PANDORAwww.pcosindia.org
Registered AddressKwality House, 1st Floor, August Kranti Marg, Kemps Corner, Mumbai 400 026
Phone: 022 23802584, 022 23803965 , Fax: 022 23804839Email: [email protected]
Volume 3 | Issue 1 | Feb.-May 2018 | Pages 12
...The Newsletter of The PCOS Society of India
■ Inositols in PCOS– Daniela Menichini, Fabio FacchinettiPage 02
■ Editorial,New patrons, Life membersPage 03
■ Events and Updates –Travelling Seminars on “Understanding PCOS”Page 04
Masterclass on "PCOS and Infertility"Page 05
■ Programme and Brochure 3rd
International ConferencePage 06
■ Events and Updates –The PCOS Society at ISGE, ItalyPCOS Online Certificate CoursePage 11
Fabio FacchinettiUniversity of Modena and ReggioEmilia, Italy
Daniela MenichiniUniversity of Modena and ReggioEmilia, Italy
Inositols in PCOS
1. Introduction on PCOSPolycystic ovary syndrome (PCOS) is a state ofhormonal dysregulation and unbalanced ovarian/follicle dynamics affecting 5-10% of women inreproductive age1. The wide range of PCOS signsand symptoms makes its severity & gradingchallenging. Clinically PCOS can be characterized bysome or all of these features:1. hyperandrogenemia2. oligo/amenorrhoea3. menstrual irregularity4. insulin resistance(IR)5. presence of 2-9 mm ovarian microcysts;6. an ovarian volume greater than 10 ml2.
Due to its multifactorial nature, the precise etiologyof PCOS has not yet been completely elucidated,but some risk factors as cardiovascular disease, type2 diabetes, hypertension and obesity3 and keytriggering conditions as insulin resistance andhyperinsulinemia4 have been identified.
Given the central role of insulin resistance in the onsetof PCOS, insulin-sensitizing agents, such as Inositolshave been proposed as new a therapeutic approach5.
Moreover, considering the economic and socialburden of PCOS , which not only represents aleadingcause of female infertility worldwide6,7, it becomesparticularly important to understand the newtreatment options, focusing on the role of Inositols,both in terms of potential mechanisms and efficacy8.
2. Inositols – Characteristics and PropertiesInositols belong to a group of molecules comprisingnine possible forms called 'stereoisomers' of inositol,all composed by the same basic structure, namedmyo-, scyllo-, epi-, D-chiro-, L-chiro, neo-, allo-, cis-, and muco-isomers9. They have a cyclic six-carbonstructure with one hydroxyl group at each carbon.These moleculesprovide the structural basis forinositol phosphates, importantsecondary messengersin eukaryotic cells, and serve as criticalcomponentsof the structural lipids, phosphatidylinositolandphosphatidylinositol phosphate10. Myo-inositol(cis-1,2,3,5-trans-4,6-cyclohexanehexol, MI) andD-chiro-inositol (cis-1,2,4-trans-3,5,6-cyclohex-anehexol, DCI)represent a promising treatment forPCOS, having shown sometherapeutic benefit11.
3. Physiological roles of Inositols: BiologicalFunctionsInositols are present in cells both as free form and ascomponents of membrane phosphoinositides andtake part in great variety of functions, including cellgrowth and survival,development and function ofperipheral nerves, osteogenesis and reproduction.
In their conjugated form, inositols are componentsof cellular membranesand have a crucial function inmembrane integrity andin intracellular signaling10.Both MI and DCI-phosphoinositides are able toinfluence the intracellularmetabolic processesactivating key enzymes involved in oxidativeand non-oxidative glucose metabolism7. MI is involved in themetabolism, transportand breakdown of glucose andits conversion to glycogen12, while DCI is involved inthe insulin-signallingpathway and in the stimulationof serial enzymes that are in turninvolved in theregulation of glucose metabolism, (e.g.,pyruvatedehydrogenase phosphatase (PDHP), proteinphosphatase 2C(PP2C), inositol-phosphate glycan13.Furthermore, it has been suggested that MI and DCIwork in synergy in theglucose metabolism; inparticular, MI induces the translocationof glucosetransporter to the cell membrane thereby enhancingglucose cellular uptake14,while DCI stimulatespyruvate dehydrogenase and supports ATPproduction via the Krebs' cycle13.
4. Role of Inositols in PCOSThe rationale behind the use of inositols in PCOSderives from studies showing that PCOS patients,due to IR, have an excess of MI and a deficiency ofDCI, together with a reduction of MI/DCI epimeraseactivity in peripheral tissues. It is, however, stillunknown at the molecular and cellular level, whetherinositol supplementation directly affects insulinsignalling and/or restores insulin sensitivity. Such aneffect would be beneficial as both IR and secondaryhyperinsulinemia trigger hyperandrogenicanovulation and / or irregular cycles. Up to now,evidence supporting beneficial clinical effects ofinositol supplementation in PCOS is provided, butmechanisms underlying these effects have not beenidentified8.
Recent studies demonstrated defects in tissueavailability oraltered metabolism of inositolphosphoglycans (IPG) in PCOS15. DCI was found tobe involved in post-receptor insulin signalling16
including androgen synthesis17. Due to MIinvolvement in FSH signalling, its impairment in PCOSmight be caused by MI deficiency5,17. A systematicreview showed that less (DCI)-containing inositol-phosphoglycan (DCI-IPG) was released in PCOSwomen compared to controls and this seemspositively correlated with IR and hyperinsulinemia.DCI administration had beneficial effects onovulation, anthropometric andmetabolic markers inPCOS by enhancing insulin sensitivity18.
