Day 2 :
- Effects of PCOS on Womens Health
PCOS in Teens and Adolescents: Early Diagnosis and Intervention
PCOS and Pregnancy
Medical Diagnosis of PCOS
Session Introduction
Alejandro Aldape Arellano
Spanish Fertility Society, Spain
Title: A fertility approach of first and second line treatments in PCOS
Biography:
Alejandro Aldape Arellano has completed his physician and gynecologist studies in Monterrey, México. He has 7 years experience as Assisted Reproduction specialist. Performing in international centers such as: Vall d'Hebron University Hospital, Barcelona Marqués Institute. He has extensive experience developing guidelines and protocols in order to optimize pharmaceutical and biological resources. He implemented European guidelines of Assisted Reproduction in "La Paz" Medical Center in Malabo, Equatorial Guinea. He is currently the director of Ovocic a startup that developed an application for monitoring Assisted Reproduction cycles. He is also member of Spanish Fertility Society since 2010.
Abstract:
Poly Cystic Ovarian Syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. According to National Institute of Health (NIH) the prevalence is around 4-10%. Nowadays lifestyle changes such as exercise and calorie-restricted diet seems to be cost-effective excellent option considering that up to 76% of diseased woman present obesity. There is no discussion about effectiveness of clomiphene citrate (CC) as first line treatment of anovulatory infertility; however, we do not have a clear protocol of drugs when there is comorbidity (insulin resistance, high adrenal androgen, hyperprolactinemia). Therefore a complete evaluation and individualized treatment is mandatory. Second line treatments include ovulation induction with gonadotropins and laparoscopic ovarian drilling (LOD) most studies granted in general terms same results with some concerns about multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) on the gonadotropin arm and premature ovarian failure (POF) on LOD arm. Anyway, whether we consider a first or second line therapy we cannot forget that the main problem in women of reproductive age is infertility therefore it is not just and individual problem but couple. A fertility approach means making an evaluation and diagnosis of both partners because only then we will know if the proposed algorithm remains in effect for a particular couple.
Dalida Omar Badla
Almazroui Medical Center, UAE
Title: Disorders of Puberty and Polycystic Ovary Syndrome (PCOS)
Biography:
Dr. Dalida Omar Badla has completed her MD at the age of 26 years from University of Aleppo, Syria. She is the director of Obstetric and Gynecology Department at Almazroui Medical Center, One Day Surgery in Abu Dhabi, UAE.
Abstract:
Polycystic ovary syndrome (PCOS) is a heterogeneous familial disorder characterized by chronic anovulation and hyperandrogenism (clinical and/or biochemical). This multi-system, polygenic, multi-factorial disorder is associated with an increased risk for metabolic abnormalities such as type 2 diabetes mellitus. Signs and symptoms of PCOS often emerge during the peri-pubertal years with premature pubarche being the earliest manifestation for some girls. Central obesity, Insulin resistance and hyperinsulinemia are important pathophysiological features that are common to both premature pubarche and PCOS. Increasing evidence suggests that PCOS arises as a complex trait with contributions from both heritable and nonheritable factors. Polycystic ovaries appear to be transmitted as a dominant trait, usually asymptomatic but often accompanied by a subclinical PCOS type of ovarian dysfunction. Risk factors such as premature pubarche, obesity, ethnicity, and family history may be helpful. The evaluation of the adolescent with suspected hyperandrogenism or PCOS must be individualized depending on the symptoms and examination findings. Treatment must be individualized, too, and often requires a multidisciplinary approach.
Biography:
Asem Anwar has completed his combined supervised MD thesis from both Alazhar School of Medicine and Glasgow Universities. He is working as a Professor of Obstetrics and Gynecology at Alazhar School of Medicine since 2002 and Ex Director of the maternity university hospital [Syed Galal] Cairo-Egypt. He is the Secretary General of the Egyptian society for population reproductive health studies, Secretary General of the Healthy Child Healthy Mother Association and Consultant of ob/gyn at Air Force Specialized Hospital.
Abstract:
Aim: To compare between the effects of clomiphene citrate, tamoxifen and letrozole as ovulation induction agents on endometrial thickness and blood flow in women with polycystic ovaries.
