Gynecologist and obstetrician Op. Dr. Aret Kamar from Istanbul Women's Health and IVF Center gives information about polycystic ovary syndrome and reproductive health.
What is polycystic ovary syndrome? In which age group does it mostly occur in women?
"Polycystic ovary syndrome is a condition that is feared by its name, in fact it symbolizes existence for us physicians. Because polycystic ovary syndrome means that we have plenty of innate eggs. It means we have a high reserve. As you can appreciate, we prefer to deal with the abundance of something rather than its absence. In reality, you are born with polycystic ovary syndrome. You struggle with polycystic ovary syndrome until you reach menopause. Because polycystic ovary syndrome is a congenital problem that leads to irregular menstruation, complaints of “I don't eat, I watch what I eat but I gain weight” and hair growth in young girls. In short, polycystic ovary syndrome is a disease that occurs in adolescence with problems such as irregular menstruation and hair growth.
When fertile age comes, of course, the greatest desire of women is to have children. A considerable number of women with polycystic ovaries ovulate normally. This is equal to almost half of all patients. So polycystic ovary syndrome does not mean that a woman cannot get pregnant. Women with polycystic ovaries who menstruate regularly can get pregnant. On the other hand, half of the women with this problem have either no or irregular periods. Some of them menstruate every two months, while others do not menstruate at all unless they take medication. Therefore, in this group, it is necessary to activate the ovaries with pills or injections and stimulate the ovulation function so that they can conceive. Of course, if their husbands' sperms are normal and there are no other problems in their tubes and uterus. Because if there is a problem in them, the treatment will not be limited to stimulation of the ovaries, but will now go towards in vitro fertilization. Polycystic ovary is associated with metabolic problems in older women. This is because the basis of polycystic ovary syndrome is actually resistance to the hormone insulin. And for this reason, women's fat and sugar metabolism is impaired. Women with polycystic ovary syndrome are more likely to develop gestational diabetes and diabetes in later life. Complications such as arteriosclerosis and infarction are more likely to occur more frequently due to lipid metabolism disorder. Therefore, it is important to pay attention to nutrition and menstrual regulation in order to prevent metabolic problems of polycystic ovary syndrome."
BEWARE OF HEALTH PROBLEMS ASSOCIATED WITH POLYCYSTIC OVARY SYNDROME!
Another problem is the risk of developing cancer by hyperplasia of the endometrial, the inner layer of the uterus, caused by irregular menstruation. Irregular menstruation also increases the risk of cancer caused by overstimulation of hormone-sensitive breasts. Treating menstrual irregularity from a young age is of great importance in these respects.
Young women with hair growth problems should be medicated. In order to have children at a fertile age, treatment is necessary. If irregular menstruation is a problem at an advanced age, it must be corrected. In order to avoid all these problems caused by polycystic ovary, the metabolic process should be regulated by using drugs for insulin resistance if necessary. Since some women are born with polycystic ovary, and polycystic ovary accompanies them throughout their lives, the importance of its treatment should not be forgotten while learning to live with it."
MALE PATTERN HAIR GROWTH IN YOUNG GIRLS IS A SYMPTOM OF POLYCYSTIC OVARY
Something you just emphasized caught my attention. You said that excessive hair growth especially in young girls can be a sign of polycystic ovary. Many young girls go to laser hair removal centers as a solution to their hair growth problem. After all, if there is a polycystic ovary, they cannot be treated. Here's what I want to know. Is the pattern of hair growth caused by polycystic ovary different from normal hair growth? Which parts of the body have more hair growth?
"Hair growth caused by polycystic ovary is different from normal hair growth. We are talking about male pattern hair growth. Armpit hair bothers every woman and they can have hair removal. But the hair on the upper arm is male pattern hair growth. Hair growth below the knee is normal, if it is excessive, they can have hair removal, but hair growth above the knee, on the buttocks, waist, between the two breasts, around the breasts, on the front of the abdomen, on the cheeks, in the beard area and mustache area are “male pattern hair growth” due to high androgens. Again, hair loss due to high male hormones, thinning, thinning of the hair, and hair starting to grow from the sides are the symptoms of male pattern hair growth, that is, high androgen levels. The treatment for these is not epilation. But unfortunately, since our age is the age of speed, everyone wants to reach what they want, when they want. Of course, in young women who receive a medical treatment, there is no such thing as decay and shedding where this hair is. The cycles of the hairs on our skin are about 3 months. In other words, it takes 3 months for a hair to start growing, grow, fall out when the time comes and a new hair to replace it. So the hairs on the skin of a young woman who starts using injections or medication this month will not thin and disappear at that moment. Those drugs cause the new hairs to be thinner and weaker when the hair cycle is over. When the treatment continues, each new hair that grows is thinner than the previous ones. After a while, normal hair growth starts to be seen on the skin instead of black hair-like hairs.
Therefore, drug treatment is a process. You need to be patient while taking medication. Because the symptoms of drug treatment begin to be seen after 3 months and this treatment can last 1-2 years. So what happens to young women who go to epilation without doing this? Now this also applies to Greece. Because Greece is also a Mediterranean country. Hair growth is a little more in the Mediterranean belt. In young women who start epilation, hormones in the body make hair again. This time, most young women complain, “I went for epilation but it did not work”. Young women with polycystic ovary syndrome should definitely be treated before epilation. Because medical treatment prevents or slows down the growth of new hair. After that, they can go for epilation."
IS POLYCYSTIC OVARY AN OBSTACLE TO HAVING CHILDREN?
Which women diagnosed with polycystic ovary require IVF treatment and what are the results of IVF treatment?