It has been demonstrated that in PCOS, the increased
release of glucose-stimulated DCI-IPG via DCIsupplementation is significantly correlated withimproved insulin sensitivity. The significantrelationship between DCI-IPG release and insulinsensitivity prompted some scientists to suggest thatthe DCI-IPG mediator may be a target for therapeuticinterventions in PCOS19.
Both MI and DCI are necessary to assure the correctglucose metabolism in cooperation with insulin. Inphysiological conditions, the intracellular pool ofinositol inhuman ovaries is about 99% of MI whereasDCI is the remaining part20. Insulin controls theepimerase-converting MI into DCI. It is important tohighlight that the ovary maintains normal insulinsensitivity also in the presence of systemic IR 21. Thiscan explain why increased insulin release stimulatesovarian epimerase activity leading to intracellular DCIincrease and MI decrease. In agreement with this, inhyperinsulinemic PCOS women unexpectedly highlevels of DCI can be found in the ovary, withconcomitant MI depletion. This finding was called'The Ovarian Paradox'22 and might be consideredthe main cause of FSH signalling impairment inPCOS20. In these conditions, glucose uptake andmetabolism could negatively affect oocyte qualitydepending on MI23.Ovarian function improvement,as well as hormonal and metabolic parameters, wasdemonstrated after MI treatment inPCOS5. Moreover,MI shows results comparable or slightly better thanmetformin in ovulation induction but withoutanyside effects24. On the contrary, high doses of DCIalone, administered to PCOS subjects, were foundsignificantly detrimental for oocytes and thereforefor fertility25. While MI is a well-established safemolecule11, the data are lacking on DCI.
While a number of studies have analysed theeffectiveness of MI and DCI, alone or in combination,in PCOS, only two studies have compared the effectsof MI to DCI and found that they seem to exertcomparable effects26.
5. Clinical Evidences of Effectiveness of MI/DCICombinationDifferent authors examined the possibility ofadministering the MI/DCI combination27,28. Based onthe supposed alteration of MI/DCI ratio occurring inovary in PCOS, the combination MI/DCI 40:1 wastested and resulted twice effective in reducingHOMA-IR, compared to MI alone28 and induced animprovement, compared with placebo, of LDL, HDL,and triglycerides29. A single study compared thecombination MI/DCI (40:1) to treatment with DCIonly in PCOS women undergoing in vitro fertilization(IVF). The patients were treated twice a day witheither MI plus DCI or with DCI alone, for 12 weeksbefore rFSH administration and throughoutpregnancy. The results suggest that combinationtherapy improved oocyte and embryo quality andthe chance of becoming pregnant30.
Continued on page 11
Editorial
Dr. Duru ShahMD, FRCOG, FCPS, FICS, FICOG, FICMCH, DGO, DFPDirector, Gynaecworld, The Center forWomen’s Fertility & Health, MumbaiPresident, The PCOS Society (India)Chief Editor, Pandora
Editorial Team
Dr. Sabahat RasoolMD, DNB, MNAMS, FMAS, MRCOG (UK)Ian Donald Diplomate in OBGY Ultrasound, CroatiaFertility Consultant, Gynaecworld, MumbaiAssociate Editor, Pandora
Ms. Rochelle LoboAdministrative Assistant
3
Duru ShahFounder President, The PCOS Society, IndiaEditor, Pandora
Email: [email protected] – Published by the The PCOS SOCIETY (INDIA).Contributions to the editor are assumed intended for thispublication and are subject to editorial review andacceptance. PANDORA is not responsible for articlessubmitted by any contributor. These contributions arepresented for review and comment and not as a statementon the standard of care. All advertising material is expectedto conform to ethical medical standards, acceptance doesnot imply endorsement by PANDORA.
Dear Friends,
We have had a very eventful quarter after our last issue of Pandora! It's amazing how our Society has grown
and we are all very proud of it. There have been 2 programs which I particularly would like to talk about.
We organized a brilliant"Masterclass on "PCOS and Infertility" in collaboration with the CRE-PCOS
(Centre for Research Excellence in Polycystic Ovary Syndrome) and the Indian Society of Assisted Reproduction
in March this year, limiting participation to 100 delegates only. The knowledge gained through interaction
with experts like Rob Norman, Helena Teede from Australia and Chandrika Wijeyratne from Sri Lanka, was
stupendous and a treat for all who attended. And the cherry on the cake was the spontaneous offer by Rob
and Helena of a Travel Grant to a young delegate less than 40 years in the meeting to Australia, on behalf
of CREPCOS, in July this year. Applications were invited from the delegates were invited from the delegates
who attended and we received 4and sent them to Rob and Helena,who reviewed the applications and have
just sent us the name of the winner......... Dr. Sabahat Rasool!
The other program was the Online Certificate Examination which was based on the 6 Online Modules
which we have installed on our PCOS Society Website (http://www.pcosindia.org/pcos_tutorials.php).
The exam for this certificate course was held online on 2 consecutive Sundays with 2 different sets of
questionnaires, to give an opportunity to those who could not appear or clear the exams on the first Sunday.
