Irregular periods and Infertility

Irregular periods and Infertility

The average duration of the menstrual cycle is generally 28 days, however, it’s completely normal for periods to come a bit early or late.

In general, females, who are still going through puberty, have higher chances of getting irregular periods, whereas females, who are past this phase, develop a regular cycle. Irregular periods are a condition when the length of the menstrual cycle becomes irregular and keeps on changing.

What causes irregular periods?

The irregularity in the periods could be caused due to various reasons such as hormonal imbalance, PCOS, obesity, thyroid dysfunction, etc. In some cases, the cycle gets back to normal on its own within 2-3 months; however, it is advisable to get these conditions evaluated by your doctor in case this irregularity continues for a longer period of time. Some of the major and common reasons behind the irregularity of the menstrual cycle can also lead to infertility.

Irregular periods and infertility

Irregular periods could be held accountable for a lot of cases where it gets difficult for a female to conceive. Irregular bleeding patterns, no bleeding at all could mean that a female is not ovulating normally. Although this condition could be possibly treated by fertility drugs, it is advisable to evaluate all the reasons that may interfere with your fertility

PCOS (Polycystic Ovary Syndrome): Irregular periods are a telltale sign of females suffering from polycystic ovary syndrome. In such cases, a female may experience a spectrum of menstrual irregularities ranging from prolonged menstrual cycle length, menstrual cycle with a very heavy flow, no menstrual cycle without taking medications. PCOS is a hormonal imbalance that can cause the ovaries not to work. In most cases, the ovaries become enlarged and appear covered with tiny, fluid-filled cysts. It can cause no ovulation or irregular ovulation.

Thyroid: In a study, it was found that almost 44% of the females who were suffering from an irregularity of periods also had thyroid issues. Where hypothyroidism causes very heavy bleeding along with severe menstrual cramping and fatigue, hyperthyroidism causes a shorter and lighter period along with anxiety and weight loss.

Stress: People may experience stress in many different ways, such as sadness, irritability, insomnia, and headaches. When an extremely stressful situation arises, any system that isn't necessary for survival shuts down, including your reproductive system. Stress does links to that part of the brain, which regulates the menstruation controlling hormones. This is why your period can be late when you're experiencing high levels of stress for an extended period of time. Stress could be one of the evils that may be causing your menstrual cycle to become irregular. For some couples, infertility itself causes a lot of stress which eventually may affect their fertility.

The study by Boston University suggests that when one person is more stressed than the other (also known as "stress discordance"), getting pregnant could be difficult because it can indicate poor relationship quality.

Overweight: Being overweight is one of the most common reasons behind irregular periods. Research shows that the excess weight messes up with the hormone level alongside affecting the levels of Insulin. This imbalance, as a consequence, interferes with your menstrual cycle, causing it to become irregular

Medication: There are certain medications that could easily alter the regularity of the menstrual cycle. These could be antidepressants and oral contraceptive pills.

Diminished Ovarian Reserve: There are not many symptoms that could tell that a female’s ovarian reserve is diminishing, nonetheless, delayed menstrual cycle, no menstrual cycle, shorter menstrual cycles, or scanty flow, could be some of the symptoms that indicate that the quality and the quantity of the eggs are getting negatively affected or getting diminished.

Fibroids- Fibroids are benign muscular growth in the uterus. When they are confined within the muscular layer, they are known as intramural fibroids, when they start growing inside the uterus lining (endometrium), they are known as submucosal fibroids. Sub-mucosal fibroids can be one of the reasons for irregular periods.

Endometrial polyps- These are small growths in the lining of the uterus(endometrium) which can because of irregular bleeding, spotting in between periods.

Cancer: Women should not be taking the infrequent periods or irregular menstrual cycle lightly as it could be a sign that a female is suffering from some form of reproductive organ cancer(ovaries, uterus, cervix).

Hormonal birth control pills and breastfeeding are also some of the causes of irregular bleeds 

Treatment

The treatment could vary depending on the actual reason if any that makes the menstruation irregular. It may also be required to treat the underlying condition that could be playing a part. Treatment can be medical interventions or surgical interventions. Sometimes optimizing ovulation Induction only helps to regularize the menstrual cycle. Structural treatments may include surgical removal of uterine fibroids, removal of polyps. Other surgical interventions, which are helpful, are -

●    Hysteroscopy. In this technique, your doctor will insert a thin hysteroscope through your vagina and cervix into the uterus. If your doctor finds any endometrial polyps that cause irregular bleeds and infertility, they will be removed at this time. 

