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.