Day 2 :
Keynote Forum
Janelle Luk
Neway Fertility
Keynote: Title: In vitro maturation (IVM) for patients with polycystic ovary syndrome (PCOS): A retrospective case series in the United States
Time : 09:30-10:05
Biography:
Janelle Luk graduated from Yale University School of Medicine, completed her residency at Harvard, and later returned to Yale, where she completed a fellowship at the Division of Reproductive Endocrinology and infertility. As a Medical Director of Neway Fertility, she specializes in creating individualized fertility treatments for her patients. She draws on her vast expertise in both traditional and alternative IVF treatments to cater to the unique needs of each individual woman. Her areas of expertise include premature ovarian failure, diminished ovarian reserve and polycystic ovarian syndrome
Abstract:
In other parts of the world, many centers employ IVM as a routine treatment option for patients with PCOS. However, in the USA, IVM is still considered to be experimental (ASRM 2013 committee opinion). rnrnMaterials & Methods: Patients with PCOS (Rotterdam criteria) who failed ovulation induction with intrauterine insemination and or IVF were offered IVM as a treatment option. 12 of these patients underwent an IVM cycle. Cycles were primed with 3 days of gonadotropins (FSH 150 units) from cycle day 3 to 5. hCG 10,000 units was administered when the lead follicle was10-12 mm. Oocyte retrieval took place 36 to 40 hours later. The oocytes retrieved were cultured with IVM media. Oocytes that matured in vitro were fertilized with ICSI. Embryo transfers were performed during fresh cycles when endometrial lining was 7-8 mm. Outcomes analyzed were implantation, clinical-pregnancy and live birthrates.rnrnResults: 12 PCOS patients 25 to 34 years of age were included. The number of germinal vesicles retrieved was13.3±1.2 (mean±SD).The per cycle implantation rate was 83% (10/12). The clinical pregnancy rate and the live birthrate was 75% (9/12, no clinical pregnancy losses). There were no cases of ovarian hyper stimulation syndrome or any surgical complications.rnrnConclusions: This case series demonstrates that young PCOS patients who underwent IVM have excellent live birthrates while eliminating the incidence of ovarian hyper-stimulation. IVM is a suitable treatment alternative for patients with PCOS and should be given further consideration in the USA.rn
- Recent Research and Current Advancements in PCOS Treatment
Effects of PCOS on Womens Health
PCOS- Medications and Treatment
PCOS and Pregnancy
Chair
Jane Nani
Fertility Centers of Illinois, USA
Co-Chair
Donna Vine
University of Alberta, Canada
Session Introduction
Caren J Frost
University of Utah, USA
Title: Crafting multidisciplinary discussions around the healthcare needs of women with PCOS: A social work frame
Biography:
Caren J Frost is a Research Professor with expertise in qualitative methods at the University of Utah’s College of Social Work. She chairs the Global and Health Concentrations for the Masters of Social Work Program, and is an active Member of the University of Utah’s Center of Excellence for Women’s Health. As chair of the Refugee Women’s Health Committee, she works with refugee women’s groups along Utah’s Wasatch Front. Her research interests are on global social work education, refugee women’s health, cancer development in youth populations and emergency contraception.
Abstract:
According to the PCOS website and the Mayo Clinic, polycystic ovary syndrome (PCOS) impacts approximately 10% of all women and girls. Since it is the most common female endocrine disorder involving multiple organ systems within the body, the treatment of PCOS requires a more holistic discussion utilizing multidisciplinary team building education. Interestingly, PCOS impacts females across the life, making this syndrome a topic area of which medical social workers worldwide should be aware. Medical teams should be structured to deal with the various facets of PCOS so that (a) women can be treated in a comprehensive manner, (b) providers can more effectively share health information among team members, and (c) women’s individual factors impacting PCOS can be identified. Understanding how the woman’s family context and her home environment can be supportive in providing treatment parameters will enable a woman to make the most of her treatment options to maximize her quality of life. The medical education of social work students needs to be enhanced so that practicing social workers can become effective clinicians in medical settings that provide healthcare to women. This plenary session will explore how to begin this discussion so that healthcare providers can develop a more concrete understanding about creating interdisciplinary teams to discuss PCOS with clients and their families.
Janelle Luk
Neway Fertility, USA
Title: In vitro maturation (IVM) for patients with polycystic ovary syndrome (PCOS): A retrospective case series in the United States
Biography:
Janelle Luk graduated from Yale University School of Medicine, completed her residency at Harvard, and later returned to Yale, where she completed a fellowship at the Division of Reproductive Endocrinology and infertility. As a Medical Director of Neway Fertility, she specializes in creating individualized fertility treatments for her patients. She draws on her vast expertise in both traditional and alternative IVF treatments to cater to the unique needs of each individual woman. Her areas of expertise include premature ovarian failure, diminished ovarian reserve and polycystic ovarian syndrome.
