Day 1 :
Keynote Forum
Richard Stouffer
Oregon Health & Science University, USA
Keynote: Chronic hyperandrogenemia and western-style diet in adolescent female monkeys: a model for onset of PCOS in young women?
Time : 10:05-10:40
Biography:
Richard L Stouffer received his PhD from Duke University and Postdoctoral training at NICHD, National Institutes of Health. He is currently a Senior Scientist in the Divison of Reproductive & Developmental Sciences, ONPRC, and Professor in Obstetrics & Gynecology, OHSU. He also serves as Director/Co-Director of NIH-supported centers studying infertility and contraception. He has published over 200 papers in preer-reviewed journals, and received distinguished research awards form the Society for the Study of Reproduction (2007) and the American Society for Reproductive Medicine (2010).
Abstract:
Since clinical symptoms of PCOS first occur after puberty, experiments tested the hypothesis that chronic exposure to elevated androgen (testosterone, T) levels, comparable to those in adolescent girls predisposed to PCOS, alone or with administration of a western-style diet, causes reproductive and metabolic features associated with PCOS. At one year of age, female rhesus monkeys received control (cholesterol) or T implants sc. Treatment increased (p<0.01) levels 3.7 fold compared to controls. Menarche occurred at a comparable age (32 months) in both groups. However, T-treated monkeys exhibited a greater number of LH pulses compared to controls (p<0.05) by 5 years of age. There were no remarkable differences in ovarian or metabolic parameters prior to changing diets. At 5.5 years of age, monkeys received a high-fat diet (WSD) for 18 months. After WSD, LH pulse amplitude declined and % body fat increased (p<0.05) in both WSD and WSD+T animals but insulin sensitivity only declined (p<0.05) in the WSD+T group. The numbers of antral follicles increased in the ovaries of both groups, and took on the clinical “string of pearls” feature. Estradiol and progesterone levels circulating during the menstrual cycle were suppressed (p>0.05) in the T+WSD group. Thus the WSD caused some features characteristic of PCOS, but T+WSD caused a more severe ovarian and metabolic phenotype. This model should help discern the peri-pubertal effects of hyper-androgenemia and diet and their possible treatment; P50HD071836 and P51OD011092.
- Polycystic Ovarian Syndrome
Medical Diagnosis of PCOS
Chair
Angeline Beltsos
Fertility Centers of Illinois, USA
Co-Chair
Yen Hao Chen
Georgia Regents University, USA
Session Introduction
Angeline Beltsos
Fertility Centers of Illinois, USA
Title: New IVF paradigm for management of PCOS: PGS followed by e-SET
Biography:
Angeline Beltsos is the Medical Director of FCI - Highland Park aParent IVF and co-managing partner of FCI. She is board certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility (REI), practicing medicine since 1991. She completed her residency in Obstetrics and Gynecology at Loyola University in 1995 followed by a fellowship in REI at Washington University in St. Louis, Missouri completed in 1997. She is also the FCI Clinical Research Division Director and participates in a number of research projects and scientific publications. She is a popular speaker both nationally and internationally and a frequent media resource on the topic of infertility. She is the Executive Chair-person for the Midwest Reproductive Symposium, an international conference of fertility experts. She is a Clinical Assistant Professor for the Department of Obstetrics and Gynecology at University of Illinois at Chicago.
Abstract:
Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. This syndrome is manifested by endocrine and metabolic dysfunctions which result in a markedly altered ovarian milieu. This environment is characterized by mutations in both the cumulus cell complexes of the oocyte as well as significant transcriptomic and secretomic alterations in the blastocyst. These factors result in a higher number of immature oocytes, possibly poorer quality oocytes, decreased rates of fertilization, decreased blastulation and blastocyst quality, less implantation and higher rates of miscarriage. Practical management of these patients remains difficult. Moving to IVF with careful stimulation, agonist trigger followed by freeze all, PGS and then single frozen embryo transfer may provide optimal results. Mitigating risks of PCOS patients doing IVF specifically their increased potential for excessive ovarian response (OHSS) coupled by a higher IVF cancellation rate is important. Increased evidence demonstrates that higher IVF implantation rates and improved pregnancy outcomes can be achieved by pre-implantation genetic screening, followed by frozen embryo transfer which may improve placentation and infant health as well. With additional data to support this trend, a new IVF paradigm is evolving single, genetically healthy FET. Applying this technology to the PCOS patient may provide an ideal outcome for many patients.
