The reason why you can't get pregnant - Evewoman

The reason why you can't get pregnant

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Dear Doctor,

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I am 35 years old and recently got separated due to failure to conceive. I was diagnosed with polycystic ovarian syndrome and hormone imbalance. Can I be helped? Joy


Dear Joy,

The likely reason you haven’t conceived is because of the condition Polycystic ovarian syndrome (PCOS). It is fairly common, with symptoms that include irregular or absent menstrual periods, reduced fertility, acne and abnormal hair distribution. In addition, many women with PCOS are overweight.

The cause of PCOS is not known, but sometimes runs in families. The symptoms are related to abnormal hormone production (hence the term hormone imbalance). There is a consequent failure to ovulate regularly, and therefore a delay in conceiving. Some women with PCOS will not conceive until they are treated with fertility medications.

The diagnosis is made following typical symptoms, hormone tests and ultrasound imaging of the ovaries. The ovaries are usually enlarged with multiple follicles (small cysts), hence the description polycystic ovaries. However, some women will have a polycystic appearance of the ovaries without having the syndrome.

Most women will have immediate concerns related to menstrual irregularity, skin and hair changes or fertility. Longer term PCOS effects that may not be immediately apparent include disordered glucose control, high blood pressure and heart disease in later life.

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With less than three menstrual periods a year, the cells lining the inside of the uterus (endometrium) may become abnormal and warrant specific treatment. In rare cases, there may be predisposition to cancer of the lining of the uterus (endometrial cancer).

It is important to realise that there is no cure for PCOS. Treatments are aimed at managing and reducing the symptoms or consequences of PCOS. Healthy eating habits coupled with exercises will often maintain a normal weight and reverse most of the PCOS symptoms. Women should aim for a body mass index (BMI) between 19 and 25. Once weight is optimized, periods become more regular, the skin and hair changes reverse, and chances of spontaneous pregnancy increase.

Hormone tablets can be used to induce regular periods and reverse physical changes. Skin and hair changes may take longer to improve, and some women will need to incorporate cosmetic measures like shaving.

If attaining a normal BMI does not lead to spontaneous conception within a few months, fertility medications usually become necessary. You should get fertility medications prescribed by your gynaecologist following appropriate testing. You will also require monitoring to ensure that you are ovulating on the prescribed dosage.

Self-medication should be resisted. Conception is usually expected within three to six months once you start on the fertility drugs. Some may require a surgical procedure to enhance conception, or more advanced fertility treatments.

Your gynaecologist will also advise you on specific follow-up to negate longer term effects of PCOS.

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