Abstract:
Abstract Introduction: In other parts of the world, many centers employ IVM as a routine treatment option for patients with PCOS. However, in the USA, IVM is still considered to be experimental (ASRM 2013 committee opinion). Materials & Methods: Patients with PCOS (Rotterdam criteria) who failed ovulation induction with intrauterine insemination and/or IVF were offered IVM as a treatment option. 12 of these patients underwent an IVM cycle. Cycles were primed with 3 days of gonadotropins (FSH 150 units) from cycle day 3 to 5. hCG 10,000 units was administered when the lead follicle was10-12mm. Oocyte retrieval took place 36 to 40 hours later. The oocytes retrieved were cultured with IVM media. Oocytes that matured in vitro were fertilized with ICSI. Embryo transfers were performed during fresh cycles when endometrial lining was 7-8 mm. Outcomes analyzed were implantation, clinical-pregnancy and live birthrates. Results: 12 PCOS patients 25 to 34 years of age were included. The number of germinal vesicles retrieved was13.3±1.2 (mean ± SD).The per cycle implantation rate was 83% (10/12). The clinical pregnancy rate and the live birthrate was 75% (9/12, no clinical pregnancy losses). There were no cases of ovarian hyper stimulation syndrome or any surgical complications. Conclusions: This case series demonstrates that young PCOS patients who underwent IVM have excellent live birthrates while eliminating the incidence of ovarian hyper-stimulation. IVM is a suitable treatment alternative for patients with PCOS and should be given further consideration in the USA.
Yoojin Lee-Sedera
Red Rock Natural Medicine, USA
Title: The role of liver detoxification in women with polycystic ovarian syndrome (PCOS)
Biography:
Yoojin Lee-Sedera is a licensed naturopathic physician practicing in Las Vegas, Nevada. She received her degree of Doctor of Naturopathic Medicine from National College of Natural Medicine in Portland, Oregon and has been working with many patients with various chronic conditions in different states and also educating the public on natural health management. Currently she is a Vice President of Nevada Association of Naturopathic Physicians (NVANP) and also pursuing another degree in Oriental Medicine and Acupuncture at Wongu University of Oriental Medicine in Las Vegas.
Abstract:
Being one of the most biochemically complex organs in our body, liver carries out hundreds of intricate metabolic functions. Amongst those many, detoxification process of endogenous metabolic end-products and exogenous toxins is one of the major functions of liver, and it plays a critical role in the catabolism of hormones, and metabolic wastes. In PCOS women, it is common to see some level of compromise in liver function, whether clinical or subclinical. In fact, many studies in recent years have proven the relations between Non-alcoholic fatty liver disease and PCOS. In this presentation, we will discuss how the liver detoxification can affect the various stages and clinical manifestation of PCOS as well as various treatment outcomes for our patients.
Donna Vine
University of Alberta, Canada
Title: Dyslipidemia and exacerbated cardiovascular disease risk in PCOS: Clinical assessment and exploration of potential mechanisms
Biography:
Donna Vine is an Associate Professor, Recipient of McCalla Professorship (2015-2016) in Teaching, Service and Research, and Co-Director of the Metabolic and Cardiovascular Disease Laboratory.
Abstract:
Polycystic ovary syndrome (PCOS) is a metabolic-endocrine disorder that occurs in 10-18% of adolescents and young women of reproductive age. PCOS is an increasing public health concern because the incidence is highly associated with the metabolic syndrome (MetS): Obesity, insulin resistance and dyslipidemia, predisposing young women to develop Type II Diabetes and Cardiovascular Disease (CVD). PCOS is considered a major risk factor for premature development of CVD and up to 70% of patients have atherogenic dyslipidemia, a primary risk factor for the early onset of CVD. The pathology of dyslipidemia in PCOS is linked to elevated testosterone and insulin mediated mechanisms, and both of these metabolic aberrations upregulate lipidogenesis. Atherogenic dyslipidemia includes increased fasting plasma triglycerides (TG), total apolipoprotein (apo)-B, and decreased High Density Lipoprotein-Cholesterol (HDL) concentrations. Recent evidence also shows non-fasting plasma apoB-remnant lipoproteins are casually associated with end-stage CVD events which support the need to assess both fasting and non-fasting apoB-remnant lipoproteins to determine early subclinical CVD risk in young women with PCOS. Clinical dyslipidemic profiles are heterogeneous in PCOS, however an exacerbated plasma lipid and apolipoprotein profile are highly associated with free testosterone, and the presence of obesity and insulin resistance. Animal models used to investigate the etiology and mechanisms of dyslipidemia in PCOS demonstrate the direct involvement of testosterone and the androgen receptor in lipidogenic pathways. Safe and efficacious options to treat dyslipidemia in women with PCOS remain limited as current pharmaco therapies may be contra-indicated in young women with PCOS. The consensus is to focus on early CVD prevention with a need to assess early sub-clinical CVD risk markers and to develop effective and safe approaches to detect and manage dyslipidemia in all women with PCOS.
