PANDORAwww.pcosindia.org

Registered AddressKwality House, 1st Floor, August Kranti Marg, Kemps Corner, Mumbai 400 026

Phone: 022 23802584, 022 23803965 , Fax: 022 23804839Email: thepcossociety@gmail.com

Volume 3 | Issue 1 | Feb.-May 2018 | Pages 12

...The Newsletter of The PCOS Society of India

■ Inositols in PCOS– Daniela Menichini, Fabio FacchinettiPage 02

■ Editorial,New patrons, Life membersPage 03

■ Events and Updates –Travelling Seminars on “Understanding PCOS”Page 04

Masterclass on "PCOS and Infertility"Page 05

■ Programme and Brochure 3rd

International ConferencePage 06

■ Events and Updates –The PCOS Society at ISGE, ItalyPCOS Online Certificate CoursePage 11

Fabio FacchinettiUniversity of Modena and ReggioEmilia, Italy

Daniela MenichiniUniversity of Modena and ReggioEmilia, Italy

Inositols in PCOS

1. Introduction on PCOSPolycystic ovary syndrome (PCOS) is a state ofhormonal dysregulation and unbalanced ovarian/follicle dynamics affecting 5-10% of women inreproductive age1. The wide range of PCOS signsand symptoms makes its severity & gradingchallenging. Clinically PCOS can be characterized bysome or all of these features:1. hyperandrogenemia2. oligo/amenorrhoea3. menstrual irregularity4. insulin resistance(IR)5. presence of 2-9 mm ovarian microcysts;6. an ovarian volume greater than 10 ml2.

Due to its multifactorial nature, the precise etiologyof PCOS has not yet been completely elucidated,but some risk factors as cardiovascular disease, type2 diabetes, hypertension and obesity3 and keytriggering conditions as insulin resistance andhyperinsulinemia4 have been identified.

Given the central role of insulin resistance in the onsetof PCOS, insulin-sensitizing agents, such as Inositolshave been proposed as new a therapeutic approach5.

Moreover, considering the economic and socialburden of PCOS , which not only represents aleadingcause of female infertility worldwide6,7, it becomesparticularly important to understand the newtreatment options, focusing on the role of Inositols,both in terms of potential mechanisms and efficacy8.

2. Inositols – Characteristics and PropertiesInositols belong to a group of molecules comprisingnine possible forms called 'stereoisomers' of inositol,all composed by the same basic structure, namedmyo-, scyllo-, epi-, D-chiro-, L-chiro, neo-, allo-, cis-, and muco-isomers9. They have a cyclic six-carbonstructure with one hydroxyl group at each carbon.These moleculesprovide the structural basis forinositol phosphates, importantsecondary messengersin eukaryotic cells, and serve as criticalcomponentsof the structural lipids, phosphatidylinositolandphosphatidylinositol phosphate10. Myo-inositol(cis-1,2,3,5-trans-4,6-cyclohexanehexol, MI) andD-chiro-inositol (cis-1,2,4-trans-3,5,6-cyclohex-anehexol, DCI)represent a promising treatment forPCOS, having shown sometherapeutic benefit11.

3. Physiological roles of Inositols: BiologicalFunctionsInositols are present in cells both as free form and ascomponents of membrane phosphoinositides andtake part in great variety of functions, including cellgrowth and survival,development and function ofperipheral nerves, osteogenesis and reproduction.

In their conjugated form, inositols are componentsof cellular membranesand have a crucial function inmembrane integrity andin intracellular signaling10.Both MI and DCI-phosphoinositides are able toinfluence the intracellularmetabolic processesactivating key enzymes involved in oxidativeand non-oxidative glucose metabolism7. MI is involved in themetabolism, transportand breakdown of glucose andits conversion to glycogen12, while DCI is involved inthe insulin-signallingpathway and in the stimulationof serial enzymes that are in turninvolved in theregulation of glucose metabolism, (e.g.,pyruvatedehydrogenase phosphatase (PDHP), proteinphosphatase 2C(PP2C), inositol-phosphate glycan13.Furthermore, it has been suggested that MI and DCIwork in synergy in theglucose metabolism; inparticular, MI induces the translocationof glucosetransporter to the cell membrane thereby enhancingglucose cellular uptake14,while DCI stimulatespyruvate dehydrogenase and supports ATPproduction via the Krebs' cycle13.

4. Role of Inositols in PCOSThe rationale behind the use of inositols in PCOSderives from studies showing that PCOS patients,due to IR, have an excess of MI and a deficiency ofDCI, together with a reduction of MI/DCI epimeraseactivity in peripheral tissues. It is, however, stillunknown at the molecular and cellular level, whetherinositol supplementation directly affects insulinsignalling and/or restores insulin sensitivity. Such aneffect would be beneficial as both IR and secondaryhyperinsulinemia trigger hyperandrogenicanovulation and / or irregular cycles. Up to now,evidence supporting beneficial clinical effects ofinositol supplementation in PCOS is provided, butmechanisms underlying these effects have not beenidentified8.

Recent studies demonstrated defects in tissueavailability oraltered metabolism of inositolphosphoglycans (IPG) in PCOS15. DCI was found tobe involved in post-receptor insulin signalling16

including androgen synthesis17. Due to MIinvolvement in FSH signalling, its impairment in PCOSmight be caused by MI deficiency5,17. A systematicreview showed that less (DCI)-containing inositol-phosphoglycan (DCI-IPG) was released in PCOSwomen compared to controls and this seemspositively correlated with IR and hyperinsulinemia.DCI administration had beneficial effects onovulation, anthropometric andmetabolic markers inPCOS by enhancing insulin sensitivity18.