We had a total of 787 participants who took the exams on the two days. Of these 469 have cleared the
exam with a percentage of 75% and more. Unfortunately, 318 have not cleared. Of the Participants who
have cleared 40 have excelled with 100% questions correct! A hearty congratulations to them.
The Third Annual International Conference of the PCOS Society of India; is to be held very soon in
June this year, once more in collaboration with the International Society of The Androgen Excess &
PCOS Society. After having 2 very successful meetings, one in the West zone (Mumbai) and the other even
better in the South zone (Bengaluru),with the enthusiasm shown by the organizing team in Gurugram, I am
sure it will be even better! The entire program has been printed in this issue of the Pandora. Registrations
can be made online through our Website (http://www.pcosindia.org/upcoming_events.php) or by bank
transfer and cheque (details on the registration form).
An added attraction in this meeting is the PCOS Practitioner Exam which will be conducted at the Conference
and is open to all members of the PCOS Society. The exam will be held as a multiple choice exam and all
those who clear will be offered a beautiful certificate of being a "PCOS Practitioner". So if you are not a
member please become one by applying through the website. (http://www.pcosindia.org/
membership.php)
We are looking for a young brigade for our society so that we can achieve even more! All those less than 40
and interested in joining our brigade, please write to us at [email protected] if you fulfill the
following conditions:
■ Less than 40 yrs, Willing to give some time to the organization, Willing to take on a responsibility, Willing
to update girls and women about PCOS through the "Conquer PCOS" Program.
I look forward to hearing from you all.
With warm regards,
4
Events and Updates
The PCOS Society's Travelling Seminars on "Understanding PCOS" are aimed at educating
the treating gynaecologists about the basics of the multifaceted disorder called PCOS.
This "Travelling Seminar " was conceptualized to bring to your door steps the latest and
best evidence-based medicine for preventing and treating the various symptoms and
health consequences arising from PCOS through exhaustive interactive sessions and case
discussions. Experts from the PCOS Society, India, have been delivering lectures in various
parts countrywide. The Travelling Seminars are being conducted with an unconditional
educational grant from USV and till May 2018, twenty eight travelling seminars have
been conducted throughout the various states of the country.
BHAYENDER
SRINAGAR
SURATGURGAON
JALGAON
January, 13th 2018Dr. Saima SidiqDr. Imam-ul-HaqDr. Gulshan ZehraDr. Mehrajuddin Bhat
December, 31st 2017Dr. Sanjiv khurdDr. Purnima NadkarniDr. Usha ValadraDr. Mona Shroff
January, 24th 2018Dr. AP SidhuDr. Neera GuptaDr. Veena KaurDr. Poonam Rastogi
Dr. Duru ShahConvenor
Dr. Uday ThanawalaConvenor
BHATINDA
CUTTACK
December, 16th 2017Dr. Rajendra NagarkattiDr. Uday JoglekarDr. Sheetal PandeyDr. Kastubh Kulkarnir.Rajesh Koradia
October 10th 2017Dr. Sujata KarDr. Maya PadhiDr. Sujata MishraDr. PC Mahapatra
November 30th 2017Dr. Shakuntala KumarDr. Ila GuptaDr. Shalu GuptaDr. Divya Sardana
January, 20th 2018Dr. Indrani HatwarDr. S B NawalDr. Tushar Nehete
5
The PCOS Society of India and The Indian Societyfor Assisted Reproduction (ISAR) jointly organized aMasterclass on "PCOS and Infertility" on 24th-25th
March, 2018 at Mumbai. The Masterclass was anacademic treat attended by nearly 100 delegatesfrom all over India.
The distinguished speakers included Prof. RobertNorman, Professor of Periconceptual & ReproductiveMedicine from the University of Adelaide,
Prof. Helena Teede, President of the AndrogenExcess Society andProf. Chandrika Wijeyaratne, President of Sri
Lanka Medical Association.
The national faculty included Drs. MridubhushaniGovindraj, Madhuri Patil, Sonia Malik, Sujata Kar and
Duru Shah.
& INFERTILITYPCOS 24th-25th March, 2018, Mumbai
The program was spread over two days. Day
1 of the Masterclass started with anintroduction by Dr. Duru Shah and Prof. RobNorman.This was followed by interactive and
educational talks on nomenclature and diagnosis ofPCOS and Genotype/Phenotype in Asian versusCaucasian population by Prof. Teede and Dr.
Wiyayaratne, respectively.
After lunch, the session included the workup andinfertility management in PCOS, Genetic and
environmental interplay as the etiology of PCOS andMetabolic Syndrome.
Day 2 of the Masterclass started off with exhaustive
lectures on Insulin Resistance and OvulationInduction in PCOS. Afternoon session was dedicatedto Assisted Reproduction in PCOS and research
methodology and collaborations.
The lectures were up-to-date, very informative and
generated a lot of audience interest and interaction.The national anthems of Australia, India and SriLanka were played at the end of the session on the
Second day and the meeting closed on a very happynote.
Prof. Norman and Prof. Helena announced an
Observership from amongst the delegates at theMasterclass, for a young member between 30-45years. The Observership includes free travel to
Australia, free Registration and free stay to the bestapplicant, to attend a 3 day meeting in Australiaorganized by CRE-PCOS. Applications were invited
by the PCOS Society, 5 applications were receivedwhich were forwarded to Prof. Norman and ProfHelena for selection.