Amelia Purser Bailey
Brigham and Women’s Hospital, USA
Title: Clinical and embryologic in vitro fertilization (IVF) outcomes in polycystic ovary syndrome (PCOS) based on body mass index
Biography:
Amelia Purser Bailey is the Director of Minimally Invasive Surgery at Fertility Associates of Memphis. She is fellowship-trained in Reproductive Endocrinology and Infertility from Brigham and Women's Hospital. While in Boston, she was a Clinical Instructor at Harvard Medical School and conducted joint research projects between Boston Children's Hospital and the Massachusetts Institute of Technology. She attended the University Of Mississippi School Of Medicine and completed residency in Obstetrics and Gynecology at the University of Virginia Health System. In addition to treating infertility, her special interests include polycystic ovary syndrome, minimally invasive techniques, and congenital reproductive abnormalities.
Abstract:
Considering that 50% of PCOS patients are not obese, characterizing associations of a range of BMI with IVF outcomes could inform management of PCOS patients. Specifically, characterizing relationships between BMI and ovarian hyper-stimulation syndrome (OHSS) would lay the groundwork for investigation of BMI-dependent dosing of gonadotropins to reduce morbidity due to OHSS, a serious disease for which PCOS patients are at elevated risk. This retrospective cohort study included 101 IVF cycles from 79 women <40 years old with a clinically-documented diagnosis of PCOS. Participants were stratified by BMI calculated within three months of cycle start: Lean (18.7-24.9 kg/m2, n=51), overweight (25-29.9 kg/m2, n=19), and obese (≥30 kg/m2, n=31). Linear, logistic, and Poisson regression were used to estimate the effect of a range of BMI on IVF outcomes while adjusting for potential confounders. Obese PCOS women had 69% lower odds of clinical pregnancy per cycle start [odds ratio (OR) =0.31, 95% confidence interval (CI) =0.11-0.86, p=0.02] and 77% lower odds of clinical pregnancy per embryo transfer (OR=0.23, 95% CI=0.08-0.68, p=0.008) compared to lean PCOS women. Among obese PCOS women, the odds of live birth were 71% lower per cycle start (OR=0.29, 95% CI=0.10-0.84, p=0.02) and 77% lower per embryo transfer (OR=0.23, 95% CI=0.07-0.71, p=0.01) compared to lean PCOS women. There was a trend toward decreased OHSS incidence with increasing BMI among women with PCOS: 19.6% in lean, 10.5% in overweight and 3.2% in obese. In conclusion, PCOS is a broad syndrome with our results demonstrating two distinct populations, lean and obese, which have different IVF outcomes including OHSS risk profiles.
Diana Dowdy
Vanderbilt University School of Nursing, USA
Title: Emotional needs of teens with polycystic ovary syndrome
Biography:
Diana Dowdy completed her Master of Nursing from Emory University in Atlanta, GA, and her Doctor of Nursing Practice from University of Alabama in Huntsville. She is a Clinical Instructor at Vanderbilt University School of Nursing. She is a certified nurse-midwife and a registered diagnostic sonographer with over 33 years of clinical and teaching experience. Having served on state and national boards, she currently serves as Vice Chair to the ARDMS Task Force for Midwifery testing. She has published many peer-reviewed journals, including the Journal of Pediatric Nursing, and published a patient guide entitled, PCOS: A Guidebook for Teens.
Abstract:
Teens with polycystic ovary syndrome (PCOS) have serious health issues that impact them on multiple levels – hormonal concerns affecting female health and future fertility, disfiguring body changes causing self image problems and lifelong health consequences related to metabolic disorders. This is superimposed on the normal teenage developmental challenges, often causing extra emotional burden for the teen with PCOS. Healthcare providers are now beginning to understand underlying pathophysiologic processes and make earlier diagnoses in the 6-10% of teens with this disorder. However, the profound psychological and social needs are often inadequately recognized by healthcare providers, causing many teens turn to peers and the internet for guidance and support. Practitioners need to explore ways to address these needs in clinical settings. This presentation explores both review of literature on this timely topic, as well as real-world experience of those who struggle with the complications of this disorder. A model of care is presented to help identify and address learning and emotional needs in providing a more holistic approach to the teen with PCOS.