Biography:
Yen Hao Chen obtained his PhD degree at the University of California, Riverside in 2006. He joined Dr. Ricardo Azziz's lab in California and studied Polycystic Ovary Syndrome (PCOS) in 2008. He got his full-time tenure-track faculty position as Assistant Professor on November 1, 2012 in Georgia Regents University. His research focuses on studying insulin resistance in adipose (fat) tissue from PCOS patients. He has discovered different microRNAs expression profile in adipose tissue from PCOS. Among these microRNAs, he found a specific small RNA called miR-93 which is over-expressed and may cause insulin resistance in fat tissue.
Abstract:
Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders and affects ≥7-9% of reproductive-aged women. 60-70% of PCOS patients demonstrate insulin resistance (IR) above and beyond that predicted by body mass, race, or age, resulting in compensatory hyperinsulinemia and an increased risk for Type 2 diabetes (T2DM) and cardiovascular disease. The underlying cellular mechanisms leading to IR in PCOS remain unclear. Subcutaneous adipose tissue (SAT) molecularly functions, including the size of adipocytes, the stimulation of glucose transport, GLUT4 production, lipolysis, adipogenesis and insulin resistance related gene expression, adipokines secretion, adipogenesis, microRNAs profile appear to be defective in this disorder. However, no defects in insulin signaling have been found; including insulin signaling related genes expression, insulin binding, insulin receptor expression and the IRS-1/PI3K/AKT pathway. In genetic study, certain polymorphisms and SNPs have been found to be directly and indirectly associated with PCOS. Understanding the unique mechanisms of adipose tissue dysfunction in PCOS patients may point to potential new therapeutic avenues for this very common disorder.
Felice L Gersh
Integrative Medical Group of Irvine, USA
Title: Tame the flames of PCOS: A unique and integrative approach to a global epidemic
Biography:
Felice L Gersh works in integrative and holistic medicine, creating new paradigms in women's healthcare. Searching for better, safer and more natural ways to achieve optimal health, she trained at the University Of Arizona School Of Medicine, completing the Fellowship in Integrative Medicine in 2012. She is a renowned national speaker on topics of women's health, with a special passion for educating all on the complexities of PCOS. She has received numerous awards, including being named Physician of Excellence in Orange County 11 years in a row, a Super Doctor of Southern California, a Top Doc, was recognized for her excellence as an attending surgeon at USC Keck School of Medicine by the OB/GYN Department, and was elected into the prestigious medical honor society, Alpha Omega Alpha. She is the Medical Director at Integrative Medical Group of Irvine, where she leads her team of dedicated holistic practitioners.
Abstract:
The driving force behind all of the problems be setting women with PCOS is chronic, systemic inflammation. Inflammation results in a wide array of metabolic abnormalities including insulin resistance, obesity, hypertension, arterial endothelial dysfunction, high cholesterol, and plaque formation. Additional maladies are also present, including elevated androgens and their related consequences, irregular menstrual cycles, infertility, pregnancy complications, cystic acne, arthritis, anxiety, depression, sleep disturbances and irritable bowel syndrome. At this time, our medical system addresses these myriad and complex symptoms and conditions in a disjointed and unconnected manner, with the result being that women with PCOS are often undiagnosed, misdiagnosed, and poorly treated by an array of doctors each focusing in on a small piece of the problem, addressing only obvious symptoms, and not the underlying foundational causalities. The integrative approach to PCOS looks at each woman as the unique and complex individual she is. Each woman is a blend of her genetics, her toxin exposures, her lifestyle choices, and her hopes and dreams. This holistic approach addresses the underlying issues contributing to the myriad medical problems suffered by women with PCOS, as well as ameliorating the devastating symptoms. This presentation will present a brief overview of new groundbreaking science which explains the development of the ubiquitous inflammation present in all women with PCOS, which continually fuels the devastating flames of PCOS, creating its numerous associated problems. This will be followed by the presentation of a comprehensive, practical and specific integrative treatment protocol, much of which all attendees can implement immediately. Copies of the protocols will be made available to all.
