Insulin Resistance and Its Effects on Polycystic Ovarian Syndrom and Infertility - Coursework Example

Running head: Insulin Resistance and Its Effects on Polycystic Ovarian Syndrome and Infertility Insulin Resistance and Its Effects on Polycystic Ovarian Syndrome and Infertility By ______________________ Insulin Resistance Insulin resistance may be defined as an inability of the cells within the body to respond normally to insulin. A surrogate marker for insulin resistance is hyperinsulinaemia, which refers to a high concentration of insulin in the blood cells. (Hardman et al, 2003, p. 72) Insulin resistance is usually defined in terms of the lack of effect of insulin on glucose disposal. Abnormalities Characterising Insulin Resistance Syndrome Diabetes, impaired glucose tolerance or impaired fasting glycaemia Hyperinsulinaemia due to insulin resistance Raised arterial blood pressure Raised plasma triglycerides and/or low HDL-cholesterol Upper body or general obesity Preponderance of small, dense low LDL particles High level of postprandial lipaemia Impaired endothelial function Procoagulant state Microalbuminuria (Hardman et al, 2003, p. 133) Causes Hypertension Obesity Physical inactivity Genetic disorder Polycystic Ovarian Syndrome (PCOS) PCOS – multiple cysts on the ovaries is due to a hormonal imbalance that sometimes prevents ovulation, making periods irregular and reducing fertility. (The Mirror, Jan 19, 2006, p. 34) Many women who have problems with ovulation have PCOS. PCOS is a collection of symptoms that may include multiple small follicles on the ovaries followed by weight gain, increased facial hair, acne, irregular periods, reduced breast size or occasional periods that are very heavy. PCOS is associated with abnormalities in the way the body metabolises insulin and glucose and, as such, there may also be a link between PCOS and insulin resistant diabetes, especially in older women. In women who have PCOS, their levels of LH are higher than usual, and their levels of FSH remain constant rather than changing throughout the menstrual cycle. This means that the immature eggs in the follicles fail to mature and, consequently, are not released at ovulation. Also, the relative resistance to insulin is associated with either a rise in the production of androgens—the male sex hormones, including testosterone—or an increased sensitivity to these androgens. All women have some androgens, but women who have PCOS sometimes have higher levels. These higher levels interfere with the balance and function of the other hormones. No one is quite sure what causes PCOS; it is often associated with being overweight, but it can also occur in women who are not overweight. It is believed there may also be a genetic link. Apart from its effect on fertility, overweight women with PCOS have an increased risk of diabetes, high blood pressure, sleep problems and heart disease. With appropriate management, however, these risks can be reduced considerably. Where infertility is the main concern, your specialist is likely to suggest an exercise and weight management program in the first instance. Losing weight may help to restore your hormone balance and periods. This may be followed by treatment with one of a range of medications that regulate the menstrual cycle and induce ovulation. Once your ovulation is restored you have a chance of conceiving naturally. (Hardman et al, 2003, p. 220) Some women suffer from polycystic ovaries without the associated problems outlined above. Where this is the case, the condition is referred to as polycystic ovaries (PCO), and a distinction is drawn between it and PCOS. PCO is usually diagnosed by ultrasound and may be accompanied by regular or slightly irregular periods. Ovulation may still occur but may not be optimal, and ovulation induction may be appropriate to improve the follicular phase of the cycle. A diagnosis of PCO might prompt your doctor to investigate for PCOS. PCOS symptoms Sugar cravings Difficulty losing weight Skin patches (dark skin)/Skin tags/Acne Tiredness and sleep apnoea Excessive hair in females Breast Reduction Mood disorders Menopause (The Mirror, Jan 19, 2006, p. 34) Thyroid Imbalance (The Mirror, Jan 19, 2006, p. 34) Postnatal Depression and stress (The Mirror, Jan 19, 2006, p. 34) Ovarian Cysts Ovarian cysts are small sacs of fluid that develop in or around one or both of the ovaries. They can form from an old follicle that no longer contains an egg, or from an old corpus luteum that failed to dissolve after an earlier cycle. They are usually identified during a transvaginal ultrasound scan. Ovarian cysts are relatively common and, in most cases, they are benign and will have no significant effect on your capacity to conceive. However, sometimes they can affect the normal functioning of the ovaries, upsetting the hormone balance and temporarily disrupting ovulation. In most cases, they will disappear after a few months of their own accord, but occasionally they can continue to grow. If there is a danger of the cyst rupturing, or if it looks like it might be interfering with your chances of conception in any way, your doctor may suggest you have it surgically removed using a laparoscopy. Once it is removed, ovulation should return to normal. In very rare cases a cyst may be cancerous. (Tomlins, 2003, p. 32) Infertility Insulin Resistance most obvious consequence is infertility; amenorrhoeic women are not developing egg cells that can be fertilized. Short luteal phases and low progesterone can also lead to infertility due to failures of implantation. Paradoxically, without contraception, irregularly menstruating athletes may be at increased risk for unwanted pregnancy because their day of ovulation