Svetlana Ten
Cornell University, USA
Title: Recent advancements in polycystic ovarian syndrome diagnosis and therapy
Biography:
Svetlana Ten received her Medical degree from Minsk Medical University in Belarus. She completed fellowships in Pediatric Endocrinology at Cornell University in 2002; studied endocrinology in Akita, Japan in 1992-1993; and at Moscow State University in 1989. She was working as a Program Director of Pediatric Endocrinology Divisions and Fellowship Programs of Maimonides Hospital and SUNY Downstate Hospital from 2004-2014. Currently, she is working as a private Pediatric Endocrinologist. Her areas of expertise are problems with short stature, irregular periods, thyroid, adrenal disorders, PCOS and diabetes. She has more than 60 publications in these areas.
Abstract:
Despite high prevalence, the etiology of PCOS is not clearly understood. In childhood premature adrenarche, SGA, weight gain can be a forerunner of the future abnormalities of insulin resistance and PCOS. Weight gain complicated with insulin resistance potentiates ovarian and adrenal hyperandrogenism by enhancing LH secretion, potentiating 17-hydroxylase and 17,20-lyase activity and suppressing SHBG. Insulin resistance can lead to relative Hexose-6 -phosphate dehydrogenase (H6PGH) deficiency and lower cortisol availability and feedback leading to increase in androstenedione, DHEA and DHEAS. Increased DHEA can decrease nuclear glucocorticoid receptor levels in the hippocampus, decrease 11 β-hydroxysteroid dehydrogenase (11β-HSD) type 1 activity and inhibit the expression of H6PDH. Decreased activity of 11β-HSD type 1 is responsible for interconverting active cortisol and inactive cortisone and thus responsible for tissue-specific glucocorticoid bioavailability and secondary hyperandrogenism. Metformin improves ovulation, reduce androgen levels, increase SHBG and helps in reduction of body weight, reduces the risk of miscarriage and the risk of gestational diabetes. Rosiglitazone increases insulin sensitivity in obese and in lean patients with PCOS. Rosiglitazone is as well effective in decreasing the androgen levels. D-chiro-inositol (DCI) treatment improves insulin resistance and serum AMH levels. Combination of Inositol and metformin decrease the oxidative damage, insulin resistance and androgens. Combined oral contraceptives (OCs) are superior to metformin in reducing androgens, but inferior to metformin in reducing insulin resistance. Treatment in each case must be individual, depending on age, weight, insulin resistance, level of androgens and hirsutism.
Jane Nani
Fertility Centers of Illinois, USA
Title: Freeze-all policy: Fresh vs. frozen-thawed embryo transfer in PCOS patients
Biography:
Jane Nani completed her fellowship in Reproductive Endocrinology at the Beth Israel Hospital/Harvard Medical School. She has been a practicing Clinical Physician and partner in Fertility Centers of Illinois for greater than 10 years. There she is the Medical Director for the Center for Collaborative Reproduction.
Abstract:
Women with PCOS who undergo IVF are inherently at high risk of ovarian hyperstimulation syndrome (OHSS). OHSS is most severe when PCOS patients undergo fresh embryo transfer and become pregnant. Prevention is a primary strategy for minimizing OHSS in the IVF setting. To this end, cycle cancellation is recommended in most IVF centers when high ovarian response exceeds set criteria. In our tertiary IVF center, PCOS patients with high egg yields are recommended for a “freeze all” (FA) cycle rather than cycle cancellation. Specifically, when 35 eggs or more are retrieved, the patient is an automatic FA. However with lower egg yields, decision for FA hinges on the presence of early signs/symptoms of OHSS. We reviewed the IVF stimulations and outcomes of PCOS women who cycled in our IVF center over the past 8 months. We report on 44 pts. who met PCOS criteria and who underwent IVF. The majority of patients underwent and antagonist IVF protocol with HCG trigger. The number of eggs retrieved ranged between 7 and 42 eggs, with an average of 19 eggs and 15 patients had greater than or equal to 20 eggs retrieved. Fourteen patients met the criteria for FA. The clinical pregnancy rate per transfer infresh IVF was 59%. When adding subsequent frozen-thawed cycles, the cumulative pregnancy rate per cycle was 64%. The rate of severe OHSS was negligible.
Deanna Minich
American College of Nutrition, USA
Title: Nutrition and lifestyle medicine for women’s health
Biography:
Deanna Minich is an internationally-recognized wellness and lifestyle medicine expert, creative visionary and author. In 2014, she launched the Certified Food & Spirit Practitioner Program and has a diverse, well-rounded experience in the field of nutrition including clinical practice, research, product formulation, marketing, writing and education. She received her nutrition education during her Doctoral (PhD) study at the University of Groningen in the Netherlands where she researched essential fatty acid absorption and metabolism and from her Master’s Degree (MS) at the University of Illinois at Chicago, where she studied carotenoids and oxidative stress. She has authored five books on health and wellness and over fifteen scientific publications. Currently, she is senior advisor to the Personalized Lifestyle Medicine Institute in Seattle, WA and is adjunct faculty for the Institute for Functional Medicine, the Maryland University of Integrative Health and University of Western States. Her passion is teaching a whole-self approach to nourishment and bridging the gaps between science, spirituality and art in medicine.