Gregory S Pokrywka
Johns Hopkins University School of Medicine, USA
Title: Lipoprotein cardiovascular risk assessment and reduction in PCOS
Biography:
Gregory Pokrywka MD FACP FNLA NCMP is a Board-Certified Fellow in Internal Medicine and Clinical Lipidology and NAMS Certified Menopause Practitioner, from Baltimore/Towson. In 2009 he was elected by his peers to the honor of “Fellow of the National Lipid Assn.” (FNLA) He currently serves as an Assistant Professor for the John Hopkins University School of Medicine. He serves on the Board of Directors of the Southeast Lipid Assn., and serves on the Editorial Board of the Journal of Clinical Lipidology. Since 2004 he has conducted over 100 lipid / lipoprotein educational programs / year, nationwide. He was recently appointed by Maryland to serve on the Board to regulate Naturopathic Doctors. Dr Pokrywka serves on the Board of Directors of the Southeast Lipid Assn., and serves on the Editorial Board of the Journal of Clinical Lipidology. Since 2004 Dr. Pokrywka has conducted over 100 lipid / lipoprotein educational programs / year, nationwide. He was recently appointed by Maryland to serve on the Board to regulate Naturopathic Doctors. He avid interests include personal fitness, Duke Basketball, sea kayaking, reptiles and the pursuit and exposure of medical pseudoscience and quackery.
Abstract:
PCOS patients have increased cardiovascular risk according to a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. Women with PCOS with obesity, cigarette smoking, dyslipidemia, hypertension, impaired glucose tolerance and subclinical vascular disease are at risk. Those with metabolic syndrome and/or type 2 diabetes mellitus are at high risk for CVD. Lifestyle management is recommended for primary CVD prevention, targeting low-density and non-high-density lipoprotein cholesterol and adding insulin-sensitizing and other drugs if dyslipidemia or other risk factors persist. Lipid and lipoprotein abnormalities in PCOS consist of 1) High triglycerides and low HDL-C (ratio greater than 3:1 in insulin resistant states), 2) Small LDL particles are prevalent; LDL-C may be high, but is often (misleadingly) low or normal. 3) These numbers from the standard lipid panel represent serum concentrations of fats 4) Underlying these abnormalities lie the pathophysiology of this (and other) insulin resistant states: hyper-production of antherogenic beta lipoproteins from the liver (delayed clearance also plays a role) 5) HDL particles are often “dysfunctional” in IRS states like PCOS. HDL-C tells you nothing about HDL function! 6) Correction of this abnormal “lipoprotein trafficking” is the goal to reducing CVD risk in PCOS, not simply targeting the lipid abnormalities.
Richard Stouffer
Oregon Health & Science University, USA
Title: Chronic hyperandrogenemia and western-style diet in adolescent female monkeys: a model for onset of PCOS in young women?
Biography:
Richard L Stouffer received his PhD from Duke University and Postdoctoral training at NICHD, National Institutes of Health. He is currently a Senior Scientist in the Divison of Reproductive & Developmental Sciences, ONPRC, and Professor in Obstetrics & Gynecology, OHSU. He also serves as Director/Co-Director of NIH-supported centers studying infertility and contraception. He has published over 200 papers in preer-reviewed journals, and received distinguished research awards form the Society for the Study of Reproduction (2007) and the American Society for Reproductive Medicine (2010).
Abstract:
Since clinical symptoms of PCOS first occur after puberty, experiments tested the hypothesis that chronic exposure to elevated androgen (testosterone, T) levels, comparable to those in adolescent girls predisposed to PCOS, alone or with administration of a western-style diet, causes reproductive and metabolic features associated with PCOS. At one year of age, female rhesus monkeys received control (cholesterol) or T implants sc. Treatment increased (p<0.01) levels 3.7 fold compared to controls. Menarche occurred at a comparable age (32 months) in both groups. However, T-treated monkeys exhibited a greater number of LH pulses compared to controls (p<0.05) by 5 years of age. There were no remarkable differences in ovarian or metabolic parameters prior to changing diets. At 5.5 years of age, monkeys received a high-fat diet (WSD) for 18 months. After WSD, LH pulse amplitude declined and % body fat increased (p<0.05) in both WSD and WSD+T animals but insulin sensitivity only declined (p<0.05) in the WSD+T group. The numbers of antral follicles increased in the ovaries of both groups, and took on the clinical “string of pearls” feature. Estradiol and progesterone levels circulating during the menstrual cycle were suppressed (p>0.05) in the T+WSD group. Thus the WSD caused some features characteristic of PCOS, but T+WSD caused a more severe ovarian and metabolic phenotype. This model should help discern the peri-pubertal effects of hyper-androgenemia and diet and their possible treatment; P50HD071836 and P51OD011092.