Dr. Sabahat Rasool has been selected for this VisitingFellowship by Prof’s Norman and Teede.
on
6
22nd June 2018 – PRE-CONGRESS WORKSHOPS08.00 am Registration
09.00 - 01.45 pm Hall A - Workshop 1Lifestyle Changes – The First Step to combating PCOS
Workshop Inauguration: Padmashree Prof. Raj Baveja
Workshop Convenors: Shilpa Joshi, Yukti Wadhawan, Shakuntla Kumar
09.00 am - 10.30 am Session I: Impact of lifestyle in PCOS09.00 am ■ Are dietary options different in lean and obese PCOS? Shilpa Joshi09.20 am ■ PCOS: A Body Image Disorder Aakanksha Bhatia09.40 am ■ Fad diets (Mediterranean / South Beach / Paleolithic / Atkins / gluten free) – What do all these diets mean? Shilpa Joshi10.00 am ■ Discussion
10.30 am - 12.00 noon Session II: Lifestyle interventions10.30 am ■ Do lifestyle changes improve sexual dysfunction? Sharmila Majumdar10.50 am ■ Role of Nutraceuticals in diet Nilanjana Singh11.10 pm ■ Ideal Exercise in Lean and Obese PCOS Shiny Surendran11.30 pm ■ Evidence of Yoga therapy in PCOS Anushree Patil11.50 pm ■ Discussion
12.15 - 01.00 pm Session III: When lifestyle fails – Reducing Morbidity of Obesity12.15 pm ■ Role of Bariatric surgery Praveen Bhatia12.35 pm ■ Management of Sleep Apnea – what should the Gynec know? Manvir Bhatia
Jointly Organized byThe PCOS Society (India) &
The Androgen Excess &PCOS Society (International)
Dates: June 22 - 24, 2018Venue: Leela Ambience Hotel, Gurugram, near Delhi Airport, India
Dear Friends & Colleagues,
Welcome to the Third Annual Congress of the PCOS Society of India, being held in
collaboration with the Androgen Excess and PCOS Society on 22nd, 23rd and 24th
June 2018 in Gurugram NCR, Delhi at the Leela Ambience Hotel.
PCOS affects women at all stages of life hence, this conference is entitled "PCOS...
through the cycle of life". The Conference will focus on the different stages of
life, including the prenatal, childhood, adolescent, reproductive and post-
menopausal periods. As gynaecologists, we are the primary care physicians of
women and manage many PCOS patients with different presentations at different
ages.
The Conference includes 3 Pre-Congress Workshops and the main conference
which will be interactive and will give in-depth knowledge on both the subjects.
Learning from experts from various disciplines of medicine can add to our
understanding of this complex endocrine problem. We will also be conducting for
the first time the "PCOS
Practitioner" Exam and the "PCOS Quiz"during the conference.
We welcome you and we are confident that it will excite you with the latest
knowledge and cutting edge research on PCOS.
For any queries, you may contact us at [email protected] or
Looking forward to meeting with you.
With warm regards,
Duru ShahFounder PresidentThe PCOS Society, India
S C I E N T I F I C P R O G R A M M E
Duru ShahFounder President
The PCOS Society, India
Madhuri PatilScientific Chair –
ConferenceThe PCOS Society,
India
Piya ThakkarScientific Chair –
Pre-congressWorkshops The PCOS
Society, India
Helena TeedePresident
The AE-PCOS Society
Enrico CarminaCEO
The AE-PCOS Society
Ragini AgrawalLocal Organizing
Chair-person
Rita BakshiLocal Organizing
Chair-person
Shakuntla KumarLocal Organizing
Secretary
Ashok KumarLocal Organizing Secretary
7
12.55 pm ■ Discussion
1.15 - 01.45 pm Session IV: FootloosePut on your dancing shoes (Zumba) Team from Mama Mia
10.00-12.00 pm Hall B - "The PCOS Practitioner" Certificate ExamsConveners: Madhuri Patil, Ashok Kumar, Rita Bakshi
01.45- 02.30 pm LUNCH
02.30 - 06.30 pm Hall A – Workshop 2"PCOS: A diagnosis of Exclusion" – What you see is not alwayswhat you get!
