2^nd World Congress on Polycystic Ovarian Syndrome and Fertility December 09-10, 2019 Dubai, UAE

Eman I. Anwar completed her master’s degree Medical Basic Science in Pharmacology general grade Excellent, 2011 and Doctor degree in Clinical Pharmacology with GPA score: 3.642, August 2016. She is Pharmacovigilance & drug counseling center advisor at university hospital clinics Since June 2015 and Egyptian Association of Medical Basic Sciences (EAMBS) member since 2009. Her research interest is on Experimental Pharmacology in Oncology, Endocrinology, Pharmacovigilance, Medical Education and E-learning.

As declared by the Centre for Research Excellence in Polycystic Ovary Syndrome (CREPCOS) in partnership with the European Society of Human Reproduction, ESHRE and American Society of Reproductive Medicine (ASRM) in 2018, the diagnosis of PCOS is made when two out of three of the following criteria are met. First, is clinical and/or biochemical evidence of androgen excess after the exclusion of other related disorders. Second, is Oligo-ovulation or anovulation evidence and the third is the ultrasound appearance of the ovaries. The latter 2003 criteria mandated the presence of >12 follicles in each ovary measuring 2–9 mm and/or increased ovarian volume (>10 ml); in 2018 the cut-off for follicle number was raised to 20 or more in either ovary, to meet the improvement in ultrasound technology. Polycystic ovary syndrome represents 80% of anovulatory infertility cases. The pathophysiology of PCOS includes excess ovarian androgen production with insulinresistance as a common aggravating factor. Hyperinsulinaemia augments luteinizing hormone (LH) -stimulated androgen production. The precise mechanism of follicular arrest and anovulation is uncertain but an elevated level of Anti-Müllerian Hormone (AMH) was reported to play a restrictive role in follicular development. The PCOS-preconception guidelines are lifestyle changes (weight loss), folic acid therapy to prevent the risk of fetal neural tube defects and halting the consumption, of tobacco and alcohol. The first-line pharmacological intervention inducing ovulation includes a clomiphene citrate (CC) treatment with timed intercourse. The second line comes the administration of exogenous gonadotropins with follicular growth monitoring. Ovulation induction is effective with cumulative live birth rates of approximately 70%. Finally, an assisted reproduction technique (in-vitro maturation / fertilization (IVM/IVF) or intracytoplasmic sperm injection (ICSI) are the third-line treatment and is recommended when the previous interventions fail, it is the first choice in cases of bilateral tubal occlusion or semen abnormalities that impair the occurrence of natural pregnancy. The routine use of metformin in infertility treatment of anovulatory women with PCOS isn’t yet pharmacological evidenced. Tamoxifen and aromatase inhibitors (anastrozole and letrozole) were reported to give promising outcomes but longer-term studies are necessary to prove their safety. Concrete recommendations for safe dosage of gonadotropins, individualized protocols and preventive methods to avoid ovarian hyper stimulation syndrome (OHSS) are lacking. The challenge is to identify those patients who are at risk and offer

the chance to use selectively more safe alternatives.

Huang Wei Ling M.D, Taiwan born and Brazilian raised, with a 27 years’ experience on the clinical and private fields of Traditional Chinese Medicine practice, Hospital Infection Control, General Practice, Parenteral and Enteral Medical Nutrition, nowadays owner and practitioner of Franca’s only Medical Acupuncture and Pain Management Clinic. Since 2007, Huang has been travelling worldwide attending conferences as special, keynote and general speaker in a variety of specialties, presenting her exclusive point of view through unique case studies from her experiences, Traditional Chinese Medicine literature and Hippocratesreasoning.

Statement of the Problem: Female infertility is defined as the inability to conceive or carry a pregnancy to term after 12 months of unprotected intercourse or 6 months if the woman is over 35 years old. The purpose of this study is to demonstrate that infertility problems may be associated with Chakras energy deficiency, and deficiency of the massive organs in the Five Elements Theory, specially the Kidney, which is the energy responsible for the

reproduction.