It has been demonstrated that in PCOS, the increased

release of glucose-stimulated DCI-IPG via DCIsupplementation is significantly correlated withimproved insulin sensitivity. The significantrelationship between DCI-IPG release and insulinsensitivity prompted some scientists to suggest thatthe DCI-IPG mediator may be a target for therapeuticinterventions in PCOS19.

Both MI and DCI are necessary to assure the correctglucose metabolism in cooperation with insulin. Inphysiological conditions, the intracellular pool ofinositol inhuman ovaries is about 99% of MI whereasDCI is the remaining part20. Insulin controls theepimerase-converting MI into DCI. It is important tohighlight that the ovary maintains normal insulinsensitivity also in the presence of systemic IR 21. Thiscan explain why increased insulin release stimulatesovarian epimerase activity leading to intracellular DCIincrease and MI decrease. In agreement with this, inhyperinsulinemic PCOS women unexpectedly highlevels of DCI can be found in the ovary, withconcomitant MI depletion. This finding was called'The Ovarian Paradox'22 and might be consideredthe main cause of FSH signalling impairment inPCOS20. In these conditions, glucose uptake andmetabolism could negatively affect oocyte qualitydepending on MI23.Ovarian function improvement,as well as hormonal and metabolic parameters, wasdemonstrated after MI treatment inPCOS5. Moreover,MI shows results comparable or slightly better thanmetformin in ovulation induction but withoutanyside effects24. On the contrary, high doses of DCIalone, administered to PCOS subjects, were foundsignificantly detrimental for oocytes and thereforefor fertility25. While MI is a well-established safemolecule11, the data are lacking on DCI.

While a number of studies have analysed theeffectiveness of MI and DCI, alone or in combination,in PCOS, only two studies have compared the effectsof MI to DCI and found that they seem to exertcomparable effects26.

5. Clinical Evidences of Effectiveness of MI/DCICombinationDifferent authors examined the possibility ofadministering the MI/DCI combination27,28. Based onthe supposed alteration of MI/DCI ratio occurring inovary in PCOS, the combination MI/DCI 40:1 wastested and resulted twice effective in reducingHOMA-IR, compared to MI alone28 and induced animprovement, compared with placebo, of LDL, HDL,and triglycerides29. A single study compared thecombination MI/DCI (40:1) to treatment with DCIonly in PCOS women undergoing in vitro fertilization(IVF). The patients were treated twice a day witheither MI plus DCI or with DCI alone, for 12 weeksbefore rFSH administration and throughoutpregnancy. The results suggest that combinationtherapy improved oocyte and embryo quality andthe chance of becoming pregnant30.

Continued on page 11

Editorial

Dr. Duru ShahMD, FRCOG, FCPS, FICS, FICOG, FICMCH, DGO, DFPDirector, Gynaecworld, The Center forWomen’s Fertility & Health, MumbaiPresident, The PCOS Society (India)Chief Editor, Pandora

Editorial Team

Dr. Sabahat RasoolMD, DNB, MNAMS, FMAS, MRCOG (UK)Ian Donald Diplomate in OBGY Ultrasound, CroatiaFertility Consultant, Gynaecworld, MumbaiAssociate Editor, Pandora

Ms. Rochelle LoboAdministrative Assistant

3

Duru ShahFounder President, The PCOS Society, IndiaEditor, Pandora

Email: thepcossociety@gmail.comwww.pcosindia.orgDisclaimer – Published by the The PCOS SOCIETY (INDIA).Contributions to the editor are assumed intended for thispublication and are subject to editorial review andacceptance. PANDORA is not responsible for articlessubmitted by any contributor. These contributions arepresented for review and comment and not as a statementon the standard of care. All advertising material is expectedto conform to ethical medical standards, acceptance doesnot imply endorsement by PANDORA.

Dear Friends,

We have had a very eventful quarter after our last issue of Pandora! It's amazing how our Society has grown

and we are all very proud of it. There have been 2 programs which I particularly would like to talk about.

We organized a brilliant"Masterclass on "PCOS and Infertility" in collaboration with the CRE-PCOS

(Centre for Research Excellence in Polycystic Ovary Syndrome) and the Indian Society of Assisted Reproduction

in March this year, limiting participation to 100 delegates only. The knowledge gained through interaction

with experts like Rob Norman, Helena Teede from Australia and Chandrika Wijeyratne from Sri Lanka, was

stupendous and a treat for all who attended. And the cherry on the cake was the spontaneous offer by Rob

and Helena of a Travel Grant to a young delegate less than 40 years in the meeting to Australia, on behalf

of CREPCOS, in July this year. Applications were invited from the delegates were invited from the delegates

who attended and we received 4and sent them to Rob and Helena,who reviewed the applications and have

just sent us the name of the winner......... Dr. Sabahat Rasool!

The other program was the Online Certificate Examination which was based on the 6 Online Modules

which we have installed on our PCOS Society Website (http://www.pcosindia.org/pcos_tutorials.php).

The exam for this certificate course was held online on 2 consecutive Sundays with 2 different sets of

questionnaires, to give an opportunity to those who could not appear or clear the exams on the first Sunday.

