What is new in Polycystic Ovarian syndrome

The Australian  centre  for Research  Excellence  in PCOS funded by NHMRC  led and primarily   funded the guideline   development . They partnered  with the American  society for Reproductive  Medicine    and the European Society  of Human   Reproductive   and Embryology   in  this Endeavour. Thirty five other   societies partnered including  FOGSI  and the PCOS Society of India .

Guideline recommendations: Recommendations and practice  points  cover  the following   broad   areas :

Diagnosis screening and risk   assessment   depending  on life  stage :

Emotional   well being

Healthy  lifestyle

A healthy   diet in pregnancy is significantly associated with higher    birth weight using customized  birth weight   centiles and lowers the risk of giving birth to a small for gestational  age  infant

. In a recent    study researchers  evaluated  the maternal   dietary patterns     and their impact   on infant   CBWC   within a group of women . A significant association was  observed  between  health  conscious dietary  pattern and maternal  body mass . Researchers estimate the burden of miscarriage  in women and evaluated  the association with maternal age  and pregnancy history. Risk of miscarriage was estimated according to   woman’s  age  and pregnancy history by logistic regression.. After one miscarriage   the risk  was increased  by half   after two  the risk  doubled index age education income  and exercise . According to adjusted regression analyses  those  women who followed Health conscious dietary  pattern    were significantly associated  with increased  CBWC      -4.75   195%    confidence interval    and were less likely   to deliver a SGA  infant  and after three consecutive  miscarriage  the risk  was four  times  greater..

 Previous     pregnancy   complications  also predicted a higher risk of miscarriage Additionally women   who themselves   were born small for gestational age also  had an increased risk of miscarriage . Therefore researchers concluded that  the risk of miscarriage    is related to a mother’s  age and suggested that it is linked to some previous  pregnancy  complications

 Exciting developments:, Insight into the international  evidence  based guidelines for the assessment   and management of polycystic ovary  syndrome 2018.

Expertise & care of PCO women : Q. 1:-What we knew of “Polycystic ovary  syndrome” ?? : Ans:- We are aware that PCO has a significant public health  issue  affecting A) reproductive B)  metabolic and C) psychological aspects of the concerned woman. Unfortunately little focus is done by gynaecologits are  on the   psychological    health of women suffering from PCO   .

Q. 2 :-What was known to us for last three decades??  We are aware that PCOS   is one of the most common endocrinopathy in reproductive aged women   with prevalence of 8% - 13%   . We also knew that  PCO is present with diverse   features including   reproductive   metabolic    and psychological features .As mentioned earlier the last two groups of the syndrome i.e. metabolic and psychological components of this common syndrome  are paid little  attention..

Q. 3 Old wine in new bottle,. Since 1935 many millions gallon of have water have passed over Amazon. If that be so,  then why still there are  dilemma on PCO still existing even  in 2019?? Where do we stand now?? Is it not the lack of knowledge of scientists, reproductive biologists that the “Diagnosis of PCOS still remain controversial and warrant many times amendments including its assessment”.  Why there is no universal consensus since 1935? Not only its diag criteria have changed about five times but we are also aware that problem also lies with its  “management-guidelines” of which are still   inconsistent. Previous   guidelines lacked rigorous evidence   based processes did not engage   consumer and international   multidisciplinary perspective or were outdated.

Q. 4:--Yet another Academic feast.  Another international evidence   based guideline was released on July 19. 2018  for the A) assessment   and B)  management of PCOS addressing   psychological  metabolic   and reproductive features of PCOS. Guideline recommendations:

 Recommendations and   practice points  cover  the following  broad   areas: Diagnosis , screening and risk   assessment   depending on   life stage; A) Emotional   well being  B) Healthy lifestyle C) Pharmacological   treatment for non fertility indications and D)  assessment   and treatment   of infertility 2)

for PCOS); 3) Thessaloniki, Greece, in 2007

dealt with infertility management in PCOS .The

conclusions of these meetings were subsequently jointly

published simultaneously in both Human Reproduction and

Fertility and Sterility. These papers are highly cited,

suggesting a great interest in this area and underlining the

value of such consensus contributions.

4) A third PCOS consensus workshop—the focus of the pres-

end report—took place in Amsterdam, the Netherlands, in Oc-

tuber 2010 and attempted to summarize current knowledge

and to identify gaps in knowledge regarding various women’s

health aspects of PCOS.

Diverse aspects of care during the reproductive and post reproductive years were addressed, including adolescence, hirsutism and acne, contraception, menstrual cycle abnormalities, quality of life and sexual

health, ethnicity, pregnancy complications, long-term (meta-

boric) cardiovascular health, and cancer risk . Due to

the complexity of the many issues discussed, this contribution

will address each topic separately in axed format: a brief

introduction, concluding statements (where there was agree-

mint), a summary of areas of disagreement (if any) and know-

edge gaps, with recommended directions for future research.

These concluding statements in relation to each specifc topic

mentioned are published in the journals, 

Summary  of clinical changes in the recommendations

Point 1;- Which criteria for daig to follow?? e.g. . of  1) Oligo or anovulation , 2) Clinical  and / or  biochemical signs of   hyperandrogenism 3) Polycystic ovaries on ultrasound and exclusion of other etiologies . Rotterdam diagnostic criteria –originally  required as  we all know  two of Oligo or anovulation , Clinical  and / or  biochemical signs of   hyperandrogenism .Polycystic ovaries on ultrasound and exclusion of other etiologies  of the above  features. 

 Modification No 1 by The Australian Center for research excellence in PCOS (CRE-PCOS), 19/07.2018.:-What was the modification of done by the “The Australian Center for research excellence in PCOS (CRE-PCOS) “?? The said -committee endorsed  the Rotterdam PCOS diagnostic criteria in adults but with slight modifications  like  Ultrasound criteria   are tightened with advancing technology like A) Transvaginal ultrasound transducers with a frequency   bandwidth  that  includes 8 MHz is recommended. B) The threshold for PCOM on either   ovary with  follicle  number per ovary   (FNPO)  of > 20  -remind my dear members earlier it was  12 and / or an ovarian volume > 10   ml on either  ovary  ensuring  no corpora lutea   cysts  or dominant  follicles  are present.

Modification No 2 by the Australian Center for research excellence in PCOS (CRE-PCOS) on 19/07.2018’ .  USG is not necessary to diagnose PCO-When ?? This modification was based on the principle is not to over diagnose PCO in adolescents Ans;-A) USG is not an essential marker for PCO in adolescents   and those   within 8 years of menarche both ovulatory   dysfunction   and hyperandrogenism   are required ultrasound not recommended as it overlaps with the normal    physiology around puberty. If only ovulatory dysfunction  or hyperandrogenism   consider  at risk of PCOS and reassess later. Changes are made not to over diagnose   PCOS  in adolescents. This is not applicable in adults    where   irregular cycles and    hyperandrogenism features are present – ultrasound is not necessary for the diagnosis.