Abstract:
The lifecycle is a spectrum of change and perhaps even more so for women than for men. For most of the 20th century, the woman’s lifecycle and corresponding health issues have not been a prime focus for the medical community despite the fact that scientific research indicates that women experience certain symptoms and diseases differently from men. However, the times are changing consistent with the flux in demographics. It has been predicted by the World Health Organization (WHO) that by the year 2025, 1.1 billion women worldwide will be age 50 or older, going through the menopausal transition. In fact, more women are going through menopause now more than any other time and with the increased longevity experienced by women compared with men, the implication is that more than one-third to even one-half of a woman’s life will be in her postmenopausal phase. Some woman experience physiological and psychological distress as their hormones begin to shift, which can begin as early as 10 to 15 years before menses completely stop. Although the “change of life†is the end of a woman’s reproductive years, it doesn’t have to mean withdrawal from an active, vibrant life. Conventional medical care has had little to offer these women in the way of relief, but by using a functional medicine approach, the clinician is empowered to assist the patient in making diet and lifestyle modifications that can make a significant difference. An understanding of the body’s changes during this unique phase of life and personalized nutritional solutions can assist the female patient in living well and remaining healthy throughout the second half of her life spectrum. In this presentation, the author will provide a whole-self, lifestyle medicine approach to women’s health through the lifespan, including scientific developments and clinical protocols for autoimmune disease, PCOS, PMS, premature peri-menopause, peri-menopausal symptoms and ovarian and breast health. As we move along the lifecycle, we will discuss conditions associated with post-menopause such as osteoporosis, body composition challenges, cardiovascular health, and metabolic syndrome.
Meaghan Ormsby
Eastern Michigan University, USA
Title: Study of Intuitive Eating Ratings and Self-Efficacy Differences in Women with Polycystic Ovarian Syndrome (PCOS)
Biography:
Meaghan Ormsby is a Registered/Certified Dietitian and Certified Intuitive Eating Counselor who specializes in women’s health, including disordered eating, insulin resistance, Polycystic Ovarian Syndrome (PCOS), and child feeding issues. She has worked with eating and weight concerns for 14 years, providing individual nutrition counseling as well as group education and monthly PCOS support groups.
Abstract:
“Traditional†interventions for elevated weight or health concerns, including PCOS, have focused on helping individuals achieve and maintain a target weight. This traditional model focuses on creating a negative caloric balance with the target outcome being weight loss. Alternatively, the nondiet approach focuses on reconnecting with physiological hunger and using hunger and fullness rather than calories or food lists to guide amounts of food eaten. The nondiet approach differs from the traditional model in that knowledge about food and nutrition is used to inform food choice rather than drive food choice. The purpose of this study was to investigate if there is a difference in self-efficacy ratings among women with PCOS who rate themselves high on the Intuitive Eating (nondiet) scale compared to women with PCOS who rate themselves low on the Intuitive Eating Scale, using a 23-question survey, which was completed by 120 women with PCOS. The difference in self-efficacy ratings among women with PCOS who rate themselves high on the Intuitive Eating (nondiet) scale compared to women with PCOS who rate themselves low on the Intuitive Eating Scale was significant (p=0.007). These results are very informative as to how relevant the nutrition philosophy used in the delivery of nutrition education is. The results of this study showed that women with PCOS who eat more intuitively feel more confident about sustaining healthy habits than women with PCOS who eat less intuitively. This is an important advancement in the treatment of PCOS because a sustainable nutrition intervention has not been found.
L. A. Ivanova
Kuban State Medical University, Russia
Title: Influence of thioctic acid on the hyper insulinemia and ovarian volume in female patients with polycystic ovary syndrome
Biography:
Ivanova L.A. was awarded the degree of Doctor of Sciences in February 2009. She was was awarded the academic title of professor of endocrinology in December 2009. She is the head of Endocrinology Department at Kuban State Medical University since 1995. She has published more than 123 articles and abstracts in Russian and international journals.
