PCOS, inflammation and pregnancy

PCOS-on-ultrasoundPolycystic ovarian syndrome (PCOS) is one the most common hormone problems in women of reproductive age as well as one of the most common causes for female infertility. While infertility caused by PCOS is often amenable to treatment, women with PCOS often have more complicated pregnancies, including problems such as gestational diabetes and pre-eclampsia.  One of the common threads with these issues is their association with inflammation. It turns out there may now be a link explaining why PCOS patients have more complications. A recent study shows that markers of inflammation are higher in PCOS women and become even worse when these women get pregnant. It could be that inflammation is the common link between in PCOS and a number of pregnancy complications.

Aspirin and miscarriages

aspirin-baby-81It is quite common for both OBGYN and Fertility doctors to encourage their patients who have had multiple miscarriages take baby aspirin in order to reduce the risk of future pregnancy losses. The problem with this is that these recommendations were never really backed up by research to see if aspirin is really effective in preventing miscarriages. In order to determine if this common practice was effective, the NIH conducted a large trial to see if taking daily baby aspirin would reduce the risk of subsequent miscarriage in women with 1 or 2 prior miscarriages. Unfortunately, as reported in the journal Lancet,  baby aspirin did not help and these women were no more likely to experience another pregnancy loss than those who took a placebo. The one bright spot in this study: women who took had a single loss early in pregnancy within the last year and took baby aspirin were more likely to actually become pregnant.

New guidelines for PCOS

ImageThe Endocrine Society has issued new guidelines for the diagnosis of Polycystic Ovarian Syndrome (PCOS). These guidelines developed by a special task force are based in part on the Rotterdam criteria and were recently published in the Journal of Clinical Endocrinology and Metabolism.

Women are diagnosed with PCOS when they have 2 out of the 3 following conditions:

  1. Problems with ovulation such as irregular cycles
  2. Excess levels of male hormone levels on bloodwork or based on symptoms such as abnormal hair growth or loss, acne
  3. Large numbers of ovarian follicles or “cysts” on ultrasound

Additionally, doctors will need to rule other hormonal disorders that may mimic PCOS and are advised to screen for medical diseases such as diabetes and hypertension that are more common in women with PCOS. They also issued recommendations for treatment of infertility and irregular cycles in PCOS patients.

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Avoiding a toxic environment…….in the womb

The American Congress of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) have begun a program to educate women about the dangers of everyday toxins in the enviroment. Some of these chemicals have been associated with  infertilitystillbirthmiscarriage, childhood cancers and impaired brain development.  

They have recommended that pregnant women limit :