World Congress on Polycystic Ovarian Syndrome and Fertility December 17- 18 2018 Abu Dhabi, UAE

An honest, ethical and diligent individual, committed to producing timely, cost-effective and outstanding results. Seventeen years work experience in the field of

Assisted Reproductive Technologies with success in managing all aspects of that specialized type of work. Now seeking a substantial and challenging work and research position where my entrepreneurial abilities will assist in the successful and profitable development of the work. Faculty of Science – Cairo University –

Egypt, he registered for doctor of Philosophy degree (Ph.D.) – Embryology and Comparative Anatomy – 2017 and many more.

Polycystic Ovary Syndrome (PCOS) has a high prevalence worldwide with an increased risk of reproductive, metabolic, and psychological features. It is characterized by a clustering of hyperandrogenism, hyperinsulinemia, hypersecretion of LH, menstrual dysfunction, hirsutism, infertility and pregnancy and neonatal complications including ectopic pregnancy and

early pregnancy loss (EPL) which have been estimated to be greater than women of similar demographics. According to the Rotterdam Consensus Criteria (ASRM/ESHRE Consensus Working Group on PCOS, 2004), the diagnosis of PCOS was based on the presence of at least two of three following criteria: oligomenorrhoea/ amenorrhoea, hyperandrogenemia and/

or hyperandrogenism and polycystic ovaries. Due to the polycystic nature of the ovaries in women with PCOS, they are at moderate risk of ovarian hyperstimulation syndrome (OHSS). Reported OHSS rates in the literature for women with PCOS who conceived after IVF are up to 7.5% compared to women without PCOS being in the order of 2.7%. Despite the increased

oocytes retrieved during an IVF cycle, the oocytes are often of a Science quality, and these cycles are characterized by lower fertilization, cleavage and implantation rates and a higher miscarriage rate and incidence of embryo transfer cancellations due to failed fertilization or OHSS. However, live birth rates per cycle are similar to women with normal ovaries. It was postulated

that alteration of many extra and intra-ovarian factors may directly or indirectly impair the competence of maturating oocytes through endocrine and local paracrine/autocrine actions, resulting in a lower pregnancy rate in patients with PCOS. The extra-ovarian factors identified included gonadotrophins, hyperandrogenemia, and hyperinsulinemia, although intra-ovarian factors included members of the epidermal, fibroblast, insulin-like and neurotrophin families of growth factors, as well as the cytokines. These abnormalities either have a direct influence on oocyte interactions and oocyte meiotic maturation, fertilization, embryonic development, and pregnancy, or the influences are through circulating endocrine and local paracrine autocrine mechanisms, which requires further clarification. Mature oocytes from PCOS patients may have an altered gene expression profile, especially for genes involved in chromosome alignment and segregation during meiosis and mitosis, cell cycle checkpoints, genes containing putative androgen receptor binding sites (Wood et al., 2007) and genes of primary follicle

recruitment (Teixeira Filho et al., 2002; Wei et al., 2011), indicating abnormal follicle recruitment, oocyte maturation and potentially impaired development for a large proportion of PCOS oocytes. Despite this, a meta-analysis (Heijnen et al., 2006) found that PCOS patients had the same pregnancy rate as other patients undergoing IVF, indicating that PCOS patients can

produce competent oocytes Regarding kinetics and embryonic development patterns, Wissing et al, 2014 found a significant delay in time of some cellular events in embryos from hyperandrogenic PCOS women compared with embryos from healthy, regularly cycling women which collectively indicates that these embryos had developed slower from fertilization to the 8-cell

stage with a higher proportion of multi-nucleated cells at the 2-cell. The clinical impact of the embryo delay was unknown.

However, the live birth rates were comparable between the PCOS and non-PCOS patients. Treatment and possible alternatives: Systematic screening for key intra-ovarian factors which are related to PCOS (such as AMH, Hcy, growth factors, and cytokines) together with proper treatment for each PCOS phenotype are essential issues in achieving success for PCOS patients undergoing assisted reproduction, to effectively improve oocyte maturation and developmental competence. It has been shown that treatment with the insulin sensitizer metformin, a synthetically derived biguanide, which leads to a reduction in serum insulin concentrations, may improve the features of PCOS. Many studies, including our unpublished data concluded that In Vitro maturation (IVM) and freeze all policy are of a University benefit for

patients with PCOS undergoing assisted reproductive technology treatment to achieve best success results and to avoid ovarian

hyperstimulation syndrome (OHSS).