Patients & Methods: One hundred and fifty cases meeting the selection criteria were prospectively randomized into 3 groups group 1 received 100 mg clomiphene citrate, group 2 received 5 mg letrozole and group 3 received 40 mg tamoxifen. Transvaginal ultrasound and Doppler were done to measure endometrial thickness and endometrial blood flow both pulsatility index (PI) and resistance index (RI) at the day of the maximum follicular growth or at day 20 in the absence of the dominant follicle in the 3 groups.
Results: Significantly thinner endometrium in the clomiphene citrate group as compared to the other two groups and lower impedance in the spiral arteries in both letrozole and tamoxifen groups were found (P value less than 0.001).
Conclusion: Endometrium was thicker with lower impedance in the spiral arteries in both letrozole and tamoxifen groups as compared to clomiphene citrate group. Ovulation and pregnancy rates were not significantly different. Further studies are needed to measure the cumulative results of 6 cycles, increasing the dose in non-responders and the incidence of miscarriage.
Lisa Morrissey
Lansdowne College of Acupuncture and Complementary Medicine, Ireland
Title: Pregnancy with PCOS through Awakened Healing and Acupuncture
Biography:
Lisa Morrissey completed his BSc at the age of 21 from Maynooth University in Dublin, Ireland and from there went on to study the discipline of Traditional Chinese Medicine and Acupuncture. Lisa has a fascination with natural healing and has also trained as a Shaman’s apprentice, studied Chakra Balancing in Thailand and lived with the Monks in Thailand for a period of time, practicing Vipassana, learning the art of silent meditation. Lisa is currently the director of Baby Steps, a natural fertility and pregnancy clinic and is in the process of opening her own health retreat centre.
Abstract:
From a Traditional Chinese Medicine perspective we look at the individual presentation of each patient. PCOS wouldn’t be considered under one generic pattern or diagnosis. The diagnosis and treatment will be specific to the individual presentation. However acupuncture alone isn’t enough to treat PCOS, there isn’t a magic bullet fix, you need to be open to healing. Regardless of what route the individual chooses to go, to choose Western Medicine and take Metformin or similar or to choose Traditional Chinese Medicine, the most important change needed is mindset and belief. You need to ground yourself and open your body up to healing. You need to love your PCOS and accept it. You may recognize yourself going through the Kübler-Ross 5 stages of grief – denial, anger, bargaining, depression and acceptance. When you open yourself to acceptance and healing you will see all of the healing possibilities around you that you were not able to see before. If you feel like a victim your mind will look for things to prove you right and you won’t see the health solutions. You will have thought you tried everything but if you really question it, have you? Now you can really change your diet with discipline to a healthier diet and to lose weight if needs be. Now you will walk in nature and meditate daily. If you don’t really believe then you won’t have the willpower to do what needs to be done to truly heal.
Biography:
Amany A Salama has completed her Master degree (OB/GYN) 1989, Faculty of Medicine, Alexandria University. Then slightly shifted to study nutrition and its application to women’s health and completed her PhD in Public Health (Nutrition) 2014, High Institute of Public Health, Alexandria University. Works as a Consultant of Women’s Health and Nutrition at Madina Women’s Hospital, Alexandria, Egypt, and a lecturer of clinical nutrition, Faculty of Allied Medical Sciences - Pharos University in Alexandria. Academic research interests: Nutrition – Inflammation - Polycystic ovary syndrome – Oncology.
Abstract:
Polycystic ovary syndrome (PCOS) is a common endocrine disorder with diverse reproductive and metabolic features. Obesity is highly prevalent in the general population and in PCOS women and is an independent risk factor for cardiovascular disease. The study was to investigate the effect of anti-inflammatory diet - in the context of lifestyle modification - with or without the use of metformin in overweight and obese women with PCOS. Out of 220 adult overweight and obese females with PCOS, 150 completed the trial, 75 in each group. Pre and post study fasting blood samples measured biological markers and body composition was assessed by the InBody720. Participants were subjected to either lifestyle interventions with an anti-inflammatory dietary combo and physical activity alone (LS-ONLY) for 12 weeks or with the added use of Metformin 850 mg twice daily (LS+MET). Both strategies achieved moderate weight loss of (±7%) and significant improvements in body composition, hormones and menstrual cyclicity, blood pressure, glucose homeostasis, dyslipidemia, C-reactive protein and serum amyloid A (surrogate measures of cardiovascular risk (CVR)). A 63% regain of menstrual cyclicity and 12% spontaneous pregnancy rate within 12 weeks were achieved. We have found that in overweight and obese women with PCOS, adding metformin to lifestyle modifications at a dose of 850 mg twice daily, had no superior effect to lifestyle modifications alone on; menstrual frequency, pregnancy rates, weight loss, reduction of insulin resistance or reduction of hyperandrogenism. An anti-inflammatory dietary approach with pharmacological targeting can achieve a clinically relevant weight loss in PCOS patients.
