Polycystic ovary syndrome is a very common disease in our country. Prominent symptoms are menstrual irregularity, hair growth and difficulty in conceiving
. If the patient is obese, these symptoms become worse. In recent years
it has been understood that the disease is related to insulin resistance in the body.
Although its frequency varies from country to country, it can reach up to 20%.
More than half of PCOS patients are obese. In these patients, the fat accumulated around the abdomen (central obesity, apple-shaped fat) further increases insulin resistance. For this reason, in this disease
there is a risk of developing type II diabetes mellitus in the future.
In patients with the above-mentioned symptoms, transvaginal ultrasonography should be performed
The appearance of the ovaries should be examined. In addition, hormone analyzes and glucose tolerance test
are required.
Treatment
Overweight PCOS patients should be advised to lose weight first of all. This situation
may reduce hair growth and menstrual irregularity by restarting paused ovulation.
Later, if the patient wishes to have children, the drug called clomifene can be used under the supervision of a doctor
. Ovulation occurs in 80% of patients and the pregnancy rate is around 40-50% after 6 months of treatment. Patients who do not respond to Clomifene are given medications in the form of injections containing gonadotropin. The treatment called laparoscopic ovarian diathermy, in which the cysts in the ovaries are burned one by one, can be considered as an alternative.
The drug, which contains metformin and is used by diabetics, is also resistant to clomifene
. Because it is not superior to clomifene. It may increase ovulation when used in combination with Clomifene. However, pregnancy rates do not increase in neither thin nor obese patients. However, it has been shown that obesity has negative effects on pregnancy and live birth rates.
Assisted reproductive techniques are very effective in patients with PCOS. The ovaries of patients with PCOS are larger than the ovaries of normal patients. may respond very differently to assisted reproductive techniques treatments
. PCOS is very sensitive to gonadotropin therapy and may respond with excessive egg production, but most of these eggs have low fertilization potential. When many eggs are obtained, the risk of OHSS (ovarian hyperstimulation syndrome) is high. Severe OHSS
accounts for approximately 2% of all cases. However, life-threatening hypovolemia (decrease in blood volume), hemoconcentration (increase in blood density), phenomenon (decrease in urine amount), electrolyte imbalance, liver dysfunction, thromboembolism, ascites ( Conditions such as fluid accumulation in the abdominal cavity), hydrothorax (fluid accumulation in the chest cavity) and adult respiratory distress syndrome (respiratory failure) may develop.
OHSS classification
Mild OHSS
- Mild abdominal pain
- Feeling of bloating in the abdomen
- Ovarian diameter <8 cm3
Moderate OHSS
- Nausea and/or vomiting
- Moderate abdominal pain
- Ascites seen on ultrasound
- Ovarian diameter 8-12 cm3
Severe OHSS
- With ascites hydrothorax present or not
- Olguria
- Ovarian diameter>12 cm3
- Hemoconcentration, hematocrit> 45%
- Hypoproteinemia
Critical OHSS
- Intense ascites or hydrothorax
- Oliguria or anuria
- Hematocrit>55
- White cell count>25000/ml
- Respiratory failure
- Thromboembolism
The main element in the formation mechanism of OHSS is the increase in vascular permeability. Thus
the fluid in the vein escapes and accumulates primarily in the abdominal cavity. Vascular endothelial
growth factor (VEGF) was found to be high in the blood and follicular fluid of patients with PCOS on the day of egg retrieval
. For this reason, it is seen as an important factor in the development of OHSS.
Other factors are that the patient is young, thin, has had OHSS before, and
hCG has been used to trigger ovulation. The fact that it is more in the cycles where pregnancy occurs also strengthens its connection with hCG. Increased hCG VEGF s It also increases the intake
.
Prevention of OHSS
- Keeping the doses of drugs used during in vitro fertilization treatment low
- Adding metformin to the treatment
- Discontinuing the drugs if the ovaries have responded excessively
- Giving albumin intravenously as a precaution
- Delaying the transfer by freezing all embryos
- It is necessary to cancel the treatment
In patients who develop OHSS, it is necessary to hospitalize them as soon as the hematocrit level exceeds 45%
.
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