Sheng Wu
Johns Hopkins University School of Medicine, USA
Title: Studying PCOS through the interaction of hyperinsulinemia and hyperandrogenemia
Biography:
Sheng Wu received MS degree from Waganingen University, Netherlands and a PhD from University of Victoria, Canada. She joined Johns Hopkins University School of Medicine as a Postdoctoral fellow and was promoted to an Assistant Professor in 2013. Her laboratory focuses on working to understand why obesity produces infertility in females and also to explore the contribution of testosterone to the development of infertility and metabolic dysfunction in women. The importance of these findings was recognized by “The Endocrinology Society and The American Physiology Society” from which she received a number of awards.
Abstract:
Polycystic ovarian syndrome (PCOS), the leading cause of female infertility, occurs in 5-10% of reproductive-aged women and is characterized by hyperandrogenism, oligo- or annovulation, and polycystic ovaries. Hyperandrogenemia and hyperinsulinemia are believed to play prominent roles in the genesis and progression of PCOS. Previous studies have shown that diet induced obese female mice were infertile and displayed insulin resistance in the energy storage tissues. In contrast, DIO female mice displayed retained insulin sensitivity in the reproductive tissues. It was noted that the DIO female mice exhibited hyperandrogenism; however, the role of high androgen levels in the progression of the reproductive and metabolic pathologies is not well understood and little is known about the precise locations or mechanisms of androgen action. Understanding how and where androgen and or insulin, signaling via the androgen receptor and or insulin receptor, impacts tissues to induce impaired metabolism and fertility in females will have clear health implications.
Julie Booker
American Board of Oriental Reproductive Medicine, USA
Title: The treatment of PCOS using traditional Chinese medicine
Biography:
Julie Booker, EAMP, Dipl. OM, Dipl. Ac, Dipl.CH, FABORM practices in Seattle at Acupuncture Northwest and Associates, an integrative clinic specializing in reproductive health, fertility, gynecology and pregnancy care. She is a Fellow of the American Board of Oriental Reproductive Medicine (ABORM); a licensed and national board certified acupuncturist and Chinese herbalist. She received her Master’s degree in Oriental Medicine from the Northwest Institute of Acupuncture and Oriental Medicine in 2003. She also completed post-graduate training in acupuncture and Chinese Herbology in gynecology. Her specialties include OB/GYN and women’s health, infertility and assisted reproduction support. She treats patients using both acupuncture and Chinese herbal medicine in combination with a deep understanding of western medical conditions and protocols.
Abstract:
Polycystic Ovarian Syndrome (PCOS) is the most common hormonal disorder affecting women of reproductive age. It is a complex condition affecting many aspects of health including metabolic syndrome and insulin resistance, anovulation and irregular mensus, hirsutism and elevated androgen levels. Symptoms worsen over time and may affect women from PCOS have a negative impact on psychological wellbeing. Stresses have been associated with functional amenorrhea, which is a symptom of PCOS. Stress and anxiety have been found to suppress the ovarian and menstrual cycle. This talk will cover the patho-physiology of PCOS as it pertains to Traditional Chinese Medicine (TCM). It will include a discussion of applicable aspects of TCM theory and how it relates to western terminology. In addition, I will outline a treatment plan including acupuncture, diet, lifestyle, Chinese herbal medicine and supplements.
Lora Shahine
University of Washington, USA
Title: Polycystic ovarian syndrome and recurrent pregnancy loss: Update on evidence and treatment for 2015
Biography:
Lora Shahine is a Reproductive Endocrinologist practicing at Pacific NW Fertility in Seattle. She completed her residency in Obstetrics and Gynecology at the University of California at San Francisco and her fellowship in Reproductive Endocrinology and Infertility at Stanford University. As the Director for the Recurrent Pregnancy Loss Center at PNWF and a Clinical Assistant Professor at the University of Washington, she is dedicated to teaching and continuing research in women’s health.