Abstract:
Hyperinsulinemia is considered by many researchers as the main cause of polycystic ovary syndrome (PCOS). The aim of our study was to evaluate the effect of thioctic acid (Thioctacid-HR) on hyperinsulinemia, insulin resistance, menstrual function, the volume of the ovaries in patients with PCOS. 25 women with polycystic ovary syndrome received Thioctacid-HR, 600 mg per day within three months. 20 people observed the high-protein diet only. Determining the level of basal and glucose-stimulated insulin calculation of the index of insulin resistance and ovarian volume were performed before and after 3 months of treatment. Thioctic acid treatment improved menstrual function and a positive impact on the average volume of the ovary after 3 months of treatment. 80% of women returned to normal duration and frequency to settle ovarian-menstrual cycle. Every third patient with amenorrhea were induced menses, two patients the appearance of the dominant follicle. Normalizing the average volume of the ovary after 3 months of treatment occurred in 64% of cases. In the control group similar positive results after 3 months of treatment were absent. Three women—heterozygous carriers of 21-hydroxylase gene mutation—had the same positive effects of influence of thioctic acid on hyperinsulinemia, ovarial volume, HOMA-IR, restoration of ovulatory cycles like patients in the main group. One in June 2015 gave birth to a healthy baby.
Maria Palmetun Ekbäck
Orebro University Hospital, Sweden
Title: What do we know about quality of life in women with hirsutism?
Biography:
Maria Palmetun Ekbäck is a Senior Consultant in Dermatology. Her sub specialization is in Laser surgery, in which she has her clinical responsibility. She is also the Head of the Pharmacology and Therapeutic Department at Region Örebro County. She obtained her PhD in Medicine with a thesis focusing on Hirsutism and quality of life. Her present research is mostly in clinical bed-side medicine. She is a member of European Academy of Dermatology and Venereology, The Swedish Society for Dermatology and Venereology, The Swedish Society of Dermatologic Surgery and Oncology and The Nordic Society of Vascular Anomalies.
Abstract:
Hirsutism is a common sign of hyperandrogenism. The prevalence of hirsutism is estimated to 5%, where PCOS is the most common cause and is estimated to be responsible for 70% of hirsutism. Excessive hair growth has been found to be the second most seriously negative rated factor after infertility in women with PCOS. To live with hirsutism means to live with a life sorrow. Quality of life is depressed, measured with EQ-5D, EQ-VAS, Dermatology Life Quality Index (DLQI) and SF-36. Women with hirsutism report lower vitality level than patients with the neurological diseases myasthenia gravis and multiple sclerosis, and low self-reported health status with SF-36. Higher levels of hair growth are significantly correlated to lower level of QoL and symptoms of both anxiety and depression. Good perceived social support seems to be associated with better quality of life. Informative support is one kind of social support. Healthcare should assist with informative support, i.e. information about the diagnosis and treatment options. Lasers or IPL for hair removal give long lasting effect and improves Qol.
Ozgun Ozcaka
Ege University School of Dentistry, Turkey
Title: Is there an interaction between polycystic ovarian syndrome and gingival inflammation?
Biography:
Ozgun Ozcaka has received her DDS degree in 2001 from Ege University and completed her PhD in 2006 from the same university. She was a Visitor in Seattle, University of Washington in 2004 and 2009. She did her Post-Doc study in 2010 in University of Pennsylvania, PA, USA and in Catholic University of Leuven; in 2011. Her main interests are mechanisms of interactions between periodontal diseases and systemic diseases such as gestational diabetes mellitus, PCOS. She has published over 22 papers in well-known scientific journals. She is the president of Turkish Society of Periodontology, Izmir Branch.
Abstract:
Periodontal diseases, including gingivitis, are common chronic infectious diseases caused by predominantly pathogenic microorganisms that colonize the sub-gingival area and cause local and systemic elevations of pro-inflammatory cytokines resulting in tissue destruction. Gingival cervicular fluid (GCF) is regarded as a transudate enriched with dental microbial and host products that increases as a result of host–microbe interactions. Several lines of evidence established the association between periodontal and systemic diseases, including metabolic syndrome, diabetes, and CV disease. Because of the fact that both periodontal disease and metabolic syndrome are associated with systemic inflammation and insulin resistance, these two disorders may be linked through a common patho-physiologic pathway. PCOS appears to be associated with increased oxidative stress and systemic inflammation because females with PCOS have increased markers of lipid peroxidation, C-reactive protein, inflammatory cytokines and percentage of blood lymphocytes and monocytes. The causes of these alterations have not yet been identified, but chronic infections may induce inflammation and oxidative stress and possibly contribute to insulin resistance, ovarian dysfunction, and other characteristics of PCOS. It is the aim of this lecture to clarify the influence of gingival inflammation and GCF, saliva, serum concentrations of inflammatory cytokines and clinical periodontal findings in PCOS females and to answer the title question whether there is any association between PCOS and gingival inflammation.
