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Fig 2. The self-perpetuating vicious cycle of elevated levels of androgens and estrogens in PCOD
Treatment of PCOD for the infertile patient will usually focus on inducing ovulation to help them conceive. Weight loss: For many patients with PCOD, weight loss is an effective treatment but, of course, this is easier said than done! Look for a permanent weight loss plan, and referral to a dietitian or a weight control clinic may be helpful. Crash diets are usually not effective.
Increasing physical activity is an important step in losing weight. Aerobic activities such as walking, jogging or swimming are advised. Try to find a partner to do this with, so that you can help each other to keep going.
The drug of first choice is clomiphene; this may be combined with low doses of dexamethasone, a steroid that suppresses androgen production from the adrenal glands. Just taking clomiphene is not enough, and you need to be monitored (usually with ultrasound scans) to determine if the clomiphene is helping you to ovulate or not. The doctor may have to progressively increase the dose till he finds the right dose for you. If clomiphene does not work, HMG can be used.
Some doctors prefer to use pure FSH for inducing ovulation in PCOD patients because they have abnormally high levels of LH. Ovulation induction can often be difficult in patients with PCOD, since there is the risk that the patient may over-respond to the drugs, and produce too many follicles, which is why the risk of ovarian hyper stimulation syndrome (OHSS) and multiple pregnancy is often increased in patients with PCOD. The doctor has to find just the right dose of HMG (called the threshold value) in order to induce maturation and release of a single or only a few follicles, and this can sometimes be very tricky.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