Workshop Convenors: Piya Ballani Thakkar, S K Bakshi, Ragini Agrawal02.30 - 04.30 pm Session I:02.30 pm ■ Introduction of the Course Piya Ballani Thakkar02.40 pm ■ Hypothyroidism Madhuri Patil03.00 pm ■ Hyperprolactinemia Piya Ballani Thakkar03.20 pm ■ Cushing Syndrome and Acromegaly Beena Bansal03.40 pm ■ Adrenal disorders – CAH and adrenal tumors Deep Dutta04.00 pm ■ Discussion
04.30 - 06.00 pm Session II:04.30 pm ■ Androgen secreting ovarian tumors Pratima Mittal04.50 pm ■ Premature ovarian failure Padma Rekha Jirge05.10 pm ■ Uterine abnormalities Ranjana Sharma05.30 pm ■ Discussion
02.30 - 06.00 pm Hall B – Workshop 3Cosmetic Therapies – Live demonstration
Workshop Convenors: Rekha Sheth, Pankaj Chaturvedi, Monisha Kapoor1. Laser Hair Reduction: What works, what doesn't and what's new?2. Treatment of Adult Acne by Energy based Devices
06.00 pm COFFEE BREAK
06.30 - 7.30 pm A thought provoking Panel Discussion on"How do we reduce the epidemic of PCOS in our country?"With Gynaecologists, Endocrinologists, Public Health Experts, Media Representatives, Scientists,Private Health Care and Government Representatives………Moderator: Shereen BhanPanelists: Alka Kriplani, Ameera Shah, Duru Shah, Nomita Chandhiok, Pooja Shali, Rama Vaidya, Shailaja Chandra
07.30 pm Inauguration
08.30 pm BANQUET (By Invitation)
Conference Day 1 – June 23rd, 201808.00 - 09.00 am Invited free papers
09.00 - 10.30 am Session I: Diagnosis of PCOS09.00 am ■ What are the new criteria for Polycystic Ovarian Morphology (PCOM)? Harsh Mahajan09.20 am ■ Is Anti Mullerian Hormone a new marker for PCOS? Togas Tulandi09.40 am ■ Revisiting PCOS phenotype Enrico Carmina10.00 am ■ Discussion
10.30 am COFFEE BREAK
11.00 am - 12.00 noon Keynote AddressChairpersons: Rama Vaidya, Nomita Chandhiok
11.00 am ■ International Guidelines on PCOS Anuja Dokras11.30 am ■ Role of gastrointestinal function in determining the metabolic aspect of PCOS Enrico Carmina
International Faculty
Anuja DokrasUSA
Enrico CarminaItaly
Kannan AlpadiUSA
Kathleen HoegerUSA
Togas TulandiCanada
MCQs based on theSix Modules of PCOSpublished by thePCOS Society (india)Available atwww.pcosindia.org
8
12.00 - 01.00 pm Session II: Dermatological manifestations – Current Trends in Management12.00 pm ■ Acanthosis Nigricans Anil Agrawal12.15 pm ■ Androgenic Alopecia Rekha Sheth12.30 pm ■ Hirsutism Anil Ganjoo12.45 pm ■ Discussion
01.00 pm LUNCH
02.00 - 02.30 pm Keynote AddressChairpersons: Maninder Ahuja, Nita Dalal■ The diagnosis and management of PCOS – Novel Immunodiagnostic Methods Kannan Alpadi
02.30 - 03.45 pm Session III: Metabolic syndrome and PCOS
02.30 pm ■ Does Metabolic Syndrome present differently in Indian Women? Sujata Kar02.45 pm ■ Is there a difference in metabolic risks of lean and obese PCOS? Anuja Dokras03.00 pm ■ PCOS and GDM Nexus Hema Divakar03.15 pm ■ Discussion
03.45 - 05.00 pm Session IV: Impact of Stress on quality of life and how to reduce it?03.45 pm ■ Are women with PCOS more stressed? Kathleen Hoeger04.05 pm ■ Panel Discussion: Helping patients to deal with Stress – Multidisciplinary approach –
Get your answers from Clinicians, Mind Therapist and a Lifestyle guru.Moderator: Uday ThanawalaPanelists: Kathleen Hoeger, Kiran Aggarwal, Manju Verma, Mansi Kothari, Siddharth Saunthalia, Vani Jain. Vinit Taneja
05.00 pm COFFEE BREAK
05.30 - 06.30 pm Session V: Pregnancy and PCOS■ Panel Discussion:Are PCOS women at a higher risk of pregnancy and delivery complications? Case-based Discussion
Moderators: Rita Bakshi, Ashok Kumar
Panelists: Garima Kachhawa, Kanwal Gujral, Kiran Guleria, Nupur Gupta, Sanjivini Khanna, Vatsala Dadwal?
6.30 pm GBM
07.00 pm Session VI: Poster SessionSavita Singhal, Bharti Minocha
08.00 pm Cultural program
09.00 pm CONFERENCE DINNER
National Faculty
Aakanksha Bhatia
Alka Kriplani
Ameera Shah
Anil Agrawal
Anil Ganjoo
Anita Sabharwal
Anjali Tempe
Anju Soni
Anushree Patil
Archana Singhal
Arshi Iqbal
Aruna Batra
Aruna Murlidhar
Ashok Kumar
Ashok Taneja
Beena Bansal
Bharti Minocha
Chandan Kachru
Deep Dutta
Duru Shah
Garima Kachhawa
Geeta Kinra
Gulrez Tyebkhan
Harsh Mahajan
Hema Divakar
Hemani Sarbadhikary
Indu Koul
Jaideep Malhotra
Jyoti Malik
K. D. Nayyer
Kanthi Bansal
Kanwal Gujral
Kiran Aggarwal
Kiran Guleria
Lakhbir Dhaliwal
M. P. S. Chawla
