Occasionally, I find the time to sift through medical journals piling up on my windowsill, or scan the table of contents of the journals that I get delivered via email. Here are a few tidbits I found interesting during my latest foray into the pile –
Diet, Exercise, Pregnancy and PCOS. A 6 week structured diet and exercise regimen significantly enhanced clomid-induced ovulation in infertile women with PCOS previously resistant to ovulation induction. Given that weight reduction will also decrease the risk for diabetes, hypertension and heart disease, that’s one very effective intervention!
DHA in Pregnancy – Is it doing a anything? DHA, despite being recommended as a supplement during pregnancy, did not improve offspring intellectual function or decrease maternal depressive symptoms. So why exactly are we recommending it?
Depo Provera and Fractures – Use of this injectable contraceptive in the UK was associated with a slightly higher rate of fractures in users of all ages, with risk highest after 2-3 years of use. This is not surprising given what we know about DMPA’s effects on bone mass. The risk is not high, and for women who cannot use other methods effectively, Depo remains an important contraceptive option. But for long term DMPA users, the risk for fracture is s a consideration that should be added into the benefit risk equation for use of this contraceptive. (This study was published in August and I just got around to reading it now…)
Perinatal Mortality in midwife vs Obstetrician-assisted births in the Netherlands. Midwife assisted low risk pregnancies have higher perinatal mortality than high risk, physician assisted pregnancies. This unexpected finding puts the entire Dutch triage system of obstetric care into question. However, as most Ob’s will tell you, much of what can go wrong at delivery is unexpected. Being ready for anything is the safest way to go as far as I’m concerned.
Genital Warts Incidence Trends Downwards after HPV Vaccine Program Initiated in Australia. A 59% decline was seen in women in the age group eligible for the vaccine. Declines were also seen in heterosexual men (who are not vaccinated) suggesting that “herd immunity” may be accumulating. A more important public health outcome will be what happens to cervical cancer rates over time. But this data are encouraging.
That final entry is really good news. The vaccine’s been available for about 5 years now? And there’s already a marked decline in one problem associated with a virus it protects against? Rock on.
I have PCOS. I tried Clomid in escalating doses and had not only no luck with it, but a lot of terrible side effects. I looked it up in the PDR, which says it’s not the best choice to use for PCOS. I did a lot of research and learned that PCOS is a result of a broken insulin feedback; when excess insulin is produced, the delicate balance of female reproductive hormones is thrown off.
I lowcarb dieted 60 lbs off in a year. My cycle returned on its own, however I still couldn’t ovulate. Then I went to a regular (NOT reproductive) endocrinologist and was treated with insulin-sensitizing medications (first Metformin for a year in escalating doses, then a combination of Metformin and Avandia). After 2 months on the combination, I ovulated on my own and became pregnant with my one and only child, who was born just after I turned 40.
I’m just bringing this up to mention that PCOS has its roots a lot further upstream than the ovaries. It’s pretty cool to be able to treat a metabolic problem and get your body working the way it’s supposed to all the time, rather than to go through sporadic fertility treatment with its awful stresses.
Celeste – There’s been a lot of hope re glucose lowering drugs in PCOS, but actually ovulation rates in PCOS are better with clomid than with metformin. Every patient is an individual, and one must sometimes try different approached till you find what works in an individual. Some patients like the idea of trying metformin first to avoid the clomid, others want things to happen quicker and go with clomid. What worked for you may not work for someone else, and vice versa. Glad you found a treatment that worked for you.
Take care.
My issue with studies on the ovulation rate of patients on Clomid is that it doesn’t translate into pregnancies or fertility restoration. I personally know so many women via support groups with PCOS who got nowhere with Clomid. I think it may be a better drug for more generic anovulation.
I just also want to say that the diabetes medications aren’t specifically for lowering glucose. I have never had elevated blood sugars, and that’s very common with PCOS. In fact many of us also deal with some degree of hypoglycemia; I certainly do. The medications help bring down insulin production and increase insulin sensitivity in the liver (Metformin) and muscles (Avandia), the only tissues that store sugar as glycogen.
But yes, we are all individuals. There are degrees of severity in this particular metabolic disorder; my point is that just looking at it from the perspective of ovarian function is to miss out on the larger health picture.
Thanks for chatting about it.