Abstract:
Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders in women resulting in a wide range of health issues including insulin resistance, obesity, cardiovascular disease and reproductive issues. PCOS is associated with chronic anovulation and elevated androgen hormones which result in difficulty with reproduction. Women with PCOS suffer not only from difficulty conceiving but a higher rate of early miscarriage compared to women of the same age without PCOS. Women with PCOS are more likely to have multiple miscarriages and suffer from recurrent pregnancy loss (RPL), defined as 2 or more miscarriages for the purposes of evaluation by the American Society of Reproductive Medicine. The specific etiology of pregnancy loss in PCOS remains unknown. Several factors have been implicated as potential contributors to miscarriage in PCOS such as obesity, endometrial defects, and hormonal imbalances and we will review the current evidence.
Brian Keevil
University Hospital of South Manchester, UK
Title: The measurement of alternative androgens in the investigation of PCOS
Biography:
Brian Keevil is a Consultant Clinical Scientist and Head of the Clinical Biochemistry Department at the University Hospital of South Manchester. He is an Honorary Professor in Clinical Biochemistry at the University of Manchester and a member of the editorial board of the Annals of Clinical Biochemistry. He has developed an interest in steroid analysis using liquid chromatography mass spectrometry (LC-MS/MS) over the past 15 years with a particular emphasis on developing an LC-MS/MS service in a routine clinical laboratory. He has developed over 30 routine analytical methods and has published over 130 papers mainly on the clinical applications of LC-MS/MS.
Abstract:
The diagnosis of PCOS requires confirmation of ovarian dysfunction: irregular or anovulatory cycles, or polycystic morphology on scanning; and androgen excess. The latest guidelines recommend that hyperandrogenemia should be evaluated biochemically in all women suspected of having PCOS and particularly in adolescents. There is currently no consensus on what is the best androgen to measure or the upper cutoff consistent with PCOS but it is generally accepted that testosterone is the best single measurement of choice for the investigation of female hyperandrogenism. However, total testosterone is not invariably elevated in patients with PCOS. Developments in liquid chromatography tandem mass spectrometry now enable the accurate measurement of steroid panels in routine laboratories, free from assay interference, and allow the reporting of other clinically useful androgens. This talk will focus on the simultaneous measurement of testosterone, androstenedione DHEA , DHT, DHEAS and 17 OHP and their potential use in the investigation of PCOS. Mention will also be given to the possible use of salivary androgen assays in the investigation of PCOS.
Dimitrios Nikolaou
Imperial College School of Medicine, UK
Title: Polycystic ovaries: Time to move on
Biography:
Dimitrios Nikolaou is considered as one of the most original thinkers in the field of Reproductive Medicine in the UK. He is the Medical Director of Fertility for Life and the Clinical Lead of the Department of Reproductive Medicine and Surgery at Chelsea and Westminster Hospital in London and the Director of the sub-specialty training program in Reproductive medicine. He is a Senior Lecturer at the Imperial College School of medicine and his unit is a center of excellence for the management of couples who are positive for HIV or Hepatitis B or C and wish to conceive. Working for the Royal College of Obstetricians and Gynecologists, he edited the book on reproductive ageing along with clinical and research guidelines. He holds full UK specialty accreditation in Obstetrics and Gynecology, full sub-specialty accreditation in Reproductive Medicine and Surgery, as well as formal accreditation in minimal access surgery.
Abstract:
The term polycystic ovary is a misnomer that has been preserved for historical or political reasons. It needs to be abolished, as it is negative, upsetting and misleading. Firstly, there are no cysts but antral follicles. Even with internationally agreed criteria, inter and intra observer variability on diagnosing a polycystic ovary on ultrasound, let alone agreeing on polycystic ovary syndrome, is average at best. Approaching the issue from the ovarian ageing perspective led to a number of interesting observations, which we will review. It is unlikely that there are two different times of human female: the normal and the PCO, with a spectrum between the almost normal ovulatory PCO and the full blown PCOS. Rather, the number of antral follicles we can see on a scan varies among women and depends on their age and ovarian reserve; which in turn depends mainly on the number of eggs they were born with. This number is a continuum in the general population. At one end of the spectrum, women who are born with fewer eggs are destined to go into menopause earlier and will experience reduced fertility at a relatively earlier age. At the other end, women who are born with many eggs will have bigger ovaries with more antral follicles. They are protected against early ovarian ageing and have a number of social characteristics that are advantageous. However, the ovaries of these women are more sensitive to environmental influences.
