Polycystic Ovary Syndrome (PCOS) and Infertility: Indian Perspective.
Sunanda Kulshrestha, Ph.D., Department of Biotechnology, GLA University, Mathura, Uttar Pradesh, India.
Background: Lifestyle diseases are rising among women worldwide. This inevitably leads to a compromised quality of life. Polycystic ovary syndrome, or PCOS, is a disorder that, although not life-threatening, is a menace with its underlying effects. It is an endocrine disorder that carries additional health risks to women of reproductive age. PCOS triggers infertility, a major health issue due to the poor quality of released eggs and hormonal imbalances. Nearly one in ten women worldwide is estimated to experience PCOS prior to menopause, and the challenges it brings in the upcoming years (Witchel et al., 2019).
The PCOS in Indian population ranges from 3.7% to 22.5% depending on the demographics (Ganie et al., 2019) whereas the number of cases representing infertility from PCOS is as high as 80% (Melo et al., 2015). Researchers have estimated that patients with PCOS have a risk of cardiovascular disease, hypertension, lipid metabolic disorders, and endometrial cancer which is two to six times higher than that in the overall population (Bharali et al., 2022). Lifestyle changes, exposure to more chemicals, and eating habits are major causes of the increasing number of patients. Potential risks leading to this syndrome in women include unhealthy eating habits, exposure to environmental toxins, heredity, gut dysbiosis, changes in neuroendocrine function, and excess body fat. Insulin resistance, hyperandrogenism, inflammation, oxidative stress, and obesity are internal variables, whereas environmental toxicants, epigenetics, stress, and nutrition are external ones. Despite the discovery of certain mechanisms contributing to PCOS, its exact pathophysiology and cause remain largely unknown.
Symptoms:
If a woman exhibits unexplained weight loss or gain, excessive body or facial hair, pimples, or lethargy, she should undergo a PCOS screening. Other symptoms include infertility, absence or disturbance of the menstrual cycle (amenorrhoea), dysmenorrhea, and insulin resistance, nausea, vomiting, abdominal pain, and diarrhoea (Akre et al., 2022).
Diagnosis:
Currently there is no foolproof method for diagnosing PCOS, since this condition is among those that do not respond to standard diagnostic procedures such as blood tests, culture, and biopsy. However, transvaginal sonography, androgen and other hormone level tests, insulin resistance, hyperprolactinemia, thyroid disease, Cushing’s syndrome, and adrenal hyperplasia are recommended to analyse the patient’s symptoms.
Enlarged or dysfunctional ovaries, elevated androgen levels, poor quality of eggs released, and failure to conceive are major signs of infertility caused by PCOS (Singh et al., 2023).
Treatment:
Complementary medicines and hormonal therapies treat PCOS-induced infertility in patients. Medications like clomid, folic acid, and metformin for treating insulin resistance are administered as the first line of treatment. Exogenous gonadotropins or laparoscopic ovarian surgery, also known as ovarian drilling, constitute the second line of pharmaceutical treatment. The third line of treatment involve a highly complex reproductive procedure like in vitro fertilization or intracytoplasmic sperm injection. Exercise, yoga, dietary changes, and the inclusion of supplements like resveratrol in the diet are also recommended alongside the course of treatment (Li et al., 2022).
Prevention:
Despite the treatment of PCOS, there is no guarantee against its future recurrence. The non-reversible nature of PCOS-induced infertility necessitates highly sophisticated and costly treatment.
The increase in the number of cases often leads to the use of contraceptive pills without medical consultation. Self-medication, such as hormonal pills, must be avoided under all circumstances. Smoking, eating junk food, consuming drinks containing soda and caffeine, alcoholic beverages, disturbed sleep cycles, and improper eating schedules are some of the factors that should be checked.
PCOS can also be passed on genetically, in addition to being a lifestyle disorder. Hence, only modulatory changes in dietary habits and physical activities could help in the prevention of the disease.
The only way to deal with PCOS and its related consequences is through lifestyle management. The inclusion of anti-oxidants, folic acid, and vitamin supplements is advised, along with the practice of yoga and regular exercise. Some of the herbs, including Shatavari (Asparagus racemosus), Ashwagandha (Withania somnifera), Moringa (Moringa oleifera), which are also popular as ‘tonic for women’s health’ could be included in diet after proper Ayurvedic consultation.
The Indian scenario depicts the careless behaviour of women towards their health due to gender imbalance in society and the traditional expectations from women to be always active and healthy. Stagnant lifestyle with overburdening of work resulting in disturbance in sleep and eating patterns are major driving forces behind the increased cases of PCOS and infertility. Women today in India are juggling between their traditional and modern roles, which puts them in a state of avoidance. These things should be checked and women should be made aware to acknowledge the changes their body is going through and seek medical advice.
Author:
Sunanda Kulshrestha, Ph.D (Department of Biotechnology, GLA University, Mathura, Uttar Pradesh, India).
Edited By:
Dr. Shalini Mukherjee, Ph.D (Molecular Biology), University of Manitoba, Winnipeg, Manitoba, Canada.
Scientific Editor at Aabir Bio-Services Foundation
May 19, 2024
References:
Witchel, S. F., Oberfield, S. E., & Peña, A. S. (2019). Polycystic ovary syndrome: pathophysiology, presentation, and treatment with emphasis on adolescent girls. Journal of the Endocrine Society, 3(8), 1545-1573.
Ganie, M. A., Vasudevan, V., Wani, I. A., Baba, M. S., Arif, T., & Rashid, A. (2019). Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India. Indian Journal of Medical Research, 150(4), 333-344.
Melo, A. S., Ferriani, R. A., & Navarro, P. A. (2015). Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics, 70, 765-769.
Bharali, M. D., Rajendran, R., Goswami, J., Singal, K., & Rajendran, V. (2022). Prevalence of polycystic ovarian syndrome in India: a systematic review and meta-analysis. Cureus, 14(12).
Akre, S., Sharma, K., Chakole, S., & Wanjari, M. B. (2022). Recent advances in the management of polycystic ovary syndrome: a review article. Cureus, 14(8).
Singh, S., Pal, N., Shubham, S., Sarma, D. K., Verma, V., Marotta, F., & Kumar, M. (2023). Polycystic ovary syndrome: etiology, current management, and future therapeutics. Journal of Clinical Medicine, 12(4), 1454.
Li, M., Ruan, X., & Mueck, A. O. (2022). Management strategy of infertility in polycystic ovary syndrome. Global Health Journal, 6(2), 70-74.
Bulsara, J., Patel, P., Soni, A., & Acharya, S. (2021). A review: Brief insight into Polycystic Ovarian syndrome. Endocrine and Metabolic Science, 3, 100085.