●    Endometrial biopsy. This is a biopsy where the doctor with the help of a small plastic tool, gets the inside lining of your uterus. This lining serves as the sample tissue to check for the state of the lining of the uterus, any infections, and for the presence of any abnormal cells which can lead to cancer.

The Effects Of Coronavirus Over Fertility

The Effects Of Coronavirus Over Fertility

Since December when the first case of symptoms because of coronavirus was reported to WHO, more and more cases of coronavirus are being reported. The W.H.O rings the alarm bell aloud and calls it a pandemic on? The death toll from coronavirus cases is world-shattering and disrupts the economic, political and social life today across continents. As nations are adopting measures to manage the crisis to prevent the rapid spread, health experts have raised concerns and effects on their treating patients. This writes up is related to the effect of coronavirus or COVID 19 on fertility. It is necessary to enlighten yourself about the new COVID 19 threat and the risks if you are pregnant or taking fertility treatment.

What is COVID 19?

Coronavirus (CoV) is a set of viruses that makes others suffer from the illness ranging from the sign of a common cold to severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The new strain discovered in 2019, which is named as COVID 19 by W.H.O has not been previously identified in humans. The virus is termed as (SARS-CoV-2). The disease outbreak was first reported in Wuhan, China. 

It has been believed that Coronaviruses are zoonotic, and that first transmission to humans came from animals. The new COVID 19 is spreading from person to person especially those in close contact. The mode of spread is by respiratory droplets when the infected person coughs or squeezes. The contagious nature of the virus increases the risk of infection which has currently no vaccine.

According to W.H.O, the symptoms of COVID 19 include fever, dry cough, and shortness in breath. Some persons are also identified with symptoms like running nose, sore throat, and nasal congestion. The symptoms appear from two to 14 days after exposure. In severe cases, the infection leads to pneumonia in lungs, multi-organ failure, and even death.  Recovery depends on the strength of the immune system of the body. This makes the disease deadly for immunocompromised patients, elderly patients, patients with medical problems like high blood pressure or chronic respiratory conditions and pregnant women. Standard recommendations to prevent COVID-19 infection include washing hands, covering nose and mouth while coughing and sneezing, avoid touching eyes, mouth, and nose and most importantly avoiding close contact with anyone showing symptoms of COVID-19 infection.

COVID 19 on Fertility and Human Reproduction

No study has proved that the new coronavirus will affect male fertility. According to the latest updates from the Centers for Disease Control and Prevention (CDC) in the USA and others in Europe, neither it will negatively affect pregnancies especially in early stages. However, there are case reports shows increase risk for preterm birth and adverse neonatal outcomes in infants born to women with COVID-19.  Hence as a precautionary measure, it is advisable for the fertility patients planning or considering the treatment to avoid it.

Couples should avoid getting pregnant this time even if they won’t meet the criteria of diagnosis for COVID-19. For those who are already in treatment, I suggest they defer the pregnancy by oocyte or embryo freezing for embryo transfer later on. If you have developed symptoms of COVID-19 after oocyte collection, you should not have an embryo transfer. It is mandatory for those who are under fertility treatment to follow necessary precautionary advice to avoid risks.

What Precautionary Measures to Follow?

●       Advised to self-isolate and stay indoors. Avoid contact with those who show COVID-19 symptoms.

●       Avoid non-essential travels, especially to infected areas. Avoid if possible use of public transports.

●       Separate themselves from other members of the household as far as possible. Use your towel and utensils and eat separately

●       Inform your fertility experts about all your medication and follow his/her instructions.

●       Minimize the number of physicians and providers

●       Avoid initiation of new treatment cycles including IUIs, IVF, ovulation induction, etc.

How to provide support to Fertility Patients amid Corona?

It is necessary to be aware of the emotional impact on pregnant women about the anxiety and the effects of the virus itself. Measures should be taken to keep them calm and composed. There must be effective communication between the fertility expert and the patient and the patient needs to be informed about the changes in the treatment and the reasons for the same.

