How does APCOD help in pregnancy?
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Hi Doctor, Hope you are good. I asked you a question on 17/10/2013 as follows, Hi, I was diagnosed with PCOD 2 years back when I was not married. With doctor's advice I took birth control pills and thus my menstruation became normal. I got married 18 months ago. I have not conceived yet but my cycles are normal for the last 8 months without any pills. Today I visited the same doctor and she said that I can never be able to become pregnant normally because of the PCOD. According to her some injections and long term monitoring will be required for successful ovulation. My weight is 58 kg, BP is low, age 27. I don't have thyroid problems and my prolactin is normal. On 12th day, my egg size is 7. Kindly suggest the future course of action for me. I have been given APCOD for three months from today. Kindly let me know the use of this medicine. Thanks To this question you replied As you have not conceived yet for 18 months, you should please consult an Infertility Specialist now. Am sure the basic problem in conception is PCOD. In this condition, due to unknown reasons, a widespread hormonal imbalance exists in the body. The ovary gets studded with multiple eggs, none of which mature to form a follicle which ovulates every month. First go for the following workup - AMH FSH and LH on day 2 of cycle DHEAS and free testosterone levels Oral glucose tolerance test TSH and prolactin ( if not within last 6 months, then repeat ) Fasting serum insulin. Next, you might be given treatment like Metformin to control PCOD. You have not mentioned your height, so I cannot calculate your BMI. If overweight, please aim at gradual weight loss as it will help PCOD. APCOD contains Myoinositol , folic acid and vitamin D 3. Its use is supposed to help to control the symptoms of PCOD, however PCOD has no absolute cure as such. Most women with PCOD do conceive successfully, but often require external aid to induce proper ovulation. Normally, ovulation occurs on day 14, and then the egg size should be between 18 - 21 mm, so on day 12, your egg size is not optimum. However, in PCOD, often ovulation is delayed , so the egg might grow to desired size later on. Mostly you would need help of ovulation inducing agents ( can be tablets and can be injections ) and monitoring to help you conceive. Let me tell you the plan of action for you, which I would suggest to a patient of mine - 1. Get the investigations for PCOD done as suggested. 2. get your husband's semen analysis done. 3. Get one cycle of plain follicular monitoring ( ultrasound throughout the menstrual cycle at regular intervals to check if you are ovulating naturally ). 4. If you ARE ovulating by yourself, then try naturally for 3 months, with follicular monitoring continued to allow you to pinpoint probable days of ovulation, around which you should be sexually active. 5. If you are NOT ovulating naturally, try ovulation induction first with clomiphene citrate tablets for 3 - 6 months ( injections of gonadotropins can be added if you do not respond to clomiphene also, most women with PCOD do respond well to clomiphene alone ). You can combine cycles of ovulation induction with IUI ( intra uterine insemination ) to increase pregnancy chances. 6. If this fails, please go for hysteroscopy and laparoscopy to check if your fallopian tubes are open. 7. If tubes are blocked / if multiple cycles of ovulation induction fail to yield pregnancy, you can go for IVF ( in vitro fertilization ). Continue taking APCOD meanwhile. Do not stress out, you are young, and am sure in due time, you will see positive results. All the best. Please feel free to ask for further clarifications. Take care. Subsequently I continued visiting the same Gynaec. On her advice I took APCOD XXXXXXX for 3 months and Doxt S tablets for 6 days and I tested for TSH and Prolactin on Day 3 of my cycle. The reports came out normal. My husband’s semen analysis was also done. It was normal too. My next cycle was on 23.11.2013. I visited the doctor on 25.11.2013. On examination, she remarked that eggs were smaller than required and there were cysts like earlier. I was prescribed ovofer 100 mg for 5 days, emgra 2 mg for 28 days and ovacare for a month along with APCOD continuation. Then I was called on Day 12 for further examination. On Day 12 (4.12.2013), there were no growing follicles according to the Gynaec and the egg size was 7. Then she suggested to continue Emgra and Ovacare and visit her on Day 3 of next cycle. But I missed periods this time on 23.12.2013. On doctor’s advice I used preganews on 30.12.2013 which was negative. With her advice I took deviry 10 mg from 31.12.2013 to 5.1.2014 to get my periods. But as it was not occurring so we visited her on 16.1.2014. After examination she said that my endometrial wall was thick. I was told to take an injection of Proluton depot 250 mg alone or with progynon 10 mg to start my periods. I took the injection on 20.1.2014 but there were no periods till 25.1.2014. So, I visited her on the evening of 25.1.2014. To my surprise she said that I have conceived for 4 weeks. Now I have been given Duphaston 10 mg, Fol 123 and Naturogest 200 mg for a month and a Ultrasound 2 weeks later. Now, my questions are 1. Is this a normal pregnancy? Should I continue with the pregnancy? 2. Will there be any effect of deviry and Proluton injection on the child? 3. As I am allergic so I take asthalin inhaler regularly. Moreover I take sinarest and cetriz too. Are these harmful to the fetus? As I am constantly allergic so is there any alternative to Sinarest/ Cetriz for a pregnant woman? My DOB- 25.10.1986, weight- 58kgs, BP- 120/80 and height- 5 ft 1 inch. Thank you.
