An Increase In Polycystic Ovarian Syndrome Concerns Bay Area IVF Experts

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Fertility;  Pregnancy / Obstetrics;  Endocrinology
Article Date: 14 Oct 2006 - 0:00 PDT

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In the last five years, infertility experts of the Reproductive Science Center of the Bay Area have seen a significant increase in patients who faced obesity-related infertility and Polycystic Ovarian Syndrome (PCOS), mirroring a national increase in the girth of Americans.

According to a CDC study released in Sept. 2006, 30 percent of U.S. adults 20 years of age and older -- over 60 million people -- are obese, almost double in the last 14 years. In 1991, no states had obesity prevalence rates at or above 20 percent, compared to 44 states in 2005.

The negative impact of the obesity epidemic on reproductive health is reflected in the increasing number of patients with PCOS, a misunderstood and often undiagnosed reproductive endocrine disorder that occurs in 5 percent of women. PCOS is one of the leading causes of infertility in women and obesity is one of its most common symptoms. Recent research from the National Institute of Health indicates that overweight males also face impaired fertility.

It is well known that obesity can complicate pregnancy and delivery, but "patients are often surprised to learn that there is an association between obesity and infertility," says Dr. Carmelo Sgarlata, reproductive endocrinologist at RSC. Body weight disorders are one of the first potential causes of reproductive failure in both men and women. PCOS, caused by a hormonal imbalance that sometimes prevents ovulation, is often overlooked because it tends to start in teenage years and many of the symptoms are common in puberty.

"When we see a patient with high Body Mass Index (BMI) it is an immediate signal to screen for PCOS. Fortunately, PCOS is highly treatable with weight loss and medication," he adds. "We are also concerned about women with PCOS because they are at greater risk for developing Type 2 diabetes, and possibly heart disease."

Twelve percent or more of infertile couples have deviations from their ideal body weight as the cause of their infertility. "We are committed to providing our patients with ample support and understanding to help them cope with difficult weight issues and their negative impact on reproductive function," says Dr. Sgarlata. "Most of our patients are successful in their weight management program and are able to achieve the healthy pregnancies they seek."

According to the American Society for Reproductive Medicine, more than 70 percent of women who are infertile as the result of body weight disorders will conceive spontaneously if their weight disorder is corrected through a weight-adjustment diet as appropriate. Medication is also efficacious in treatment support for PCOS and other weight-related infertility problems.

In addition to obesity, symptoms of PCOS can include ovarian cysts, absent or irregular menstrual periods, acne, high blood pressure and elevated insulin levels, according to the Polycystic Ovarian Syndrome Association.

One in eight women of childbearing age had trouble getting pregnant or carrying a baby to term in 2002, according to the most recent research from the Centers for Disease Control and Prevention.

About Reproductive Science Center

Established in 1983, the Reproductive Science Center of the San Francisco Bay Area was one of the earliest IVF facilities in the United States, begun just two years after the nation's first successful IVF treatment. RSC was among the first in the United States to report a successful pregnancy from an egg donated from one woman to another for gestation and delivery, and were also responsible for the nation's second successful transfer of a previously frozen embryo into a mother's uterus. Today, RSC boasts a staff of six infertility physicians with a collective 65 years' experience with offices in San Ramon, Orinda, San Jose, Fremont, Modesto, and Brentwood. The Reproductive Science Center is a member of IntegraMed, an exclusive network limited to the highest performing infertility practices in each of 30 of the top 50 cities. One of every five IVF procedures in the United States is performed in an IntegraMed practice. For more information, visit http://www.rscbayarea.com.

Backgrounder

PCOS, Obesity, and Infertility

Common symptoms of PCOS include:

-- irregular, infrequent menstrual cycles
-- hirsutism
-- acne
-- infertility
-- chronic anovulation (absence of ovulation)
-- chronic hyperandrogenism (elevated of serum testosterone or other androgens)
-- polycystic appearing ovaries (enlarged with many small cysts (fluid- filled sacs) that are visible on ultrasound

According to the American Society for Reproductive Medicine (ASRM), fertility issues related to obesity include:

-- Irregular or infrequent menstrual cycles
-- Risk of infertility
-- Increased risk during fertility surgery
-- Increased risk of miscarriage
-- Decreased success with fertility treatments

The Role of Fats in Reproductive Health

Women with PCOS may be at increased risk for developing a metabolic syndrome characterized by abdominal obesity, cholesterol abnormalities, hypertension, and insulin resistance that impair blood sugar regulation.

Fat-soluble sex hormones testosterone (the principal male hormone) and estradiol (the principal female hormone) accumulate in body fat. Once body fat stores are saturated with sex steroid hormones, they reach equilibrium with blood. In addition, fat cells convert the weak male hormone, androstenedione, to the weak female hormone, estrone, which results in metabolic effects on the hypothalamic-pituitary axis of the brain (the area of the brain that regulates testicular and ovarian function) to alter reproductive function.

These complex interactions have the net effect of impairing reproductive function. Slender women metabolize estradiol to 2-hydroxyestrone -- an antiestrogen, while obese women metabolize estradiol to estriol -- a weak estrogen. The rate of metabolic change seems to correlate with the percent of body fat of total body mass. Thus, slender women progressively "turn down" the reproductive cycle until it is "turned off" when the condition of anorexia nervosa is reached. On the other hand, obese women progressively increase their alternate estrogens until ovulation ceases and they become infertile.

Reproductive Science Center of the Bay Area
http://www.rscbayarea.com