We had a total of 787 participants who took the exams on the two days. Of these 469 have cleared the

exam with a percentage of 75% and more. Unfortunately, 318 have not cleared. Of the Participants who

have cleared 40 have excelled with 100% questions correct! A hearty congratulations to them.

The Third Annual International Conference of the PCOS Society of India; is to be held very soon in

June this year, once more in collaboration with the International Society of The Androgen Excess &

PCOS Society. After having 2 very successful meetings, one in the West zone (Mumbai) and the other even

better in the South zone (Bengaluru),with the enthusiasm shown by the organizing team in Gurugram, I am

sure it will be even better! The entire program has been printed in this issue of the Pandora. Registrations

can be made online through our Website (http://www.pcosindia.org/upcoming_events.php) or by bank

transfer and cheque (details on the registration form).

An added attraction in this meeting is the PCOS Practitioner Exam which will be conducted at the Conference

and is open to all members of the PCOS Society. The exam will be held as a multiple choice exam and all

those who clear will be offered a beautiful certificate of being a "PCOS Practitioner". So if you are not a

member please become one by applying through the website. (http://www.pcosindia.org/

membership.php)

We are looking for a young brigade for our society so that we can achieve even more! All those less than 40

and interested in joining our brigade, please write to us at thepcossociety@gmail.com if you fulfill the

following conditions:

■ Less than 40 yrs, Willing to give some time to the organization, Willing to take on a responsibility, Willing

to update girls and women about PCOS through the "Conquer PCOS" Program.

I look forward to hearing from you all.

With warm regards,

4

Events and Updates

The PCOS Society's Travelling Seminars on "Understanding PCOS" are aimed at educating

the treating gynaecologists about the basics of the multifaceted disorder called PCOS.

This "Travelling Seminar " was conceptualized to bring to your door steps the latest and

best evidence-based medicine for preventing and treating the various symptoms and

health consequences arising from PCOS through exhaustive interactive sessions and case

discussions. Experts from the PCOS Society, India, have been delivering lectures in various

parts countrywide. The Travelling Seminars are being conducted with an unconditional

educational grant from USV and till May 2018, twenty eight travelling seminars have

been conducted throughout the various states of the country.

BHAYENDER

SRINAGAR

SURATGURGAON

JALGAON

January, 13th 2018Dr. Saima SidiqDr. Imam-ul-HaqDr. Gulshan ZehraDr. Mehrajuddin Bhat

December, 31st 2017Dr. Sanjiv khurdDr. Purnima NadkarniDr. Usha ValadraDr. Mona Shroff

January, 24th 2018Dr. AP SidhuDr. Neera GuptaDr. Veena KaurDr. Poonam Rastogi

Dr. Duru ShahConvenor

Dr. Uday ThanawalaConvenor

BHATINDA

CUTTACK

December, 16th 2017Dr. Rajendra NagarkattiDr. Uday JoglekarDr. Sheetal PandeyDr. Kastubh Kulkarnir.Rajesh Koradia

October 10th 2017Dr. Sujata KarDr. Maya PadhiDr. Sujata MishraDr. PC Mahapatra

November 30th 2017Dr. Shakuntala KumarDr. Ila GuptaDr. Shalu GuptaDr. Divya Sardana

January, 20th 2018Dr. Indrani HatwarDr. S B NawalDr. Tushar Nehete

5

The PCOS Society of India and The Indian Societyfor Assisted Reproduction (ISAR) jointly organized aMasterclass on "PCOS and Infertility" on 24th-25th

March, 2018 at Mumbai. The Masterclass was anacademic treat attended by nearly 100 delegatesfrom all over India.

The distinguished speakers included Prof. RobertNorman, Professor of Periconceptual & ReproductiveMedicine from the University of Adelaide,

Prof. Helena Teede, President of the AndrogenExcess Society andProf. Chandrika Wijeyaratne, President of Sri

Lanka Medical Association.

The national faculty included Drs. MridubhushaniGovindraj, Madhuri Patil, Sonia Malik, Sujata Kar and

Duru Shah.

& INFERTILITYPCOS 24th-25th March, 2018, Mumbai

The program was spread over two days. Day

1 of the Masterclass started with anintroduction by Dr. Duru Shah and Prof. RobNorman.This was followed by interactive and

educational talks on nomenclature and diagnosis ofPCOS and Genotype/Phenotype in Asian versusCaucasian population by Prof. Teede and Dr.

Wiyayaratne, respectively.

After lunch, the session included the workup andinfertility management in PCOS, Genetic and

environmental interplay as the etiology of PCOS andMetabolic Syndrome.

Day 2 of the Masterclass started off with exhaustive

lectures on Insulin Resistance and OvulationInduction in PCOS. Afternoon session was dedicatedto Assisted Reproduction in PCOS and research

methodology and collaborations.

The lectures were up-to-date, very informative and

generated a lot of audience interest and interaction.The national anthems of Australia, India and SriLanka were played at the end of the session on the

Second day and the meeting closed on a very happynote.

Prof. Norman and Prof. Helena announced an

Observership from amongst the delegates at theMasterclass, for a young member between 30-45years. The Observership includes free travel to

Australia, free Registration and free stay to the bestapplicant, to attend a 3 day meeting in Australiaorganized by CRE-PCOS. Applications were invited

by the PCOS Society, 5 applications were receivedwhich were forwarded to Prof. Norman and ProfHelena for selection.

