New Strategies In PCOS, Infertility and Cancer
Exploring The Insulin Connection
Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrine disorders affecting fertility in women. In addition to irregular cycles and hormone imbalances, there are changes in lipid metabolism and increased risk for other health problems.
A high incidence of insulin resistance and obesity are associated with this condition, and patients often experience difficulty in losing weight.
But which came first? PCOS? Obesity? Insulin resistance? Are they all interconnected? And if so, how can we unravel the tangle?
Reducing glycemic load in the patient's diet is one strategy now being studied in the Department of Nutrition at UAB. Barbara Gower, PhD, and Laura Lee Goree, MSRD, are gathering preliminary data from an NIH-funded study, which is expected to be completed in late summer or early fall.
"We're comparing the effects of a typical diet and a low glycemic diet in each participant to see how insulin resistance changes with changes in nutrition," Gower said. "Participants follow each diet for eight weeks. To get a clear view that isn't influenced by weight loss, we are careful to keep the calorie level as near as possible to what each individual needs to maintain a stable weight."
Nutritionist Goree said, "We plan and prepackage food for each participant so we can follow exactly what and how much each individual is consuming. One thing we've found is that with the lower glycemic diet, there is a tendency for the participants to lose weight, even when consuming the number of calories we would have predicted would have kept them at a stable weight, so we've had to make a few adjustments along the way"
Data is still being collected, and it will be several months before a final report is ready, but some trends are already being noted.
"Subjectively, most participants like the lower glycemic load diet better and say they feel better and their cycles are more regular. Thus far, fasting glucose levels tend to be lower with the lower glycemic load," Gower said. "We've also seen more of what we call the 'candy bar crash' in PCOS patients, who seem to react with a sudden dip in blood sugar following a spike."
Goree said, "At the end of the study, participants have the option of meeting with a nutritionist to plan how they can continue the diet that they feel better following."
The underlying causes of PCOS seem to be a combination of predisposition and event.
"Women who develop PCOS seem to have a predisposition, but they may not develop it until they reach a certain weight or other trigger," Gower said. "We're trying to determine how glycemic load influences insulin resistance. The next step will be understanding how these changes affect hormones."
Comparing Fertility Drugs
For PCOS patients who would like to become pregnant, but find the uncovered expenses of fertility treatment difficult to afford, a clinical trial now recruiting local participants could be of particular interest.
"We're comparing Femara (generic Letrozole), which was originally a breast cancer drug, with currently prescribed fertility medications," G. Wright Bates, MD, said. Director of UAB's Reproductive Endocrinology and Infertility Services Clinic, Bates said Femara decreases estrogen in the blood stream and after a few days, this decreased level signals the brain to begin ovulation.
"Another advantage is that this drug doesn't impact the brain or moods as much. It has fewer side effects and the body clears the drug faster," Bates said.
"The question we're hoping to answer is, does Femara work as well as or better than the medication we are currently prescribing. We're excited to be the only facility in the southeast participating in the trial.
"Fertility treatments are often not covered under insurance in Alabama and can be expensive. We have a grant that pays for testing and treatment for participants who aren't covered by insurance, and that includes testing of the male partner, X-rays, blood work and medications for four cycles of treatment. Patients will also be screened for thyroid, adrenal and other imbalances."
The study will be recruiting approximately 60 patients over the next two years. Potential candidates include women who have irregular cycles with fewer than eight periods per year and some evidence of hormone imbalances or PCOS. For enrollment information, contact coordinator Susan Beason at 801-8200, or e-mail WBates@uab.edu.
Preserving Fertility In Cancer Patients
Chemotherapy and radiation can mean life itself to cancer patients. They can also end the dreams of sharing that life with biological children yet unborn.
However, a program to work around the effects of treatment is restoring the hope for future fertility after cancer treatment. A UAB Health Services Foundation grant is being used to develop technologies and increase awareness of fertility in cancer patients of reproductive age.
"For female patients with partners, we can harvest eggs and freeze embryos. We're also part of a nationwide group working in an experimental program to freeze ovarian tissue," G. Wright Bates, MD, said. "What is especially exciting is that we are seeing success in harvesting an ovary before treatment and transplanting it back into the patient after recovery. Nationwide there have been about 20 pregnancies following this procedure, and we're seeing some return of hormone function.
"This offers great promise for young girls. It has been used in patients as young as eight, and one at Brown in Rhode Island was eighteen months old."
The program also includes sperm banking for male patients, with up to six samples banked for up to a year included in the consult fee. The consult fee is waived if banking is unsuccessful.
"What's important is to talk with cancer patients when they are diagnosed," Bates said. "Give them the fertility options. Even if they decide not to pursue it, having options helps to ease at least one of the worries in coping with cancer."