Posted Tue, 18 Feb 2014 in Pregnancy
Answered by Dr. Aarti Abraham 10 hours later
Brief Answer: EXPLAINED BELOW Detailed Answer: Hello Yes, I am indeed glad to hear from you after a long time, and that too with good news ! First of all, congratulations on your pregnancy ! It is indeed a much awaited and precious one for you. Let me answer your questions one by one - 1. Yes, this is very much a normal pregnancy. In PCOS, as I told you even the previous time, ovulation can be very erratic and delayed . So you have ovulated later than expected, and hence conceived. But this is a normal pregnancy. 2. Deviry contains medroxyprogesterone acetate - there is no side effect of this drug on the baby or on pregnancy. Please go through this link, it will reassure you WWW.WWWW.WW Regarding Proluton injection, it is perfectly safe, and at times even given in high risk pregnancies to reduce the risks of abortion. 3. All the three drugs - Asthalin inhaler, Sinarest and Cetirizine are best avoided during pregnancy, especially in the first trimester. Cetirizine is the safest and can be used occasionally , but it is best to let the first trimester go by without any added drugs, as already a lot have been taken. I cannot grade the severity of your allergy without examining you. Please consult a XXXXXXX and experienced Physician in your city, to diagnose if you really need drugs, and if there are any safe alternatives. I think in my opinion, stay away from allergic triggers, and take Cetirizine as and when needed. You are very lucky to have conceived with the severe PCOS, so stop worrying, as negative thinking and stress will negatively impact your pregnancy and your baby. Also, dont stress about the ultrasound findings, as this is a delayed conception, so going by the dates of your period, normal ultrasound findings will not appear ( all milestones will be slightly delayed ) but that is to be expected and natural. Keep me posted as the pregnancy progresses. Starting from 25th of January, have an ultrasound scan after 6 weeks to know if the pregnancy is normal ( earlier if you have bleeding or spotting ). Please take Duphaston, Folic acid and Naturogest sincerely as advised. I wish you all the best for your motherhood ! Take care, and write in whenever you feel like.
Follow-up: How does APCOD help in pregnancy? 13 hours later
Hi Doctor, Thanks a ton for your detailed reply and caring words. Kindly clear my doubts on the following topics also. 1. Are there any precautionary measure I can undertake from now so that my child doesn't get any kind of allergy from my blood? 2. What can be the expected time of delivery? 3. As of now my husband gives me lift in his scooter to and from my office. Is that alright or should I go on leave immediately? If yes, then till when I should be only indoors? Moreover should I avoid any kind of vehicles for the first trimester like rickshaw, auto rickshaw or car? 4. Kindly recommend some nutritional supplements for my upcoming child during my pregnancy. 5. Should I get tested my blood for any particular diseases?
Answered by Dr. Aarti Abraham 12 hours later
Brief Answer: EXPLAINED BELOW Detailed Answer: Hi dear. Thank you for the appreciation. 1. The allergy cannot be passed on to your child, so do not worry. Dont expose yourself to pollution, dust and smoke. Take daily Vitamin C tablets to boost your immunity. Stay protected in cold, chilly or windy weather. Avoid cleaning, dusting and travelling excessively in the open. Allergy cannot be transmitted from the bloodstream. 2. I can tell you the expected date of delivery only after your ultrasound scan. As your cycles and ovulation were irregular, the delivery date will be calculated from the first ultrasound scan report. Make sure it is done at a reliable centre in experienced hands. It should be done transvaginally and with an empty bladder, 6 weeks from now. 3. It is better to take rest till the baby's heartbeat is confirmed. If the ultrasound scan shows proper heartbeat, you can then work , as long as there is no jerky travelling involved, safely till the third trimester, if no complications arise. It is best to avoid public transport, as there would be pushing and exposure to dust. Better to have a private vehicle, on good roads, and to drive carefully with a seat belt and proper safety precautions. Avoid standing for prolonged periods at work, take frequent rests. Take lots of fluids to avoid dehydration. If you have cramping pain, spotting etc, then immediately take rest. 4. Take daily 5 mg per day Folic acid tablets. From the second trimester onwards, please take daily iron and calcium supplements, once a week Vitamin D sachets and Protein powder daily. 5. Yes, please get the following tests done - Complete blood count HIV HBsAg HCV VDRL Urine microscopy and culture OGTT ( oral glucose tolerance test ) TSH HbA2 ( screening for thalassemia ) Ultrasound at 6 weeks, 18 weeks, 34 weeks and more if required. All the best. Please feel free to ask anything else. Take care.
Follow-up: How does APCOD help in pregnancy? 35 hours later
Thank you doctor once again for your insightful and detailed reply. I forgot to mention that I take tab Wysolon for my allergic cough when it gets out of control. Moreover, may I ask you whether lovemaking is safe during pregnancy?
Answered by Dr. Aarti Abraham 2 hours later
Brief Answer: EXPLAINED BELOW Detailed Answer: Hello Thanks for writing to us. Please avoid Wysolone during the first trimester at least, and curtail its use if possible throughout pregnancy. Sexual intercourse is alright once your first trimester scan is done, and cardiac acitivity is documented. If no complications arise further on in pregnancy, intercourse is allowed.