Q: You talk about how 10-20% of women have no way to conceive naturally and need to undergo assisted reproduction. Which patients have a higher chance of having this problem? We talked about the three lines of treatment, the first line is medication, and the second line surgery can be used if it doesn’t work well. However, there are some patients who have had previous laparoscopic surgery, and if they have surgery again, it will be more difficult and they will also be prone to damage the intestinal canal, etc. Such patients do not want to have surgery, they can do in vitro fertilization and embryo transfer directly. Some people still cannot get pregnant naturally after laparoscopic perforation. Among them, there may be problems such as poor tubal egg collection function. There are also problems in the husband, who himself is weak sperm, oligospermia, or even azoospermia. Normally, a man should have more than 20 million sperm, at least 15 million sperm, and enough motility of sperm to cross the cervix of the female reproductive tract and reach the uterine cavity to meet the egg. If the husband is unable to do so, it is useless for the wife to be treated. We suggest that women with polycystic women who cannot get pregnant after more than 6 effective ovulations should consider: firstly, whether the fallopian tubes can pick up this egg, and secondly, whether there is any problem with the egg and sperm and whether they can be fertilized. If there are abnormalities, in vitro fertilization and embryo transfer may be needed. Q: What is the chance of success after in vitro fertilization and embryo transfer for polycystic patients? The success rate of in vitro fertilization and embryo transfer in polycystic patients is about the same compared to those who have infertility due to tubal factor, or male factor only. We hope to get about 10 eggs for in vitro fertilization and embryo transfer, usually six to seven good embryos, and then keep one or two as an alternative. This results in a clinical pregnancy rate of about 40 percent at one time. The clinical pregnancy rate is the chance that the embryo will be placed in the uterine cavity and a gestational sac will be visible in the uterine cavity afterwards. Frozen embryos have a clinical pregnancy rate of about 40%. Cumulatively, this gives a pregnancy rate of about 80%. However, when ovulation-promoting drugs are used in polycystic patients, the difficulties increase and the chances of ovarian hyperstimulation syndrome are higher. Therefore, when ovulation promotion is performed, polycystic patients should guard against serious comorbidities. If the ovulation promotion is too much, don’t get pregnant this time, freeze all the embryos first, wait for the effect of hyperstimulation to pass, adjust their uterine lining with progesterone, and then do embryo transfer later, the pregnancy rate will also be around 40%. Polycystic patients don’t have to worry too much, they can basically conceive a child. It’s just that some people are simple, once they lose weight, they get pregnant. The more complicated ones, use clomiphene to promote ovulation, and they get pregnant. Those who are not so lucky, get gonadotropins. For those who are unlucky, especially those with combined tubal problems, laparoscopic or hysteroscopic treatment may be needed. 80% of the patients can get pregnant by these methods. For the remaining 20%, in vitro fertilization and embryo transfer will be needed. Q: You mentioned before that the endometrium of polycystic patients is not fertile enough, which can also affect pregnancy. What can women do on their own to maintain this lining? Is it through diet or something else? There are many various statements. Some say it is good to eat sea cucumber every day. That it is okay for those who are well-off to eat one sea cucumber every day. But it may not be cost-effective, and sea cucumber is not an effective medicine to treat polycystic. In my opinion, what is effective is to adjust the lifestyle, reduce weight and exercise actively. If we talk about diet, a light meal is good, less sugar, not less protein, some tofu and some soy milk are good. With comprehensive nutrition and exercise, high androgens will drop, estrogen will slowly form a cycle, and the patient’s own progesterone can be secreted again. In this way, the land of the endometrium will be naturally fertile. Eventually, most polycystic patients are able to get pregnant and have children. Except for those with special cases, such as abnormal endometrial hyperplasia to the point of cancer, when the hysterectomy is definitely necessary in order to put the woman’s health first. Therefore, once again, it is important to diagnose and treat early, and to solve fertility problems early in the reproductive age. Q: A question of great interest to netizens, which you just mentioned, is that 40%-50% of pregnancies in polycystic patients may result in embryonic abortion or miscarriage, what are the reasons? Can it be prevented? The reasons are complicated. In the average woman, embryonic abortion and recurrent miscarriage are usually due to chromosomal abnormalities, which account for 40-50% of