Polycystic Ovary Syndrome, or PCOS, is a hormonal condition that women can get during their childbearing years. It can have an impact on their fertility, cause acne, and lead to irregular periods. Dr. Shipra Singla, Senior Consultant, IVF & Fertility, Cloudnine Hospitals, New Delhi explains Polycystic Ovary Syndrome (PCOS) and how it affects fertility.

There is high prevalence of unsuspected intrauterine lesions in females with unexplained infertility. So this could be in the form of small adhesions polyps or there could be even partial or complete septum and sometimes these intrauterine lesions are not picked up by the normal transvaginal ultrasonography.

"Laparoscopy or minimal invasive surgery. So laparoscope is a very tiny instrument with 10 mm diameter and it has attached light and camera. With the help of laparoscope we can actually see inside of abdomen we can also see the pelvic organs. So we make a small incision near the umbilicus 1 cm and through this small incision we introduce laparoscope inside the abdominal cavity and we can clearly visualize the pelvic organs like uterus ovaries and tubes so in the same sitting we can also do the fertility enhancing surgeries. For pregnancy to happen tubes and ovary relationship really matters because once ovulation happens to they capture the ovum into fimbria and then into the ampula and where sperm travels from cervix to the tubes and where the fertilization happens and tube should be healthy for this fertilization to happen and after staying in tube for 2 to 3 days and implants in the uterus. So for pregnancy to happen tubes should be healthy ovaries should be healthy and uterine environment should also be healthy. Through laparoscopy we can actually study this tubo ovarian relationship. If there are any adhesions peritubal adhesions in the same sitting we can do the adhesions and we can releasee the fimbria so that when ovulation happens they can pick up the oven to the tube. If there are any cyst in the ovaries if there is any big large simple cyst more than 5 cm or in mild endometrosis. When there could be chocolate cyst in the ovaries in the same sitting we can do the ovarian cystectomy. Now enough enough evidence says in the mild endometriosis laproscopy really helps and such patients after laproscopy they can even conceive naturally. So after these fertility enhancing surgeries 6 months are best after post surgery to conceive naturally or with minimal treatment like ovulation induction or IUI"

"When a couple cannot conceive after 1 year of regular intercourse and there is a male factor involved, we call it male Infinity, so now it is almost 50% of factors is because of the male partner. It could be because there could be less bum count. It could be an issue with the morality or morphology could be poor if the Simon parameters are severely compromised. The treatment recommended is intracytoplasmic sperm injection. Here is what we do an ICSI. So embryologists choose the morphologically normal healthy sperm and they inject this sperm directly into the egg. So this technique is called intracytoplasmic sperm injection with the help of ICSI. Even with the compromised semen parameters, we can have very good top quality embryo. IUI is not recommended if the simian count is less than 10 million or if the total morality is less than 30% or morphology is poor"

"Endometrium is the innermost lining of the uterine cavity. So it has two components. One is the basal layer. The other is the functional layer. So the basal layer has a tendency to regenerate the functional layer. So what happens in one particular menstrual cycle of a female. So the functional layer under the hormonal influence gradually thickens so that it helps in the implantation. But if the pregnancy does not happen, this functional layer sheds off where the hormones decline in the menses. So for pregnancy to happen, ideal endometrium thickness. We think it is almost 7 to 8 mm. So when we prepare patients for the am transfer in any IVF cycle, there are many protocols involved and we select the patients and whatever protocol is best, we prepare the endometrium lining accordingly. So these protocols could be hormone replacement therapy. Here we start the patient on estrogen therapy from Day 2 or Day 3 of the period. We give estrogen in gradually increasing doses till the lining reaches 7 or 8 mm. Once the lining reaches 7 to 8 mm, we give estrogen for at least 10 days. So once the lining reaches 7 to 8 mm, then we start progesterone. Day three or day five before am transfer depending on whether we are transferring day three embryo transfer or blastocyst transfer. We are doing another protocol is the regulated HART cycle. Here before periods we regulate the pituitary gland with the help of some injections or some medication and from day two we start the estrogen therapy and once the lining reaches optimum size like 7 to 8 mm then we give the progesterone 3 or 5 days prior to the embryo transfer. Another could be the modified natural cycle or even sometimes we can do natural cycle embryo transfer. Here we follow the menstrual cycle of the female with the help of ultrasound and hormones and once the lining is suitable, we do the embryo transfer"

"After any embryo transfer there is a 2 week wait period. After this 2 weeks, 14 days, you will get to know the outcome of IVF. So please follow these tips to increase the IVF outcome after embryo transfer. First, take your medications on time as prescribed by your doctor. It could be in the form of some vitamins like folic acid, vitamin D, vitamin C and it could be the hormonal support in the form of estrogen or progesterone tablets. Second, a healthy diet and home - cooked food is preferred. Avoid junk food food from outside. take loads of fresh food and vegetables. Number three is avoid stress. Try to stay relaxed and be happy with your partner. Nowadays, there is no evidence to support bed rest after embryo transfer. So you can do light breathing exercises, yoga or meditation. Fourth, you can carry on with your routine activities. If you're going out for work, you can absolutely go to work also, but try to stay happy and relaxed"