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.
- Prevention and Management of PCOS
Alternative PCOS Treatment
Endometriosis
Chair
Felice L Gersh
Integrative Medical Group of Irvine, USA
Co-Chair
Kirsten Karchmer
American Board of Oriental Reproductive Medicine, USA
Session Introduction
Rashmi Kudesia
Icahn School of Medicine at Mount Sinai, USA
Title: Prevention and management of PCOS
Biography:
Rashmi Kudesia completed her undergraduate degree at Brown University and received her MD from the Duke University School of Medicine. She completed her residency at New York Hospital-Weill Cornell and and her fellowship training at Montefiore Medical Center-Albert Einstein College of Medicine, along with a Master of Science in Clinical Research Methods. She is an Assistant Professor of Reproductive Endocrinology & Infertility at Icahn School of Medicine at Mount Sinai/Reproductive Medicine Associates of New York. She has presented and published clinical research, review articles and book chapters focused on PCOS, and enjoys the clinical care of PCOS patients.
Abstract:
Polycystic ovary syndrome (PCOS) can manifest in different forms – with phenotypes ranging from lean women who have irregular menses and polycystic ovaries to overweight women with insulin resistance, hyperandrogenism and high risks for worsening metabolic disease over the lifetime. Despite the different presentations, women who raise the clinical suspicion of PCOS require detailed and thoughtful evaluation to (1) confirm the condition, particularly in adolescents in whom diagnosis can be particularly challenging, (2) evaluate for specific phenotype and co-morbidities with ongoing screening intervals reflective of their individualized disease risks, and (3) counsel women regarding their lifelong reproductive and metabolic risks. Prior evidence has suggested that provider specialty and training influences how many of these goals are actually met, and thus more training and emphasis is required for both women with PCOS and their healthcare providers. The proposed talk could be tailored to cover the individual topics within this session, including managing PCOS in primary care settings, in adolescents, and/or over the long term. Detailed review of the evidence and available guidelines regarding risks, screening and treatments would be featured alongside tips to address common barriers to provision of complete care, such as provider discomfort with lifestyle counseling. An emphasis will be placed on prevention of co-morbidity development, particularly among young girls and adolescents, in whom the ongoing childhood obesity crisis raises concerns for increasing rates of PCOS.
Felice L Gersh
Integrative Medical Group of Irvine, USA
Title: The care and feeding of the microbiome: A new approach to lowering the inflammation of PCOS
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:
It has become increasingly apparent that the microbiota residing within our gastrointestinal tract plays a critically key role in a great variety of essential bodily functions. In fact, the microbiome is as essential to our health as are our other organs. More DNA exists within us which derives from the trillions of bacteria comprising our microbiome than from our personal genetic DNA. Sadly, the standard Western diet, comprised of large quantities of processed foods, which are nutrient deficient, chemically laden, antibiotic containing, and devoid of sufficient quantities of both soluble and insoluble fiber, kills rather than supports a healthy microbiome. Women with PCOS frequently experience gastrointestinal problems, have irritable bowel syndrome, and develop chronic low grade systemic inflammation as a consequence of the unhealthy state of their gut microbiome. This lecture will provide a comprehensive presentation of the best diet to support a healthy microbiome, thereby facilitating the myriad essential functions of the microbiota, supporting a healthy diversity of microbes, along with boosting the colony sizes, while promoting the growth and survival of the right balance of bacteria to keep the body functioning optimally.
Kirsten Karchmer
American Board of Oriental Reproductive Medicine, USA
Title: Using technology to deploy multivariate approaches to improving PCOS
Biography:
Kirsten Karchmer is a board certified Reproductive Acupuncturist and former President of the American Board of Oriental Reproductive Medicine. She is the founder of The Texas Center for Reproductive Acupuncture, one of the largest fertility wellness clinics in the US. For the last 15 years, she has been pioneering proprietary infertility assessment and treatment protocols that maximize the natural fertility of her patients and while improving their overall health. In 2013, she founded conceivable, translating her successful clinical programs into a technology enabled program that provides affordable and impactful reproductive solutions to women nationwide. She lectures internationally on the future of integrative medicine, and using technology to better serve patients, providers, and healthcare systems.
Abstract:
PCOS is a complicated, chronic endocrine disorder that accounts for roughly â…“ of infertility cases among women in the US. Common interventions such as metformin, temporary blood sugar management and inducing ovulation (to promote pregnancy) fail to address the chronic underlying metabolic issues which impact progesterone and severely impact miscarriage and live birth rates. The temporary management of PCOS distinctly as a disorder of ovulation eliminates the opportunity to examine and address long term health impacts such as heart disease and diabetes that significantly undermine the individual's overall health and dramatically contribute to future healthcare costs. Complex, multisystem disorders like PCOS require new medical paradigms that can employ multivariate interventions designed to identify and address a wide range of underlying factors. These interventions extend beyond treating inconvenient symptoms, such as anovulation, and fundamentally change patient health and future health care outcomes. As the stewards of our patient’s health, we should leave them fundamentally better than we found them. This plenary session will detail novel diagnostic models that can expand a physician's ability to address the underlying issues related to PCOS and infertility, discusses a multivariate intervention strategy that can easily be employed in any office, and reviews the relevant supporting literature.
