Polycystic ovary

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Polycystic ovary

  1. 1. Pco . DR G A RAMA RAJU. Krishnaivf
  2. 2. PCOS .WOMB TO TOMB
  3. 3. Lecture outline Diagnostic work up. Implication for health. Implication for infertility. Implication for pregnancy.
  4. 4. Diagnostic pcos criteria hyeperandrogen ism Oligo/ameno POS rrhea NIH Rott Cons AES
  5. 5. • To diagnose pcos the following are needed • ACOG practice bulletin ,OG,oct 2009 • Physical exam. • Laboratory • Ultrasound • Optional test
  6. 6. Physical. • Blood pressure. • BMI. • Waist circumference. • Presence of stigmata hyperandrogenism. ACOG practice bulletin ,OG,oct 2009
  7. 7. • 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
  8. 8. • Ultrasound ACOG practice bulletin ,OG,oct 2009
  9. 9. Optional tests • Gonadotrophins • Fasting Ins in young women • 14h urinary free cortisol ACOG practice bulletin ,OG,oct 2009
  10. 10. Morphology Syndrome Endocrinology Ultrasound Metabolic 1935 1963 1980 1988 1990 45% metabolic 70 % 60% insulin syndrome 0besity resistance
  11. 11. What is Metabolic syndrome Blood pressure >130/85 Abdominal obesity triglycerides >150 Hdl cholesterol < 50 mg/dl Faasting glucose >110 mg /dl
  12. 12. Metabolic syndrome marker for cardiovascualr disease Blood Dyslipedemia pressure Insulin Central resistance obesity
  13. 13. a condition requiring life long attention. Reproductive disorder Metabolic disorder 15 yrs……………………… 60 yrs
  14. 14. Implication for future health
  15. 15. Pcos follow up studies • More diabetes , hypertension and • cerebro vascular disease 24
  16. 16. INCREASED INCIDENCE OF OBESITY
  17. 17. Cardio vascular risk. • Gender • Age • Systolic pressure • Smoking • Cholesterol
  18. 18. • ROLE AND RESPONSIBILITY OF THE DOCTOR IN PCO – HEALTH PRECAUTION – HEALTH EDUCATION – TREATMENT
  19. 19. IMPLICATION FOR INFERTILITY
  20. 20. • Optimal treatment of PCOS has not been identified
  21. 21. Life style modification
  22. 22. 500 kcal/day deficit with reduced glycemic load DIET
  23. 23. Life style modification • Attention to weight and metabolic syndrome. • Should happen before treatment
  24. 24. First line of drug • Clomiphene citrate Ovulation rate 73 % and pregnancy rate 37 %
  25. 25. 50 yrs ago
  26. 26. Starting dose 50 – to 150 mg Ovulation Ovulation /Nopregnancy and No (laproscopy/letrizole/gonado Pregnancy(6 trophin male factor) response cycle)
  27. 27. Age issues Dose Clomiphene citrate Monitoring 75% OVULATION RATE DURATION COMBINATION NO ADDITIOAL BENEFITS Obesity
  28. 28. 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
  29. 29. Second line of treatment • Gonadotropin • Laparoscopy ovarian drilling
  30. 30. AN operation which became obsolete
  31. 31. Laparoscopic ovarian drilling
  32. 32. Laparoscopy ovarian drilling • Cc resistance • Women needing laparoscopy . • (best for normal bmi ,shorter duration of infertility)
  33. 33. GONADOTROPHIN VS DRILLING
  34. 34. Where does metformin fit • Glucose intolerance. • Role in obese > 35 . • CC resistance. In 2006 2 large RCT did not show any benifit
  35. 35. Gonadotropin therapy Step up Step down Avoid multiple follicle and hyperstimulation
  36. 36. 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.
  37. 37. DURATION OF GONADOTROPIN THERAPY INTENSE OVARIAN RESPONSE MONITORING STRICT CYCLE CANCELLATION CRITERIA.
  38. 38. CC FAILURE LETRIZOLE CC RESISTANCE NOT A FIRST LINE OF TREATMENT
  39. 39. Third line of management • Assisted reproduction: IVF
  40. 40. Implication for pregnancy
  41. 41. GESTATIONAL DIABETES 20 T0 24 WEEKS GLUCOSE SCREEN
  42. 42. PREGNANCY INDUCED HYPERTENSION BP / URINE ALBUMIN
  43. 43. PRETERM AND PCOS ASSESMENT OF CERVIX AND PRECUATIONS
  44. 44. Birth weight
  45. 45. NICU ADMISSION
  46. 46. PERINATAL MORBIDTY Higher nicu admission
  47. 47. Boomsma, C.M. et al. Hum Reprod Update 2006 12:673-683; doi:10.1093/humupd/dml036 Copyright restrictions may apply.
  48. 48. Prevalence of metabolic syndrome at the age of 65 yrs in relation to birth weight
  49. 49. Diagnostic Algorithm for the Polycystic Ovary Syndrome Ehrmann D. N Engl J Med 2005;352:1223-1236
  50. 50. 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.
  51. 51. THANK YOU

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