Dr. Sabahat Rasool has been selected for this VisitingFellowship by Prof’s Norman and Teede.

on

6

22nd June 2018 – PRE-CONGRESS WORKSHOPS08.00 am Registration

09.00 - 01.45 pm Hall A - Workshop 1Lifestyle Changes – The First Step to combating PCOS

Workshop Inauguration: Padmashree Prof. Raj Baveja

Workshop Convenors: Shilpa Joshi, Yukti Wadhawan, Shakuntla Kumar

09.00 am - 10.30 am Session I: Impact of lifestyle in PCOS09.00 am ■ Are dietary options different in lean and obese PCOS? Shilpa Joshi09.20 am ■ PCOS: A Body Image Disorder Aakanksha Bhatia09.40 am ■ Fad diets (Mediterranean / South Beach / Paleolithic / Atkins / gluten free) – What do all these diets mean? Shilpa Joshi10.00 am ■ Discussion

10.30 am - 12.00 noon Session II: Lifestyle interventions10.30 am ■ Do lifestyle changes improve sexual dysfunction? Sharmila Majumdar10.50 am ■ Role of Nutraceuticals in diet Nilanjana Singh11.10 pm ■ Ideal Exercise in Lean and Obese PCOS Shiny Surendran11.30 pm ■ Evidence of Yoga therapy in PCOS Anushree Patil11.50 pm ■ Discussion

12.15 - 01.00 pm Session III: When lifestyle fails – Reducing Morbidity of Obesity12.15 pm ■ Role of Bariatric surgery Praveen Bhatia12.35 pm ■ Management of Sleep Apnea – what should the Gynec know? Manvir Bhatia

Jointly Organized byThe PCOS Society (India) &

The Androgen Excess &PCOS Society (International)

Dates: June 22 - 24, 2018Venue: Leela Ambience Hotel, Gurugram, near Delhi Airport, India

Dear Friends & Colleagues,

Welcome to the Third Annual Congress of the PCOS Society of India, being held in

collaboration with the Androgen Excess and PCOS Society on 22nd, 23rd and 24th

June 2018 in Gurugram NCR, Delhi at the Leela Ambience Hotel.

PCOS affects women at all stages of life hence, this conference is entitled "PCOS...

through the cycle of life". The Conference will focus on the different stages of

life, including the prenatal, childhood, adolescent, reproductive and post-

menopausal periods. As gynaecologists, we are the primary care physicians of

women and manage many PCOS patients with different presentations at different

ages.

The Conference includes 3 Pre-Congress Workshops and the main conference

which will be interactive and will give in-depth knowledge on both the subjects.

Learning from experts from various disciplines of medicine can add to our

understanding of this complex endocrine problem. We will also be conducting for

the first time the "PCOS

Practitioner" Exam and the "PCOS Quiz"during the conference.

We welcome you and we are confident that it will excite you with the latest

knowledge and cutting edge research on PCOS.

For any queries, you may contact us at pcosconference2018@gmail.com or

thepcossociety@gmail.com

Looking forward to meeting with you.

With warm regards,

Duru ShahFounder PresidentThe PCOS Society, India

S C I E N T I F I C P R O G R A M M E

Duru ShahFounder President

The PCOS Society, India

Madhuri PatilScientific Chair –

ConferenceThe PCOS Society,

India

Piya ThakkarScientific Chair –

Pre-congressWorkshops The PCOS

Society, India

Helena TeedePresident

The AE-PCOS Society

Enrico CarminaCEO

The AE-PCOS Society

Ragini AgrawalLocal Organizing

Chair-person

Rita BakshiLocal Organizing

Chair-person

Shakuntla KumarLocal Organizing

Secretary

Ashok KumarLocal Organizing Secretary

7

12.55 pm ■ Discussion

1.15 - 01.45 pm Session IV: FootloosePut on your dancing shoes (Zumba) Team from Mama Mia

10.00-12.00 pm Hall B - "The PCOS Practitioner" Certificate ExamsConveners: Madhuri Patil, Ashok Kumar, Rita Bakshi

01.45- 02.30 pm LUNCH

02.30 - 06.30 pm Hall A – Workshop 2"PCOS: A diagnosis of Exclusion" – What you see is not alwayswhat you get!

Workshop Convenors: Piya Ballani Thakkar, S K Bakshi, Ragini Agrawal02.30 - 04.30 pm Session I:02.30 pm ■ Introduction of the Course Piya Ballani Thakkar02.40 pm ■ Hypothyroidism Madhuri Patil03.00 pm ■ Hyperprolactinemia Piya Ballani Thakkar03.20 pm ■ Cushing Syndrome and Acromegaly Beena Bansal03.40 pm ■ Adrenal disorders – CAH and adrenal tumors Deep Dutta04.00 pm ■ Discussion

04.30 - 06.00 pm Session II:04.30 pm ■ Androgen secreting ovarian tumors Pratima Mittal04.50 pm ■ Premature ovarian failure Padma Rekha Jirge05.10 pm ■ Uterine abnormalities Ranjana Sharma05.30 pm ■ Discussion

02.30 - 06.00 pm Hall B – Workshop 3Cosmetic Therapies – Live demonstration

Workshop Convenors: Rekha Sheth, Pankaj Chaturvedi, Monisha Kapoor1. Laser Hair Reduction: What works, what doesn't and what's new?2. Treatment of Adult Acne by Energy based Devices

