|
TOPIC: PCOS & The Contraceptive Pill |
| Q |
Is it better for PCOS ladies to go on the pill for a period of time: |
|
Leading up to IVF or any other stimulation treatment to improve response? (If so how long?) |
| A |
The use of the pill during IVF is essentially for planning from a logistical point of view. However, with PCOS it has the added benefit of giving the patients a regular cycle prior to an IVF attempt, as well as keeping the ovaries quiescent, theoretically leading to easier recruitment of follicles due to hormonal quiescence. This can be between 30 to 60 days depending on the indication.
|
| Q |
For the prevention of cysts leading up to stimulation treatment? (If so how long?) |
| A |
The pill definitely leads to prevention of cyst formation due to hormonal quiescence. A period of 30 to 90 days depending on the indication.
|
|
TOPIC: High Dose Stimulation / Low Dose Stimulation |
| Q |
According to our discussion last week, excessive stimulation has a negative impact on productive ovarian response (good quality eggs). Does taking a lower dose of fertility drugs improve your chances of becoming pregnant with IVF? And if so why?
|
| A |
New literature supports the fact that excessive stimulation is detrimental to the outcome of an IVF cycle from the point of view that it has a negative effect on the endometrial lining from an implantation point of view. According to ISMAAR, a milder approach may lead to a better outcome.
|
|
TOPIC: Day 3 / Day 5 Embryo Transfer |
| Q |
How do the success rates differ between day 3 and day 5 embryo transfer and what are the advantages/disadvantages of each? |
| A |
Whether to grow to day 3 or 5 should be individualised according to the specific circumstances of each case. However, recent literature supports the fact that a day 5 growth has a better outcome if compared directly with day 3 transfers from a pregnancy rate point of view. However, each case should be individualised and judged according to the circumstances surrounding each case.
|
|
TOPIC: PCOS – Very Long Cycles |
| Q |
What is the longest that an anovulatory PCOS patient should go without having her uterine lining shed? Can waiting too long pose adverse health effects? Is it advisable to alternate natural cycles with contraceptive pill cycles to prevent excessively long cycles? What is the best approach to take while trying naturally? |
| A |
The longest period should be 3-4 months. Waiting too long to withdraw can lead to endometrial hyperplasia (abnormal thickening of the lining) If pregnancy is not an issue, staying on the pill will give the added benefit of monthly shedding. If a pregnancy is wished for, the best route to follow would be ovulation induction.
|
|
TOPIC: PCOS – Fertility Drugs & Cancer |
| Q |
Does the repeated use of infertility drugs increase the risk for cancer? Does PCOS increase the risk of ovarian or uterine or cervical cancer? |
| A |
There is no clear evidence in the literature to date of an increase in cancer rates among IVF patients. However, there is definite evidence that continuous use of clomifene citrate for 12 consecutive months, may lead to ovarian cancer. Untreated PCOS has an increased prevalence of endometrial cancer.
|
|
TOPIC: PCOS – Donor Eggs vs. Own Eggs |
| Q |
What is the success rate (live birth rate) for couples doing IVF with ICSI, using donor eggs? (lower, same, better than using own eggs) |
| A |
The live birth rate varies from clinic to clinic. ICSI is usually indicated for a severe male factor. This in itself leads to lower success rates due to the compromised nature of the sperm. This would be true for both donor eggs or the patients own eggs.
|
|
TOPIC: PCOS – Donor Eggs & HIV |
| Q |
Can HIV be transmitted when using donor eggs? |
| A |
This would depend on who the HIV positive person is, the male, the recipient or the donor. Theoretically the oocyte does not have receptors for the HIV virus to bind to and therefore transmission should not occur. The only way to go would obviously to use an HIV negative donor.
|
|
TOPIC: Pain & ER |
| Q |
Some ladies have experienced very uncomfortable pain despite the use of Dormicum at ER. Are there any additional measures one can take to minimise pain or should one just rely on Dormicum? |
| A |
At our clinic we feel that using only Dormicum is not adequate. We therefore do full conscious sedation with Dormicum, propofol and pethidine. Our patients are therefore completely unaware of the procedure.
|
|
TOPIC: Full/Fat Free Dairy & Caffeine |
| Q |
In terms of diet how big an impact does each of the following have on successful ovarian stimulation, conception and carrying a baby to term?
Caffeine intake has received some bad press in the news this week, see: http://abcnews.go.com/Health/story?id=4159798&page=1 , with Prof. Kruger from Tygerberg advising total abstinence on a 702 radio interview. Does normal caffeine use (no more than 3 cups a day) impact the success of conceiving and carrying a pregnancy to term, or is it all just hot air? |
| A |
Caffeine in excess is known to be a possible cause for early pregnancy loss. Therefore one should try and stay with decaf, or else not exceed one cup a day.
|
| Q |
There was some debate regarding research that fat free dairy products affect fertility and that women trying to conceive should rather go the low/full fat option, it was published in Living & Loving and Fair Lady last year sometime. What is your opinion? |
| A |
There is some evidence that the “fertility diet” does improve the overall outcome. This would include lots of monosaturated fats and avoiding trans fat. Limiting animal protein is adviseable, substituting this with plant protein. A regular intake of vitamins is also advisable with low glycaemic carbohydrates and non-haeme iron.
|
|
TOPIC: Most recent advances in ART |
| Q |
What is the next "big thing" in terms of ART? We've had ICSI, AH, PGD etc, what is next? What are researchers working on? Anyone found the magic 'glue' to make embies stick? |
| A |
Unfortunately no “magic glue” yet. The latest field of research is IVM (in vitro maturation), especially for PCOS patients with a history of ovarian hyperstimulation syndrome or difficult stimulations. Oocyte freezing for cancer patients is also something new in the ART field. |