Tracy Roake is the Head of Education at Danat Al Emarat Hospital, Abu Dhabi. She is an advanced midwife and general nurse. She has been awarded an MBA and MSc Healthcare Management Degree, and has a Master of Applied Business Research and pursuing a doctorate. She is a qualified hypnobirthing instructor and has a diploma in Aromatherapy, Herbalist, Reflexology, and Naturopathy. She The a great passion for midwifery and pioneered all the first private hospital waterbirths in KZN South Africa

This presentation is going to hold the attention of the medical team on the story of my personal experience as a PCOS sufferer. Resulting in many issues such as irregular painful periods, unusually thick fast hair growth, up and down weight gain and unsuccessful attempts to fertility treatments.

I will highlight the following:

• Expectation as a young girl

• Expectation as a women

• The trauma of infertility

• The frustration of what the doctor does not tell you

• The side effect and the frustrations

Mili Sarkar has completed her MBBS, MD (AFC), and she is a working as a clinical researcher in certified human genetic, clinical research & trail, IVF / hospital project head, in feni hospital & laparoscopic institute, Bangladesh. She is also a worked as Senior Advisor of “CPHFS” Central Publish Health & Food Safety, India. She achieved international global achiever award / multi-talented award and served as keynote speaker for the international conference at Sri Lanka 2016, rashtrawad patrakarita global achiever award in health care, & Sahitya conference, Thailand-2017. Published articles & blogs in health times, via media newsletter, awarded

by Rx pharma, Equinox Lab.

 

Parag Nandi has completed his Ph.D. in University of Calcutta and MSc in Biotechnology. He is a Scientific Director & Chief Embryologist, Cradle Fertility Centre, Joka, Kolkata and Founder Member, Academy of Clinical Embryologists, India. Organizing & Scientific Committee Member, ISAR 2018, Kolkata. Trained in embryology from CREST Bangalore & CREST Singapore, trained in embryology from CREST Bangalore & CREST Singapore, published his research papers in high impact factor scientific journals. Authored number of chapters in books. Current research interests include various ways of air quality management indifferent levels of clean room, an effect of VOC in embryo culture condition, reproductive toxicology, the effect of heavy metals in male & female infertility & sub-fertility.

Polycystic Ovarian Syndrome (PCOS) is a very common cause of female infertility associated with obesity. Factors other than anovulation, such as low embryo quality has been suggested to contribute to infertility in this group. The follicular microenvironment previously found to be altered in PCOS women might influence oocyte maturation and oocyte developmental competence. This excessive follicle number is linked to disturbances in folliculogenesis, which are thought to be the consequence of intraovarian hyperandrogenism. In addition, the number and quality of mature oocytes have been proposed as being poor; and recent data suggested that oocyte competence could be impaired in PCO patients owing to an inadequate dialogue between the cumulus cells and oocyte. In PCOS patient’s embryo development it is observed few important differences in some embryo kinetic parameters. Notably, times to 2PN breakdown and up to 7 cells stage are significantly longer in hyperandrogenic PCOS patients than the healthy population. Time to 4 cells is significantly longer for embryos from hyperandrogenic PCOS group than healthy population and even normoandrogenic PCOS group. After the seventh cell stage, no significant difference between normal and PCOS group can be observed up to the blastocyst stage of development. The maternal influence on early embryo kinetics could be caused by the embryo’s dependence on maternal RNA transcripts until the embryo genome is activated primarily from the 4-cell stage and completed at the eighth cell stage. This might explain why the observed delay in the hyperandrogenic group was most significant at stages earlier than 5 cell stage, began to level out after 5 cell stage and became undetectable after 7 cell stage. The mitochondria of the preimplantation embryo only from the mother because paternal side mitochondria do not survive post-fertilization. Therefore, the slower development in early embryos from hyperandrogenic PCOS women might in part relate to some sort of mitochondrial functional anomaly in their oocytes. The only study led by Wissing et al, in 2014 has nicely documented this kinetics of PCOS embryos though it is yet to establish that, why is impaired oocyte developmental capability not a general finding in PCOS patients undergoing ovarian stimulation for ART.

Uma Shrivastava is an Endocrinologist in Infertility and IVF Specialist. She is Founder and Executive Director of the Pioneer Institute in Infertility treatment in

Infertility Centre, Nepal. She is also the Professor of Physiology and Vice Principal at College of Biomedical Engineering and Applied Sciences. She has published more than 20 papers in journals, conference preceding and newspapers.

