Decoding Polycystic Ovarian Syndrome (PCOS) Kanthi Bansal, Pooja Sharma Dimri, Apoorva Pallam Reddy
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fm1Decoding Polycystic Ovarian Syndrome (PCOS)fm2
fm3Decoding Polycystic Ovarian Syndrome (PCOS)
Editors Kanthi Bansal MD DGO FICOG Director Safal Fertility Foundation and Bansal Hospital Ahmedabad, Gujarat, India E-mail: kanthibansal@gmail.com Website: www.safalivf.com Pooja Sharma Dimri MD DNB FMIS Consultant Gynecologist Obstetrician and Gynec–Laparoscopic Surgeon Bellevue, Cloudnine, and Mahavir Hospitals Mumbai, Maharashtra, India Apoorva Pallam Reddy MS DNB (OBG) Consultant Department of Endoscopy and Fertility Mathrutva Fertility Center Bengaluru, Karnataka, India Foreword Sadhana K Desai
fm4
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Decoding Polycystic Ovarian Syndrome (PCOS)
First Edition: 2017
9789386322852
fm5Dedicated to
Polycystic Ovarian Syndrome (PCOS) Patientsfm6
fm7Contributors
  • Aditya Khurd
  • Director
  • Dr Khurd's Infertility, ICSI and IVF Centre
  • Pune, Maharashtra, India
  • Anu Agarwal
  • Director
  • Vansh Fertility and Test Tube Baby Center
  • Varanasi, Uttar Pradesh, India
  • Apoorva Pallam Reddy
  • Consultant
  • Department of Endoscopy and Fertility
  • Mathrutva Fertility Center
  • Bengaluru, Karnataka, India
  • AK Pancholia
  • Head
  • Department of Medicine
  • Arihant Hospital and Research Centre
  • Indore, Madhya Pradesh, India
  • Asha Baxi
  • Director
  • Disha Fertility and Surgical Center
  • Indore, Madhya Pradesh, India
  • CB Nagori
  • Director
  • Dr Nagori's Institute for Infertility and IVF
  • Ahmedabad, Gujarat, India
  • fm8Chandana A
  • Consultant Gynec–Endoscopic Surgeon
  • Chandana Health Care Clinic
  • Bengaluru, Karnataka, India
  • Dhaval Baxi
  • Associate Gynecologist
  • Disha Fertility and Surgical Center
  • Indore, Madhya Pradesh, India
  • Dolly Sandhu Gill
  • Embryologist
  • Canada
  • Hitesh J Bhatt
  • Medicolegal Consultant
  • Mumbai, Maharashtra, India
  • Jaideep Malhotra
  • Managing Director
  • Rainbow IVF
  • Agra, Uttar Pradesh, India
  • Kanthi Bansal
  • Director
  • Safal Fertility Foundation and Bansal Hospital
  • Ahmedabad, Gujarat, India
  • Kedar Ganla
  • Consultant Fertility Physician
  • Ankoor Fertility Clinic
  • Mumbai, Maharashtra, India
  • fm9Keshav Malhotra
  • Director, Rainbow IVF
  • Malhotra Nursing Home
  • Agra, Uttar Pradesh, India
  • Kundan Vasant Ingale
  • Consultant and Director
  • Nirmiti Clinic
  • Centre for Assisted Reproduction and Endoscopy
  • Pune, Maharashtra, India
  • Manish Banker
  • Director
  • Nova IVI Fertility
  • Ahmedabad, Gujarat, India
  • Milind R Shah
  • Professor and Head
  • Department of Obstetrics and Gynecology
  • Gandhi Natha H Medical College
  • Mumbai, Maharashtra, India
  • Narendra Malhotra
  • Managing Director
  • Global Rainbow Healthcare
  • Agra, Uttar Pradesh, India
  • Nirmal N Gujarathi
  • Clinical Associate and Coordinator
  • Nanavati Super Speciality Hospital
  • Mumbai, Maharashtra, India
  • Parul Kotdawala
  • Endoscopy Surgeon
  • Department of Obstetrics and Gynecology
  • VS Hospital and NHL Municipal Medical College
  • Ahmedabad, Gujarat, India
  • fm10Pooja Sharma Dimri
  • Consultant Gynecologist,
  • Obstetrician and Gynec–Laparoscopic Surgeon
  • Bellevue, Cloudnine, and Mahavir Hospitals
  • Mumbai, Maharashtra, India
  • Rajeev Agarwal
  • Director
  • Care IVF
  • Kolkata, West Bengal, India
  • Reena Gupta
  • Nova IVI
  • Ahmedabad, Gujarat, India
  • Ritu Bijarnia
  • Consultant
  • Radhakrishna Multispeciality Hospital
  • IVF Centre
  • Bengaluru, Karnataka, India
  • Rupal N Shah
  • Medical Director
  • Rupal Hospital for Women
  • Women's Health Centre of Excellence
  • Surat, Gujarat, India
  • Sadhana Khurd
  • Director
  • Dr Khurd's Infertility, ICSI and IVF Centre
  • Pune, Maharashtra, India
