Infertility has become a bane of modern living and PCOS is one of the major causes of infertility.

Polycystic Ovarian Syndrome commonly called PCOS condition is a very common endocrine condition in reproductive-aged women often leading to difficulty in conceiving. Women diagnosed with PCOS can experience irregular periods, abnormal hair growth, acne, and can have ovaries containing multiple small cysts.

PCOS has a negative effect on fertility since such women are not able to ovulate or release an egg, each month due to an overproduction of estrogen. This subsequently leads to irregular periods and increased levels of hormones such as testosterone that can affect oocyte quality, inhibit ovulation, lead to insulin resistance, and increase the risk disorders such as gestational diabetes.

The relation between PCOS and obesity can be termed as complicated. Signs and symptoms of PCOS begin for some females soon after they start having periods. Women with PCOS produce too much insulin, or the insulin they produce does not function normally which leads to weight gain. Women diagnosed with PCOS may also find it difficult to lose weight. For some others substantial weight gain is followed by PCOS. However, it is certain that women suffering from obesity have a greater risk for PCOS and women with PCOS have a greater risk for obesity.

Many PCOS women with obesity may also develop coronary artery disease and glucose abnormalities at a very young age. Bariatric surgery can be a significant procedure to fight against all these abnormalities and a solution for all such irregularities. According to a study, in the state of Gujarat itself 18% females and 14 % of Males are over-weight.

If the prevailing PCOS condition is due to obesity, the chances of cure are almost close to 100% particularly young females with such condition. There are few types of surgeries and procedures for such condition, but your surgeon will likely have a recommendation as to which will be most effective for PCOS. The proven methods are Laparoscopic Sleeve Gastrectomy (LSG) and Endoscopic Sleeve Gastroplasty (ESG).

The Laparoscopic Sleeve Gastrectomy (LSG) generates weight loss solely through gastric restriction (reduced stomach volume). In LSG approximately 2/3rd of the stomach is stapled off roughly the size and shape of a Banana or Sleeve. This operation does not involve any ‘rerouting’ or reconnecting of the intestines. Hence it is technically as simpler operation than the gastric bypass.

Endoscopic Sleeve Gastroplasty (ESG) is one of the latest advancements in Medical Science. Endoscopic Bariatric Procedure does not require any hole or incision to put on any part of the body but a special Endoscopic instrument is inserted through an oral route to reach the stomach. Then the size of the stomach is reduced using stitches. On the same day after 4-6 hours of the procedure, a patient can go home. Moreover, as the procedure involves zero blood-loss, there is no need for blood transfusion and chances of infections are also almost nil.

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In Vitro fertilisation, also known as IVF, is a fertility treatment where in fertilisation takes place in the lab instead of the female body.

The basic steps involved in IVF technology is taking many eggs from female retrieved through transvaginal ultrasound-guided needle and placing in a petri-dish with cleanly washed sperm cells retrieved via masturbation or else sperm donor. The retrieved eggs will become fertilized by the sperm cells and become embryos. One of the healthy embryo is then transferred to the same female uterus. After process completion, bed rest is advised for at least 24 hrs.

An estimated 6.5 million IVF conceived babies have been born in the world since IVF conception in 1980s. Also famously known as test tube babies, produced by IVF are as healthy and normal as naturally conceived children.

Success rate of IVF, according to a study of approximately 156,000 women, the average live-birth rate for the first cycle was 29.5 percent, which is a comparable success ratio as that to couples with the natural cycle of fertility. Researchers in the UK have developed a prediction model to estimate the success rate of a live birth over multiple cycles of IVF. This prediction model can be personalized based on a number of variables (reproductive history, maternal age, the cause of infertility, and lifestyle factors) as well as their response to treatment for a realistic understanding of the long-term probability of success of IVF.

IVF is the preferred choice of treatment in the following health conditions:

1. Fallopian tube damage or pathology: women with blocked or removed fallopian tubes
2. Unexplained infertility (idiopathic): irregular ovulation cycles 
3. Male factor: low sperm count may turn to an intracytoplasmic sperm injection (ICSI) which only required 1 healthy sperm to fertilize an egg.
4. Endometriosis
5. Cervical factor / immunological infertility: polycystic ovarian syndrome (PCOS) 
6. Hormonal disturbances

Further, obesity can also complicate IVF, making it harder for overweight women to have successful IVF with their own eggs. Obesity is associated with increased dose and duration of gonadotropin stimulation, lower peak E2 levels, and increased oocyte retrieval time.

A large study published in 2013 reviewed over 9,500 egg donation IVF treatments. The egg donors were all of normal weight, and the recipients were divided into four groups: underweight, normal, overweight and obese. The rates of embryo implantation reduced to 23%, pregnancy rate decreased by 19% and live birth percentage reduced by 27% as body mass index (BMI), increased to obese.

A recent study indicated that obese women may need different doses and dosing regimen and fertility drugs than normal-weight women in order to ensure that their eggs ripen at the right time and can be extracted for IVF.

Therefore, it is recommended that patients with a high BMI reduce their weight before IVF treatment. Bariatric surgical procedures can be a durable option for weight reduction. This study highlights 5 patients who underwent Roux-en-Y gastric bypass bariatric surgery followed by in vitro fertilisation (IVF). Overall, these patients tolerated IVF well, and four of the five went on to have term deliveries. Rapid weight loss and increased risk of nutritional deficiencies in the first year after bariatric surgery have led to recommendations that gastric bypass surgery patients should wait at least a year before attempting pregnancy. IVF after bariatric surgery can be safe and successful.

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