 

Methodology: Two case reports of two women with infertility, with all laboratorial tests appearing normal. They were already trying to achieve pregnancy with in vitro fertilization. However, in the point of view of the energy of the chakras, all their chakras were depleted. They were treated with acupuncture, Chinese dietary counselling and treatment of the chakras’ energy with homeopathy and crystal-based medication. Findings: Both patients were able to achieve pregnancy only after the treatment with acupuncture, Chinese dietary nutrition and replenishment of the chakras’ energy through homeopathy and crystal-based medication.

 

Conclusion: Normal laboratorial fertility exams do not mean absence of disease. It is important to study in the energy level, which is invisible to the naked eye. The corrections of the chakra’s energy and the Yin, Yang, Qi and Blood, leads to a more successful treatment. The corrections of the energy imbalances improves the blood production, responsible for the fetus nutrition, and tones the chakras, mainly the second, represented by the Kidney’s energy, leading to an improvement of the conception.

Jayanta Jana is working as Executive Vice President, Medical Affairs & Marketing at Pharmed Limited, Bangalore, India. Experienced Senior Vice President with a demonstrated history of working in the pharmaceuticals industry. Skilled in Business Planning, Medical Devices, Sales, Biotechnology, and Market Research. Strong professional with a Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.) and Postgrad Oncology focused in Radiation Oncology Residency Program from NRS Medical College and SSKM Calcutta.

Introduction: Polycystic ovary syndrome (PCOS) encompasses a group of clinical presentations, the clinical and biochemical features are apparently centrally driven by insulin resistance, leading to incidence, disease progression, complications, or suboptimal clinical outcomes. In this review presentation, the pathobiology of PCOS has been evaluated from the standpoint of insulin resistance as the central driver.

 

Description: Insulin resistance and metabolic dysfunctions are hallmark and key pathological features in PCOS which lead to several associated abnormalities like irregular cycles, anovulation, infertility, hyperandrogenemia and hirsutism which adversely affects the quality of life in women. Further, it also has a psychological impact on daily life including poor self-esteem. Hyperinsulinaemia and metabolic dysfunctions are known to stimulate ovarian androgen production and decrease hepatic sex hormone-binding globulin, resulting in hyperandrogenism and the associated clinical features of PCOS. An extensive review of literatures establishes this concept, and hence management should also consider these elements more specifically. Conventional treatment for PCOS includes diet and lifestyle changes, specific medications, targeted to address different facets of the pathological events. To that end, we explored the possible role of magnesium as a therapeutic agent in the totalitarian management of PCOS. Several randomized trials and retrospective cohort studies found subclinical magnesium deficiency (SMD) in this set of populations. SMD in turn leads to lack of vitamin D absorption, transportation and pharmacological actions. Both magnesium and vitamin D have a potential role in insulin action and metabolic control. It has been well-established that

in PCOS women, magnesium deficiency was found to be in the range of 14.5% to 81% in the affected individuals and vitamin D deficiency in the range of 67%-85%. Deficiency of both these nutritional factors exacerbates metabolic abnormalities in PCOS which further adversely affects mainstream therapy outcomes.

 

Conclusion: Critical review of literatures shows that magnesium increases vitamin D level, and both have beneficial effects in controlling metabolic dysfunctions. Of note, magnesium itself has a crucial role in insulin signalling and thus improves insulin sensitivity and metabolic improvements along with a reduction in cardiovascular risk factors. So, supplementing magnesium in PCOS should be a novel and routine therapeutic approach in managing metabolic syndrome thus improving primary therapy outcomes.

Poornima Durga, MBBS, DNB (OBG) trained in Monash IVF, Australia, is the medical director of MOM IVF & Research Centre, Hyderabad, India. She has been a national speaker and participated in many national and international conferences.

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrinopathy affecting women. It affects around 80% of anovulatory infertile cases. It has an unknown etiology and is recognized as a heterogeneous disorder that results in overproduction of androgens, primarily from the ovary, and is associated with insulin resistance. Patients with PCOS represent a challenge for reproductive medicine. They present with many complications and challenges for IVF treatment. The use of a calculated low-dose stimulation strategy with step-up according to ovarian response may help in thoughtful management of these patients. Careful selection of FSH dose may help in mitigating the risk of OHSS. The choice of the starting dose of FSH has to be calculated by patient’s basal AMH level, AFC, age, BMI and PCOS diagnosis.