Kelton Tremellen
Flinders University, Australia
Title: Can gut bacteria alter gonadal function? An overview of the DOGMA theory of PCOS
Biography:
Kelton Tremellen is a Gynaecologist and board certified sub-specialist in reproductive endocrinology and infertility. He has a PhD in the field of reproductive immunology from the University of Adelaide and is currently Professor of Reproductive Medicine at Flinders University and Clinical Director at a private fertility unit (Repromed). His research interests include how nutrition and the immune system influence reproductive function. He has published more than 50 journal articles, book chapter and a book (Nutrition, Fertility and Human Reproductive Function, CRC press). He is on the Editorial Board of the journal ‘Human Reproduction’.
Abstract:
Polycystic Ovarian Syndrome (PCOS) is the commonest endocrinopathy seen in reproductive age women, presenting with a myriad of features including reproductive dysfunction (anovulation, infertility, endometrial pathology and increased risk of miscarriage and preterm delivery), hyper-androgenism (acne, hirsutism), diabetes, cardiovascular disease and psychological impairment (depression, anxiety). From a biochemical perspective PCOS is characterised by a chronic state of inflammation, which is now recognised as a potential trigger for insulin resistance and possibly many other features of the disorder. Therefore, the key to effective long term management of PCOS is to identify and treat the cause of chronic inflammation underlying the creation of a PCOS state. Recently we proposed that the passage of gut bacterial endotoxin into the circulation may be responsible for triggering chronic inflammation and PCOS- the Dysbiosis of Gut Microbiota (DOGMA) theory. Women with PCOS have a significantly greater incidence of obesity and irritable bowel syndrome (IBS), both linked with an increase in intestinal wall permeability allowing translocation of gut bacteria into the systemic circulation. The resulting endotoxin exposure (metabolic endotoxaemia) triggers a chronic low grade inflammatory state, which in turn impairs insulin sensitivity, with a compensatory hyper-insulinaemia increasing free androgen levels, while also impairing ovulation. The presence of gram negative bacteria endotoxin in the circulation has been shown to impair lipid profiles and has been linked with poor mental health. Therefore, we contend that the effective long term treatment of PCOS may be best directed at reducing metabolic endotoxaemia, rather than directly treating individual pathologies such as anovulation.
Bob Tygenhof
Integrative Medical Group of Irvine, USA
Title: Exercise and PCOS: Filling in the lifestyle treatment blanks
Biography:
Bob Tygenhof is the Director of the Center for Active Lifestyle Medicine at Integrative Medical Group of Irvine. In that capacity he has designed and implemented a number of programs that utilize various lifestyle treatment modalities to reduce inflammation, oxidative stress and hormonal imbalances. He ties together detox, nutrition and fitness programs with other prescribed PCOS treatments to achieve optimal results. He is a Graduate of Princeton University and received his MA degree from the University of Southern California. He completed a Fitness Specialist certificate program and is an American College of Sports Medicine-certified Personal Trainer.
Abstract:
Exercise is an extraordinarily effective way to reduce systemic inflammation and lower oxidative stress, and should be an integral part of every PCOS treatment program. It also plays a powerful role in balancing hormones and increasing HGH expression. By attending this informative session, you’ll learn how and when to write a fitness prescription, and how to make exercise a part of your PCOS treatment plan. You will also find out how exercise and fitness complement other lifestyle aspects of an integrative treatment program and get answers to some of your patients’ most pressing concerns. 1) Learn how to begin a fitness program for de-conditioned PCOS patients and how to advance fitness over time. 2) Find out which types of exercise are most suited to dealing with PCOS symptoms – aerobic or resistance training. 3) How often should one train and at what intensity? 4) What’s the latest data on high intensity interval training – is compliance better or worse than it is for long, slow exercise and is the benefits worth the extra effort and risk? 5) How does exercise impact the elevated chronic disease risks faced by PCOS patients?
Nora Shilo
Yinstill Reproductive Wellness, Canada
Title: Alternative treatment options for PCOS patients looking to conceive
Biography:
Nora Shilo currently practices at Yinstill Reproductive Wellness in Vancouver. Her practice is primarily focused on fertility, reproductive wellness and women’s health. She has a strong passion for fertility and loves working with couples and women who are looking to optimize their health prior to conception. She also regularly performs on-site acupuncture treatments for embryo transfer day at 3 of Vancouver’s largest IVF clinics, including the Pacific Centre for Reproductive Medicine. She is a graduate of the Canadian College of Naturopathic Medicine and also has a BSc in Psychology from York University in Toronto.