06.00 pm COFFEE BREAK

06.30 - 7.30 pm A thought provoking Panel Discussion on"How do we reduce the epidemic of PCOS in our country?"With Gynaecologists, Endocrinologists, Public Health Experts, Media Representatives, Scientists,Private Health Care and Government Representatives………Moderator: Shereen BhanPanelists: Alka Kriplani, Ameera Shah, Duru Shah, Nomita Chandhiok, Pooja Shali, Rama Vaidya, Shailaja Chandra

07.30 pm Inauguration

08.30 pm BANQUET (By Invitation)

Conference Day 1 – June 23rd, 201808.00 - 09.00 am Invited free papers

09.00 - 10.30 am Session I: Diagnosis of PCOS09.00 am ■ What are the new criteria for Polycystic Ovarian Morphology (PCOM)? Harsh Mahajan09.20 am ■ Is Anti Mullerian Hormone a new marker for PCOS? Togas Tulandi09.40 am ■ Revisiting PCOS phenotype Enrico Carmina10.00 am ■ Discussion

10.30 am COFFEE BREAK

11.00 am - 12.00 noon Keynote AddressChairpersons: Rama Vaidya, Nomita Chandhiok

11.00 am ■ International Guidelines on PCOS Anuja Dokras11.30 am ■ Role of gastrointestinal function in determining the metabolic aspect of PCOS Enrico Carmina

International Faculty

Anuja DokrasUSA

Enrico CarminaItaly

Kannan AlpadiUSA

Kathleen HoegerUSA

Togas TulandiCanada

MCQs based on theSix Modules of PCOSpublished by thePCOS Society (india)Available atwww.pcosindia.org

8

12.00 - 01.00 pm Session II: Dermatological manifestations – Current Trends in Management12.00 pm ■ Acanthosis Nigricans Anil Agrawal12.15 pm ■ Androgenic Alopecia Rekha Sheth12.30 pm ■ Hirsutism Anil Ganjoo12.45 pm ■ Discussion

01.00 pm LUNCH

02.00 - 02.30 pm Keynote AddressChairpersons: Maninder Ahuja, Nita Dalal■ The diagnosis and management of PCOS – Novel Immunodiagnostic Methods Kannan Alpadi

02.30 - 03.45 pm Session III: Metabolic syndrome and PCOS

02.30 pm ■ Does Metabolic Syndrome present differently in Indian Women? Sujata Kar02.45 pm ■ Is there a difference in metabolic risks of lean and obese PCOS? Anuja Dokras03.00 pm ■ PCOS and GDM Nexus Hema Divakar03.15 pm ■ Discussion

03.45 - 05.00 pm Session IV: Impact of Stress on quality of life and how to reduce it?03.45 pm ■ Are women with PCOS more stressed? Kathleen Hoeger04.05 pm ■ Panel Discussion: Helping patients to deal with Stress – Multidisciplinary approach –

Get your answers from Clinicians, Mind Therapist and a Lifestyle guru.Moderator: Uday ThanawalaPanelists: Kathleen Hoeger, Kiran Aggarwal, Manju Verma, Mansi Kothari, Siddharth Saunthalia, Vani Jain. Vinit Taneja

05.00 pm COFFEE BREAK

05.30 - 06.30 pm Session V: Pregnancy and PCOS■ Panel Discussion:Are PCOS women at a higher risk of pregnancy and delivery complications? Case-based Discussion

Moderators: Rita Bakshi, Ashok Kumar

Panelists: Garima Kachhawa, Kanwal Gujral, Kiran Guleria, Nupur Gupta, Sanjivini Khanna, Vatsala Dadwal?

