From Mumbai to Melbourne, an enlightened journey for excellence in PCOS
Dr Sabahat Rasool is a Fertility Consultant & Reproductive Medicine Specialist at Gynaecworld in Mumbai. She lectures at the Govt. LD Hospital in Srinagar and is Associate Editor of the wonderful Pandora Newsletter.
I was interested in Reproductive Endocrinology during my years as a Resident in Gynaecology. The myriad and complex disorders of women of reproductive age, particularly PCOS, were baffling to me. Later in my career, I was fortunate to work as a Fertility and Reproductive Medicine Consultant with one of the pioneers of Reproductive Endocrinology in India, Professor Duru Shah at Gynaecworld, Mumbai where Polycystic Ovary Syndrome was being treated regularly.
I began my association with the PCOS Society of India way back in 2015 when the Society was first founded by Prof Duru Shah. The PCOS Society of India is the first common platform for all specialties treating PCOS to meet, and currently has over 1000 members, and is one of the largest PCOS societies in the world. I am the Associate Editor of the Newsletter of the Society, Pandora, since its inception in 2016. To view the newsletters and educational content of the society, please visit http://www.pcosindia.org./
The Society has organised three brilliant International Conferences on PCOS and it was as a part of the PCOS Society of India, that I attended a Masterclass on PCOS & Infertility in Mumbai in March 2018 organised by the Society in collaboration with the Centre for Research Excellence in PCOS (CREPCOS), Melbourne. During the Masterclass, Professor Rob Norman and Professor Helena Teede announced a visiting fellowship/travel grant for a budding reproductive endocrinologist from India with a special interest in PCOS. I applied for the fellowship, along with many others, and was delighted to know later that I had been selected to attend the annual meeting of the CREPCOS in Melbourne.
My stay in the lovely city of Melbourne was memorable. The people at CREPCOS were welcoming and very warm and I was privileged to have visited the Monash Centre for Health Research and Implementation (MCHRI), interacted with the researchers and heard the likes of Professors Rob Norman and Helene Teede. It was a real pleasure and honour meeting and interacting with the internationally renowned expert, Professor Bart Fauser.
The CREPCOS staff, particularly Gillian and Linda who handled my pre-visit formalities were very helpful, especially with regards to the Visa documents, and I faced no hassles in the process. As the dates drew close, I received a complete itinerary for my stay of close to one week, including a visit and guided tour of the Centre, and participation in the Annual Meeting, where I was to present a paper on, ‘Ethnic and Cultural Differences in PCOS in Southeast Asia.’ Gillian was kind enough to show me around the best shopping centre in Melbourne besides treating me to a lovely lunch on the last day of my visit.
Ethnic and racial differences in PCOS are well known but still not well understood. Genotype and environment, through a complex interplay, lead to a full-blown picture of PCOS. Ethnicity seems to be the most likely contributor of diverse expressions of Insulin Resistance (IR), Metabolic Syndrome and hyperandrogenemia in women with PCOS. Hispanics present with the most severe phenotype and cardiometabolic complications. Asians are more insulin resistant, pre-diabetic and more hirsute compared to others. I presented the data on 421 PCOS patients visiting our PCOS clinic in Mumbai and compared the data with other ethnic populations from all over the world. In our patients, menstrual disturbances followed by hyperandrogenic features were the most common presenting features. The mean modified FG score of our PCOS patients was 10. Classical phenotype was the most common phenotype, being observed in 36% of these women. Acanthosis nigricans, a surrogate marker of Insulin Resistance, was seen in 21.08% patients. Using oral glucose tolerance test with 75 grams glucose challenge, IR was identified in 44.78% women. 58.27% women were obese, and Metabolic Syndrome was identified in 45.33% of our PCOS population.
Ethnic-specific cut-offs for obesity, hirsutism and ethnic-specific guidelines are the need of the hour to prevent long-term sequelae of PCOS in different ethnic groups. Asians may be less obese than Caucasians but metabolically relevant central-obesity is more common in Asians who tend to have higher waist to hip ratios. In countries with limited resources, expensive tests are not available and affordable. We need to sensitise our doctors and paramedics to pick up the markers like Acanthosis nigricans, waist to hip ratios which can guide us for early patient education and lifestyle modifications. We need to collaborate on multicentric and multiethnic research on different aspects of PCOS to understand the diversity better and to help in modifying guidelines based on ethnicity and race to prevent over and under-diagnosis of the disorder.