PCOS In Youngs Adolescents - Important Factors To Know

Polycystic Ovary Syndrome (PCOS) is hormonal and reproductive disorder found commonly among young adults including women of reproductive age. It is regarded as a common cause of chronic hyperandrogenic anovulation and ovulatory dysfunction. The disorder is also a risk factor for metabolic syndrome, cardiovascular diseases, impaired psychological well-being, and increased cancer risk.

Although it is a very common health issue that affects 5-10% of adolescents, the disease remains undiagnosed or seems untreated in most people who have it. There are also occasions where it is misdiagnosed. Thus, diagnosing PCOS and so the PCOS treatment is very complicated in its terms and aspects. If your doctor thinks you are suffering from PCOS, she/he may refer you to an endocrinologist or specifically reproductive endocrinologist and infertility specialist.

PCOS in Young Adolescents

As a common endocrine reproductive disorder among women of childbearing age PCOS impacts many women from their very young age. The most common symptoms of the disease include irregular periods, acne, overweight, excess hair growth, etc. The severity of symptoms may vary from girl to girl and PCOS treatments are taken accordingly. Many young girls are distressed with the PCOS and its symptoms in their life and it can affect their self-esteem.

Challenges in Diagnosing PCOS in Adolescents

The signs and symptoms of PCOS can vary with age, weight, and medical conditions and this aspect of PCOS becomes a challenge in its accurate diagnosis, especially in young ones. The diagnostic practices tend to be inconsistent in adolescents since the normal pubertal physiological events are very much similar to the signs of PCOS. This overlap between PCOS and pubertal changes can lead to an over-diagnosis of PCOS among young girls which can be followed by unnecessary treatment as well as psychological impairment.

Considering the diagnosis of PCOS below are certain important factors young people need to keep in mind:

●       Hyperandrogenism

Studies have shown that puberty is characterized by high testosterone levels and acne in the body. The hormone level can reach its apex within a few years after menarche. This physiological hyperandrogenism can be misinterpreted as a sign of PCOS. However, neither testosterone levels nor acne can clarify PCOS, since they are influenced by other factors and, are not well defined in young females.

●       Irregular menstrual cycles

Adolescent girls often exhibit various patterns of physiological menstrual irregularities such as oligomenorrhea, primary amenorrhea, secondary amenorrhea, uterine bleeding, etc. According to a recent study, the most common etiology in young females with abnormal uterine bleeding is PCOS. Nevertheless, irregular menstrual cycles can’t be a reliable criterion for PCOS diagnosis in adolescents. It is necessary to differentiate the physiological anovulation related to puberty and the pathological anovulation which is identified as dysfunction in PCOS.

●       Metabolic risks

Once PCOS is identified in an adolescent girl, she should be tested for metabolic abnormalities which is an important risk associated with PCOS. Studies suggest that about one-third of the girls diagnosed with PCOS meet the risk of metabolic syndrome at a very early age. The criteria are different for the diagnosis of metabolic syndrome in young girls and the treatment must be given immediately as it reduces the future risks of other diseases like diabetes and coronary diseases.

Final Thoughts

These are the important factors to know about PCOS for the young generation including the challenges faced by the adolescents at the time of PCOS diagnosis. If you are facing issues related to this, you must get in touch with Gynecologist who deals specifically with Reproductive Endocrinologist

Does PCOS Come With Multiple Health Issues?

Polycystic ovarian syndrome (PCOS) is considered the most common endocrine system disorder found among women of the reproductive age group. PCOS is understood as a multifaceted disease that is associated with chaotic ovarian steroid genesis, excessive oxidative stress, deviant insulin signaling, etc. To date, clinical attention and PCOS treatment focused on the management of the specific signs and symptoms associated with PCOS.

Most of the time they are referred to endocrinologists due to its multifactorial association with other systems of the body.  Gynecologists are the next line of referral. Lately, with more understanding of this condition and increased awareness among the population, the trend is moving towards being referred to and seen by Reproductive Endocrinologist and infertility specialist’s the especially reproductive age group women with PCOS as PCOS and infertility are related.

Following are the late consequences or health conditions consociated with the syndrome:

1. Metabolic syndrome

Metabolic syndrome occurs when the body fails to balance its chemical processes as well as other processes which are necessary to create and use energy. Many patients who are diagnosed with PCOS also have metabolic syndrome which is a constellation of metabolic disorders. It includes metabolic disorders such as abdominal obesity, high blood sugar, insulin resistance, high cholesterol, and blood pressure.