Alqahtani Huda
King Saud University, Saudi Arabia
Title: Genetic Analysis in relation to Vascular Endothelial Growth Factor level in Saudi women with Previous Ovarian Hyperstimulation Syndrome
Biography:
Alqahtani Huda A. has completed her M.D. at the age of 30 years from King Saud University, College Sciences, Major Animal Physiology & Development since 2014. She has been a lecturer in King Saud University, Zoology department since 2011 in different specializations include Physiology, Molecular Biology, Parasitology, insects and Ecology. She applied her research in King Faisal Specialist Hospital & Research Center, and she has an intensive experience in different areas of molecular techniques. She was a member of a national project that analyzed the genetic level of Saudi women who had Polycystic Ovarian Syndrome and developed to Ovarian Hyperstimulation Syndrome. Recently, she has been moving to U.S.A to complete her Ph.D. in Molecular Endocrinology major
Abstract:
The ovarian hyperstimulation syndrome (OHSS) is a serious and potentially life- threatening physiologic complication, classically encountered in patients who undergo controlled ovarian hyperstimulation (COH) cycles. OHSS is a rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy. It is characterized by enlargement of the ovaries, fluid retention, and weight gain. Ovarian hyperstimulation syndrome is self-limiting and will undergo gradual resolution with time. The pathophysiology of OHSS is characterized by increased capillary permeability, leading to leakage of fluid from the vascular compartment, with third-space fluid accumulation and intravascular dehydration.
Young age, an explosive response to gonadotropin stimulation evident with rapid increase of serum estradiol (E2) levels, development of multiple follicles ( >20) during stimulation and the presence of polycystic ovary syndrome have been described as risk factors for the development of the syndrome in IVF patients.
There is evidence that several other factors such as vascular endothelial growth factor may play a modulatory role on ovarian physiology and in the pathogenesis of ovarian hyperstimulation syndrome.angiogenic, mitogenic and vascular permeability-enhancing activities specific for endothelial cells. The serum was obtained from 38 patients, Control Group, healthy pateints (n=8) visiting Dr. Sameer Abbas IVF clinic, H-OHSS Group (n=10) and PCOs Group (n=20) visiting the IVF clinic in King Faisal Specialist hospital. The level of VEGF was measured by using Enzyme- linked immunosorbent assay (ELISA) technique. The observed differences in the VEGF between the different groups were statistically significant (P<0.05). It was found that VEGF level in H- OHSS and PCOs groups were statistically higher when they were matched control group. The VEGF levels were markedly the highest among H-OHSS group compared to the control group. The levels were almost seven times higher among H- OHSS patients (718.186 ± 421.241pg/ml) compared to normal control (86.149 ± 73.825pg/ml). The observed differences in the VEGF between the different groups were statistically significant (P<0.05). The VEGF levels were higher among the PCOs group compared to the control group. The levels were almost three times higher among PCOs patients (350.806 ± 252.478pg/ml) compared to normal control (86.149 ± 73.825pg/ml). The observed differences in the VEGF between the different groups were statistically significant (P<0.05). The levels of VEGF were almost two times higher among H- OHSS group (718.186 ± 421.241pg/ml) compared to PCOs group (350.806 ± 252.478pg/ml). The observed differences in the VEGF between the different groups were not statistically significant (P=0.0577).The correlations between VEGF, anthropometric measurement, metabolic and hormones variables were performed in the three groups. In H-OHSS group, only a negative correlation was significant between the testosterone level and the weight of patients. In PCOS group, the level of VEGF was correlated significantly and negatively with estradiol (E2) level.
