should be performed annually. Women of non Caucasian ethnicity ( particularly south Asian women) should have an oral glucose tolerance test regardless of their BMI, in view of their propensity towards higher insulin resistance . Fasting blood glucose level alone has been shown to be inaccurate and results in underdiagnosis of type ll diabetes in PCOS. Hence an oral glucose tolerance test is considered to be appropriate for screening women with PCOS for diabetes . 

Q.4 What is the risk of developing sleep apnoea in women with PCOS?

       Women diagnosed with PCOS should be asked (or their partners asked ) about snoring and daytime fatigue / somnolence, informed of the possible risk of sleep apnoea and offered investigation and treatment when necessary .

Q.5 What is the risk of developing cardiovascular disease (CVD) in women with PCOS ?

       Clinicians need to be aware that conventional cardiovascular risk calculator have not been validated in women with PCOS. 

       All women with PCOS should be assessed for CVD risk by assessing individual CVD risk factors (obesity, lack of physical activity, cigarette smoking, family history of type ll diabetes, dyslipidaemia, hypertension, impaired glucose tolerance, type ll diabetes) at the time of initial diagnosis.

       In clinical practice, hypertension should be treated; however, lipid-lowering treatment is not recommended routinely and should only be prescribed by a specialist. 

       The conventional cardiovascular risk calculators have not been validated in this group of women. 

       At the time of initial diagnosis women with the PCOS should be assessed for obesity with BMI and waist circumference.

      Blood pressure should be checked at the time of initial diagnosis and during oral contraceptive therapy . 

      However lipid-lowering treatment is not recommended for treating hyperandrogenaemia and should only be prescribed by a specialist. 

Q.6 What is the risk of having reduced health-related quality of life in women with PCOS ?

         They should refer the person to an appropriate professional.if    this professional is not the person’s general practitioner (GP), inform the GP of the referral. 

Q.7 What are the risk of cancer in women with PCOS and how should these women be screened ?

      It is good practice to recommend treatment with gestogens to induce withdrawal bleed at least every 3to4 months. In PCOS an endometrial thickeness of less than 7 mm is unlikely to be hyperplasia. A thickened endometrium or an endometrial polyp should prompt consideration of endometrial biopsy and/ or hysteroscopy. These does not appear to be an association with breast or ovarian cancer and no additional surveillance is required . 

     Regular  induction of a withdrawal bleed with cyclical gestogens – gestogens foe at last 12 days, oral contraceptive pills or endometrial protection gained by exposure to gestogens by device such as the Mirena^R (Bayer plc,Newbury, Break, UK) intrauterine system would be advisable in oligomenorrhoeic women with PCOS as part of good clinical practice but the most effective regimen is unclear due to a lack of randomised clinical trials.

        Found that compared with 7 mm a higher cut- off 9 mm in patient with PCOS had comparable sensitivity (100%) negative predictive value (100%) and positive predictive value (50%) but superior specificity (56%) ; for every 1 mm increase in endometrial thickness the odds ratio of hyperplasia increased by 1.48 (95% CI  I.04-2.10).

Q.8 How should women with PCOS be advised on lifestyle issues ?

        It is recommended that lifestyle changes, including diet, exercise and weight loss, are initialled as the first line of treatment for women with PCOS for improvement of long – term outcomes and should precede and/ or accompany pharmacological treatment. 

         Women who have failed to lose weight with lifestyle strategies and who have a BMI of 40 kg/m² or more or who have a BMI of 35 kg/m² or more together with a high risk obesity – related condition ( such as hypertension or type ll diabetes) should be considered for bariatric surgery .

Q.9 Is drug therapy appropriate for long-term management of women with PCOS !

        Insulin- sensitising agent have not been licensed in the UK for use in patient without diabetes. 

        Metformin has been shown to have beneficial short-term effect on insulin resistance and other cardiovascular risk markers in women with PCOS without type ll diabetes . There is evidence that metformin may modestly reduce androgen levels by around 11% in women with PCOS compared to placebo and modest reduction in body weight have been reported by some but not all studies . women with a BMI of more than 37 kg/m may not reported well to the standard dose of metformin therapy. It must be emphasised that both metformin and the thiazolidinediones are unlicensed for use in PCOS and women should be counselled before initiating therapy so that they can make an informed choice . 

        Incretin hormone-based therapies such as exenatid have been shown to reduce weight and improve insulin resistance in women with PCOS. However the clinical experience with these agents in PCOS ih limited and significant side effect may occur there for routine use of incretin-based therapies in PCOS is not recommended.Biochemical hyperandrogenaemia but without changing glucose insulin homeostasis or lipid pattern . 

Q.9 What is the prognosis following electrocautery ?

       For selected anovulatory patient especially those with a normal BMI as an alternative to ovulation induction. 

      Well as normalisation of serum androgens and SHBG up to 20 year after laparoscopy  ovarian electrocautery in over 60% of subject particularly if they have a normal BMI. Reserved for selected anovulatory patient with a normal BMI or where a laparoscopy  is required for other indication. 

Q.10 What is the prognosis following bariatric surgery ?

          Bariatric surgery may be an option for morbidly obese women with PCOS (BMI if 40 kg/m² or more or 35 kg/ m² or more with a high risk obesity related condition) if standard weight loss strategies have failed .