2. Cardiovascular diseases and high blood pressure

Several elements of PCOS such as insulin resistance, hyperinsulinemia, obesity, metabolic disorders, etc. increase the risks of cardiovascular diseases in women. The insulin resistance associated with PCOS works in two ways to heighten the chances of cardiovascular diseases in women. One is the direct atherogenic action and the other is the adverse effect of the lipoprotein profile.

The most common cardiovascular diseases affected by women having PCOS are coronary artery diseases like atherosclerosis and cardiomyopathy. There is also a direct relationship between blood pressure and insulin plasma level because of which the risks of hypertension is higher in women with PCOS.

3. Ovarian cancer

Concerns about the risks of ovarian cancer in women with PCOS are still debated. Studies suggest that there is a connection between PCOS and ovarian cancer and that PCOS can increase the risk of ovarian cancer. One of the hypotheses could be because of anovulatory cycles in such a group of women and hence the broad use of drugs for inducing ovulation in these patients to achieve pregnancy. The risk seems to be greater in nulliparous women or those who have early menarche and late menopause. The lack of sufficient evidence put the relation between PCOS and ovarian malignancy at odds. However, ovarian cancer is generally seen as one of the important risks affiliated with PCOS.

4. Endometrial cancer

Concerning the long-term health risks linked with PCOS, endometrial cancer is one of them. Prolonged anovulation which characterizes PCOS is conceived to be responsible for the continual unopposed secretion of estrogens. This can cause endometrial hyperplasia which leads to the risks of endometrial malignancy.

Abnormal amounts of estrogen when not balanced with a sufficient amount of progesterone are one of the reasons for abnormal overgrowth of the endometrial lining of the uterus. Furthermore, factors such as obesity, diabetes, infertility, null parity or certain medications, etc. which are very much consociated with PCOS are the known factors that increase the chances of developing endometrial cancer.

5. Breast cancer

The development of breast cancer in women having PCOS seems to be associated with obesity, infertility, and hyperandrogenism. The family history of breast cancer and PCOS is another reason.  However, data on the link between PCOS and breast cancer are very limited.

Conclusion

PCOS is a syndrome or a disease which is very common in women. This disease does not come alone; it can come with several other diseases that are mentioned above. One should take proper follow up and counseling and medication if needed. Every woman carries her own individualized risk of getting affected by these health issues, hence it is very important to discuss these issues with treating doctors if there are any concerns.

Effect of Cancer Treatment on Fertility

Effect of Cancer Treatment on Fertility

Cancer is the abnormal growth and division of cells and can develop almost anywhere in the body. There are different types of cancers including lung cancer, skin cancer, breast cancer, prostate cancer, lymphoma, etc. The symptoms of cancer can vary depending on the type of body part is affected.

Fertility issues with cancer and cancer treatment

Cancer and some of the cancer treatments can affect a woman’s fertility or her ability to carry a child. Different types of treatments cause different problems concerning present and future fertility because of which it is important to  consult a fertility expert to know about the risks and if possible preserve fertility before starting treatment of cancer. Infertility resulting from cancer treatments can range from difficulty to conceive a child or the ability to maintain a pregnancy. The problem can be temporary, lasting for some period or even permanent. Again, it will be different for different kinds of cancer and their treatments. If you are a cancer patient or a cancer survivor, the fertility depends on the following factors such as:

●       The type of cancer

●       Type of treatment of cancer such as chemotherapy, radiotherapy or surgery

●       The age at the time of diagnosis and treatment

●       The dose and duration of the treatment

●       Associated other health issues

It is important to understand how the treatment can affect your fertility and pregnancy before starting the treatment. You should ask questions regarding the recommended treatments, and its effects on infertility, fertility options for the future, etc. to your fertility expert whenever possible.

How cancer treatments affect your fertility?

Cancer treatments can affect pregnancy in many ways. Some treatments can directly damage the ovaries and reduce the number of available eggs and others can affect other reproductive organs like the uterus. Some can cause variation in the hormone secretion between the brain and ovaries which may lead to infertility. One of the important factors that impact the effectiveness of these treatments is the age of the patient especially the hormone production and effect on ovaries. Based on the cancer type and age, the treatments vary and so the impacts.