6.30 pm GBM

07.00 pm Session VI: Poster SessionSavita Singhal, Bharti Minocha

08.00 pm Cultural program

09.00 pm CONFERENCE DINNER

National Faculty

Aakanksha Bhatia

Alka Kriplani

Ameera Shah

Anil Agrawal

Anil Ganjoo

Anita Sabharwal

Anjali Tempe

Anju Soni

Anushree Patil

Archana Singhal

Arshi Iqbal

Aruna Batra

Aruna Murlidhar

Ashok Kumar

Ashok Taneja

Beena Bansal

Bharti Minocha

Chandan Kachru

Deep Dutta

Duru Shah

Garima Kachhawa

Geeta Kinra

Gulrez Tyebkhan

Harsh Mahajan

Hema Divakar

Hemani Sarbadhikary

Indu Koul

Jaideep Malhotra

Jyoti Malik

K. D. Nayyer

Kanthi Bansal

Kanwal Gujral

Kiran Aggarwal

Kiran Guleria

Lakhbir Dhaliwal

M. P. S. Chawla

Madhuri Patil

Manisha Kapoor

Manju Puri

Manju Verma

Manoj Pandya

Mansi Kothari

Manvir Bhatia

Munish Prabhakar

Nalini Mahajan

Navneet Magon

Neena Malhotra

Nilanjana Singh

Nomita Chandhiok

Nupur Gupta

Nutan Agrawal

O P Gangwani

Padma Rekha Jirge

Pankaj Chaturvedi

Pankaj Talwar

Piya Ballani Thakkar

Pooja Shali

Poonam Goyal

Pratima Mittal

Praveen Bhatia

Preiti Kumar

Puneeta Hasija

Pushpa Sethi

R. P Gupta

Ragini Agrawal

Raj Baveja

Rajesh Rajpal

Rakhi Singh

Rama Vaidya

Ranjana Sharma

Rekha Seth

Renu Misra

Rita Bakshi

Ritu Jain

Rukma Idanani

S K Bakshi

Sangeeta Agrawal

Sanjay Narula

Sanjivini Khanna

Satish Koul

Savita Singhal

Seema Pandey

Shailaja Chandra

Shakuntla Kumar

Sharmila Majumdar

Shashi Lata Kabra

Shereen Bhan

Shilpa Joshi

Shiny Surendran

Siddharth Saunthalia

Smita Mahale

Sonia Malik

Sudha Prasad

Sudha Sharma

Sujata Kar

Sujata Sharma

Sunita Malik

Swati Singh Rathor

Uday Thanawala

Vandana Narula

Vani Jain

Vatsala Dadwal

Vinit Taneja

Yukti Wadhawan

9

Conference Day 2 – June 24th, 201808.00 - 09.00 am Session VII: Round Tables with Experts

Convenors: Madhuri Patil, Rakhi Singh, Ashok Kumar(Each table limited to 10 participants) Experts

1. Luteal Support in infertility management in PCOS women Maninder Ahuja, Nutan Agarwal

2. Letrazole v/s Clomiphene Citrate in ovulation induction in PCOS? Togas Tulandi, Lakhbir Dhaliwal

3. Gonadotropins for ovulation induction in PCOS? Anuja Dokras, Duru Shah

4. Medical Treatment for Obesity Beena Bansal, S K Bakshi

5. Role of Oral Contraceptive Pills in Adolescent PCOS Kathleen Hoeger, Chandan Kachru

6. Use of Metformin in obese and lean PCOS? Rakhi Singh, Deep Dutta

7. Use of Inositols in the management of PCOS Nita Dalal, Sujata Sharma

8. Vitamin D in PCOS Satish Koul, Savita Singhal

9. Acne in PCOS Pankaj Chaturvedi, Gulrez Tyebkhan

10.Hirsutism in PCOS Sudha Prasad, Anil Agarwal

09.00 - 10.15 am Session VIII: Evidence based treatment for enhancing fertility09.00 am ■ Is PCOS an inflammatory process? Madhuri Patil09.20 am ■ Managing insulin resistance in infertility Sonia Malik09.40 am ■ Recent evidence on oral ovulogens Kanthi Bansal10.00 am ■ Discussion

10.15 - 11.15 am Session IX: Panel Discussion:■ Increasing efficacy and safety with ARTModerators: Jaideep Malhotra, Nandita PalshetkarPanelists: Arshi Iqbal, Nalini Mahajan, Pankaj Talwar, Preiti Kumar, Ritu Jain, Shakuntla Kumar, Seema Pandey

11.15 am COFFEE BREAK

11.45 am - 12.45 pm Session X: Keynote AddressChairpersons: Smita Mahale,Sudha Prasad

11.45 am ■ Consensus statement on the "Use of OCP in PCOS Women in India" Duru Shah12.15 pm ■ How does Ovarian Drilling fit in the treatment scheme, Togas Tulandi

is this a safe procedure and why do we use it so infrequently?

12.45 - 01.45 pm Session XI: Adolescent PCOS12.45 pm ■ Diagnosis of adolescent PCOS – A difficult task Neena Malhotra01.00 pm ■ Role of inositols in Adolescent PCOS Manoj Pandya01.15 pm ■ Abnormal Uterine Bleeding in Adolescent PCOS Ragini Agrawal01.30 pm ■ Discussion

01.45 pm PCOS Quiz - Live

02.15 pm Valedictory function and Awarding of CertificatesGuest of Honour: Smita Mahale, Director, NIRRH

02.30 pm LUNCH

Welcoming....Our New Patrons

Our New Life Members

Dr. Bharati Morey

Dr. Aarti MahlaDr. Angeline JobDr. Anita ManeDr. Anjali KumarDr. Aparajita GulatiDr. Asna Beg AshrafDr. B. Mohana Priya

Dr. C. JyothiDr. Dinesh JainDr. Geetha MuralidharaDr. Gopal Chandra DashDr. Gorakh G. MandrupkarDr. Gouri RaiDr. Indira Palo

Dr. Gitanjali G. Dr. Milind Shah Dr. Shashi LataKabra Maheshwari

Dr. Shefali D. Jain Dr. Sunil KumarChoudhari

Dr. Jyoti ShahDr. Kalpana M. BhattDr. Kothagattu SrinivasDr. M. LipikaDr. Mamta (Fogla)BukalsariaDr. Manisha M. Laddad

Dr. Rita Bakshi Dr. Varuna Pathak

Dr. Manu LaxshmiDr. Molina Niket PatelDr. MonikaDr. Naini TandonDr. Niket H. PatelDr. Preety AggarwalDr. Rakesh Pandia

Dr. Rana Mohammed AfzalChoudharyDr. Rashmi KapoorDr. Rekha RajendrakumarDr. Ritu ChauhanDr. Sadaram RamyaDr. Sagarika Sarkar

Dr. Seema SehgalDr. Shameem Kamal KhanDr. ShivaniDr. Shobha Rani RaoDr. Smita MoorthyDr. Trupti MhapsekarDr. Vaishali Vasant Khatav

Dr. Vanajakshi R.Dr. Vedhapriya S.Dr. Veena SurendraDr. Versha JainDr. Vinutha S.Dr. Yuvrajsingh D. Jadeja

10

Table1: Intervention studies with MI, DCI & acombination of DCI and MI in women affected byPCOS.