Awatif Al Bahar
Dubai Health Authority, UAE
Title: Management and treatment of PCOS patients undergoing ART
Biography:
Awatif Al Bahar is a Medical Director, Senior Consultant in Obstetrics/Gynaecology, reproductive Endocrinology at the Dubai Gynaecology & Fertility Centre, Dubai Health Authority. After completing her graduation, she specialized in Obstetrics & Gynaecology from the German Board, Koln and has a membership in Endocrine and Infertility from Academic University in Bonn. She had been selected in 2002 in Dubai Excellency Program. Her name is mentioned in the U.A.E Book of Special Personalities of All Fields (i.e. Medicine, Politics, Art etc.) She was honored as hero of health care in 2012 by her highness ruler of Ajman. She has held multiple posts in various capacities in the OBS/GYN and is currently the Director of the IVF Board of the Ministry of Health of UAE. She is the Chairperson of the Emirates Obs/Gyne & Fertility Forum (EOFF) and a regular speaker on U.A.E activities in mother and child health via media – television, radio, ladies association, universities etc. She has many publications on polycystic ovaries and infertility.
Abstract:
Polycystic ovaries syndrome (PCOS) is noted to affect 5% to 10% of women of reproductive age all over the world, which is approximately 4 million individuals. Its prevalence among infertile women is 15% to 20%. PCOS accounts for 95% of cases of hyper-androgenism and is responsible for over 20% of all cases of amenorrhea. Studies also reveal that 75% of all cases of an ovulatory infertility are caused due to PCOS. Coming to the economic perspective, according to the statistics available to us, experts have calculated the mean annual cost of the initial evaluation for PCOS to be about 93 million (2.1% of total costs). It is notable that hormonally treating menstrual dysfunction / abnormal uterine bleeding is estimated to cost about 1.35 billion (31% of total). Providing infertility care incurs an expenditure of about 533 million (12.2% of total), treatment of PCOS – associated diabetes comes to around 1.77 billion (40.5% of total), and that of treating hirsutism costs in the range of 622 million (14.2% of total). The presentation will discuss the pros and cons of PCOS. We will dwell on the relation of other medical sub-specializations with the treatment of PCOS, with special emphasis on overcoming the problems for PCOS in IVF. Highlights of the discussion will include how we can avoid ovarian hyperstimulation syndrome, diagnosis and mild stimulation, oral contraceptive pre-treatment, antagonist/GnRH agonist to trigger ovulation, use of Metformin in treating PCOS, freezing of embryos.
Zhang Shaofen
Fudan University
Title: Efficacy of GnRHa plus Yasmin or Mirena in the treatment of polycystic ovarian syndrome with a typical hyperplasia in patients with adenomyosis accompanied with dysmenorrhea
Biography:
Professor, Chief physician and Doctoral supervisor of Gynecology & obstetrics hospital of Fudan University; member of Shanghai reproductive and endocrine center’s expert group; vice leader of menopause group of Chinese medical association; member of time and biology committee attached to Chinese Association of the Integration of Traditional and Western Medicine; special reviewer of Chinese Journal of Geriatrics. Her research area mainly focuses on gynecological reproductive and endocrinology, geriatric gynecology. She has gained academic achievements in HRT after menopause, osteoporosis after menopause, dysfunctional uterine bleeding and hormone therapy for endometriosis. Some researches have got progress prize in scientific and collective technology from Shanghai medical college and Shanghai city. Has educated over 20 graduates and published original articles over 100.
Abstract:
Objective: To investigate the efficacy of GnRHa plus Yasmin or Mirena in the treatment of polycystic ovarian syndrome (PCOS) with a typical hyperplasia in patients with adeno myosis accompanied with dysmenorrhea. Methods: The patients of PCOS with severe dysmenorrhea of adenomyosis had severe abnormal uterine bleeding and a typical hyperplasia confirmed by the diagnostic uterine curettage, accompanied by high insulin and high testosterone levels in blood plasma. Through blood transfusion and hormone hemostasis, the patients' condition was stable. After menstruation, we started GnRHa treatment. GnRHa was subcutaneously injected at a dose of 3.6mg each time for 6 times (once every 28 day) to induce pseudo-menopause, followed by oral administration of Yasmin for three cycles. Afterwards, curettage was performed before the next menstruation since the discontinuance of Yasmin, followed by administration of Yasmin or Mirena, each in combination with DMBG (0.85mg) for 12 cycles. During this 12 cycles-long period, endometrial thickness (two-layer), menstrual amount, uterus volume, dysmenorrhea severity (VAS score), hemoglobin level, serum insulin level, androgen level and body weight were measured at each fellow-up regularly. Results: After the treatment, a conversion from atypical hyperplasia into simple hyperplasia or proliferative endometrium was observed, with marked decreases in endometrial thickness (22mm vs. 4mm), uterus volume (251.04cm3 vs. 180cm3) and menstrual amount and the menstrual cycle became regular, along with alleviated dysmenorrhea (7’ vs. 3’). Meanwhile, hemoglobin level was increased (4-6g/l vs. 13.2g/l) and serum insulin and androgen levels were reduced; patient body weight also dropped, which declined from 102kg to 87kg in one case. Conclusions: GnRHa treatment with either Yasmin or Mirena can effectively alleviate endometrial hyperplasia, relieve dysmenorrhea, diminish adenomyotic lesions and reduce serum insulin and androgen levels in PCOS patients with a typical endometrial hyperplasia and adenomyosis accompanied with dysmenorrhea.