Polycystic Ovarian Syndrome (PCOS) is a heterogenous multisystemic endocrine disorder. Ovulation induction is one of the procedures for the development of follicles in anovulatory infertile women with Polycystic Ovarian Syndrome. There are different drugs which have been used widely for this condition. Clomiphene citrate was very popular ovulation stimulant in

the past and letrozole has been an alternative for the same purpose in recent years. Metformin has also been used either singly or in combination with clomiphene citrate and letrozole for better results. However, no single therapeutic measure has been recommended as being effed active. In this study, the efficacy of clomiphene citrate, letrozole, metformin, and the combination of metformin with either clomiphene citrate or letrozole have been reviewed based on the available literature. We conducted a review of existing literature from January 2006 to December 2016. Databases such as PubMed, Medline, and Scopus were searched with the search item PCOS, clomiphene citrate, letrozole, metformin, and infertility. Clinical trials, meta-analysis, and systematic reviews were reviewed and the conclusion was drawn. The study revealed clomiphene citrate as the first line of treatment for ovulation induction in Polycystic Ovarian Syndrome. Most of the studies showed that letrozole was effed active in regulating ovulation and achieving pregnancy among women with Polycystic Ovarian Syndrome as compared to clomiphene citrate and is used in cases where women are resistant to clomiphene citrate. Metformin is more effective when used in combination with either clomiphene citrate or letrozole and the effectiveness is more when used in combination with letrozole as compared to clomiphene citrate. However, some studies also showed that the combination of metformin with clomiphene citrate is superior to the combination of metformin with letrozole. As there is no clear evidence on which medication is the most effective in achieving pregnancy among Polycystic Ovarian Syndrome cases, more studies with large sample size or clinical trials are warranted.

Raja Selvarajan an eminent consultant physician & Diabetologistidentificationan Alumnus from M.S.Ramiah medical college, Bangalore persuaded post-graduation, MDInternal medicine, further to which he obtained a post-graduate diploma in diabetology. He served as an associate consultant -internal medicine & diabetology in BGS global hospital in Bangalore, then at the global hospital and health city at Chennai. Later continued, as consultant physician & diabetologist with Apollo group of hospitals, to cater specialty services in the field of diabetology. He has a special interest in the Epidemiology of Diabetes, Epidemiology, Gestational Diabetes and The in young. He Received national award at RSSDI 2013, the most prestigious diabetes conference in India.

Background: Uncontrolled and Undiagnosed diabetes continues to be a global burden on society, governments, HCPs, adding to this has been an alarming rise in the incidence of diabetes in young. Many young females with PCOS are unaware of their dysglycemic status. We conducted a screening study to study the prevalence of dysglycemia in young, in and around our clinic with an urban population visitation in Bangalore. Material and Methods: We prospectively conducted an observational study on 1056 outpatient subjects of both sexes who visited our screening events conducted by Corona Sugars. The age range of the cohort was 18-65 years. A detailed clinical history including family history of Diabetes, Hypertension, smoking /alcohol intake, Occupation status were recorded. Random blood sugars of patients who had not measured their blood glucose levels for at least one year and their anthropometric data were measured.

Results: In our study, out of 1056 screened the prevalence of women with impaired glucose tolerance was 461. 51% of them were under the age of 40 and 29% amongst them had PCOD.

Conclusion: Our study showed an increasing burden of undiagnosed DM in all age groups, especially in young (18-40), which is alarming. In young females, PCOS was the probable contributing factor for the development of T2DM along with faulty lifestyle, sedentary extended working hours and urban lifestyle. Early identification of PCOS with dysglycemia, would help to prevent/ delay onset of Diabetes and its related complications.

Passionate Nutrition and Dietetics professional with 7+ years of experience, dedicated to improving dietary habits and long-term health of people of all ages. She has a Post Graduate Diploma in Hospital Administration & Health Care Management. She is a dynamic speaker & educator with a passion for teaching healthy nutritional habits. Competent Communicator with the ability to lead large group sessions, while still giving individualized attention. Passionate medical blog writer and keen research-oriented professional with data analytics and content writing skills.

Objective: To assess the feasibility of a dietary intervention among women with polycystic ovary syndrome (PCOS) with an iso-caloric low glycaemic index diet.

Study Design:

• Participants- overweight women with PCOS

• BMI (Body Mass Index): >30

• Age: 18-40 years

Time intervention: 6-month randomized weight loss study.

Method: A randomized 12-week low-GI dietary intervention, preceded by a 12-week habitual diet control phase & preceded by a 12-week follow-up phase was conducted. Dietary intake, body composition, and metabolic risk markers were determined at baseline, after completion of the habitual diet control phase, and after the low-GI dietary intervention. Primary outcome: Change in insulin sensitivity.