is less predictable. (Tomlins, 2003, p. 48) Being overweight can also cause disruptions to the menstrual cycle because of an imbalance of hormones, and is associated with the development of insulin resistance in women with polycystic ovarian syndrome (PCOS), which can affect ovulation. Being overweight makes ovarian stimulation difficult, and some aspects of treatment—egg retrieval and embryo transfer, for example—are more difficult to perform in severely overweight women. (Tomlins, 2003, p. 48) Problems with ovulation are one of the more common causes of infertility in women and, in the absence of any other obvious problem, the doctor will begin by investigating menstrual cycle. Disruptions to ovulation can be minor and fixed easily, or may be more serious and require more complex treatment. It may be that ovulation is just a little irregular, or that one woman ovulate only occasionally—oligoovulation—or that she does not ovulate at all— anovulation. The effect on her fertility will depend on the cause and extent of the disruption. Disruptions to the normal pattern of ovulation may be caused by an imbalance of the various reproductive hormones. Polycystic ovarian syndrome (PCOS) is the most common cause of this. Very occasionally, disruption can result from a lack of FSH produced by the pituitary gland due to a lack of Gn RH being released from the hypothalamus, a condition known as hypothalamic anovulation. Problems may also result from an increase in prolactin produced by the pituitary gland—a condition known as hyperprol actinaemia—or from a disruption of the hormones produced by the thyroid. These hormone imbalances can affect the normal development of the follicle and the maturation and release of the egg. (Tomlins, 2003, p. 54) The most common symptom of ovulation problems is irregularities with periods. Women who have no periods at all, amenorrhea, or periods longer than 35 days, oligomenorrhea, have an obvious ovulation problem. However, you may still have an ovulation problem if your periods are only sometimes irregular, or even if they are completely regular, although this is less common. (Tomlins, 2003, p. 56) Metformin – Latest Research prescribed for Infertility Metformin, also called ‘Glucophage’, ‘Diformin’ and ‘Glycon’ possess the main effect while improving insulin sensitivity thus suppressing gluconeogenesis in the liver and enhancing glucose uptake in skeletal muscle. Metformin is currently regarded as the drug of choice for overweight and obese individuals with type 2 diabetes. Drugs prescribed for diabetes are now being used to treat PCOS. Women who go on insulin-lowering medications or insulin-sensitizers also tend to lose weight more easily. (Stevens, Nov. 14 2005, p. 1) Metformin help controls insulin levels and recent studies suggest that women with PCOS who are treated with metformin have a higher chance of getting pregnant. Other studies have suggested that continuing metformin after becoming pregnant may decrease the chance of first-trimester miscarriage when compared to women with PCOS who did not take metformin. (Metformin, August 2005) Conclusion The relationship between Insulin Resistance and PCOS is not just that simple as that between obesity and pregnancy. Instead, the disorders resulting from Insulin Resistance somehow become the root cause of PCOS, thereby escorting towards the thresholds of Infertility. PCOS is clearly identified when belly starts to swell due to excessive fats or when thick hair starts to cover the body. Researchers and doctors are still on their way to discover more and more about PCOS, however it is not necessary that PCOS affect every female in the same way. Patients with PCOS are a group in whom obesity is considered to be especially common. In these women, there is known to be an increased vascular risk, but again obesity exacerbates the problems of PCOS. Weight loss may be especially beneficial to women with PCOS since it can improve fertility and reduce the menstrual irregularity of these patients. Glucophage – a drug used for diabetes II is recommended by most of the doctors just after the diagnosis of PCOS. Glucophage where on one hand, when taken on a regular basis helps in weight reduction while on the other it helps in the regulation of ovarian functions, thereby reducing cysts. As a result it helps in conceiving while increasing the chances of pregnancy. Outline Insulin Resistance…………………………………………………..…………………. 1 Abnormalities characterizing Insulin Resistance Syndrome………………..………… 1 Causes………………………………………………………………………..………... 1 Polycystic Ovarian Syndrome (PCOS)………………………………………..………. 2 PCOS Symptoms……………………………………………………………..……….. 3 Ovarian Cysts…………………………………………………………………..……… 4 Infertility………………………………………………………………………..……… 4 Metaformin – Latest Research prescribed for Infertility……………………..……….. 6 Conclusion…………………………………………………………………………….. 8 References & Bibliography Hardman E., Adrianne, Morris Cbe. N Jeremy & Stensel J, David. (2003) Physical Activity and Health: The Evidence Explained: Routledge: New York. Tomlins Jacqueline, (2003) The Infertility Handbook: A Guide to Making Babies: Allen & Unwin: Crows Nest, N.S.W. “Your Life: Are Your Hormones Ruling Your Life? Cravings, Weight Gain, Moods, Spots. Your Body Chemistry has a lot to answer for. Here’s how you can stop the emotional Roller- Coaster”. Newspaper Title: The Mirror: (January 19, 2006). Stevens Susan, (Nov 14, 2005) “Out of the Dark Polycystic Ovary Syndrome Can Easily Escape Notice, but Diagnosis - and Early Treatment - Is Important for Women’s Long-Term Health”. Newspaper Title: Daily Herald. “Don’t Ignore Chronic Aches”. Newspaper Title: The Washington Times: (October 16, 2005). Metformin2005, accessed from Read More