Silvana Aparecida Alves Correa
Federal University of Sao Paulo, Brazil
Title: Glycolysis, TCA cycle, glycosylation, polycomb and trithorax complexes-related gene expression in the brain of fat tissue implanted polycystic ovarian syndrome mice
Biography:
Silvana Aparecida Alves Correa has completed his PhD from Federal University of Sao Paulo and Postdoctoral studies from Federal University of Sao Paulo (Sao Paulo, Brazil) and Fox Chase Cancer Center (Philadelphia, PA, USA). She is Biomedical Researcher at Translational Surgery Laboratory, Federal University of Sao Paulo. She has published more than 25 papers.
Abstract:
Polycystic Ovary Syndrome (PCOS) is the most common androgenic disorder in women during reproductive life. PCOS may also be accompanied by metabolic syndrome and recent studies point to leptin as playing a role in disrupting infertility. Previously, our group demonstrated the effect of gonadal white adipose tissue transplantation from wild-type lean and fertile female mice to isogenic obese anovulatory ob/ob mice. These complex metabolic interrelationships between obesity and PCOS have yet to be fully understood. The leptin treated mice show a decrease in the glucose metabolism. These confirm the ability of the adipose tissue-derived hormone leptin to regulate early crucial genes that are related to glycolysis mechanisms and to the TCA cycle. Besides that, quite relevant seems to be the responses triggered by the adipose tissue hormone, leptin, on the glycosylation in the brain molecules of obese mice. These mechanisms are markedly suppressed after treatment. These changes, caused by the rise of this hormone, induce the treated mice brain to display a generic profile similar to those of the normal weight. Ultimately, underlying neuronal changes caused by leptin in obese mice brain, there is an important role also being played by the histone code. Here there is evidence that leptin drives the chromatin packing to a more condensed pattern. In conclusion, leptin seems to change molecularly the expression of genes related to these signaling pathways. This can help us to better understand the neuronal mechanisms underlying the reversion of PCOS.
Moustafa K Eissa
Cyberjaya University College of Medical Sciences, Malaysia
Title: Anti mullerian hormone in polycystic ovarian syndrome patients
Biography:
Moustafa K Eissa is a graduate of Cairo University in 1975. He did his Postgraduate training in Birmingham, UK where he got MD from Medical School and MSc from High Registry of Science and Engineering. He is a Fellow of RCOG since 2000. He was promoted to a Professor of Obstetrics & Gynecology in 1999. Currently he is an Associate Professor at CUCMS, Malaysia. He spent almost 35 years in the field of Infertility, Assisted Reproduction and particularly PCOS. He published about 100 papers in national and international journals.
Abstract:
PCOS is a multi-factorial complex characterized by chronic anovulation, polycystic ovaries and biochemical and clinical manifestation of hyperandrogenism. AMH is secreted exclusively by granulosa cells of primary, pre-antral and small antral follicles. The level of serum AMH correlates with the number of small follicles, ovarian reserve. It is known that AMH is elevated in PCOS patients probably because of the large numbers of small follicles. This high level may lead to desensitization of the primordial follicles to FSH. This may lead to poor response of ovaries to stimulation by gonadotropins. This increase of serum AMH is implicated in the pathogenesis of PCOS. It desensitizes the small antral follicles to secreted FSH, so prevent growth and selection with failure of dominance. Also it inhibits aromatization resulting in reduction of secretion of E2. This low E2 may cause further failure of follicle selection.This serum level of AMH can be used as indicator of good or bad response to ovarian stimulation in induced and assisted reproduction cycles. Some researchers reported a negative correlation between serum level of AMH and fertilization and pregnancy rates in PCOS patients. Others reported opposite findings. This led us to investigate the predictive value of circulating AMH in PCOS patients undergoing ovarian stimulation with gonadotropins. We found that circulating AMH was negatively correlated with ovarian response to gonadotropins stimulation and a high cancellation rate. This extends to other lines of stimulation as Laparoscopic ovarian drilling (LOD) and clomiphene citrate stimulation. This is opposite to non PCOS patients where response to ovarian stimulation positively correlates with the level of AMH. This may suggest that there is an optimum level of AMH for optimum response. So, pre-treatment estimation of serum AMH may be a valuable predictor of the possible response and the suitable dose of stimulation.