  • fm11Sanjeev Khurd
  • Director
  • Dr Khurd's Infertility, ICSI and IVF Centre
  • Pune, Maharashtra, India
  • Shalini Gainder
  • Associate Professor
  • Department of Obstetrics and Gynecology
  • Postgraduate Institute of Medical Education and Research
  • Chandigarh, India
  • Sonal Panchal
  • Director
  • Dr Nagori's Institute for Infertility and IVF
  • Ahmedabad, Gujarat, India
  • Sonia Malik
  • Director and Head
  • Southend Fertility and IVF
  • New Delhi, India
  • Suyesha Khanijao
  • Jr Consultant
  • Southend Fertility and IVF
  • New Delhi, India
  • T Ramani Devi
  • Consultant
  • Obstetrics, Gynecology and Infertility
  • Tiruchirappalli, Tamil Nadu, India
  • fm12Vidhya V Bhat
  • Director
  • Radhakrishna Multispeciality Hospital
  • IVF Centre
  • Bengaluru, Karnataka, India
  • Vidya Pancholia
  • Head
  • Department of Obstetrics and Gynecology
  • Arihant Hospital and Research Centre
  • Indore, Madhya Pradesh, India
  • Yasodhara Pallam Reddy
  • Consultant
  • Sri Durga Hospital
  • Nellore, Andhra Pradesh, India
fm13Foreword
It is an honor to pen a Foreword for the book of great clinical utility, titled Decoding Polycystic Ovarian Syndrome, edited by an eminent assisted reproductive technology and infertility specialist Dr Kanthi Bansal, and co-edited by Dr Pooja Sharma Dimri and Dr Apoorva Pallam Reddy.
In an age, when conventional diagnostic aids and therapeutic treatments are being challenged and replaced by newer innovations, the gynecologists, particularly infertility specialists must know all the recent advances with their advantages and pitfalls in managing women with polycystic ovarian syndrome (PCOS).
The PCOS is a condition where gynecologists have debated on its definition, diagnosis and management every few years. In-depth knowledge of pathophysiology of the PCOS and update in management of it is necessary for postgraduates as well as practicing gynecologists.
The chapters in this book cover, in detail, various problems and their management that PCOS women come across. I am sure that this book will find its place as a ready reckoner in the library of medical colleges, gynec-endocrinologists and infertility specialists. The experts have worked hard to address various issues related to PCOS.
I congratulate Dr Kanthi Bansal and her team for bringing out this book!
Sadhana K Desai
MD FRCOG (Eng) FICOG
Emeritus Professor
Department of Obstetrics and Gynecology
Bombay Hospital Institute of Medical Sciences
Founder Director
Fertility Clinic and IVF Centre
Mumbai, Maharashtra, Indiafm14
fm15Message
Polycystic ovarian syndrome (PCOS) is a silent disorder that creates havoc on young bodies, and is one of the most critical, underserved, underdiagnosed and underfunded conditions affecting the women's health. There is a huge health disparity when it comes to PCOS diagnosis, funding and support, as 50% of women and girls with PCOS are undiagnosed. Additionally, it often takes the women several years and, on an average, they see almost seven doctors before they can find someone who can help them with the condition.
Despite being one of the most common women's disorders with serious long-term health consequences, the PCOS awareness and support organizations receive less amount from the government, corporate, or community funding than any other health condition receives.
Our vision is that the PCOS be treated as a public health priority and hence we created the PCOS Society of India, which is a multidisciplinary organization of gynecologists, endocrinologists, dermatologists and other associated specialists, who attend to PCOS women. I am delighted that Dr Kanthi Bansal, who is one of the patrons of the PCOS Society, is editing this book. This book will help to update the knowledge on PCOS amongst the medical community.
I wish her and her team all the best and congratulate her on this stupendous creation!
