POLY­CYS­TIC OVARY SYN­DROME

More peo­ple are now aware of poly­cys­tic ovary syn­drome, thanks in part to celebrity “cys­ters” – a play on “cyst” and “sis­ter”. EVELINE GAN talks to the doc­tors about the in­fer­til­ity con­di­tion and two women who over­came it.

Young Parents (Singapore) - - CONTENTS -

The in­fer­til­ity con­di­tion that celeb mums want you to know about.

When Har­tini Ab Ghani was di­ag­nosed with poly­cys­tic ovary syn­drome (PCOS) at 18, she wasn’t overly con­cerned about her ir­reg­u­lar pe­ri­ods at that age. Nor the fact that the hor­monal dis­or­der, which causes small cysts on the ovaries, may cause in­fer­til­ity.

But that be­came Har­tini’s ma­jor stum­bling block when she was ready to start a fam­ily. With PCOS, Har­tini says it was vir­tu­ally im­pos­si­ble for her to be­come preg­nant nat­u­rally.

“The scans showed many ‘bub­bles’ (cysts) in my ovaries. While my eggs were there, they weren’t com­ing out and I wasn’t ovu­lat­ing. Even af­ter I took med­i­ca­tion, un­der­went surgery as well as in­trauter­ine in­sem­i­na­tion (IUI), noth­ing hap­pened,” shares Har­tini, 36, a se­nior spe­cial­ist at the Sin­ga­pore Uni­ver­sity of Tech­nol­ogy and De­sign. “It was re­ally frus­trat­ing.”

IUI is a fer­til­ity treat­ment that in­volves plac­ing sperm in­side a woman’s uterus to fa­cil­i­tate fer­til­i­sa­tion.

The # TTC sabo­teur

One of the lead­ing causes of in­fer­til­ity, PCOS af­fects as many as one in 10 to 20 women of child­bear­ing age, says Dr Seng Shay Way, a spe­cial­ist in ob­stet­rics and gy­nae­col­ogy and con­sul­tant at the Rafes Women’s Cen­tre.

More peo­ple are made aware of the hor­monal dis­or­der to­day, thanks in part to celebrity “cys­ters” – a play on the words “cyst” and “sis­ter” of­ten used on so­cial me­dia to re­fer to women with PCOS – such as Amer­i­can model-ac­tress Jaime King and lo­cal so­cial me­dia star Velda Tan (pic­tured, top right). Both have shared their #ttc (try­ing to con­ceive) strug­gles on­line.

Jaime, 38, took al­most ve years of try­ing and suf­fered ve heart­break­ing mis­car­riages be­fore wel­com­ing her rst child in 2013.

In July, Velda, who founded fash­ion brand Col­late The La­bel and Love, Bonito, shared on her In­sta­gram ac­count @bel­lus­puera that her road to con­ceiv­ing “wasn’t quite a walk in the park”.

At one point, she found that she wasn’t ovu­lat­ing any­more. “Over the next year, I was put on hor­ri­ble cy­cles of med­i­ca­tion to stim­u­late egg growth, with no re­sult, only more pain, more weight gain, and cy­cle af­ter cy­cle of dis­ap­point­ment,” Velda wrote.

She is about ve months’ preg­nant, and con­tin­ues to be open in shar­ing her in­fer­til­ity strug­gles to in­spire other women.

There are no ofcial PCOS sta­tis­tics in Sin­ga­pore. But Dr Ser­ena Lim, an as­so­ciate con­sul­tant at Sin­ga­pore Gen­eral Hos­pi­tal’s (SGH) depart­ment of ob­stet­rics and gy­nae­col­ogy, says it is “not sur­pris­ing” if PCOS is on an up­trend among women here, given the ris­ing obe­sity rates and greater aware­ness about women’s health is­sues.

Re­searchers can­not pin­point the ex­act cause, but be­lieve it could be due to a com­bi­na­tion of ge­netic and en­vi­ron­men­tal fac­tors.

What is known, says Dr Lim, is that the con­di­tion tends to run in fam­i­lies (you have a greater chance of get­ting it if your mother or sis­ter has it, for ex­am­ple) and is more com­mon among South Asian women. Be­ing over­weight also in­creases your risk.

Stud­ies have also shown that PCOS suf­fer­ers are less re­spon­sive to in­sulin, a hor­mone that helps pre­vent high blood sugar. They also ap­pear to have low-grade inam­ma­tion in the body, says Dr Seng.

Signs not al­ways ob­vi­ous

Women with PCOS may nd it harder to con­ceive be­cause the hor­monal im­bal­ances af­fect ovu­la­tion, nar­row­ing the win­dow of fer­tile pe­riod when a ma­ture egg is re­leased from the ovary.