"Let's start from the end. An abundance of eggs is always good for us. We love the abundance of eggs, but as I said before, this situation needs to be managed. If a woman with polycystic ovary with abundant eggs has irregular menstruation, it means that she has an ovulation problem. If there is no problem in the man and there is no problem with the tubes, we can do two things. Either in vitro fertilization or, if her husband's sperm is normal, we can ovulate the young woman and try to get her pregnant normally.
As for who we should treat and who we should do IVF for. We can treat those who are underweight and do IVF for those who are overweight. Almost half of polycystic ovaries have weight problems. It is easy to manage the ovary in a thin woman. We can obtain a reasonable number of eggs from the ovary by starting with small doses of drugs and injections and gradually increasing them. So we can get two eggs, we can get four eggs. This is not easy in women who are overweight. Because in overweight women, low-dose treatment is applied to prevent the formation of many eggs. However, when you give a low dose, there is no response to the treatment in the overweight patient group. Even if you increase the dose a little bit, you will still not get results. When you start to increase the dose, there may be a situation such as the development and growth of 20-30 eggs. However, this is not a preferred situation. We prefer IVF in overweight women with polycystic ovary. Because in IVF, we collect the eggs and make the embryos ourselves. And we can implant as many embryos as we want. We can also freeze the excess. So the woman undergoes treatment once. She produces a lot of eggs. From those many eggs, we get as many embryos as we want. The woman is not treated again. This is an advantage. We can freeze and store the embryos for a while. Even if the woman does not conceive in the first transfer, the next IVF attempt can be made with these frozen embryos. There are even some women who have their third child with frozen embryos and say, “I don't want any more children, you don't need to keep them anymore”.
One of the most important problems in polycystic ovary is “hyperstimulation syndrome”. The pregnancy hormone is the same as the drugs used in treatment. In cases where a lot of eggs are released after the medication, the eggs may gradually grow and the woman may need very serious intensive care conditions. Especially if the woman becomes pregnant, life-threatening conditions may occur. Therefore, the treatment approach in polycystic ovary is extremely important. In this group of patients, it may be preferable to transfer the embryos the following month after the ovary is relieved. Thus, the woman's health and life are not put at risk."
MALE-RELATED PROBLEMS ARE MORE COMMON IN PATIENTS APPLYING FOR IVF TREATMENT!
Based on the overseas patient experience of Istanbul IVF Center, I would like to learn the following: What is the rate of female-induced inability to have children among patients who apply from abroad? And what is the place of polycystic ovary syndrome in this rate?
"I can say that polycystic ovary syndrome is almost 30 percent of the problems that prevent having children. The situation may be different in Northern Europe, but this is the case in our geography, in the Mediterranean race. However, among women with polycystic ovaries, those with high egg reserve are more common. Male-related problems are more common in the applications made to our center for IVF from abroad. When we first started IVF treatment, when we drew a diagram, we used to say 55 percent women and 45 percent men. But now it is not like that. Today, there are more problems in men. All over the world, sperm counts and sperm motility are decreasing day by day in men. Sperm have deformities. In fact, eggs are also decreasing in women. There is a decrease in fertility worldwide. Why is this happening? Unhealthy diet, stress, harmful habits are the main risk factors. Tight clothing is fashionable, but it reduces sperm count, especially in men. Sitting life and lack of exercise reduce sperm count. Eating junk food in fast food style, eating foods high in gluten deteriorates sperm count and egg quality. Therefore, fertility is decreasing significantly all over the world. Therefore, more and more people need IVF treatment. We are also in the age of speed. In the past, we used to say, “You don't have a problem, go and try to have a child naturally for another 6 months and then come back.” Couples would try for 6 months and then come back if necessary. Personally, in my practice, I used to deal with people who had undergone 3, 5, 7 times of vaccination before trying IVF. Now there is no such thing. Nobody wants vaccination. Most couples want to reach a solution directly with IVF. "We don't have much time. We cannot take leave from work. We can't go back and forth too often. We can't get away from our jobs. If it will happen in one try, it will happen". When you respond, “You are only married for 3 months, we suggest you wait a little longer”, again, the desire of most couples is "Let's do IVF quickly. Let's reach a solution as soon as possible." Therefore, today IVF has become a more preferred treatment."
You said that nowadays, the problems of inability to have children caused by men are more common. What would you recommend to couples who are experiencing the problem of not being able to have children abroad, especially in the Balkan countries, who are looking for a solution to this problem, and who even think “Let's go for IVF treatment in Turkey and have a vacation”?
WHICH TESTS SHOULD THOSE WHO APPLY FOR IVF FROM ABROAD HAVE DONE BEFORE THEY ARRIVE?
"We first do some tests for those who want to apply for this treatment. Some of the tests come out in 1-2 days, but the results of some tests, especially genetic tests, may take 1 or 2 months. Therefore, it is very important that patients can explain what their main problem is when they apply. Do they want to have a healthy baby because they had an unhealthy baby before? Or is their problem just the inability to get pregnant? There are certain tests we ask for. There will definitely be a sperm test. There will be a uterine X-ray. There will be tests on the general health of the husband and wife. If there is an unhealthy baby born in the family and the disease of this baby is not known, the genes of the mother and father will be questioned and genes will be mapped so that we know what to deal with when we do in vitro fertilization. Therefore, gene tests of the husband and wife should also be done. Of course, at the end of these, we can inform them about the cost of the treatment. Because the difference between “We want a child and we want to have in vitro fertilization” and "I had an unhealthy baby before. I will have the uterus checked to see if it is sick or not" are separate problems that require different treatment approaches. They will also cost differently. When they send us the results of these tests through you, Health Bridge90 30, we will be able to give the couple specific information about the treatment, the duration of the treatment and the cost."