Zhang We
Obstetrics and Gynecology Hospital of Fudan University, China
Title: An association between dietary intake and polycystic ovary syndrome in Chinese women
Biography:
Wei Zhang has completed her PhD from Fudan University, Shanghai, China. She has been a visiting scholar in Stony-Brook University in USA from 2004 to 2005. She has been working in OB/GYN Hospital of Fudan University after PhD graduation. She is the Director of Lab and Department of Reproductive endocrinology. She has published more than 110 papers in reputed journals and has been serving as an Editorial Board Member of reputed Journals.
Abstract:
Objective: To compare dietary intake of women with and without polycystic ovary syndrome (PCOS) for investigating the relationship between dietary intake and PCOS. Methods & Materials: Design: A case control study. Setting: Outpatient of gynecological endocrinology department in Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Patient(s): 47 women with PCOS and 42 age-matched control women were investigated. Eighty nine women visiting the outpatient of gynecological endocrinology were received evaluation of anthropometry, B ultrasound examination and sex hormone. Dietary intake was collected from a food questionnaire and 24-hour recalls. Associations between nutrients and features of PCOS were analyzed using multiple linear regression and analysis of covariance. Results: (1) Compare with normal women, women with PCOS had a higher BMI (25.5±5.4 VS 20.8±2.7, P<0.001), their intake of carbon-hydrate (P<0.05) and fat (P<0.05) were higher and their intakes of protein as a proportion of energy was significantly lower (P<0.05). (2)There were positive correlations between BMI and calories intake and lipid, but negative correlations between BMI and the ratio of protein in the diet intake (rï¼-0.361, P<0.05). (3) Multiple stepwise regression analysis showed that BMI was passively associated with the amount of fat and negatively associated with the ratio of protein in diet in 24 h (both P<0.001). Conclusion(s): The statistical differences exist in the nutritional composition and calories of PCOS patient’s diets intake, which may contribute to development and clinical features of PCOS.
Biography:
Wanakan Singhasena is a graduate of Chulalongkorn University, Thailand. She is a Reproductive Endocrinologist practicing at Vejthani ART Center in Bangkok, Thailand. She completed her residency in Obstetrics and Gynecology and fellowship in Reproductive Medicine at Chiang Mai University, Thailand. She is the Director of Vejthani ART center.
Abstract:
Regardless of the diagnostic criteria used, the management of polycystic ovary syndrome (PCOS) includes treatment of individual components of the syndrome (hirsutism, oligomenorrhea, infertility, obesity and glucose intolerance), depending upon the patient's goals. It is important to complete a basic evaluation of the couple before initiating therapy in an infertile woman, including a semen analysis of the male. Weight loss should always be attempted prior to initiating ovulation induction because ovulation can be restored with a modest amount of weight loss. If unsuccessful, a multi-step approach to ovulation induction is then undertaken. For women with PCOS who desire pregnancy, first recommend weight loss if the woman is overweight or obese (Grade 1B). If they are unable to lose weight or modest weight loss does not restore ovulatory cycles, suggest initiating ovulation induction with clomiphene citrate for women with a BMI <30 kg/m2 and letrozole for those with a BMI ≥30kg/m2 (Grade 2B). Laparoscopic surgery has been abandoned, both because of the efficacy of clomiphene and because of the high incidence of pelvic adhesions seen with wedge resection. A substitute for wedge resection, laparoscopic ovarian laser electro-cautery, may be effective in some women with PCOS. If weight loss is seen and ovulation induction with medications or laparoscopic ovarian laser electrocautery is unsuccessful, the next step is in vitro fertilization. Women with PCOS are at increased risk for both multiple gestation and OHSS.
Murat Api
Zeynep Kamil Training and Research Hospital, Turkey
Title: Is ovarian reserve diminished and is there a risk of adhesion formation which may affect fertility after laparoscopic ovarian drilling?
Biography:
Murat Api has completed his PhD from Marmara University and Postdoctoral studies from Zeynep Kamil School of Medicine. He is the Director of Obstetrics and Gynecology, a premier Gynecologic Endoscopy service organization. He has published more than 100 papers in reputed journals and has been serving as an Editorial Board Member of several medical journals. muratapi@hotmail.com
Abstract:
According to the guidelines, second line therapy in clomiphene resistant infertile PCOS should be either with gonadotropins or laparoscopic ovarian drilling (LOD) surgery. Surgical alternative have the advantageous of singleton pregnancies and less OHSS if pregnancy occurs. On the other hand, there are some hesitations among the physicians in performing LOD because of the reason that ovarian reserve may diminish after the operation or there might be some adhesion formation which might affect the fertility of the woman. This concern seems to be not valid under the light of the available literature.