Secondary outcomes: Assessment of changes to lipids, body composition, & estimated macronutrient intake.

S M Rahman has done his MBBS from R G Kar Medical College, Kolkata, India in 2001. He completed his MD in obstetrics and gynecology from prestigious AIIMS, New Delhi, India in 2006. He completed his senior residency from the same institute in 2009. At present, he is working a consultant in obs & gynae at CMRI hospital, Kolkata, India. He is also working as an IVF consultant at CRADLE fertility center at Kolkata, India. He is also the founder and medical director of CRADLE fertility center which is a high-quality IVF setup. He has publications in several national and international journals.

PCOS is a common polygenic multifactorial condition affecting a wide population. PCOS poses an interesting problem for assisted reproduction. Initial treatment of infertility in PCOS is ovulation induction with clomiphene citrate, letrozole, and low dose gonadotrophin. LOD has been suggested as an effective alternative to OI. Patients’ refractory to all these interventions or with existing pathology can undergo ART with a closely monitored setting to produce the desired outcome without much complication. Ovarian stimulation for women with PCOS often requires a different approach to that for women with normal ovaries. The response often is slow but then spiral rapidly to a picture of over response leading to OHSS and cyst formation. More oocytes are retrieved but fertilization rates were reduced when compared to another group of infertility patients. Despite comparable pregnancy rates, the miscarriage rate in PCOS following IVF remains high compared with women with normal ovaries. This the unwanted outcome is proportional to BMI, increased waist-hip ratio, and insulin resistance. OHSS is the most serious iatrogenic complication of IVF treatment. Patients with PCOS are at a higher risk of OHSS during IVF. The incidence is hard to quantify ranging from 10 to 18%. Pituitary desensitization with a GnRH agonist or antagonist has become a universal concept with ART. Risk of OHSS is more with agonist protocol in PCOS patients. The pros and cons of different gonadotrophin preparation have been debated for years. After the initial use of hMG and then highly purified FSH came the recombinant FSH, LH, and hCG. Overall, there appears to be little difference in outcomes when all studies are combined. Use of metformin as an adjunct within the context of IVF has been explored. Although there is variable data on improvement of take-home baby rate with metformin, it definitely reduces the incidence of OHSS. IVM has attracted a lot of attention as a new technique in patients with PCOS.

Ruhi Yasmin has completed her MBBS from Shri Krishna Medical College and MS from Patna Medical College and Hospital, Bihar, India. She is the Director of Metro IVF Center, Darbhanga, India. She has published more than 14 papers in reputed journals and currently, she is working as a Teacher in Darbhanga Medical

College and Hospital, India.

Polycystic Ovarian Syndrome (PCOS) is the common endocrine disorder in women of a reproductive age, occurring in approximately one in seven women. Of these women approximately two-thirds will not ovulate on a regular basis and consequently may, therefore, seek treatment for ovulation induction. After exclusion of other significant causes of sub-fertility the pragmatic approach to ovulation induction is to commence with clomiphene citrate. The goal of ovulation induction is the development of a single ovulatory follicle and the avoidance of multiple gestations. Second line therapies consist of gonadotrophin therapy and laparoscopic ovarian drilling, the place of metformin therapy is believed to lie in the management of a woman with impaired glucose tolerance. It is imperative that all ovulation induction is performed with access to rapid serum estradiol monitoring and ultrasound facilities. The benefit of the use of aromatase inhibitors has not yet been proven in large studies. Women with PCOS undergoing in vitro fertilization (IVF) are at a substantial risk of ovarian hyperstimulation syndrome and this approach should be avoided if at all possible. If it is required these women may be suitable candidates for in vitro maturation of oocytes (IVM) so avoiding ovarian hyperstimulation. Women with PCOS are potentially at an increased risk of miscarriage and in pregnancy if they are at an increased risk of developing gestational diabetes, pregnancy-induced hypertension, and pre-eclampsia. Furthermore, the neonate has a significantly higher risk of admission to a neonatal intensive care unit and a higher perinatal mortality.