Amani Ali Shaman
University of Tabuk, Saudi Arabia
Title: Metabolic syndrome and cardiovascular risk assessment among women with polycystic ovary syndrome attending King Khalid Hospital in Tabuk
Biography:
Amani Ali Shaman completed her Residency in Obstetrics and Gynecology in 2005, followed by fellowship in Reproductive Endocrinology and Infertility. In 2009, she joined Tabuk University as Assistant Professor in Obstetrics and Gynecology and become the Head of the Department in 2012 till current.
Abstract:
Background: Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder at a reproductive age. It is associated with a high risk of metabolic syndrome (MS) and cardiovascular diseases (CVD). Objectives: To study the prevalence of MS in women with PCOS, and to investigate the metabolic profile and global cardiovascular risk (CVR) among them. Subjects & Methods: We randomly selected 404 infertile women, checked them for diagnosing PCOS, MS and estimated CVD probability. Student T–test, Chi-square and conditional logistic regression were used for statistical analysis. Results: MS was diagnosed in about 58% and 32% of women with and without PCOS respectively (p<0.00). Older age groups and women with high BMI showed statistically significant more prevalence of MS in PCOS compared to NO PCOS group. Patients with the two syndromes showed statistically significant higher averages of clinical and biochemical values (p<0.00), higher rate of CVR, and higher percentage of clustering of MS factors compared to NO PCOS patients with MS (p<0.00). Weight, waist circumference, and high density lipoprotein are predictive for the occurrence of MS among PCOS group. Conclusion: Patients with PCOS have a higher risk of development of MS, and CVD. Screening for early detection of PCOS and MS, and the application of cohort studies are recommended to better study the role of PCOS in development of CVD, and to assess the significance of interventions.
Kalpana Dash
Apollo Hospitals Education and Research Foundation, India
Title: Effects of PCOS on women's health
Biography:
Kalpana Dash has completed her medical degree from Utkal University, India and completed her Doctorate in Medicine in Endocrinology from SGPGIMS, Lucknow. She has been working with Apollo Group of Hospitals since 2001 and has been conferred as the Adjunct Professor of Endocrinology in the AHERF. She serves as the Editorial Board Member of Apollo medicine Journal. She has been actively involved in clinical as well as research activities. She presented papers in national and international forums. She is now working as Chief of Diabetes & Endocrinology at Apollo Hospitals and Apollo Sugar and Endocrine care clinic based at Raipur and Bilaspur.
Abstract:
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females in their reproductive age with prevalence varying from 6.1–19.9% depending on the diagnostic criteria used. There is a 7-fold increase in risk of myocardial infarction (MI) in PCOS women. However, a retrospective study in the United Kingdom, demonstrated that PCOS women neither had raised mortality nor MI morbidity, despite of having higher prevalence of above metabolic risk factors and hypertension. Surprisingly, same study has demonstrated higher prevalence of stroke among this cohort of PCOS women. Two studies reported an increased risk of endometrial cancer in PCOS. Breast cancer is the most common cancer and the risk is not higher than the normal population. Mood disturbances, severe depression, and reduced quality of life are independent CVD risk factors and very common among women with PCOS. Depression and anxiety in PCOS patients, lead to fatigue, sleep disturbances, phobia, change in appetite change, and binge eating habits. Nonalcoholic fatty liver disease (NAFLD) is common (27.4–62%) compared to age and weight matched non-PCOS individuals. However the progression of NAFLD to NASH is less frequent. Prevalence of advanced liver disease (NASH with fibrosis) is very high, even in the adolescent females with PCOS. Weight loss is a part of treatment and helps in reversing the natural history of NAFLD. Obstructive sleep apnea syndrome (OSA) in women with PCOS is 5 to 30 fold higher. It is demonstrated that, IGT is 2-fold higher (55 vs. 23%) in women with PCOS with OSA compared with those without OSA. Successful treatment of OSA improves cardio-metabolic function, blood pressure, and insulin sensitivity in obese women with PCOS. In conclusion, polycystic ovary syndrome (PCOS) is the most common (6.1-19.9%) endocrinopathy in women. Common diagnostic features are hirsutism, acne, polycystic-appearing ovaries, obesity and oligo/amenorrhea. It has many features in common with the metabolic syndrome such as insulin resistance, central obesity, hypertension, IGT/ diabetes mellitus, dyslipidemia, increased prevalence of CVD and all-cause mortality. They have a higher prevalence of breast cancer, uterine cancer, infertility, NAFLD, OSA, depression, mood disturbances and decreased quality of life.