Abstract:
PCOS is a disease that affects millions of women around the world. It is extremely common in North America and is also one of the most common causes of female infertility. Conventional treatment options for PCOS patients normally include oral contraceptives, spironolactone, or metformin for blood sugar regulation. It is important for us to realize that there are several dietary, lifestyle and alternative interventions that help to improve patients’ overall wellness and make this disease much more manageable. I am going to focus on a number of alternative treatments that have some good evidence backing their safety and efficacy in the complimentary treatment of PCOS. These include botanical medicine, acupuncture, dietary interventions and lifestyle interventions. I will also touch on the importance of stress management in PCOS patients and how we can naturally optimize the physiological environment of a woman with PCOS who is trying to conceive, as well as improve her chances of successful conception, a healthy pregnancy and a healthy baby.
Donna R Chizen
University of Saskatchewan, Canada
Title: A practical approach to the clinical management of polycystic ovary syndrome (PCOS)
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, Saskatoon, 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, 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:
As health care providers we need to make use of opportunities to engage women with PCOS to be involved in the management of their health. There is a tendency to address each presenting symptom as they turn up and miss opportunities to motivate healthy lifestyle practices that will improve symptoms and prevent future problems and disease. How and when can we motivate change? Teaching about the pathophysiology of PCOS will provide women with a global understanding about why symptoms such as weight gain, irregular bleeding and anovulation occur. The pathophysiology becomes more meaningful when personalmetabolic test results are translated to provide reasons to make changes. Theunique and ideal times to motivate women to be involved with the management of their health and the future wellbeing of their families occurs first at the time of diagnosisand again when problems need to be addressed. PCOS is often poorly understood by patients. Women believe that they have pathological ovarian cysts. The relationship between hyperinsulinemia and hirsutism, anovulation, diabetes and cancer is not appreciated. It is important to educate women to understand how lifestyle changes may offset hyperinsulinemia. Evidence based management of PCOS will be reviewed. Clinical cases will illustratetimes when women have common, significant presenting complaints. Practical management strategies will be offered that can help to motivate healthy changes & improve the pathogenesis of women’s journeys with PCOS.
Biography:
Amal A L Mulla has completed her Masters in Infertility in 2004, from Ain Shams University, Cairo and had 2 memberships from Royal college of Obstetrics & Gynecology in United Kingdom in 2009 and Royal College of Physician in Ireland in 2009. She is a Consultant in Obstetrics, Gynecology and infertility in Dubai Health Authority. She is a Member in Endometriosis Leak in UAE and member in Embryology club. She has published many papers in reputed journals. aaalmulla@dha.gov.ae
Abstract:
Polycystic ovary syndrome (PCOS) is a condition with a range of reproductive and metabolic features that affect 4-18% of reproductive age group, and subsequently affect the quality of life. Underproduction of estrogen and over production of androgen (testosterone, dehydro epiandrsterone and androstendione) by the ovaries can result in a number of additional clinical features, including tiny cysts on the surface of the ovaries and hair and skin symptoms. Women with PCOS and related disorders comprise a large proportion of women undergoing induction of ovulation for infertility therapy. The major reproductive adversity facing these patients is their elevated risk of endometrial cancer. Unopposed estrogen exposure probably contributes to this risk. Women with PCOS who become pregnant are at higher risk than those without PCOS of developing gestational diabetes or suffering a first – trimester spontaneous abortion.
Jae Yen Song
The Catholic University of Korea,South Korea
Title: Copy number variation in pelvic endometriosis
Biography:
Dr Jae Yen Song has completed his PhD at the age of 32 years from The Catholic university of Korea. She is the assistant professor of he Catholic university of Korea. She is committee member of many Korean associations and societies. She has published more than 35 papers in reputed journals and has been serving as an editorial board member of repute. She recieved Best oral presentation award of the Korean Society of Menopause, Best poster presentation award of Korean Association of Obstetrics & Gynecology Shan S. Ratnam – Young Gynaecologist Award et al, and research funds.
Abstract:
Samples consisting of 673 controls and 65 patients with Stage Ⅲ,Ⅳ endometriosis were used. The average age of subjects was 41.2 ± 11.6 in controls, 35.2 ± 8.0 in patients with Stage Ⅲ endometriosis and 34.5 ± 8.3 in patients with Stage Ⅳ. In CNVR of 1q21.3, there was no coding gene and the frequency of copy number loss CNVs was significantly lower in endometriosis patients compared to controls (p<0.028). In CNVR of 1p13.3, GSTM1 gene was positioned and the frequency of copy number gain CNVs was significantly higher in endometriosis patients than controls (p<0.038). It was found through Genomic qPCR that 1q21.3 CNVs had a significant difference in an independent replication set as well. While 20 out of 42 controls had deletion with the intensity ratio of 0.5 or less, only 9 out of 37 patients showed deletion (p=0.032). The average signal intensity ratio of controls was also lower than that of cases (0.6 versus 0.8). When it comes to CNVR 1p13.3, the average signal intensity ratio of patients was higher than that of controls (3.7 versus 3.0) and the frequency of copy number gains (intensity ratio ≥ 2) was higher in patient group (19 out of 37) than control group (16 out of 42). However, there was no statistical significance (p=0.235). This study identified two CNVRs for endometriosis. 1q21.3 and 1p13.3 could be a potential target for screening and diagnosis of pelvic endometriosis.