cases. Every person and every month ovulates differently and may not always be normal. Oocytes may undergo abnormalities during pre-division and fail to fertilize. Sometimes, cells with mild abnormalities can still be fertilized, but then something goes wrong during growth and miscarriage occurs. This is nature’s process of elimination. There are also some relatively complex factors, such as systemic factors in the mother. Sperm is a “foreign object” and under normal circumstances, a woman’s body has an immune tolerance that can only accept a fertilized egg if it is shielded against the foreign object. However, some women’s bodies lack this shielding and may treat sperm as bad, which may lead to embryo abortion or miscarriage. In addition, some systemic disorders, as well as many diseases that are currently untreatable or unknown to humans, can cause embryonic abortion and miscarriage. After ovulation in polycystic patients, the quality of eggs varies and the number of good ones is not high. If you encounter a bad one, you will be prone to embryo abortion and miscarriage. Polycystic disease itself may be associated with immune abnormalities that can have a rejection effect on the embryo. Polycystic disease adds an additional risk factor. Unlike other women, some polycystic patients have elevated LH levels and androgens, both of which are associated with miscarriage. Therefore, it is important to check these hormone levels in polycystic patients who have repeated miscarriages. Usually those with mild elevation have little effect. Therefore, we advocate that polycystic patients should take progesterone promptly two or three days after ovulation promotion, whether they are pregnant or not. If you get pregnant, you should continue to use it until the embryo is stable and not easy to miscarry. If you are pregnant for the first time, it is recommended to take progesterone for two to two and a half months, and then stop it. At this time, the placenta produces enough progesterone on its own to maintain the pregnancy. If you have a history of miscarriage before, it is recommended to use it until about two weeks after the last miscarriage, and then stop taking it, which is safer. With this treatment, 50% of polycystic patients with recurrent miscarriages and embryonic abortions can have a healthy child of their own. For the remaining 50%, we now carry out an immunotherapy treatment that allows 20-30% of these patients to have a full-term pregnancy. But in the end, there are still about 20% of people who never find out the cause, and with the current knowledge it is impossible to explain what the problem is. When we meet these patients, we still have to encourage them to adjust their lifestyle and keep trying. If the next pregnancy is normal, there is still a hope to keep it. Q: Is there any difference between the maternity checkups for polycystic patients and normal people since they have many endocrine abnormalities themselves? The prenatal checkups for polycystic patients are generally similar to those for normal women of childbearing age. The difference is the frequency of the checkups. If there is a history of infertility and pregnancy through treatment, or if you are over 35 years old, we call it a high-risk pregnancy. Those who had high blood pressure and diabetes in the past are also included in this category. Polycystic patients are prone to hypertension and diabetes during pregnancy and have difficulty getting pregnant. We call them “precious fetuses”, so we also classify polycystic patients as high-risk pregnancies. Therefore, patients with polycystic disease should have prenatal checkups more frequently than normal women. Other women have prenatal checkups almost once a month until 28 weeks of pregnancy, once every two weeks from 28 weeks to 36 weeks, and once a week after 36 weeks. In the case of polycystic patients, at the beginning, it is once every two weeks. When others are checked once every two weeks, polycystic patients are checked once a week. Another special monitoring during pregnancy for polycystic patients is the monitoring of blood sugar. If, at 36 weeks of pregnancy, a polycystic patient develops diabetes or hypertension and has been admitted to hospital for observation, it may be necessary to end the delivery a little earlier to avoid harm to the mother and child. Polycystic patients who are pregnant through ovulation promotion should consider the issue of multiple births. If the ovulation stimulant used is clomiphene, the chances of causing multiple births are low. If gonadotropins are used, the rate of multiple births is slightly higher. In vitro fertilization and embryo transfer can cause a 20% rate of multiple births. Multiple births significantly increase the incidence of hypertension and diabetes. This is true for the average woman and even more so for polycystic. If you are pregnant with multiple children, it is recommended that you lose one child and keep only one child during early or mid pregnancy. This will allow for a smoother pregnancy, avoid premature births, and the chances of having a healthy child will increase. Q: What are the chances of ectopic pregnancy