Hassan El Motawkel Ala Allah Hassan Soliman has done his M.B.B.Ch. At Ain Shams University, Cairo, Egypt. In 1983, and done his M.Sc (Obst. & Gyn.) in Ain Shams University, Cairo, Egypt in1989, Diploma of Obstetrics & Women Health, Dublin, Ireland. He worked as a consultant and head of the department of Ob&Gyn in different Egyptian Military Hospital from 2001 to 2007 in Egypt. He got the membership in Royal College of Obstetricians & Gynaecologists,(M.R.C.O.G.), London, UK in 2000. He got the Fellowship in Minimal Access Surgery. World Laparoscopic Hospital. Guryana, Haryana, India. Acting as a Consultant and Head of Department Ob .& Gyn. In Saudi German Hospitals from 2007 till now (2018) in K.S.A. He became the senior member of the European Society of Aesthetic Gynecology (E.S.A.G.) in 2015.

Introduction & Aim: Since its introduction in 1984, Laparoscopic Ovarian Drilling (LOD) has evolved into a safe and effective surgical treatment for ovulatory, infertile women with Polycystic Ovary Syndrome (PCOS), unresponsive to Clomiphene Citrate. It is as effective as gonadotropins in terms of pregnancy and live birth rates but without the risk of ovarian hyperstimulation syndrome and multiple pregnancies. It improves ovarian responsiveness to successive ovulation induction agents, its favorable reproductive and endocrinal effects are sustained long. The aim of this study was to evaluate the role of laparoscopic ovarian drilling in correcting an ovulation and failure of conception in women with Polycystic Ovarian Syndrome. The investigation was designed as a retrospective study, was undertaken at a tertiary referral unit in KSA, Saudi German Hospital, Asser. The participants comprised of 150 women between 20-30 years old and Body Mass Index (BMI) between 20-30, treated with Clomiphene Citrate but failed to ovulate or get pregnant.

Method: During the period from November 2015-July 2017, 150 patients of PCOS who underwent LOD were included in the diagnosis of PCO was based on Rotterdam criteria which to be present for diagnosis four punctures for 4 seconds at 40 Watts for each ovary using the diathermy needle, diameter per ovary were applied during laparoscopy as standard technique for LOD

and were followed up a patient for one year.

Result: A total of 150 patients with anovulatory infertility associated with PCOS who underwent LOD were included among the 150 patients, only 78 included (52%) ovulates spontaneously after LOD and a further 31 patients ovulated after giving them Clomiphene Citrate in a dose of 100 mg/day for five days starting from the third day of their menses. Giving an overall ovulation rate of 109 out of 150 (72%). One patient conceived with twins and six ended in early fi rst trimester miscarriage and two were

ectopic pregnancies.

Conclusion: LOD is successful in PCOS patients who failed to ovulate on Clomiphene Citrate. LOD is more cost-effective than

gonadotropin’s as a single treatment results in several mono ovulatory cycles, thus allowing multiple attempts at conception whereas one course of gonadotrophic therapy yields a single ovulatory cycle with the inherent need for intensive monitoring. LOD is currently recommended as a safe, efficacious and cost-effective alternative to gonadotropins for induction of ovulation in infertile, anovulatory Clomiphene Citrate: Resistant PCOS women without the risk of ovarian hyperstimulation syndrome or multiple gestations.

Sini S Venugopal has completed her MBBS from SCB Medical College, Utkal University and MD (O&G) from VSS Medical College, Sambalpur University, India. She is currently the Director and Chief Fertility Consultant of Genix Fertility Care, India.

Implantation is a complex synchronized endometrial blastocyst cross-talk. Human reproduction is a relatively inefficient process. The probability of conception is only 25-30% per cycle of all the pregnancies that are lost, 75% represents the failure of implantation. Recurrent implantation failure refers to the failure to achieve a clinical pregnancy after transfer of at least four good quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40 years. There are multiple factors of recurrent implantation failure, mainly embryo factor, uterine factors, tubal factors, ovarian factors etc. In PCOS patients markers of uterine receptivity like V3 integrin, HOXA-10 and IGFBP-1 expression are decreased during the secretory phase. PCOS endometrium overexpresses androgen receptors and fails down to regulate estrogen receptor: α in the window of implantation. A thorough evaluation of both the female and the male partner is warranted to ascertain. Various treatment modalities to improve the chances of implantation like correcting uterine/tubal factors, endometrial coring, day-5 blastocyst transfer, assisted hatching have been explored. PGD/PGS is also done to improve the chances of implantation. Now personalized embryo transfer using a personalized window of implantation called endometrial receptivity array is also offered to patients with recurrent implantation failure. Time-lapse imaging of the cultured embryo may provide a complete picture of the developmental kinetics that the embryo undergoes. Applying this system, the morpho-kinetic parameters specific to embryos that are capable of implanting can be identified. The promising future options are gene therapy and endometrial stem cell therapy.