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Abstract: Polycystic ovary syndrome (PCOS) is a complex disease commonly seen in women of reproductive age due to endocrine and metabolic abnormalities, with the main clinical manifestations being irregular menstruation, infertility, and hirsutism. The main clinical manifestations are irregular menstruation, infertility and hirsutism. In this case, the patient came to the clinic because of irregular menstruation and infertility and was diagnosed with polycystic ovary syndrome. After weight loss and medication, the patient finally lost 5kg and successfully became pregnant.
Basic information】Female, 32 years old
Type of disease】Polycystic ovary syndrome
Hospital】Wuhan Children’s Hospital affiliated with Tongji Medical College of Huazhong University of Science and Technology
Date of Consultation】July 2021
Treatment plan】Weight loss treatment (exercise, diet) + oral medication (ethinyl estradiol cyproterone tablets, metformin hydrochloride tablets, letrozole tablets, didrogestrel tablets) + injectable medication (injectable urotropin, injectable chorionic gonadotropin)
Treatment period】2 months of weight loss, 1 cycle of ovulation promotion
Results】Weight loss of 5kg, successful pregnancy
I. Initial consultation
The patient’s menstrual cycle has been disordered since the first menstruation, once every 30-90 days, and she has been taking Chinese medicine intermittently to regulate it, but the effect is not good. In the past 2 years, she has gained 10 kg in weight, accompanied by facial acne. She has been married to her husband for more than 1 year, with normal sex life and no contraception, but she is still infertile. 2 cycles of outpatient ovulation promotion (LE+HMG) in June and July 2021, with ovulation and no pregnancy, her husband’s semen is normal, and she has fertility requirements. After comprehensive evaluation, she was diagnosed with polycystic ovary syndrome with infertility, insulin resistance and obesity.
II. Treatment history
We explained that polycystic ovary syndrome (PCOS) is a common endocrine disorder and that obese patients with PCOS may have insulin resistance and reproductive endocrine disorders. After communication with the patient and obtaining her consent, a treatment plan was developed, suggesting weight loss through exercise and diet modification first, along with oral ethinyl estradiol cyproterone tablets and metformin hydrochloride tablets to regulate the menstrual cycle. It is desirable to lose 5-10% of body weight to improve reproductive and metabolic indicators. Afterwards, outpatient ovulation promotion is performed, and oral letrozole tablets + injectable urotropin are used to promote pregnancy. After the follicle reaches 18 mm, the injectable chorionic gonadotropin will be injected, and the luteal support treatment with dextran tablets will be started once the follicle is confirmed to be ovulated, and coitus will be guided.
III. Treatment effect
The patient lost 5 kg of weight in 2 months through diet and exercise, and her facial acne improved significantly after taking metformin hydrochloride tablets and 2 cycles of ethinyl estradiol cyproterone tablets. The patient returned to the hospital on the second day of her menstruation and the sex hormone LH/FSH ratio was close to 1, indicating a good recovery. 1 cycle of ovulation treatment was very effective and the ovulation process was very smooth, and the patient finally had a successful pregnancy.
IV. Notes
The patient was very happy that she finally got pregnant. She was instructed to stop using metformin hydrochloride tablets during pregnancy, pay attention to rest, maintain good mood, avoid mental tension and anxiety, maintain balanced nutrition, not to affect fetal development due to poor nutrition, and not to blindly take supplements. Regular maternal checkups should be conducted and the use of Didrogestrel tablets should be stopped slowly after stabilization as prescribed by the doctor. Based on the patient’s current body mass index, it is recommended to control weight gain throughout pregnancy to 7-11.5 kg and limit the intake of foods high in sugar, salt and saturated fatty acids. The risk of gestational diabetes and gestational hypertension will increase if over-supplementation occurs. In addition, you can exercise appropriately during pregnancy, such as walking, to strengthen your resistance, but avoid strenuous exercise.
V. Personal insight
PCOS leads to infertility, which is an important factor affecting women’s mental health. Infertility can easily lead to family and marital tensions and cause marital instability, which leads to increased divorce rates. PCOS is a common endocrine disease with the characteristics of a chronic disease, and psychological support should be emphasized in the treatment of patients. Patients with questions or difficulties in weight loss during treatment should give feedback to their doctors and seek professional help in a timely manner.