Madhuri Patil
Manisha Kapoor
Manju Puri
Manju Verma
Manoj Pandya
Mansi Kothari
Manvir Bhatia
Munish Prabhakar
Nalini Mahajan
Navneet Magon
Neena Malhotra
Nilanjana Singh
Nomita Chandhiok
Nupur Gupta
Nutan Agrawal
O P Gangwani
Padma Rekha Jirge
Pankaj Chaturvedi
Pankaj Talwar
Piya Ballani Thakkar
Pooja Shali
Poonam Goyal
Pratima Mittal
Praveen Bhatia
Preiti Kumar
Puneeta Hasija
Pushpa Sethi
R. P Gupta
Ragini Agrawal
Raj Baveja
Rajesh Rajpal
Rakhi Singh
Rama Vaidya
Ranjana Sharma
Rekha Seth
Renu Misra
Rita Bakshi
Ritu Jain
Rukma Idanani
S K Bakshi
Sangeeta Agrawal
Sanjay Narula
Sanjivini Khanna
Satish Koul
Savita Singhal
Seema Pandey
Shailaja Chandra
Shakuntla Kumar
Sharmila Majumdar
Shashi Lata Kabra
Shereen Bhan
Shilpa Joshi
Shiny Surendran
Siddharth Saunthalia
Smita Mahale
Sonia Malik
Sudha Prasad
Sudha Sharma
Sujata Kar
Sujata Sharma
Sunita Malik
Swati Singh Rathor
Uday Thanawala
Vandana Narula
Vani Jain
Vatsala Dadwal
Vinit Taneja
Yukti Wadhawan
9
Conference Day 2 – June 24th, 201808.00 - 09.00 am Session VII: Round Tables with Experts
Convenors: Madhuri Patil, Rakhi Singh, Ashok Kumar(Each table limited to 10 participants) Experts
1. Luteal Support in infertility management in PCOS women Maninder Ahuja, Nutan Agarwal
2. Letrazole v/s Clomiphene Citrate in ovulation induction in PCOS? Togas Tulandi, Lakhbir Dhaliwal
3. Gonadotropins for ovulation induction in PCOS? Anuja Dokras, Duru Shah
4. Medical Treatment for Obesity Beena Bansal, S K Bakshi
5. Role of Oral Contraceptive Pills in Adolescent PCOS Kathleen Hoeger, Chandan Kachru
6. Use of Metformin in obese and lean PCOS? Rakhi Singh, Deep Dutta
7. Use of Inositols in the management of PCOS Nita Dalal, Sujata Sharma
8. Vitamin D in PCOS Satish Koul, Savita Singhal
9. Acne in PCOS Pankaj Chaturvedi, Gulrez Tyebkhan
10.Hirsutism in PCOS Sudha Prasad, Anil Agarwal
09.00 - 10.15 am Session VIII: Evidence based treatment for enhancing fertility09.00 am ■ Is PCOS an inflammatory process? Madhuri Patil09.20 am ■ Managing insulin resistance in infertility Sonia Malik09.40 am ■ Recent evidence on oral ovulogens Kanthi Bansal10.00 am ■ Discussion
10.15 - 11.15 am Session IX: Panel Discussion:■ Increasing efficacy and safety with ARTModerators: Jaideep Malhotra, Nandita PalshetkarPanelists: Arshi Iqbal, Nalini Mahajan, Pankaj Talwar, Preiti Kumar, Ritu Jain, Shakuntla Kumar, Seema Pandey
11.15 am COFFEE BREAK
11.45 am - 12.45 pm Session X: Keynote AddressChairpersons: Smita Mahale,Sudha Prasad
11.45 am ■ Consensus statement on the "Use of OCP in PCOS Women in India" Duru Shah12.15 pm ■ How does Ovarian Drilling fit in the treatment scheme, Togas Tulandi
is this a safe procedure and why do we use it so infrequently?
12.45 - 01.45 pm Session XI: Adolescent PCOS12.45 pm ■ Diagnosis of adolescent PCOS – A difficult task Neena Malhotra01.00 pm ■ Role of inositols in Adolescent PCOS Manoj Pandya01.15 pm ■ Abnormal Uterine Bleeding in Adolescent PCOS Ragini Agrawal01.30 pm ■ Discussion
01.45 pm PCOS Quiz - Live
02.15 pm Valedictory function and Awarding of CertificatesGuest of Honour: Smita Mahale, Director, NIRRH
02.30 pm LUNCH
Welcoming....Our New Patrons
Our New Life Members
Dr. Bharati Morey
Dr. Aarti MahlaDr. Angeline JobDr. Anita ManeDr. Anjali KumarDr. Aparajita GulatiDr. Asna Beg AshrafDr. B. Mohana Priya
Dr. C. JyothiDr. Dinesh JainDr. Geetha MuralidharaDr. Gopal Chandra DashDr. Gorakh G. MandrupkarDr. Gouri RaiDr. Indira Palo
Dr. Gitanjali G. Dr. Milind Shah Dr. Shashi LataKabra Maheshwari
Dr. Shefali D. Jain Dr. Sunil KumarChoudhari
Dr. Jyoti ShahDr. Kalpana M. BhattDr. Kothagattu SrinivasDr. M. LipikaDr. Mamta (Fogla)BukalsariaDr. Manisha M. Laddad
Dr. Rita Bakshi Dr. Varuna Pathak
Dr. Manu LaxshmiDr. Molina Niket PatelDr. MonikaDr. Naini TandonDr. Niket H. PatelDr. Preety AggarwalDr. Rakesh Pandia
Dr. Rana Mohammed AfzalChoudharyDr. Rashmi KapoorDr. Rekha RajendrakumarDr. Ritu ChauhanDr. Sadaram RamyaDr. Sagarika Sarkar
Dr. Seema SehgalDr. Shameem Kamal KhanDr. ShivaniDr. Shobha Rani RaoDr. Smita MoorthyDr. Trupti MhapsekarDr. Vaishali Vasant Khatav
Dr. Vanajakshi R.Dr. Vedhapriya S.Dr. Veena SurendraDr. Versha JainDr. Vinutha S.Dr. Yuvrajsingh D. Jadeja
10
Table1: Intervention studies with MI, DCI & acombination of DCI and MI in women affected byPCOS.