Shirin Jahan has passed MBBS from Dhaka Medical College in 2003. She has completed her Fellowship (FCPS) in OBGYN in 2013 from Bangladesh College of physicians and Suegeons and Masters in Surgery (MS) in OBGYN from Dhaka University in 2016. Currently, she is working as Junior Consultant in the Department of Reproductive Endocrinology and Infertility in Bangabandhu Sheikh Mujib Medical University , Dhaka, Bangladesh.

The aim of this study was to evaluate the serum lipid status in patients with PCOS and to compare the lipid status between PCOS patients and woman without PCOS. This cross sectional analytical study was carried out in 50 women diagnosed as polycystic ovary syndrome on the basis of Rotterdam Criteria (group I) and 50 women of reproductive age group without polycystic ovary syndrome (group II) attending the outpatient department of Obstetrics and Gynaecology of Dhaka Medical College Hospital, Dhaka, Bangladesh during the period of July 2013 to June 2015. The mean serum total cholesterol, triglycerides and LDL were significantly (p<0.005) higher in group I but mean HDL cholesterol was not significantly (p>0.05) associated with PCOS. Patients with raised total cholesterol: HDL ratio having the risk of developing dyslipidemia estimated to be 11.16 (95% CI = 3.9-33.1) times higher in PCOS patients than that in the group II. In multivariate logistic regression analysis of lipid profile, only raised LDL-C (>130 mg/dl) was found to be significantly associated with PCOS (p<0.05). High LDL level was more associated with PCOS followed by TC, TG and TC: HDL ratio. This study demonstrated a higher level of dyslipidemia specially in PCOS with higher BMI.

Saleem Ali Banihani has completed his PhD from Cleveland Clinic-Cleveland State University collaborative program in the field of Clinical Bioanalytical-Chemistry and Molecular Medicine. In addition, he completed a research fellowship in Andrology from Reproductive center at Cleveland Clinic and another research fellowship in Responsible Conduct of Research from University of Claifornia San Diego. Currently, he was the Vice Dean of Faculty of Applied Medical Sciences at Jordan University of Science and Technology. He has published more than 50 papers in reputed journals, mainly in the field of Andrology.

Lansoprazole is a commonly used acid reducer belongs to proton pump inhibitors family. It is used to relief various gastric illnesses such as esophageal reflux disease, ulcers, and Zollinger Ellison syndrome. In this study, as a supporting research of the post-marketing surveillance of lansoprazole, we revealed the in vitro effect of various concentrations of lansoprazole on

some seminal quality parameters such as sperm motility, sperm viability, and seminal nitric oxide concentration. Men with normal semen quality were recruited in this study. Lansoprazole at approximately 3.0 μg mL-1 concentration was found to significantly reduce progressive and total sperm motility, but it had no effect sperm viability or seminal nitric oxide level. Such

findings are of great importance for health care providers, mainly andrologists and urologists, and patients with poor semen quality, mainly patients with asthenozoospermia.

Eman I. Anwar completed her master’s degree Medical Basic Science in Pharmacology general grade Excellent, 2011 and Doctor degree in Clinical Pharmacology with GPA score: 3.642, August 2016. She is Pharmacovigilance & drug counseling center advisor at university hospital clinics Since June 2015 and Egyptian Association of Medical Basic Sciences (EAMBS) member since 2009. Her research interest is on Experimental pharmacology in oncology, endocrinology, Pharmacovigilance, Medical education and E-learning.

