Changes in lifestyle help 'Syndrome O'

By JENNIFER GOLDBLATT / The News Journal

12/21/2004



In her early 20s, Joy Burch was frustrated with two major issues. She hadn't been able to conceive a child, even with the help of fertility drugs. And she couldn't take off the extra pounds she had gained after her wedding.

She also had abnormal hair growth.

Burch was resigning herself to the possibility that kids and a healthier figure might be out of reach.

"I had pretty much given up," said Burch, 29, a nurse from Newark.

It was years before Burch understood the medical conditions fueling her frustrations. She said the knowledge helped her overcome her health problems and conceive her now month-old twins, Aidan and Myah.

Burch suffered from a condition a Newark reproductive specialist has dubbed "Syndrome O," which refers to polycystic ovarian syndrome, which afflicts up to 10 percent of women of reproductive age. It can include infertility, irregular periods, excessive hair growth, acne, hair-thinning, ovarian cysts, obesity and an increased risk of diabetes.

"For years, this disease was approached as an ovarian problem, and in the last 10 years people have started to examine the whole-body component that's at play," said Dr. Ronald Feinberg, medical director for the In Vitro Fertilization Program at Reproductive Associates of Delaware in Newark and Dover. Feinberg is author of the book, "Healing Syndrome O" which was published in May by The Penguin Group.

Scientists first identified the symptoms of polycystic ovarian syndrome in 1935. But until recent decades, doctors have treated it by addressing each of its symptoms individually, guiding patients to fertility drugs to help them conceive and cosmetic treatments to deal with the acne and excess facial hair. It wasn't until 1990 that the National Institutes of Health created an official diagnosis for polycystic ovarian syndrome and proposed that problems with insulin resistance might play a role in it.

As the medical world has learned more about insulin, its relationships to organs and ability to adjust levels with lifestyle changes, more attention has been paid to the role insulin, exercise and eating habits could play in fertility.

In normal ovaries, each month, the follicles - which serve as incubators for eggs, start to develop. Under the right signals, one of the follicles dominates, and ultimately releases an egg.

In a normal metabolic process, after the body consumes sugar, the pancreas responds by producing insulin, which is needed to shuttle the sugar into the bloodstream for the cells to use. If the cells don't effectively respond to insulin, or become insulin-resistant, the pancreas overproduces insulin.

There is a growing body of evidence that the overproduction of insulin disrupts the production of androgen and estrogen in the ovaries. A woman who is making too much insulin can easily have her hormone levels disrupted, stop having a normal menstrual cycle and become unable to conceive. If her eggs grow inappropriately they can become cysts over time. If the androgens spill into the bloodstream, women can grow excess facial hair, have thinning head hair, oily skin and acne.

Dr. Ricardo Azziz, chair of the department of Obstetrics and Gynecology at Cedar Sinai Medical Center in California, said that while the relationship between insulin resistance and PCOS is much more well-known now, "we still understand very little about why insulin resistance occurs in PCOS.

Modification to diet and exercise is a very important element to treating PCOS, and one that's underprescribed, both because of the resistance of patients and the challenges for health care professionals in counseling patients on weight loss, he said.

Evidence also has mounted that the risk of polycystic ovarian syndrome is greater in women with a family history of type 2 diabetes and those who are obese, according to the American Society of Reproductive Medicine. The society recommends patients be tested for metabolic syndrome, which can include abdominal obesity, high blood pressure and high cholesterol.

But diet and exercise are just one element of broader treatment of PCOS, along with measures like oral contraception for regulation of menstrual cycles and measures to regulate the amount of androgen being produced in a woman's body, Azziz said.

Before getting pregnant, Burch lost 80 pounds by following the Atkins diet and exercising regularly. She also had one treatment of in-vitro fertilization. By March she was pregnant with twins. "Our approach is to treat the whole person and the whole body first," Feinberg said. "As physicians, many of us are taught to look for the drug or the quick fix that can help people. ... Our philosophy is: get yourself healthy first, and then we'll intervene with conservative treatments that are appropriate."

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