Xia Hexia
Obstetrics and Gynecology Hospital of Fudan University, China
Title: Preconception sex-hormone binding globulin (SHBG) as a valuable predictor for gestational diabetes mellitus in infertile Chinese women with polycystic ovary syndrome
Biography:
Xia Hexia has completed her MD from Fudan University. She is pursuing her Doctoral studies in Fudan University and also working as a Doctor in charge of Ob & Gyn Hospital of Fudan University. She has published more than 7 Chinese papers and 1 English paper in reputed journals. xhx0101@hotmail.com
Abstract:
We aim to elucidate whether preconception SHBG levels are predictive of GDM in women with PCOS. A prospective cohort study was conducted between January 2010 and December 2013 in Ob & Gyn Hospital of Fudan University. A total of 94 infertile Chinese women treated with ovulation induction were recruited and then prospectively followed up until 6 weeks after delivery. Serum SHBG levels before conception was measured. Diagnosis of GDM was based on a 2-hour, 75 g oral glucose tolerance test (OGTT) performed between 24 and 28 weeks of gestation. We examined the incidence of GDM and plotted a receiver operating characteristic (ROC) curve to assess discrimination. We found that 31(32.98%) were diagnosed with GDM in the 94 pregnant PCOS women. The SHBG levels in women with GDM were (41.5±37.5) nmol/L, significantly lower than (123.7±95.7) nmol/L in those without GDM (P=0.000, and P= 0.041, even after BMI was adjusted). And the area of insulin under the curve (IAUC) in GDM group was (389.6±153.7) mIU/ml, significantly higher than (252.4±93.3) mIU/ml in the non-GDM group (P=0.000, and P= 0.003, even when BMI was adjusted). The area of SHBG and IAUC under the ROC was 80.8% (95% confidence interval [CI] 0.692- 0.925, P=0.000) and 0.786 (95% CI 0.656- 0.916, P=0.001). The optimal cut-off value for detecting GDM was a SHBG ≤37.26 nmol/l and an AIUC≥313.42 mIU/ml. SHBG associated with IAUC predicted the risk of GDM with a sensitivity and specificity of 77.8% and 77.5%. We concluded that SHBG levels before conception might be a valuable predictor of GDM in pregnant women with PCOS.
Biography:
Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). She completed MRCOG from Royal College of Obstetrician and gynecologist, London and worked in UK for 5 years. She believes in scientific and ethical practice and is currently the director of Gift Gyno IVF Centre, Cochin and Bangalore. Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI, donor egg / sperm and surrogacy. Her proficiency is in genetic abnormalities and high-risk pregnancies.
Abstract:
PCOS is a chronic condition, affecting 3 to 20 % population, of which 70 % remains undiagnosed. Reproductive symptoms of PCOS are anovulation, sub fertility and hyperandrogenism. Metabolic disorders include glucose intolerance, type 2 Diabetes and CVD. Depression and anxiety are found in some patients. Life style changes including diet, exercise and weight loss should precede any pharmacological intervention. Even a 5% loss of body weight will reduce insulin resistance and circulating androgens, resulting in spontaneous ovulation and relief of symptoms. Behavior change techniques should target optimal weight. Protocols should be provided to clinicians, to assess CVD risks considering obesity, physical inactivity, smoking, dyslipidemia, hypertension, glucose intolerance and type II diabetes/family history. Clinicians should also look for sleep apnea symptoms. Pharmacological indications includes, gestogens to induce periods in severe oligomenorrhea patients to reduce risk of endometrial hyperplasia /cancer. Insulin-sensitizing agents does not seem to have long-term benefits. Weight reduction drugs reduce hyperandrogenaemia in selected patients. Laparoscopic ovarian drilling will induce ovulation in 60% of the subjects for 20 years. When weight loss strategies fail, morbidly obese women can benefit from bariatric surgery. Psychological issues like depression and anxiety must be screened assessed and referred to professionals. Creating public health awareness on healthy eating and the necessity of regular exercise and including them in school curriculum is needed. A multidisciplinary approach involving a trained team of physicians, dieticians, exercise specialists and counselors is needed in long-term management of PCOS.
- 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.