1.   Chemotherapy

Chemotherapy includes treatment with drugs like cyclophosphamide, doxorubicin, idarubicin (Idamycin), busulfan, carboplatin, cytarabine, vincristine, etc. Some drugs are more potential to lead to infertility than others. The drug dosage can affect the ovaries and can cause stop releasing eggs and decrease the levels of the hormone estrogen. This condition is called primary ovarian insufficiency (POI). Sometimes POI is temporary and fertility can be restored. Getting pregnant during or soon after chemotherapy is not advisable and it is best to talk to the doctor in such cases.

2.   Radiation therapy

Radiation therapy destroys cancer cells using high energy rays. If the treatment is taken near the abdomen or pelvis, the radiation damages the ovaries and causes infertility. A high dosage of radiation treatment destroys healthy eggs in the ovaries or early menopause. A high dose of radiation therapy to the brain can also affect brain hormones responsible for egg growth. However, measures like ovarian shielding or Oophoropexy can protect the ovaries from radiation.

3.   Surgeries

Surgery near the reproductive system or tissues can affect your fertility. For example, cystectomy in the ovary can damage the eggs, hysterectomy, where the uterus is removed, can affect the capacity to carry the pregnancy. There are chances to cause scarring in the fallopian tubes while surgery.

How to preserve your Fertility?

There are options to preserve fertility for cancer patients. These procedures or treatments may available at the hospital you are taking treatment or in the fertility clinics. Talk with an experienced fertility expert for the best option considering your age and treatment. One of the most common options is fertility freezing methods including egg freezing and embryo freezing. There are other methods like ovarian shielding, ovarian transposition, etc. available. It is best to meet fertility expert before starting cancer treatment.

Effects of Cervical Cancer over Fertility

Cancer, also known as malignancy is a disease where the cells in the body grow abnormally. Cancerous tumors have the potential to invade healthy cells and spread to other parts of the body by continuing to grow. The disease is always named for the part where it starts in the body.

What is cervical cancer?

Cervical cancer is a type of cancer that arises in the cervix. It is the lowest part of the uterus that is connected to the vagina. Every woman is at risk of cervical cancer in their life. Figures suggest that every year, about 13,000 are diagnosed with cervical cancer. Out of it, 4000 are losing their life.

Cervical cancer mostly arises in the zone of the cervix termed as the transformation zone. Later on, it can spread to other parts like lungs, liver and lymph nodes. Cervical cancer can affect female reproductive organs like ovaries and fallopian tubes which can ultimately lead to infertility in some.

How Cervical Cancer affects Fertility?

The most common question asked by cervical cancer patients is whether it affects their fertility or not. Fertility issues in females depend on many things including the stage of cancer and the treatment recommended to them.

Treatments and medication for advanced cervical cancer can affect the fertility and hinder the patient’s ability to carry the baby. For example, treatments like radiotherapy, chemotherapy, and surgery can affect uterus, ovaries which in turn can lead to infertility. However, that does not imply you can never get pregnant. For that, you need to consult the best fertility expert who deals with such cases as in Oncofertility.

Options like oocyte cryopreservation or embryo freezing can be offered depending on individual case and type of cancer. Also, treatments like fertility-sparing surgeries such as conization and simple or radical trachelectomy can be considered which carry about 70% chances of pregnancy. Trachelectomy is the treatment suggested for those who are in the early stages of cervical cancer. These surgical treatments do carry the risk of miscarriage or premature birth. Thus, it is important to discuss these treatment options and fertility concerns with a fertility specialist before starting the treatment.

The most important step one can do is to undergo a preventive test which helps to detect cancer at very early stages when cancer is less aggressive and treatment is much milder. Early detection and treatment also help to restore fertility issues. Discussing fertility issues prior to cancer treatment offers you better possibilities and opportunities.

Early stages of cervical cancer

The early stages of cervical cancer generally are not associated with any symptoms but can be picked up by preventive tests like Pap smear. It is better if cancer is detected in its early stages when it is treatable. Statistics show that over a five-year period, the woman who is affected by cervical cancer and received early detection have a 92% survival rate.

Symptoms of much advanced cervical cancer include:

●       Abnormal vaginal bleeding between menstrual cycles, after intercourse, post-menopause, etc. Abnormal vaginal secretion with a strong odor and blood is also considered as a sign of cervix cancer.

●       Pelvic pain

●       Severe pain during or after sexual intercourse

It is possible to have these symptoms for other causes including infection. However, anyone experiencing these symptoms is advised to consult a doctor and complete a gynecological exam.