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Promise for PCOS patients

November 2004

by Natalie Gutierrez

PCOS affects between
5 percent and 10 percent of women of reproductive age.
Marina Bello remembers her wedding like it was yesterday – a cake with white icing, gold wedding bands symbolizing the promise of eternal love, and dreams of a family in the future.

"Children are a blessing. We have so much love to share with a child," she said of herself and her husband of 13 years, Jesse. Years passed but Bello never became pregnant. The couple sought treatment at several fertility clinics across the city to no avail. Hopelessness hovered and was compounded by the fact that Bello noticed bothersome changes in her body – acne, excessive hair growth, weight gain and acanthosis nigricans (light brown-black, rough or thickened areas on the surface of the skin, typical in diabetes patients). Little did she know these symptoms, coupled with her infertility, were signs of something far more complicated.

It wasn’t until she visited physicians in the department of obstetrics and gynecology (ob-gyn) at the Health Science Center in 2004 that she learned she had a disorder called Polycystic Ovary Syndrome (PCOS). PCOS affects between 5 percent and 10 percent of women of reproductive age. Although doctors identified the disease in the 1930s, the exact cause remains elusive. Recently doctors have noticed a frightening new trend among PCOS patients. Most have high insulin levels, making them more prone to developing type 2 diabetes and diabetes-related health problems. The disease also could lead to other serious side effects, including high blood pressure, high cholesterol levels, heart disease and endometrial cancer.

"I was scared to learn that PCOS left me vulnerable to so many other health problems," Bello said.

Researchers in the departments of medicine, ob-gyn and surgery, and the Research Imaging Center at the Health Science Center are conducting a study to find the cause of PCOS and treatment for its symptoms. Bello is among the study participants.

"This is the first time that PCOS has been looked at from such a wide perspective," said Rachele Berria, M.D., research fellow in the division of diabetes. Dr. Berria, along with Ralph DeFronzo, M.D., professor of medicine and chief of the division of diabetes, are the principal investigators. They are collaborating with Robert Brzyski, M.D., Ph.D., associate professor of ob-gyn; Scott Lucidi, M.D., assistant instructor of ob-gyn; and Douglas Cromack, M.D., assistant professor in the division of plastic and reconstructive surgery. Researchers in the department of molecular medicine at Northwestern University in Chicago also are involved in the project.

"Our analysis shows that a drug called pioglitazone, used to treat patients with type 2 diabetes, dramatically decreases the level of a male hormone, called androgen, in women," Dr. Lucidi said. "It allows the majority of the women in our study, like Marina, to ovulate on a monthly basis. Theoretically, ovulation would allow this infertile population to eventually conceive."

One month after being in the study and on pioglitazone, a routine sonogram indicated that Bello had ovulated – something her body hadn’t done in several years.

"I was thrilled that after so many years, my body was finally beginning to work normally again," she said.

Doctors are studying the drug closely to find out how it can help alleviate other symptoms of PCOS, such as acne, excessive hair growth and weight gain. Dr. Lucidi said more information is needed to determine what causes PCOS, the mechanisms through which pioglitazone works, and whether other treatment methods can be used to supplement the positive effects of pioglitazone. In addition, researchers plan to conduct a similar study using a drug called letrozole that will focus solely on pregnancy in infertile women with PCOS.

For women like Bello, who suffer from PCOS, a cure could mean relief from unwanted hair growth and acne. More importantly, it could mean protection from diabetes, heart disease and endometrial cancer. For women who are infertile, a cure for PCOS could mean the ability to become pregnant in the future.

Because the pioglitazone study requires that women not become pregnant while in the study, Bello has put her plans to conceive on hold.

"I know that being in this study means I have to wait just a little bit longer before I can try to become pregnant," she said. "But it’s all worth it because for the first time in a long time, I feel like a normal woman again. This study has given me renewed hope that I could be a mom some day, and a much healthier one at that. I’m happy that other women will benefit from my experience."

For information on the PCOS study, call (210) 567-4773. For information on the letrozole study, call (210) 567-6121.

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