Ovarian hyper-stimulation syndrome (OHSS) is a severe iatrogenic potentially life-threatening complication of controlled ovarian stimulation. The primary risk factors for OHSS are young age, low body mass index, polycystic ovarian

syndrome (PCOS), and history of previous OHSS. Ovarian hypersecretion of vascular endothelial growth factor (VEGF) has been identified as a prime causative factor, playing a major role in the observed increases in angiogenesis and vascular permeability that are the pathophysiological components of OHSS. The pathogenesis of OHSS induced by either exogenous or endogenous human chorionic gonadotropin (hCG) triggers the syndrome. As hCG alone doesn’t exert a vascular activity, at least one angiogenic substance must be released from the ovary in response to gonadotropins. Subsequent studies have

focused on substances present in the follicular and ascitic fluid of hyper-stimulated women. Cytokines and growth factors (interleukins IL-2, IL-6, IL-8, IL-10, IL-18 and VEGF) are known to be implicated in the inflammatory processes associated with late follicular maturation, ovulation, corpus luteum function and embryo implantation. These factors were reported to mediate the vascular permeability in response to hCG. Several pharmacologic interventions have been proven to be effective in OHSS prevention, but randomized controlled trials have seldom compared multiple drugs’ effectiveness in preventing OHSS (primary outcome) and their influence on pregnancy rate as a secondary outcome. Five pharmacologic interventions were superior to placebo in decreasing OHSS incidence were cabergoline, metformin, aspirin, intravenous calcium, and hydroxyethyl starch. Glucocorticoid administration can presumably be linked to both beneficial and harmful effects on fertility

and pregnancy, depending on individual woman immune parameters and effects of glucocorticoids on immune cells in the peri-implantation endometrium. Immune cells including T cells, NK cells, dendritic cells and macrophages are all required for embryo implantation and robust placental development. Glucocorticoids affect the generation, recruitment, activation

phenotypes and function of different immune cells in various ways. The assumed possible protective effect of corticosteroids in OHSS is based on previous studies reporting inhibition of VEGF-gene expression, VEGF-induced vascular leakage and their current clinical use in the local management of diabetic retinopathy neovascularization and macular edema. The present study

compared the effects of hydrocortisone sodium succinate, methyl-prednisolone and dexamethasone systemic pre-treatment on induced severe OHSS model in female albino rats. Then the effect of methyl-prednisolone on severe OHSS prevention and endometrium immune cells infiltration were compared to cabergoline use alone and their combination.

Saher Rafiq , she is a student and doing Master in Clinical Psychology from University of Central Punjab Lahore. She worked in Fountain House which is a Mental Asylum for the duration of four months. She done her internship in Special Education amd Training Center and worked with the special children for four months. She also have gained experience of working with drug addicts as a psychologist in the addiction center of Lahore. Saher Rafiq previously done her graduation in Psychology from Government College University Lahore.

Women are often recognized and judged by their appearance, features and physique instead of their character, abilities, and intellect. While looking at the representation of women in popular media, one quickly gets picture of great looks and perfect body which is very difficult to attain, prompting feelings of deficiency or inadequacy. The aim of the current study is to explore the psychological problems faced by the women who are under treatment of polycystic ovarian syndrome (PCOS). PCOS is a purely medical and hormonal problem its symptoms include obesity, infertility, hair loss, acne, hirsutism

and menstrual irregularities but it had been shown to trigger psychological burden as well. The symptoms of PCOS lead women towards the fear of being negatively judged and distress regarding their appearance so it would impact social, dermatological as well as psychological aspects of women. Data was collected from public and private hospitals. Cross-sectional research design

was used by using purposive sampling. Sample size was n =180, calculated with the help of G-power analysis. The participants filled the demographic sheet along with following standardized scales; Derriford Appearance Scale (Carr, Moss & Harris,1991), Fear of Negative Evaluation Scale (Leary, 1983) and UCLA Loneliness Scale (Russell, 1996). The proposed statistical analysis includes descriptive statistics, Pearson product moment correlation, and analysis of variance (anova).

Fahimeh Golbabaei has completed her bachelor of midwifery at the age of 22 years and master’s degree at the age of 26 years both from School of Nursing and

Midwifery, Iran University of Medical Sciences. She worked in a hospital as a midwife for 2 years. Now, she is an access officer in “Family Health Association of Iran” which is an international NGO. She has done research in field of sexuality and taken many courses about sex therapy, couple therapy and psychotherapy in

university and other educational and research institutions.

