Polycystic ovary
Upcoming SlideShare
Loading in...5
×
 

Polycystic ovary

on

  • 1,204 views

 

Statistics

Views

Total Views
1,204
Views on SlideShare
1,204
Embed Views
0

Actions

Likes
1
Downloads
85
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Polycystic ovary Polycystic ovary Presentation Transcript

  • Pco . DR G A RAMA RAJU. Krishnaivf
  • PCOS .WOMB TO TOMB
  • Lecture outline Diagnostic work up. Implication for health. Implication for infertility. Implication for pregnancy. View slide
  • Diagnostic pcos criteria hyeperandrogen ism Oligo/ameno POS rrhea NIH Rott Cons AES View slide
  • • To diagnose pcos the following are needed • ACOG practice bulletin ,OG,oct 2009 • Physical exam. • Laboratory • Ultrasound • Optional test
  • Physical. • Blood pressure. • BMI. • Waist circumference. • Presence of stigmata hyperandrogenism. ACOG practice bulletin ,OG,oct 2009
  • • TSH. laboratory • Prl. • 17-0hprog • Consider screening for Cushing and acromegaly • Evaluation metabolic abnormalities. • Fasting Lipid and lipoprotein levels ACOG practice bulletin ,OG,oct 2009
  • • Ultrasound ACOG practice bulletin ,OG,oct 2009
  • Optional tests • Gonadotrophins • Fasting Ins in young women • 14h urinary free cortisol ACOG practice bulletin ,OG,oct 2009
  • Morphology Syndrome Endocrinology Ultrasound Metabolic 1935 1963 1980 1988 1990 45% metabolic 70 % 60% insulin syndrome 0besity resistance
  • What is Metabolic syndrome Blood pressure >130/85 Abdominal obesity triglycerides >150 Hdl cholesterol < 50 mg/dl Faasting glucose >110 mg /dl
  • Metabolic syndrome marker for cardiovascualr disease Blood Dyslipedemia pressure Insulin Central resistance obesity
  • a condition requiring life long attention. Reproductive disorder Metabolic disorder 15 yrs……………………… 60 yrs
  • Implication for future health
  • Pcos follow up studies • More diabetes , hypertension and • cerebro vascular disease 24
  • INCREASED INCIDENCE OF OBESITY
  • Cardio vascular risk. • Gender • Age • Systolic pressure • Smoking • Cholesterol
  • • ROLE AND RESPONSIBILITY OF THE DOCTOR IN PCO – HEALTH PRECAUTION – HEALTH EDUCATION – TREATMENT
  • IMPLICATION FOR INFERTILITY
  • • Optimal treatment of PCOS has not been identified
  • Life style modification
  • 500 kcal/day deficit with reduced glycemic load DIET
  • Life style modification • Attention to weight and metabolic syndrome. • Should happen before treatment
  • First line of drug • Clomiphene citrate Ovulation rate 73 % and pregnancy rate 37 %
  • 50 yrs ago
  • Starting dose 50 – to 150 mg Ovulation Ovulation /Nopregnancy and No (laproscopy/letrizole/gonado Pregnancy(6 trophin male factor) response cycle)
  • Age issues Dose Clomiphene citrate Monitoring 75% OVULATION RATE DURATION COMBINATION NO ADDITIOAL BENEFITS Obesity
  • Source: Fertility and Sterility 2008; 89:505-522 (DOI:10.1016/j.fertnstert.2007.09.041 ) Copyright © 2008 American Society for Reproductive Medicine Terms and Conditions
  • Second line of treatment • Gonadotropin • Laparoscopy ovarian drilling
  • AN operation which became obsolete
  • Laparoscopic ovarian drilling
  • Laparoscopy ovarian drilling • Cc resistance • Women needing laparoscopy . • (best for normal bmi ,shorter duration of infertility)
  • GONADOTROPHIN VS DRILLING
  • Where does metformin fit • Glucose intolerance. • Role in obese > 35 . • CC resistance. In 2006 2 large RCT did not show any benifit
  • Gonadotropin therapy Step up Step down Avoid multiple follicle and hyperstimulation
  • Gonadotropin therapy 1. THE RECOMMENDED STARTING DOSE OF GONADOTROPIN IS 37.5–50.0 IU/DAY. 2 SMALL FSH DOSE INCREMENTS OF 50% OF THE INITIAL OR PREVIOUS 3 PREVENTING ALL MULTIPLE PREGNANCIES AND OHSS IS NOT POSSIBLE AT THIS TIME.
  • DURATION OF GONADOTROPIN THERAPY INTENSE OVARIAN RESPONSE MONITORING STRICT CYCLE CANCELLATION CRITERIA.
  • CC FAILURE LETRIZOLE CC RESISTANCE NOT A FIRST LINE OF TREATMENT
  • Third line of management • Assisted reproduction: IVF
  • Implication for pregnancy
  • GESTATIONAL DIABETES 20 T0 24 WEEKS GLUCOSE SCREEN
  • PREGNANCY INDUCED HYPERTENSION BP / URINE ALBUMIN
  • PRETERM AND PCOS ASSESMENT OF CERVIX AND PRECUATIONS
  • Birth weight
  • NICU ADMISSION
  • PERINATAL MORBIDTY Higher nicu admission
  • Boomsma, C.M. et al. Hum Reprod Update 2006 12:673-683; doi:10.1093/humupd/dml036 Copyright restrictions may apply.
  • Prevalence of metabolic syndrome at the age of 65 yrs in relation to birth weight
  • Diagnostic Algorithm for the Polycystic Ovary Syndrome Ehrmann D. N Engl J Med 2005;352:1223-1236
  • Dr G A RAMA RAJU • Krishna ivf clinic Visakhapatnam. • Visiting professor Giessen university Germany. • Published 8 article in peer review journal with 70 citations • PhD guide in human genetics ,andhra university.
  • THANK YOU