Posted: 5/10/2006
The PCOS Puzzle
…From the pages of South Jersey Magazine…

Long misunderstood, Polycystic Ovarian Syndrome, a leading cause of infertility, is treatable.

Like many couples who have difficulty conceiving naturally after a reasonable amount of time, Jennifer and Christopher Naddeo looked for answers. After meeting with the team of specialists at the Delaware Valley Institute of Fertility & Genetics (DVIF) in Marlton, the Cherry Hill couple was shocked to learn that Jennifer was insulin resistant, a condition that often leads to Polycystic Ovarian Syndrome (PCOS). PCOS is a common cause of infertility in women.

Happy to learn that PCOS is treatable, Jennifer diligently followed the advice of her medical team. With the help of Chung H. Wu, MD, FACOG, director of DVIF’s Polycystic Ovarian Syndrome (PCOS) Early Detection and Treatment Program, and Melissa Bennett, RD, CDE, a medical nutrition therapist at DVIF, Naddeo lost 25 pounds and was no longer insulin resistant. Soon after, she became pregnant with twin boys, Justin and Jonathan, who are now 21/2.

“By working with Dr. Wu and Melissa, I was able to understand how my diet affected my ability to conceive,” says Jennifer. “I learned how to eat healthy, how to relieve stress, and how to fit exercise into my daily routine.” This healthy regimen continued through her pregnancy with the Stork’s Nutrition Program®, a program exclusive to DVIF that provides medical nutrition therapy to pregnant women to optimize the health outcomes of both mother and child.

According to the Polycystic Ovarian Syndrome Association, a national nonprofit organization operated by women with the condition, an estimated 6 to 10 percent of all women have PCOS. Most don’t even know it. Also known as Stein-Leventhal Syndrome or Polycystic Ovary Disease (PCOD), PCOS is the most common hormonal disorder among women of reproductive age. Often caused by insulin resistance, being overweight, and high stress levels, PCOS not only affects a woman’s chances of conceiving, but her ability to carry to term as well.

“Insulin resistance means that the body doesn’t respond to insulin properly to bring the sugar levels down, so the pancreas works harder and harder to produce more insulin to get the blood glucose level under control,” explains Dr. Wu. “The pancreas eventually becomes exhausted and can no longer output enough insulin to keep the blood sugar level down. This chronic condition causes the ovaries to produce too many male hormones, which can suppress egg maturation and damage the eggs themselves. This makes it difficult for a woman to achieve pregnancy and also increases the rate of miscarriage if she does conceive.”

If a woman with PCOS undergoes a full course of fertility-drug treatment to boost egg production for in-vitro fertilization (IVF), her ovaries can become hyperstimulated, a very serious condition that can lead to life-threatening breathing problems, blood clots, and kidney failure. Severe hyperstimulation of the ovaries also can cause strokes and other long-term complications.

IVF involves joining a mature egg and sperm in a dish, growing the embryos, and then transferring them to implant in the uterus. Approximately 2 million babies have been born worldwide using the technology. An experimental technique called in-vitro maturation (IVM) offered by DVIF prevents women with PCOS from ovarian hyperstimulation by dramatically decreasing the length of time spent taking fertility drugs. The technique involves removing immature eggs, ripening them in a lab dish, and then adding sperm. Christine Mozes of Lumberton, the first to undergo IVM at DVIF, became pregnant last fall and is due later this year.

Besides infertility and early pregnancy loss, symptoms of PCOS due to insulin resistance include irregular menstrual cycles (few or no periods) excess facial or body hair acne sudden unexplained weight gain difficulty maintaining a healthy weight darkened patches of skin on the neck, groin, under the arms, or in the skin folds depression or anxiety balding or thinning hair and elevated cholesterol, especially LDL, or triglycerides. There is often a family history of type II diabetes, heart disease, or hypertension. The symptoms and severity of PCOS vary from woman to woman.

“The threshold for identifying women with PCOS has changed. For many years, it was a black and white issue. You either had it or you didn’t. Now we realize the condition may be present in varying degrees, ranging from the typical classical variety to more subtle cases that may be difficult to detect. Women with severe PCOS have a very large number of small, immature follicles, which makes ovulation induction very difficult,” says Louis Manara, D.O., a reproductive endocrinologist who practices in Voorhees.

“Because there’s still a lack of awareness about PCOS, I set aside an hour to talk with my patients that have been diagnosed with this condition to go over what they need to do to identify and protect them from the medical risks associated with the syndrome. Often that involves losing weight, exercising, and taking medication.”

According to Dr. Manara, even if a woman with PCOS does not wish to get pregnant, she needs to be treated properly. “It used to be okay to just put these women on birth control pills to regulate their periods, but not anymore. PCOS carries a host of medical concerns besides infertility, including the increased risk of hypertension, diabetes, and heart disease. It needs to be taken seriously.”

What’s less known but just as important, PCOS also causes women to suffer a diminished quality of life, family dysfunction, difficulties at work, and an altered sense of feminine identity, according to Karen Ann Brook, MSW. Brook is a NJ-licensed clinical social worker and marriage and family therapist in private practice in Medford. Brook has counseled many PCOS patients to help them manage stress and to stick to a healthy eating and exercise plan.

“I help PCOS patients focus on making “small-step” changes to their lifestyle by teaching them certain therapeutic techniques and by giving them positive feedback,” she explains. “Combined with weight loss and exercise, these coping techniques have a great impact on controlling PCOS.”

The good news is that PCOS is treatable if it’s detected early, according to Dr. Wu. “Our institute is one of the very few facilities that can not only detect, but treat the condition as well,” he says. “The specialized test for insulin resistance is as simple as drawing blood. Then we develop a plan to get the insulin level under control.”

Dr. Wu has successfully treated over 2,000 women with PCOS and has conducted several studies on the effect of lifestyle change on controlling the condition. He has found that many of his patients with PCOS who begin exercising regularly, eating a well-balanced diet filled with fruits, vegetables, and whole grains, and managing stress can control the condition without medication. Some, however, do need to take insulin-sensitizing medications, such as metformin (Glucophage®), in conjunction with adopting a healthy lifestyle to manage PCOS.

Several studies are also underway investigating the role of stress and food choices on PCOS. No longer is this condition a medical mystery. Because PCOS is treatable, there is now hope for the estimated 3 million women that long to fulfill their dream of motherhood.

Helpful Resources for PCOS
For more information about PCOS or to locate a support group near you, visit the Polycystic Ovarian Syndrome Association at www.pcosupport.org.

Published (and copyrighted) in South Jersey Magazine, May 2006.