This re­duces the chance of the sperm meet­ing the egg and be­com­ing preg­nant, SGH’s Dr Lim ex­plains.

Plus, they tend to have slightly higher than nor­mal lev­els of the male hor­mone, testos­terone, Dr Lim says. As such, they may de­velop mas­cu­line char­ac­ter­is­tics like ex­cess hair on the face, ch­est and stom­ach, male-pat­tern hair loss, a deeper voice, acne and weight gain, Dr Seng adds.

The signs aren’t al­ways ob­vi­ous, though. Apart from ir­reg­u­lar menses – a sign which many women tend to at­tribute to stress – Har­tini shares that she did not ex­pe­ri­ence other clas­sic symp­toms like weight gain or hair growth in un­likely ar­eas.

“It is a het­eroge­nous dis­or­der with dif­fer­ent symp­toms and sever­ity,” Dr Lim says.

For ex­am­ple, while obe­sity can raise PCOS risk, about 30 per cent are of nor­mal weight. If they put on too much weight, any symp­toms they ex­pe­ri­ence could worsen.

‘‘I was put on hor­ri­ble cy­cles of med­i­ca­tion to stim­u­late egg growth, with no re­sult, only more pain, more weight gain, and cy­cle af­ter cy­cle of dis­ap­point­ment.’’

Higher risk of preg­nancy com­pli­ca­tions

Stud­ies show that be­com­ing preg­nancy is only the rst hur­dle. PCOS trou­bles may con­tinue even dur­ing preg­nancy, putting mums-to-be at a higher risk of cer­tain com­pli­ca­tions in­clud­ing mis­car­riage, ges­ta­tional di­a­betes and preeclamp­sia (high blood pres­sure in preg­nancy) as well as a C-sec­tion de­liv­ery, Dr Seng shares.

Malaysian blog­ger Au­drey Ooi, 32, bet­ter known as Four­feet­nine on­line, is one suf­ferer who has ex­pe­ri­enced the preg­nancy com­pli­ca­tions rst-hand.

At around 28 weeks of her rst preg­nancy, Au­drey de­vel­oped preeclamp­sia. She fought to keep her baby in her womb un­til 31 weeks to give him a bet­ter shot at sur­vival, risk­ing health com­pli­ca­tions her­self. In se­vere cases, mums with preeclamp­sia can get seizures, strokes, be­come blind or die from it.

Against the odds, both mother and child sur­vived the or­deal. The high blood pres­sure came back dur­ing her sec­ond preg­nancy, but was kept un­der con­trol un­til she de­liv­ered her daugh­ter at 36 weeks.

Now, the good news

Not all women with the con­di­tion may nd it hard to con­ceive, Dr Lim says. It can be treated and the odds of con­ceiv­ing nat­u­rally “are very good”, Dr Seng adds.

Ac­cord­ing to the ex­perts, it helps to watch what you eat and to ex­er­cise reg­u­larly. For over­weight pa­tients, for in­stance, los­ing just ve to 10 per cent of body weight can re­verse some symp­toms with­out the need for med­i­ca­tion, Dr Lim says.

Reach­ing a healthy weight and blood sugar lev­els be­fore you con­ceive can lower preg­nancy com­pli­ca­tions risks, Dr Seng adds.

There is also med­i­ca­tion in the form of tablets or in­jec­tions to help a woman ovu­late. More than 95 per cent of pa­tients who seek treat­ment for fer­til­ity are usu­ally put on med­i­ca­tion rst, Dr Lim says.

If that doesn’t work, Dr Lim says there are other op­tions, such as key­hole surgery known as ovarian drilling, which may be help­ful in cer­tain pa­tients, par­tic­u­larly those of nor­mal weight.

This pro­ce­dure in­volves “burn­ing” holes in some parts of the ovaries – us­ing laser or an elec­tric cur­rent – which may bal­ance hor­mone lev­els and re­store ovu­la­tion.

When ovarian drilling and other fer­til­ity treat­ments failed to work for Har­tini, she turned to in vitro fer­til­i­sa­tion (IVF). She con­ceived suc­cess­fully, but mis­car­ried twin ba­bies in her sec­ond trimester.

Last year, she nally closed her seven-year-long heart­break­ing #ttc chap­ter by wel­com­ing Baby Ei­man, whom she de­liv­ered nat­u­rally at 36 weeks.

Her jour­ney to grow her fam­ily hasn’t ended. Har­tini in­tends to go through IVF again next year to give Ei­man a sib­ling. She tells her fel­low “cys­ters” who are strug­gling to con­ceive not to give up.

“There was a point where my hus­band and I thought of giv­ing up af­ter we buried our twin ba­bies. But we de­cided to give it an­other shot. At the end of the day, even if we don’t suc­ceed, at least we know we’ve tried our best,” she says.

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