in polycystic patients? From most reports in the literature, there is no significant increase in the incidence of ectopic pregnancy in patients with polycystic. Q: A patient asked: Patients with polycystic have to take medications for a long time during the pre-treatment and may also have to use some medications after pregnancy. She herself took Daimler 35 and Metformin for a long time before she got pregnant. She is worried that with such medication, will it have any effect on the fetus, the mother? In the case of metformin, it is a class B drug, which was originally considered “cautionary use” during pregnancy. However, it is now well documented that metformin is relatively safe to use during pregnancy. Da Vinci 35 is a drug that is used before pregnancy. It has to be stopped when you are going to get pregnant. When taken, it has little effect on the cells already present inside the ovaries, including the primordial oocytes. In principle, the application of metformin does not affect later pregnancies and metformin can be taken throughout pregnancy. With the application of short-acting oral contraceptives, pregnancy is possible one month after stopping the pill. Q: Here is another patient’s question: After giving birth, is polycystic cured and not to be managed in the future? As I mentioned earlier, 40%-50% of patients with polycystic need no special treatment, just active adjustment of lifestyle, and they are fine. A small number of patients are more relaxed after giving birth and are happy to have a healthy child with them. Also, their endocrine abnormalities will gradually improve with age. So those who have very mild symptoms and their menstruation is only mildly abnormal and disordered, the polycystic symptoms may disappear through childbirth. Generally, after having children, those who do not have hypertension and hyperlipidemia, and who can insist on weight control and not obesity, only need to do annual comprehensive medical checkups, and no special monitoring is needed. These are the lucky ones. Most polycystic patients who have children will have abnormal menstruation again, or individually have more hair. At this point, taking a short-acting oral contraceptive pill can provide benefits such as contraception, menstrual adjustment, protection of the uterine lining, and reduction of acne and hypertrichosis. If you don’t want to take the pill every day, a simpler solution is to use progesterone once every two or three months to induce menstruation. Overall, polycystic is a disease state. If there are no special circumstances and the examination is convenient, it is still recommended to have a full medical checkup once a year and consult with your doctor. This is necessary. Q: Is it possible to briefly summarize that after childbirth, whether and how often menstruation can come is a main criterion to determine whether to use medication for polycystic or self-adjustment? For self-monitoring, this can be an important criterion. Also, things like weight and the amount of menstrual flow are criteria. Q: You mentioned that about 1% of polycystic patients have difficulty in realizing their dream of becoming a mother. What advice do you have for these women? This is really not even 1%. We sometimes joke that where there is a will, there is a way. Clinically, there are three types of women who have a higher chance of infertility. One is a woman who has missed her age, whose ovarian function is really failing and has tended to fail, or even completely fail. This is the most painful situation for doctors and there is nothing they can do. The second type is repeated treatment failure. Most of them have a bad endometrium or problems with their husbands. I would encourage them and continue the treatment. The third kind is a part of polycystic patients, especially those who come to my office, are more difficult cases. But polycystic patients are the ones I am most willing to see among the three types of infertility patients. This is because with persistent treatment, polycystic patients are able to have children successfully. It will be much easier if treated earlier. Moreover, I prefer to have a pregnancy close to natural and not to do laparoscopy or in vitro fertilization or embryo transfer, after all, there are so many drugs to use and a long process to go through, and the success rate is only about 40-50% and the risk of failure is high. Q: Facing many women who are troubled by polycystic, what do you want to say to everyone most? The most important thing is to understand polycystic and face it correctly. Polycystic is just a disease state. Women should plan their lives a little earlier. I often say to polycystic patients who come for consultation during adolescence, just study and work well now, and remember two things, “don’t eat too much and find a date early. If you control your diet, your weight will come down and your polycystic will not be too heavy. Find a date early, you can avoid the eventuality and don’t gamble with your happiness because of your condition. By adjusting your life plan early, every polycystic patient has a chance to have their own healthy children and happy life.