- Medical Diagnosis
Recent Research and Current Advancements in PCOS Treatment
PCOS in Teens and Adolescents: Early Diagnosis and Intervention
Session Introduction
Donna R Chizen
University of Saskatchewan, Canada
Title: Identification of polycystic ovary syndrome(PCOS) with the newest diagnostic criteria: Problems, pitfalls, practical application to clinical care
Biography:
Donna R Chizen completed her BSc (Genetics) in Guelph Ontario, MD at McMaster Medical School in Hamilton, Ontario, FRCSC in Obstetrics & Gynecology at the University of Saskatchewan and Reproductive Endocrinology and Infertility (REI) founder status was granted in 2012. She has an academic, clinical practice and research program at the Department of Obstetrics, Gynecology and Reproductive Sciences, Royal University Hospital, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan. She is the Andrology Laboratory Director and Postgraduate Faculty Representative for REI. She has published more than 23 papers in peer reviewed journals.
Abstract:
Since the syndrome was described in 1935, it has not been a simple process to diagnose PCOS. Many diagnostic criteria have been entertained over years.The newest criteria for the polycystic ovary (PCO) has the potential to reliably identify affected women. The Androgen Excess/PCOS society acknowledged a higher threshold follicle count in the PCO (2013). The higher threshold has prevented false positive PCO/PCOS diagnoses. However, even with improved diagnostic criteria, many women with PCOS are not identified because presentations vary widely at different ages and treatments mask symptoms of PCOS. For example, hormonal contraceptives may control and thereby mask symptoms of PCOS. A missed diagnosis is a missed opportunity to prevent infertility and gestational diabetes preconceptually and prevent diabetes, endometrial cancer and heart disease before and after the menopause transition. Early diagnosis of PCOS is integral to defining at risk individuals.The time of initial assessment is a significant opportunity to motivate better health and prevent disease. Revisiting the meaning of PCOS can reinforce healthy behaviours. In this presentation, clinical cases will illustrate common and unexpected histories from women who have been diagnosed with PCOS. Presenting complaints will be discussed in relationship to making a diagnosis and avoiding false positive diagnoses. The concept of latent and missed PCOS will be considered. Phenotypes of women diagnosed with the newest PCO diagnostic criteria will be reviewed and implications for management will be examined. Women with PCOS need a diagnosis to learn how and why to adopt health promoting strategies.
Hefeng Huang
Shanghai Jiao Tong University School of Medicine, China
Title: Alternative splicing of the androgen receptor in PCOS with ovulatory dysfunction
Biography:
Hefeng Huang completed her MD and PhD in 1982 from Zhejiang University. She is a Professor of Obstetrics and Gynecology. Currently she is the President of International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. She is Vice Chairman of the Chinese Society of Reproductive Medicine. She has published more than 100 papers in reputed journals including Nature Medicine, PNAS, Cell Research, JCEM etc. and has been serving as an Editorial Board Member of Endocrinology, Fertility and Sterility, Journal of Ovarian Research, Clinical Endocrinology etc.
Abstract:
Androgen receptor is essential for healthy developing follicle, while excess intra-ovarian androgens impair follicle growth. Hyperandrogenism is main characteristic of polycystic ovary syndrome (PCOS), a highly prevalent endocrine disorder and major threat to women’s health. However, the etiology of hyperandrogenism is poorly understood. We describe the specific transcription of two AR splice variants, insertion (ins) and deletion (del) isoforms, in granulosa cells (GCs) of women with PCOS. Wild-type (wt) AR existed in each individual; surprisingly its transcription is comparable between PCOS and control group. Women with AR ins or del isoforms showed distinct hyperandrogenism, attenuated androgen metabolism, enhanced androgen synthesis and altered expression corresponding enzymes, aromatase and steroid 17α-hydroxylase, in GCs, particularly the former. In vitro over-expression of different AR variants in primarily cultured human GCs not only confirmed the in vivo results, but also revealed notable change of expression of folliculogenesis, steroidogenesis and ovarian structure modeling-related genes. Its underlying mechanism is inferior ability of nuclear shuttle and DNA binding, including U1 androgen response element (ARE) of CYP19A1 gene, of AR as nuclear receptor. In conclusion, alternative splicing of AR in GCs is a cause of hyperandrogenism, leading to follicular arrest in PCOS.