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HEALTH Fertility problems could be caused by PCOS

PCOSPCOS among top causes of fertility problems – but it’s treatable

Almost everyday, I see or hear coverage of infertility in the media. It certainly seems more common nowadays, with many specialists proposing different reasons for this upswing. It is commonly agreed that people are now busier than ever and are starting their families later in life than before, and that this small delay may be affecting our fertility statistics.
I have met many couples experiencing fertility difficulties, and have seen the stress and worry it can inflict on a couple’s personal life and relationship.
Polycystic Ovary Syndrome (PCOS) affects between 5 per cent and 10 per cent of women in their reproductive years. It is considered one of the leading causes of subfertility in females. Subfertility describes a situation where a person less fertile than normal but still capable of reproducing. PCOS is treatable.

Cause
Believed to be genetic, the primary cause of PCOS is a resistance (or lack of responsiveness) of fat and muscle tissue and a converse oversensitivity of the ovaries to insulin.
Insulin is a hormone involved in regulating the amount of sugar in the bloodstream and its availability to the body as a fuel.
When a person is resistant to the effects of insulin, they start to produce more of it.
It is believed that higher levels of insulin stimulate the ovaries to produce more male sex hormones called androgens e.g. testosterone.
Increased levels of male sex hormones are believed to cause the main physical and hormonal abnormalities associated with PCOS.

Skin and hair

Male sex hormones stimulate increased sebum production in the hair follicle, making the skin more oily. Skin that is more greasy is more susceptible to acne. These hormones also over stimulate growth of facial and bodily hair, causing a condition known as hirsutism. They can also cause as thinning and loss of scalp hair in a similar pattern to male baldness.
Acne and increased hair growth are very common problems in PCOS, and treatment is usually quite straight forward. These include hair removal by waxing, shaving, bleaching, plucking, depilation and electrolysis. Although GPs like to be involved at every level of a condition, I tend to leave the plucking and bleaching to the beauticians! Doctors can prescribe hormonal treatments to reduce the effects of male sex hormones on the skin.

Metabolic problems
Resistance to insulin is associated with obesity, high blood pressure, type II diabetes and high colesterol levels, all of which are risk factors for cardiovascular disease. Women with untreated polycystic ovary syndrome are twice as likely to develop diabetes (including gestational diabetes in pregnancy) and almost three times as likely to have a stroke later in life due to a combination of the above conditions.
Medications can be prescribed to improve the body’s sensitivity to insulin and to treat coexisting issues, such as high blood pressure and cholesterol.
The universally sound objective of weight management, frequent exercise, healthy diet and avoiding smoking holds ever firm in this condition.

Menstrual and fertility problems
Due to elevated male sex hormones and insulin resistance, the finely controlled hormonal signalling system between the brain and ovary (hypothalamic-pituitary-ovarian axis) loses its normal cyclical function. Instead of one primary follicle (egg) developing in the ovary followed by rupture, egg release and menstruation each month, the ovary will develop many follicles (eggs) without rupture and release. Periods consequently become irregular, infrequent, patchy or disappear completely.
It is the lack of normal, predictable ovulation that makes conception and pregnancy more difficult in PCOS, although still possible to achieve. Treatment of subfertility involves complex hormonal treatments with drugs which promote and induce ovulation and are typically initiated by fertility experts. Results are good.
Even if fertility is not required, regulation of the menstrual cycle is important as it can reduce the risk of diabetes, cardiovascular disease and cancer of the womb later in life.

Diagnosis
A diagnosis of PCOS is made using specific criteria. These take into account the pattern of the menstrual cycle, the physical and chemical signs of excess male sex hormones, and an ultrasound scan of the ovaries.
If you are experiencing skin, menstrual or fertility problems in your reproductive years, your GP can assess you investigate things for you in a caring and confidential environment.
PCOS is a treatable condition which should not be left undiagnosed or untreated, not only for fertility purposes, but also to effectively prevent the longer-term health risks associated with the syndrome.

Dr Ronan Clancy is a GP at the newly opened Clancy Medical Practice, James street, Westport (www.westportgp.ie). He is in practice with Sarah Kavanagh, chartered physiotherapist.

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Ovarian tissue transplant – A new hope for female cancer survivors

Ovarian CancerCancer treatments, like chemotherapy or radiation therapy, highly hinder both hormonal production and reproductive potential in women, as the treatments attack fast growing cells in the body.

However, with an Australian woman, rendered infertile by ovarian cancer treatment, expecting twins after successfully undergoing ovarian tissue transplantation, doctors are expecting that the new technique could revolutionise fertility treatment.

Though the procedure had been carried out previously, this is for the first time that the tissue has been successfully transplanted into the abdomen instead of the ovaries.

Ovarian tissue transplant: How it is done

Healthy ovarian cortical tissue is removed using laparoscopic surgery (keyhole surgery) from the woman about to undergo cancer treatment. The minimally invasive procedure lasts approximately 1 hour and requires general anesthesia.

The ovary`s cortex is cut into tiny 1 millimetre thick strips and then frozen to be used for future transplantation.

Once the patient goes into remission post cancer treatment and plans to have a baby several slices of the previously frozen ovarian tissue can then be thawed and implanted near the fallopian, either orthotopic (on the natural location) or heterotopic (on the abdominal wall).

The cortex tissue strips contain immature follicles, once implanted back into the body start producing hormones and eggs like a normal ovary following which a woman starts to ovulate and can try for pregnancy either naturally or through in vitro fertilisation (IVF) technique.

Gall bladder, uterine cancer on the rise

Cervical cancer in women is decreasing, while uterine and gall bladder cancer is on the rise at least in major metropolitan cities, suggests India’s latest cancer statistics without providing any explanation for the observed trend.

According to the population based cancer registry prepared by the Indian Council of Medical Research (ICMR), actual reported cases of cervical cancer declined between 2009 and 2011 in Bangalore, Bhopal, Chennai, Delhi and Mumbai. Decline was seen in Assam, Mizoram and Thiruvananthapuram, too. Uterine cancers,  are on the rise in Bangalore, Chennai, Delhi and Mumbai in the same period. In Bangalore, the number of cases increased by 7.4 per cent between 1986 and 2009, whereas the rise was 7.3 per cent between 2005 and 2010 in Mumbai, compared to 1.7 per cent increase between 1982 and 2004.

“There is a declining trend in cervical cancer and increase in uterus and gall bladder cancer cases in some cities. We don’t know the reason yet,” said V M Katoch, director-general of ICMR. In the country, breast and cervical cancer remain the two most common cancers in women.

Among men, cancer of the lung, mouth, oesophagus and stomach are common. Cancers of the tongue, rectum, liver, lung, prostate, brain, non-Hodgkin’s lymphoma and a type of leukaemia have shown statistically significant increase.Cancer of the gall bladder in women is increasing in Chennai, Bangalore and Bhopal. In Delhi, the hike is seen in men, whereas in Mumbai, it went up both in men and women. Lung cancer among women, too, had increased in the four metros.

The new statistics come from collation of data from 28 population based cancer registries, covering 7.45 per cent of the population. As many as 250 centres contributed to the database, which was approved by ICMR’s top science advisory panel last week.

This is the third report from the ICMR registry with the addition of new sites.

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