Given the complexity of PCOS, numerous studies onthe use of these two Inosotol stereoisomers havebeen performed.Their different concentration at the
tissue level and their different roles in the cell led tothe conclusion that both of them have to be usedfor the purpose of better treatment efficacy27. Indeed,
the data, summarized in Table 1, suggest that thecombination MI/DCI might be more effective thanthe supplementation with a single inositol species.
Due to the small number of treated patients thesestudies need to be confirmed in larger trials.
6. ConclusionsPCOS is a common endocrine and metabolic disordercharacterized by oligo-anovulation, hyperan-drogenism, and insulin resistance, this latter playing
a key role in the pathogenesis of this syndrome, bothin lean and obese women. Various therapeuticapproaches have been attemptedin PCOS, including
supplementation with Inositols, MI and DCI, whichmay have distinct and synergic physiologic roles inthe metabolism of glucose and in the regulation ofinsulinaction, counteracting the endocrine disorder
of this syndrome8.
The most recent literature reports that MI, DCI andin particular their combination in the physiological
ratio 40:1 could represent an important therapeuticapproach for the improvement of metabolic,hormonal and reproductive aspects of PCOS19.
By now, it is possible to outline a comprehensiveframework and bring about the best treatment forPCOS in keeping with the above cited findings,
specifying some milestones useful for the therapeuticapplication. Many articles testing the efficacy ofInositols contributed to further shed light on this
topic and strengthen several points with originalstudies and insightful reviews of up-to-date scientificliterature31.
However, future studies based on large cohorts andtesting a "tailored" dosage, calculated on thepretreatment conditions, are needed in order to
clarify the pivotal role of inositol's isoforms inaddressing the hormonal and metabolic parameterstoward homeostasis in PCOS patients.
References1. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES,
Yildiz BO. The prevalence and features of the polycysticovary syndrome in an unselected population. J ClinEndocrinol Metab. 2004;89:2745-9.
2. The Rotterdam Eshre/Asrm-sponsored PCOS consensusworkshop group. Revised 2003 consensus on diagnosticcriteria and long-term health risks related to polycystic ovarysyndrome (PCOS). Vol. 19, Human Reproduction. 2004. p.41-47.
3. Orio F, Palomba S. Reproductive endocrinology: newguidelines for the diagnosis and treatment of PCOS. NatRev Endocrinol. 2014;10:130-132.
4. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profoundperipheral insulin resistance, independent of obesity, inpolycystic ovary syndrome. Diabetes Metab Res Rev.1989;38:1165-1174.
5. Unfer V, Carlomagno G, Dante G, Facchinetti F. Effects ofmyo-inositol in women with PCOS: a systematic review ofrandomized controlled trials. Gynecol Endocrinol.2012;28(7):509-15.
6. Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A. European survey ofdiagnosis and management of the polycystic ovarysyndrome: results of the ESE PCOS Special Interest group'squestionnaire. Eur J Endocrinol. 2014;171:489-498.
7. Lauretta R, Lanzolla G, Vici P, Mariani L, Moretti C,Appetecchia M, et al. Insulin-sensitizers, polycystic ovarysyndrome and gynaecological cancer risk. Int J Endocrinol.2016;2016:1-17.
8. Sortino MA, Salomone S, Carruba MO, Drago. PolycysticOvary Syndrome: Insights into the Therapeutic Approachwith Inositols. Front Pharmacol. 2017;8(341):1-13.
9. Micheal J B, Robin F I. Inositol triphosphate, a novelsecondmessenger in cellular signal transduction. Nature.1984;308(22):339.
10.Di Paolo G, De Camilli P. Phosphoinositides in cell regulationand membrane dynamics. Nature. 2006;443:651-657.
11.Carlomagno G, Unfer V. Inositol safety: clinical evidences.Eur Rev Med Pharmacol Sci. 2011;15:931-6.
12.Croze ML, Vella RE, Pillon NJ, Soula HA, Hadji L, GuichardantM, et al. Chronic treatment with myo-inositol reduces whiteadipose tissue accretion and improves insulin sensitivity infemale mice. J Nutr Biochem. 2013;24(2):457-66.
13.Larner J. D-chiro-inositol: its functional role in insulin actionand its deficit in insulin resistance. Int J Exp Diabetes Res.2002;3:47-60.
14.Dang NT, Mukai R, Yoshida K, Ashida H. D-pinitol andmyoinositol stimulate translocation of glucose transporter
4 in skeletal muscle of C57BL/6 mice. Biosci BiotechnolBiochem. 2010;74:1062-1067.
15.Baillargeon JP, Diamanti-Kandarakis E, Ostlund RE. AlteredD-chiro-inositol urinary clearance in women with polycysticovary syndrome. Diabetes Care. 2006;29:300-5.
16.Nestler JE, Jakubowicz DJ, Iuorno MJ. Role ofinositolphosphoglycan mediators of insulin action in thepolycystic ovary syndrome. J Pediatr Endocrinol Metab.2000;13(5):295-8.
17.Nestler J, Unfer V. Reflections on inositol(s) for PCOS therapy:steps toward success. Gynecol Endocrinol. 2015;31(7):501-505.
18.Galazis N, Galazi M, Atiomo W. D-Chiro-inositol and itssignificance in polycystic ovary syndrome: a systematicreview. Gynecol Endocrinol. 2011;27:256-62.