A negative significant correlation was found between the level of E2 and the age, and between E2 and the weight of patients. Also the testosterone level was correlated significantly and positively with the level of FSH.
Conclusion: the genes identified in this study may play an essential role in the pathogenicity of ovarian hyperstimulation syndrome. Also serum VEGF concentrations may predict OHSS occurrence.
Anita Mani
GIFT IVF Center, Cochin, India
Title: Difficulties in diagnosis and management of PCOS in teens
Biography:
Anita Mani is a renowned Infertility Specialist in South India with 15 years of experience in ART (Assisted Reproductive Technology). She completed her MRCOG from Royal College of Obstetrician and Gynecologist, London and worked in UK for 5 years before returning to India to establish GIFT IVF centers. PCOS awareness among teenagers and young women is her special interest. An integrated PCOS clinic has been established with counselors, dietician and physical trainers at GIFT IVF center.
Abstract:
The clinical symptoms of PCOS in teenagers often overlap with the normal development, making it difficult to diagnose the condition. The symptoms like irregular periods can be found in normal adolescents, as it takes a few years for hypothalamo-pituatory axis to become mature after menarche. Acne is a sign of hyperandrogenism, but it is found in 80% teenagers and hence not specific for PCOS. Hirsutism is related to the duration of exposure of androgens, and becomes marked towards adulthood. The third criteria as per Rotterdam criteria of polycystic ovaries on scan can be missed on a trans-abdominal scan, especially in obese girls. Teenagers can have multi cystic ovaries without PCOS. The intake of contraceptive pills can mask the symptoms. General reluctance towards a consultation at that age can often delay the diagnosis; especially as they are prone to social isolation, anxiety and depression in addition to mood variations and irritability. Weight loss is well known as the most difficult target due the hormonal abnormalities. Motivating obese girls to lose weight takes professional help, targeted behavioral change techniques, which is not widely practiced. Dietary changes and regularity of food intake are difficult to impose on young girls. The most important aspect is counseling, and is very much lacking in the current management. Risks of metabolic sequelae are often overlooked.
Svetlana Colovic
Belgrade University, Serbia
Title: PCOS and quality of life among students of Belgrade University, Serbia
Biography:
Svetlana Colovic graduated from Belgrade Medical School in 1994. She did her Residency in OBGY in 2001 at Belgrade University Clinic. She has been working in Health Care Institute for University Student since 2007; and is also doing her private OBGY practice. She attended Women’s Health Program CA, USA in 2010. She is active Member and Reviewer of European Society for Reproductive Health, Member of Consortium for Urgent Contraception NY, USA, and is part of UNICEF and USAID program for opening counseling in Serbia.
Abstract:
Background: Reproductive and sexual health is an important aspect of quality of life. PCOS is complex endocrine condition, being recognized as impacting students in Serbia and world at much greater degree than previously thought. The clinical and biochemical presentation is heterogeneous, but elevated serum concentrate of androgens are the most consistent biochemical abnormality. High percentages of women have insulin resistance and ultrasound picture of PCO. The most concern for students with PCOS is signs of obesity, hirsutism, acne, loss of hair, etc. Reviewing about 10,000 students of Belgrade University with PCOS during last 10 years, average 5 per day, age 17 to 26 showed importance of early diagnosis and early treatment as the best way to protect reproductive health.
Methods: Descriptive correlation research design is conducted in Women’s Department, Health Care Institute for University Students Belgrade, Serbia. Data was collected from 1000 female students for last 5 years with PCOS, with or without medical or alternative treatment, in the form of questionnaires plus gynecological and ultrasound exam by myself.
Results: The result showed that the most of the study of the sample (>60%) have negative implicate on quality of life (social, sexual, self-respect, etc.). Women with PCOS without treatment (medical or alternative) were 94%. Women with PCOS with treatment (medical or alternative) were 30%.
Conclusion: Importance of early diagnosis especially subclinical forms of PCOS, early diagnosis and appropriate treatment as crucial thing in prevention and improvement of reproductive health, good quality of life, sexual health, self-confidence and self-respect of Belgrade students and young people at all is concluded.