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 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. 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. Her proficiency is in genetic abnormalities and high risk pregnancies.
