Wednesday, 20 January 2016

Facts and information on PCOS discussed in World PCOS conference 2015 - Seattle, USA


PCOS (Polycystic Ovarian Syndrome ) is a common condition affecting numerous teenage girls in the present scenario, causing obesity, irregular periods and excessive hair growth. Recent studies and researches reveal that a shocking 20% of teenagers are affected and the numbers even go up to 60% in some urban cities.  PCOS results in abnormal hormones in the body which often leads to infertility and other metabolic disorders like diabetes and heart diseases. The psychological issues like anxiety and depression and social problems like feeling of isolation are often inadequately recognised by both healthcare providers and the parents.

It was indeed a great learning experience for me to attend the first annual world Polycystic Ovarian Syndrome Conference  held on November 16-18, 2015 in Seattle, Washington, USA. The conference highlighted scientific studies and discussions on PCOS.The selection of top 42 research fellows from all over the world, was impeccable. The expert doctors from around the globe shared creative ideas about the various aspects of research and also various measures to help create public awareness on the subject.

Professor Richard L Stouffer presented a paper on PCOS, after studying the effect of western style diet on monkeys and concluded that the diet developed PCOS in the animals. He is the Senior Scientist in the Division of Reproductive & Developmental Sciences, ONPRC and has published over 200 papers. Presently, the dangerous trend in India is that lot of fast food chains are coming up and we, especially the young generation are embracing this diet with open arms and mind, which could be catastrophic. This could be one explanation for the recent rice in cases of PCOS among Indian teenage population.

Professor Dimitrios Nikolaou from the Imperial College School of Medicine, London, tried to establish that PCOS  is a misnomer ! He is considered as one of the most original thinkers in the field of Reproductive Medicine. He argued that women are protected against early ovarian ageing and have a number of social characteristics due to male hormones  that are advantageous.

Dr. Angeline Beltsos from Fertility Centers of Illinois, USA advocated single frozen embryo transfer in IVF cases for PCOS . Higher IVF implantation rates and improved pregnancy outcomes can be achieved by pre-implantation genetic screening, followed by single frozen embryo transfer which may improve placentation and infant health as well. 

Dr. Yen Hao Chen, a researcher from Georgia Regents University, USA, established a new study to prove that  Adipose tissue ( fat cells ) dysfunction is present in PCOS. This may help in finding new treatment in future.

Dr.Sheng Wu, from Johns Hopkins University did Study of PCOS through the interaction of androgens and insulin.  High levels of male hormones and insulin  are believed to play prominent roles in the genesis and progression of the disease and study revealed intricate cellular mechanism.

Dr. Lora Shahine, had done fellowship in Reproductive Endocrinology and Infertility at Stanford University. Her work was a proof that women with PCOS suffer not only from difficulty in conceiving, but a higher rate of early miscarriage compared to women of the same age without PCOS because of obesity, endometrial defects and hormonal imbalances.

Professor in Clinical Biochemistry at the University of Manchester, Dr.Brian keevil 
focused on the simultaneous measurement of testosterone, androstenedione DHEA, DHT, DHEAS and 17 OHP and their potential use in the investigation of PCOS. The possible use of salivary androgen assays were interesting, which offered a possibility of no blood tests in future.

Dr. Janelle Luk , who graduated from Yale University , and did residency at Harvard, presented paper on IVM ( in vitro maturation ). This is a technique in which immature eggs are collected from women with PCOS and is matured and used in IVF/ ICSI. This technique is probably going to be employed in the future treatments, as it helps in reducing injections and also risks of hyper stimulation.  

The matter of  increasing public health concern, as the incidence is highly associated with the metabolic syndrome  was highlighted by Dr.Donna Vine. She is the recipient of McCalla Professorship in Teaching, Service and Research. 

Russian Professor,  L. A. Ivanova did a study on the effect of thioctic acid on PCOS, and it is now available.

We had expert doctors from various fields who emphasized the side effects of PCOS on different parts of the body. The Dermatologist from Sweden, Dr. Maria Palmetun indicated that quality of life is very badly affected by PCOS and the dentist Dr. Ozgun Ozcaka, from Turkey  Spoke about the connection between PCOS and gingival inflammation.

Dr. Awatif Al Bahar, from Dubai Health Authority, UAE,  threw light at the epidemiology of PCOS and the economic cost which it is causing to the healthcare sector. It is shocking  that every year the health insurance companies incur huge costs to cover the direct and indirect  medical expenses related to PCOS ! 

A new era of medicine has started with study of bacteria in our body. Dr. Felice L Gersh from USA gave a wonderful insight into this new topic titled -  The care and feeding of the microbiome: A new approach to lowering the inflammation of PCOS. More DNA exists within us which derives from the trillions of bacteria comprising our microbiome than from our personal genetic DNA. Bad news is that, the standard Western diet, comprising of huge amounts of processed foods, which are nutrient deficient, chemical laden, antibiotic containing and which are 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 tend to develop chronic low grade systemic inflammation as a consequence of the unhealthy state of their gut bacteria.


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, explained Bob tygenhof, the exercise specialist.

Julie Booker, rightly pinpointed that Stress and anxiety have been found to suppress the ovarian and menstrual cycle. She provided a treatment plan including acupuncture, diet, lifestyle, Chinese herbal medicine and supplements.

My presentation on long term managment of PCOS highlighted that Life style changes including diet, exercise and weight loss should precede any medicines. Protocols should be provided to doctors  to assess  cardiovascular disease (CVD) risks. (currently this protocol is not widely followed, although recommended by Royal colleges of London and Australia) Medicines are rarely needed ,as in  gestogens to induce periods atleast 3-4 times a year to reduce risk of endometrial hyperplasia/cancer.

 
Recent studies suggests that Insulin-sensitising agents like metformin, which is commonly prescribed for PCOS does not seem to have any long-term benefits and should be restricted to only diabetic / glucose intolerant PCOS.

Ovulation inducing agents like clomiphene should be used only for  6 to 12 months, as prolonged use of this medicine increases risk of cancer, the option of IVF should be considered after this period.

Laparoscopic ovarian drilling will induce ovulation in 60% of the subjects for 20 years, especially in PCOS patients who are not overweight. Psychological issues are often easily overlooked, problems 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 is very essential and should be included in the school curriculum. Specialised PCOS clinics with a trained team of doctors, dieticians, exercise specialists and counselors is absolutely needed in proper long-term management of PCOS.



Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com

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Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha 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.

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