19.Gateva A, Unfer V, Kamenov Z. The use of inositol(s) isomersin the management of polycystic ovary syndrome: acomprehensive review. Gynecol Endocrinol. 2018;1-6.
20.Unfer V, Carlomagno G, Papaleo E, Vailati S, Candiani M,Baillargeon J. Hyperinsulinemia alters myoinositol to d-chiroinositol ratio in the follicular fluid of patients with PCOS.Reprod Sci. 2014;21(7):854-858.
21.Harwood K, Vuguin P, Di Martino-Nardi J. Currentapproaches to the diagnosis and treatment of polycysticovarian syndrome in youth. Horm Res. 2007;68:209-17.
22.Carlomagno G, Unfer V, Roseff S. The D-chiro-inositolparadox in the ovary. Fertil Steril. 2011;95(8):2515-2516.
23.Unfer V, Orru' B, Monastra G. Inositols: from physiology torational therapy in gynecological clinical practice. ExpertOpin Drug Metab Toxicol. 2016;12:1129-31.
24.Raffone E, Rizzo P, Benedetto V. Insulin sensitiser agentsalone and in co-treatment with r-FSH for ovulation inductionin PCOS women. Gynecol Endocrinol. 2010;26:275-80.
25. Isabella R, Raffone E. Does ovary need D-chiro-inositol? JOvarian Res. 2012;5:14.
26.Formuso, C Stracquadanio M, Ciotta L. Myo-inositol vs. D-chiro inositol in PCOS treatment. Minerva Ginecol.2015;67:321-325.
27.Unfer V, Porcaro G. Updates on the myoinositol plus D-chiro-inositol combined therapy in polycystic ovarysyndrome. Expert Rev Clin Pharmacol. 2014;7:623-31.
28.Nordio M, Proietti E. The combined therapy with myo-inositol and Dchiro- inositol reduces the risk of metabolicdisease in PCOS overweight patients compared to myo-inositol supplementation alone. Eur Rev Med PharmacolSci. 2012;16:575-81.
29.Minozzi M, Nordio M, Pajalich R. The combined therapymyoinositol plus d-chiro-inositol, in a physiological ratio,reduces the cardiovascular risk by improving the lipid profilein PCOS patients. Eur Rev Med Pharmacol Sci. 2013;17:537-540.
30.Colazingari S, Treglia M, Najjar R, A B. The combined therapymyo-inositol plus D-chiro-inositol, rather than D-chiroinositol, is able to improve IVF outcomes: results froma randomized controlled trial. Arch Gynecol Obs.2013;288:1405-11.
31.Unfer V, Nestler JE, Kamenov ZA, Prapas N, Facchinetti F.Inositol(s) from Bench to Bedside in Endocrinology andGynecology. Int J Endocrinol. 2017;
Reproductive
Reference SD Treatment N° BMI Outcomes
Hormonal Insulin Resistance
A) higher fertilizationrate and embryo quality;
greater numberof transferred embryos
B) increased number andquality of oocytes
Colazingariet al., 2013
(30)
RCT A) MI 550mg/twice day +DCI 13.8 mg/twice a day
B) DCI 500 mg/twicea day COH
100 <28 Reduction in total rFSHunits and in peak E2
levels
NA
NAMinozzi et al.,2013(29)
Cohort MI 550 mg + DCI13.8mg/twice a dayNo other treatment
20 33.7±6.1
Improvement in LDL,HDL, and TG levels
Reduction
Nordio andProietti, 2012
(28)
Restoredovulation activity
RCT A) MI 2g/twice a dayB) MI 550mg/twice a day
plus DCI 13.8 mg/twice a day
50 27.5 ±2.9
Reduction of total Tand Major increaseof SHBG in group B
compared to A
Reduction ofglucose andinsulin levelsin group B
Continued from page 11
Inositols in PCOS
11
The PCOS Society of India at The International Society of Gynecological Endocrinology (ISGE), Italy
Events and Updates
The PCOS Society (India) held a one-hour session at the 18th World Congress of
"The International Society of Gynecological Endocrinology (ISGE)" in Italy.
The PCOS Society (India) conducted a panel discussion on "From Conception to
Delivery in Indian PCOS". The session was moderated by Dr. Sujata Kar from
Bhubaneshwar, and the panel included Dr. Nalini Mahajan from Delhi, Dr. Madhuri
Patil from Bangalore, Dr. Ritu Joshi from Jaipur and Dr. Annita Soni from Mumbai. It
was a case based interactive discussion. Four cases were discussed, which included
Controlled Ovarian Stimulation in PCOS, Prevention of Ovarian Hyper Stimulation
Syndrome and multiple pregnancies, Gestational Diabetes Mellitus in PCOS women
and maternal and neonatal complications in PCOS women. The session was well
attended and well appreciated with a lot of audience participation.
PCOS Online Certificate Course – 22nd and 29th April, 2018
The PCOS Online Certificate Course examination was
helo on the 22nd and 29th April, 2018. Dr. Duru Shah
& Dr. Madhuri Patil were the Course Directors and
the faculty included Drs. Piya Ballani Thakkar, Sujata
Kar, Rekha Sheth, Uday Thanawala, Nikhil Bhagwat
& Gaapa thi B.
Nearly 800 doctors took the exam and 469 passed
it. The successful candidates with get a Certificate
from the Society and the Top 3 scorers will get
surprise gifts as well.