Given the complexity of PCOS, numerous studies onthe use of these two Inosotol stereoisomers havebeen performed.Their different concentration at the

tissue level and their different roles in the cell led tothe conclusion that both of them have to be usedfor the purpose of better treatment efficacy27. Indeed,

the data, summarized in Table 1, suggest that thecombination MI/DCI might be more effective thanthe supplementation with a single inositol species.

Due to the small number of treated patients thesestudies need to be confirmed in larger trials.

6. ConclusionsPCOS is a common endocrine and metabolic disordercharacterized by oligo-anovulation, hyperan-drogenism, and insulin resistance, this latter playing

a key role in the pathogenesis of this syndrome, bothin lean and obese women. Various therapeuticapproaches have been attemptedin PCOS, including

supplementation with Inositols, MI and DCI, whichmay have distinct and synergic physiologic roles inthe metabolism of glucose and in the regulation ofinsulinaction, counteracting the endocrine disorder

of this syndrome8.

The most recent literature reports that MI, DCI andin particular their combination in the physiological

ratio 40:1 could represent an important therapeuticapproach for the improvement of metabolic,hormonal and reproductive aspects of PCOS19.

By now, it is possible to outline a comprehensiveframework and bring about the best treatment forPCOS in keeping with the above cited findings,

specifying some milestones useful for the therapeuticapplication. Many articles testing the efficacy ofInositols contributed to further shed light on this

topic and strengthen several points with originalstudies and insightful reviews of up-to-date scientificliterature31.

However, future studies based on large cohorts andtesting a "tailored" dosage, calculated on thepretreatment conditions, are needed in order to

clarify the pivotal role of inositol's isoforms inaddressing the hormonal and metabolic parameterstoward homeostasis in PCOS patients.

References1. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES,

Yildiz BO. The prevalence and features of the polycysticovary syndrome in an unselected population. J ClinEndocrinol Metab. 2004;89:2745-9.

2. The Rotterdam Eshre/Asrm-sponsored PCOS consensusworkshop group. Revised 2003 consensus on diagnosticcriteria and long-term health risks related to polycystic ovarysyndrome (PCOS). Vol. 19, Human Reproduction. 2004. p.41-47.

3. Orio F, Palomba S. Reproductive endocrinology: newguidelines for the diagnosis and treatment of PCOS. NatRev Endocrinol. 2014;10:130-132.

4. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profoundperipheral insulin resistance, independent of obesity, inpolycystic ovary syndrome. Diabetes Metab Res Rev.1989;38:1165-1174.

5. Unfer V, Carlomagno G, Dante G, Facchinetti F. Effects ofmyo-inositol in women with PCOS: a systematic review ofrandomized controlled trials. Gynecol Endocrinol.2012;28(7):509-15.

6. Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A. European survey ofdiagnosis and management of the polycystic ovarysyndrome: results of the ESE PCOS Special Interest group'squestionnaire. Eur J Endocrinol. 2014;171:489-498.

7. Lauretta R, Lanzolla G, Vici P, Mariani L, Moretti C,Appetecchia M, et al. Insulin-sensitizers, polycystic ovarysyndrome and gynaecological cancer risk. Int J Endocrinol.2016;2016:1-17.

8. Sortino MA, Salomone S, Carruba MO, Drago. PolycysticOvary Syndrome: Insights into the Therapeutic Approachwith Inositols. Front Pharmacol. 2017;8(341):1-13.

9. Micheal J B, Robin F I. Inositol triphosphate, a novelsecondmessenger in cellular signal transduction. Nature.1984;308(22):339.

10.Di Paolo G, De Camilli P. Phosphoinositides in cell regulationand membrane dynamics. Nature. 2006;443:651-657.

11.Carlomagno G, Unfer V. Inositol safety: clinical evidences.Eur Rev Med Pharmacol Sci. 2011;15:931-6.

12.Croze ML, Vella RE, Pillon NJ, Soula HA, Hadji L, GuichardantM, et al. Chronic treatment with myo-inositol reduces whiteadipose tissue accretion and improves insulin sensitivity infemale mice. J Nutr Biochem. 2013;24(2):457-66.

13.Larner J. D-chiro-inositol: its functional role in insulin actionand its deficit in insulin resistance. Int J Exp Diabetes Res.2002;3:47-60.

14.Dang NT, Mukai R, Yoshida K, Ashida H. D-pinitol andmyoinositol stimulate translocation of glucose transporter

4 in skeletal muscle of C57BL/6 mice. Biosci BiotechnolBiochem. 2010;74:1062-1067.

15.Baillargeon JP, Diamanti-Kandarakis E, Ostlund RE. AlteredD-chiro-inositol urinary clearance in women with polycysticovary syndrome. Diabetes Care. 2006;29:300-5.

16.Nestler JE, Jakubowicz DJ, Iuorno MJ. Role ofinositolphosphoglycan mediators of insulin action in thepolycystic ovary syndrome. J Pediatr Endocrinol Metab.2000;13(5):295-8.

17.Nestler J, Unfer V. Reflections on inositol(s) for PCOS therapy:steps toward success. Gynecol Endocrinol. 2015;31(7):501-505.

18.Galazis N, Galazi M, Atiomo W. D-Chiro-inositol and itssignificance in polycystic ovary syndrome: a systematicreview. Gynecol Endocrinol. 2011;27:256-62.

