New IVF Paradigm for the management of PCOS: Preimplantation Genetic Screening followed by elective single embryo transfer Dr. Angeline Beltsos Medical.

New IVF Paradigm for the management of PCOS: Preimplantation Genetic Screening followed by elective single embryo transfer Dr. Angeline Beltsos Medical Director Clinical Assist Professor University of Illinois Chicago FCI HP IVF /aparent IVF 1 NOV PCOS Conference Seattle New IVF Paradigm for Management of PCOS: PGS followed by eset. Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. This syndrome is manifested by endocrine and metabolic dysfunctions which result in a markedly altered ovarian milieu. This environment is characterized by mutations in both the cumulus cell complexes of the oocyte as well as significant transcriptomic and secretomic alterations in the blastocyst. These factors result in a higher number of immature oocytes, possibly poorer quality oocytes, decreased rates of fertilization, decreased blastulation and blastocyst quality, less implantation, and higher rates of miscarriage. Practical management of these patients remains difficult. Moving to IVF with careful stimulation, agonist trigger followed by freeze all, PGS and then single frozen embryo transfer may provide optimal results. Mitigating risks of pcos patients doing IVF specifically their increased potential for excessive ovarian response (OHSS) coupled by a higher IVF cancellation rate is important. Increased evidence demonstrates that higher IVF implantation rates and improved pregnancy outcomes can be achieved by pre- implantation genetic screening, followed by frozen embryo transfer which may improve placentation and infant health as well. With additional data to support this trend, a new IVF paradigm is evolving: single, genetically healthy FET. Applying this technology to the PCOS patient may provide an ideal outcome for many patients. Angeline Beltsos, M.D. Medical Director PCOS The most common endocrine disorder affecting women of reproductive age (2-10%). Current suggested prevalence in the U.S.: Caucasian: 4.8% African American: 8.0% Hispanic or Latino: 13% Manifested by endocrine and metabolic dysfunctions which result in a markedly altered ovarian milieu. Obesity: big part of picture Knochenhauer et al. J Clin Endocrinol Metab 83:3078; 1998 Azziz et al. J Clin Endo Meta 89:2745; 200 Goodarzi et al. Fert Ster 84:766; 2005 Ehrmann. NEJM 325:1223; 2005 Diabetes Finger Prick Test Blood Sugar Readings YBFAT 101YBFAT 101 New Diabetes CureNew Diabetes Cure Out Live Your DoctorOut Live Your Doctor Diabetes Cure 101Diabetes Cure 101 Diabetes Self HelpDiabetes Self Help Harlan Jacobsen 2009 Obesity: Prevalence in Women JAMA 2005 Morbidly Obese 9 Mill adults Overweight 127 Mill adults Obese 60 Mill adults Obesity and pcos Altered ovarian environment Characterized by mutations in both the cumulus cell complexes of the oocyte as well as embryos. These factors result in a higher number of immature oocytes, possibly poorer quality oocytes, decreased rates of fertilization, decreased blastulation and blastocyst quality, less implantation, and higher rates of miscarriage. Reprod Biomed Online.Reprod Biomed Online Oct;31(4): doi: /j.rbmo Epub 2015 Jul 15. miR-483-5p and miR-486-5p are down-regulated in cumulus cells of metaphase II oocytes from women with polycystic ovary syndrome. Shi L Shi L 1, Liu S 2, Zhao W 2, Shi J 3.Liu SZhao WShi J Reprod Biomed Online Oct;31(4): doi: /j.rbmo Epub 2015 Jul 15. Reprod Biomed Online. miR-483-5p and miR-486-5p are down-regulated in cumulus cells of metaphase II oocytes from women with polycystic ovary syndrome. Shi L 1, Liu S 2, Zhao W 2, Shi J 3. Shi LLiu SZhao WShi J Author information Author information 1 Department of Immunology and Microbiology, Xi'an Jiaotong University Health Science Center, Xi'an , China. 2 Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shaanxi Province, Xi'an , China. 3 Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shaanxi Province, Xi'an , China. Electronic address: Abstract The aim of this study was to compare the expression of microRNAs (miRNAs) in cumulus cells from polycystic ovary syndrome (PCOS) and non-PCOS women. In the present study, miRNA expression profiles of the cumulus cell samples were determined by miRNA microarrays. Quantification of selected miRNAs and predicted target genes was performed using quantitative real- time PCR (qRT-PCR). The results showed that miR-483-5p and miR-486-5p are significantly decreased in cumulus cells of PCOS patients PCOS (fold change >2, false discovery rate