Sexuality is an important aspect of life and sexual dysfunction is a common health problem among Iranian women. Prevalence of sexual dysfunction is very high in women with polycystic ovarian syndrome which has been most neglected in clinics. Studies have shown the effectiveness of sexual counseling based on PLISSIT model in improving sexual performance of women in various groups. However, the impact of this model has not been studied on women with PCO yet. This clinical trial study was conducted on 66 patients between the ages of 18-45 years. They were randomly allocated to two intervention (33 people) and control groups (33 people). In the intervention group, women received four sessions of weekly, one hour and face to face sexual counseling. Patients in the control group received routine care. The data gathering tools were a demographic questionnaire and Female sexual function Index (FSFI). The data were collected in three phases including before intervention, one month after the pre-test and follow up three months after the pre-test in both intervention and control groups. The sexual function score in two groups were compared by using Friedman, Mann Whitney U and Wilcoxon tests. Friedman test showed that the sexual function’s score and its domains in the intervention group were significantly higher than the control group (p<0/05), but there was no significant difference between the two groups in the lubrication score. The present study shows that PLISSIT model is effective in treatment of sexual dysfunction of women with polycystic ovarian syndrome. This model can be used in clinics in order to conduct sexual assessment and treatment of women with PCO.

Background: Gestational Diabetes Mellitus is a public health issue and one of the causes of maternal and fetal mortality and morbidity. Awareness of the condition among antenatal women will translate into adoption of a healthy lifestyle, better healthcare-seeking pattern, better self-care practice, which prevents acute complications, reduces the risk of long-term complications and promotes pregnancy outcome.

 

Objectives: The study was aimed to assess the knowledge and self-care practice among the antenatal women with Gestational Diabetes Mellitus.

 

Method: A descriptive cross-sectional study was conducted among 60 antenatal women who had GDM attending antenatal ward and OPD of BPKIHS by using purposive sampling method. Data was collected by interview method and analyzed using descriptive and interferential statistics at level of significance 0.05.

 

Result: The study findings revealed that 36.7% of the respondents were in the age group of less than 25 years and the mean age was 28.10 with standard deviation of 5.251. Among the respondents, 64.2% had completed secondary level education. The overall knowledge regarding GDM was good in 33.3%, average in 40% and poor 26.7%, whereas regarding self-care practice only 11.7% had good practice, majority of 80% had average and 8.3% had poor practice. And the relationship between knowledge, and practice was found statistically significant.

 

Conclusion: Most of the respondents had good knowledge regarding GDM but most of them did not have positive self-care

practice though there is positive relationship that reflects the need of further support.

Uzma Ilyas, Senior Lecturer at University of Central Punjab, Lahore. She have experience of both academia and clinical practice of last almost 11 years. She served at different designations including Clinical Psychologist at SOS Children’s Village, Lahore. She also served as Head of Department Psychology, Garrison University, Lahore. Currently, she is polishing and focusing the gaps in research in Pakistani societies. My main area of interest includes female population along with cross cultural aspects among professional and genders.

The role of female as wife is considered crucial in child-bearing and extending family and any delays in conception attributed towards non-productive and stagnant. Infertility is the worldwide issue, it has profound impact on women's

mental health and on the person as a whole. For many couples, infertility is as much an emotional and spiritual crisis as it is a physical challenge. The role of spouse and uncertainity in relationship is aftermath that follows infertility and need to be addressed for comprehending correlate of infertility. Physical, emotional, sexual and spiritual aspects of one's life are all affected by this disease of the reproductive system. Women with infertility felt anxious and depressed, along with low selfesteem, stigma, and depression as childless women. (Harvard& Mental Health, 2009).Data was collected from public and

private hospital from the women with primary infertility. Cross-sectional research design was used by employing purposive sampling. Sample size was n =200, calculated with the help of G-power analysis. The participants filled the demographic sheet along with following standardized scales; Relational Uncertainty Scale (Knobloch, 2007), Multidimensional Scale of Perceived

Social Support(Zimet,1988), Coping Styles Scale(Zaman,2015), Relational Turbulence Scale(Knobloch, 2007) and Symptom Checklist-R (Dawood, Rahman, Mansoor, Rehman& Ali, 2009). The proposed statistical analysis includes descriptive statistics, Pearson product moment correlation, and analysis of regression.