19.Gateva A, Unfer V, Kamenov Z. The use of inositol(s) isomersin the management of polycystic ovary syndrome: acomprehensive review. Gynecol Endocrinol. 2018;1-6.

20.Unfer V, Carlomagno G, Papaleo E, Vailati S, Candiani M,Baillargeon J. Hyperinsulinemia alters myoinositol to d-chiroinositol ratio in the follicular fluid of patients with PCOS.Reprod Sci. 2014;21(7):854-858.

21.Harwood K, Vuguin P, Di Martino-Nardi J. Currentapproaches to the diagnosis and treatment of polycysticovarian syndrome in youth. Horm Res. 2007;68:209-17.

22.Carlomagno G, Unfer V, Roseff S. The D-chiro-inositolparadox in the ovary. Fertil Steril. 2011;95(8):2515-2516.

23.Unfer V, Orru' B, Monastra G. Inositols: from physiology torational therapy in gynecological clinical practice. ExpertOpin Drug Metab Toxicol. 2016;12:1129-31.

24.Raffone E, Rizzo P, Benedetto V. Insulin sensitiser agentsalone and in co-treatment with r-FSH for ovulation inductionin PCOS women. Gynecol Endocrinol. 2010;26:275-80.

25. Isabella R, Raffone E. Does ovary need D-chiro-inositol? JOvarian Res. 2012;5:14.

26.Formuso, C Stracquadanio M, Ciotta L. Myo-inositol vs. D-chiro inositol in PCOS treatment. Minerva Ginecol.2015;67:321-325.

27.Unfer V, Porcaro G. Updates on the myoinositol plus D-chiro-inositol combined therapy in polycystic ovarysyndrome. Expert Rev Clin Pharmacol. 2014;7:623-31.

28.Nordio M, Proietti E. The combined therapy with myo-inositol and Dchiro- inositol reduces the risk of metabolicdisease in PCOS overweight patients compared to myo-inositol supplementation alone. Eur Rev Med PharmacolSci. 2012;16:575-81.

29.Minozzi M, Nordio M, Pajalich R. The combined therapymyoinositol plus d-chiro-inositol, in a physiological ratio,reduces the cardiovascular risk by improving the lipid profilein PCOS patients. Eur Rev Med Pharmacol Sci. 2013;17:537-540.

30.Colazingari S, Treglia M, Najjar R, A B. The combined therapymyo-inositol plus D-chiro-inositol, rather than D-chiroinositol, is able to improve IVF outcomes: results froma randomized controlled trial. Arch Gynecol Obs.2013;288:1405-11.

31.Unfer V, Nestler JE, Kamenov ZA, Prapas N, Facchinetti F.Inositol(s) from Bench to Bedside in Endocrinology andGynecology. Int J Endocrinol. 2017;

Reproductive

Reference SD Treatment N° BMI Outcomes

Hormonal Insulin Resistance

A) higher fertilizationrate and embryo quality;

greater numberof transferred embryos

B) increased number andquality of oocytes

Colazingariet al., 2013

(30)

RCT A) MI 550mg/twice day +DCI 13.8 mg/twice a day

B) DCI 500 mg/twicea day COH

100 <28 Reduction in total rFSHunits and in peak E2

levels

NA

NAMinozzi et al.,2013(29)

Cohort MI 550 mg + DCI13.8mg/twice a dayNo other treatment

20 33.7±6.1

Improvement in LDL,HDL, and TG levels

Reduction

Nordio andProietti, 2012

(28)

Restoredovulation activity

RCT A) MI 2g/twice a dayB) MI 550mg/twice a day

plus DCI 13.8 mg/twice a day

50 27.5 ±2.9

Reduction of total Tand Major increaseof SHBG in group B

compared to A

Reduction ofglucose andinsulin levelsin group B

Continued from page 11

Inositols in PCOS

11

The PCOS Society of India at The International Society of Gynecological Endocrinology (ISGE), Italy

Events and Updates

The PCOS Society (India) held a one-hour session at the 18th World Congress of

"The International Society of Gynecological Endocrinology (ISGE)" in Italy.

The PCOS Society (India) conducted a panel discussion on "From Conception to

Delivery in Indian PCOS". The session was moderated by Dr. Sujata Kar from

Bhubaneshwar, and the panel included Dr. Nalini Mahajan from Delhi, Dr. Madhuri

Patil from Bangalore, Dr. Ritu Joshi from Jaipur and Dr. Annita Soni from Mumbai. It

was a case based interactive discussion. Four cases were discussed, which included

Controlled Ovarian Stimulation in PCOS, Prevention of Ovarian Hyper Stimulation

Syndrome and multiple pregnancies, Gestational Diabetes Mellitus in PCOS women

and maternal and neonatal complications in PCOS women. The session was well

attended and well appreciated with a lot of audience participation.

PCOS Online Certificate Course – 22nd and 29th April, 2018

The PCOS Online Certificate Course examination was

helo on the 22nd and 29th April, 2018. Dr. Duru Shah

& Dr. Madhuri Patil were the Course Directors and

the faculty included Drs. Piya Ballani Thakkar, Sujata

Kar, Rekha Sheth, Uday Thanawala, Nikhil Bhagwat

& Gaapa thi B.

Nearly 800 doctors took the exam and 469 passed

it. The successful candidates with get a Certificate

from the Society and the Top 3 scorers will get

surprise gifts as well.