Duru Shah
MD FRCOG FCPS FICS FICOG DGO FICMCH DFP
Director
Gynaecworld
Center for Assisted Reproduction and Women's Health
Panel Consultant
Breach Candy Hospital, Jaslok Hospital and Global Hospital
Mumbai, Maharashtra, India
Founder President
PCOS Society of Indiafm16
fm17Message
As we are all aware, polycystic ovarian syndrome (PCOS) was first reported in modern medical literature by Stein and Leventhal in 1935. We have come a long way since then, and it is now recognized as a common, heterogeneous and heritable disorder affecting women throughout their reproductive period and beyond.
The PCOS is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries, but there is considerable inter-individual variation in presentation. Although not required for diagnosis, the presence of insulin resistance and hyperinsulinemia is common and places those affected at increased risk of diabetes and cardiovascular disease. Thus, the PCOS adversely affects endocrine, metabolic, and cardiovascular health in the long term.
In addition, the prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but may be as high as 15–20% when the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine (Rotterdam) criteria are used. An alarming fact is that the rise of PCOS is inexorable and stretches across the continents, affecting more women irrespective of caste, creed, religion and social background.
Hence, it is of paramount importance that we have greater depth of understanding of this multisystemic disease and keep ourselves updated regarding the latest advances on diagnosis, treatment and long-term implications. Implementing these in our daily practice will significantly improve our therapeutic approaches to the patients’ complaints, including subfertility, obesity, menstrual problems, and pregnancy complications.
This excellently put together book is a step in this direction. I have no doubt that this book will go a long way toward improving our knowledge and understanding of the PCOS.
I congratulate Dr Kanthi Bansal, Dr Pooja Sharma Dimri, and Dr Apoorva Pallam Reddy, for this endeavor!
Nandita Palshetkar MD FCPS FICOG
Professor
Obstetrics and Gynecology
Dr DY Patil Medical College, Hospital and Research Center
Navi Mumbai, Maharashtra, India
President, MOGSfm18
fm19Preface
“Books are the quietest and most constant of friends; they are the most accessible and wisest of counselors, and the most patient of teachers.”
—Charles William Eliot
Polycystic ovarian syndrome (PCOS) is a heterogeneous condition with a range of clinical, endocrine and metabolic manifestations. The increasing prevalence of the condition and plethora of presentation along with the consequences on fertility make it a complex disorder. It puts up a mighty challenge to gynecologists, dermatologists and endocrinologists alike. Though there are numerous publications and books on the PCOS, this subject provokes a lot of discussion and controversy about pathophysiology, diagnosis and therapy. We thought there was a need to evaluate comprehensively the latest trends in the management of this disorder, hence this book was conceived.
This book Decoding Polycystic Ovarian Syndrome is divided into 5 sections comprising 20 chapters. The sections deal with the basics, diagnosis, areas of concern, and management of the PCOS. The chapters have been written by expert gynecologists, sonologists, laparoscopic surgeons, and fertility experts, who have contributed to various aspects of the spectrum. In addition, a section is dedicated to the important issue of PCOS and fertility. The text is accompanied by tables, boxes, and key points, that make the content reader-friendly. This book combines the latest research and knowledge with the experiences of the authors.
We believe that this book will be useful for the postgraduates and practicing gynecologists to deal with the management of PCOS patients. Hopefully, it will add to our knowledge and information about this enigmatic syndrome.
Kanthi Bansal
Pooja Sharma Dimri
Apoorva Pallam Reddyfm20
fm21Acknowledgments
“Feeling gratitude and not expressing it is like wrapping a present and not giving it.”
—William Arthur Ward
A book in the hands of a reader is a combined effort of so many people, most of them behind the scenes. This book also is a culmination of the hard work of many individuals, who contributed in various capacities to convert an idea into reality. The following lines are our sincere effort to acknowledge and thank all those who helped us in our endeavor.
First and foremost, we want to thank all the contributing authors, who shared their clinical acumen and experience in the form of chapters, and added gems of knowledge to the book in spite of their busy schedules. This book would not have been possible without their cooperation. A special mention is for Ms Shilpa Damodar, who worked tirelessly for the compilation and editing work and did a wonderful job of ‘smoothing out the hard edges’. Also, no words can thank enough all the staff we work with, who make our life easier and help us to carry out our academic pursuits. Special thanks go to Dr Sadhana K Desai for the Foreword.
We want to sincerely thank M/s Jaypee Brothers Medical Publishers (P) Ltd. New Delhi, India, and the entire team, for all the support.
We offer our heartfelt gratitude to all the patients who keep faith in our abilities and allow us to enhance our knowledge and learning. Last but not least, we express our gratitude to our family members for their continuous and unconditional support.