Polycystic Ovarian Syndrome Conference November 16-18, 2015 Seattle, USA

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.

In the healthcare system there has been in the past an under-recognition of PCOS in teens. In addition to failing to make early diagnosis, there has been a tendency to treat symptoms and not address PCOS in a comprehensive fashion. Teens themselves have perceived a frustration over lack of information. Since PCOS is a complex disorder it requires an individualized approach, which is often very time-prohibitive. A booklet was developed to augment the use of the providers\' time in explaining PCOS in simple terms to help teens receive basic knowledge about the disorder, how it can affect them, and how they can begin to manage it.

Amr Farag had Masters and MD from Ain Shams University, Egypt. He obtained MRCOG degree from UK and Award of Med Ed from Warwick University, UK. Amr is a member of Egyptian Gynecological Cancer Society, RCOG, and is RCOG Tier two Educator in Postgraduate Obstetrics and Gynecology. He is a lecturer of Obstetrics and Gynecology in Ain Shams University, Egypt and a Specialty Doctor in Warwick Hospital, UK. Amr shared in more than ten research projects as: “The role of endometrial Leukemia Inhibitory Factor gene expression in failure of implantation after Intracytoplasmic Sperm Injection” and “Intrauterine insemination timing after hCG administration in unexplained infertility. Does it matter?\".Amr has six publications in peer-reviewed journals with an interest in reproductive medicine and has three papers under review for publishing. He is a member of the editorial board of \"Obstetrics and Gynecology International Journal\" and a reviewer for \"Journal of Fertilization: In Vitro, IVF Worldwide, Reproductive Medicine, Genetics & Stem Cell Biology\".

Aim: To compare GnRH agonist to hCG for triggering ovulation in polycystic ovarian syndrome treated with clomiphene citrate \r\n\r\nMaterials & Methods: Study Design: Prospective randomized study. Materials & Methods: Eighty five infertile women with PCOS participated in a randomized allocation concealed prospective trial and had induction of ovulation with clomiphene citrate. GnRH agonist 0.2 mg subcutaneously (group 1) or hCG 10,000 IU intramuscularly (group 2) was given to trigger ovulation. Primary outcome was mid-luteal serum progesterone, while secondary outcomes were ovulation rates and clinical pregnancy rates along 3 cycles \r\n\r\nResults: No difference was found between group-1 and group-2 regarding mean serum progesterone and clinical pregnancy rates in each cycle. Cumulative pregnancy rates were similar (17.14% vs. 20% respectively; P=0.332). Ovulation rates were 80% vs. 68.6% (P=0.413); 94.3% vs. 90.9% (P=0.669); 97.1% vs. 93.7% (P=0.603) in the two groups respectively. However, a significant rise in number of patients with mid-luteal serum progesterone >10 ng/mL was noted in the 3rd cycle among both groups, (P<0.0001 for group 1 while P=0.007 for group 2). \r\n\r\nConclusion: Triggering ovulation with GnRH-A after treatment with clomiphene citrate in PCOS, in view of its known protective effect against OHSS, may be an effective physiological alternative to conventional hCG without compromising luteal function and pregnancy rates after repeated cycles of treatment.\r\n

Kulvinder Kochar Kaur is the Scientific Director of Dr. Kulvinder’s Centre for Human Reproduction. In 1980, she topped in medicine of all medical colleges thereby getting the Dr. Devi Chand Gold medal from the late PM Indira Gandhi. Besides topping in all the MBBS subjects, following that she reported the 40th case in world literature of hydrometrocolpos in Saudi Arabia. She has been working in the field of neuroendocrinology to unearth the complexities of obesity and is trying to work on the neurophysiology of GnRH control, kisspeptins besides her endeavor to unearth the complexities of AIDS/Cancer. During this period she managed to successfully treat the first case of non-gestational chorio-carcinoma of uterine body in a young girl medically, thereby preserving her fertility.

The definitions of PCOS have changed from the classic NIH definition to more inclusive Rotterdam’s criteria (any 2 of the following 3 criteria after excluding etiologies like hyper-prolactinemia, clinical etc., and/or biochemical androgen excess, oligo/anovulation and polycystic morphology on USG. Ovulation induction in PCOS 1) CC acts by increasing serum FSH remains the first line of treatment 2) Metformin-commonly used as an oral hypoglycaemic has been found to improve menstrual cyclicity, by reducing insulin levels and altering the effects of insulin on androgen biosynthesis , also potentially inhibits through a direct effect on inhibiting ovarian gluconeogenesis. Further allopregnanolone secretion is altered with no change in progesterone secretion in obese PCOS patients which gets corrected by metformin restoring normal steroid synthesis both from the ovary as well as the adrenal gland (Gennazzani) 3) Aromatase Inhibitors- letrozole/ anastrazole -banned in India , special interest was for getting monofolliculogenesis but Kasper et al show how under the false impression as many as sixtuplets got born with 3rd cycle of 7.5 mg letrozole and hence careful monitoring needed even when planning an IUI 4) Glucocorticoids-dexamethasone-used to induce by adding high dose short courseto CC resistant PCOS with normal DHEAS - Enthusiasm has dampened by potential adverse effects on insulin sensitivity 5) Gonadotrophins-2nd line of action, main drawback-multiple folliculogenesis, OHSS 6) D-chloroinositol (DCI) is effective in restoring insulin sensitivity in obese hyper-insulinemics especially with diabetic relatives. 7) Myoinositol, Kamanovetalin n=50 led to ovulation in 61.7%, 38.3%-resistant. 11/29(37.9% became pregnant .Of 18 R after CC addition 13(72.2%) ovulated of which 6(42.6%) became pregnant. 8) In severely obese PCOS topiramate/exenatide, considered in morbid obesity. 9) Occasional extreme PCOS - >100 df /ovary -how successful OI/ pregnancy achieved is discussed.