AEPCOS NewSLET TER. Finally AEPCOS is seeking a new Editor of AEPCOS Newsletter. A N D R O G E N E X C E S S & P C O S S O C I E T Y

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1 AEPCOS NewSLET TER A N D R O G E N E X C E S S & P C O S S O C I E T Y A P R I L - M AY n e w s l e t t e r D I E T I N P C O S B O S T O N A E P C O S U P D A T E M E E T I N G This issue of the newsletter is dedicated to Diet in women with PCOS. The experts who gave the main lectures at the PCOS Diet Session of AEPCOS Update Meeting that was held on March 31, 2016 at Harvard Medical School in Boston, MA, USA, have answered some questions regarding their presentation The preliminary program of 14th AEPCOS Annual Meeting that will be held in Lorne, near Melbourne, Victoria State, Australia, November 10-12, 2016 is presented. Finally AEPCOS is seeking a new Editor of AEPCOS Newsletter. V o l u m e 4, I s s u e 2 Editorial Board M A Y 3 1, In this issue: Diet in PCOS Program of AEPCOS Annual Meeting, Lorne, Victoria, Australia, November 10-12, 2016 Enrico Carmina, M.D., Palermo, Italy Ellen Connor, M.D., Madison, WI, USA Frank Gonzalez M.D., Indianapolis, IN, USA Helen Mason, Ph.D., London, United Kingdom Poli Mara Spritzer, M.D., Porto Alegre, Brazil F O R T H C O M I N G A E P C O S M E E T I N G S Joint AEPCOS-ASRM Postgraduate Course, Salt Lake City, UT, USA, October 15, th AEPCOS Annual Meeting, Lorne, Victoria, Australia, November 10-12, 2016 AEPCOS Update Meeting, Orlando, FL, USA, April th AEPCOS Annual Meeting, San Antonio, TX, USA, October 25-27,

14th ANNUAL MEETING OF AEPCOS SOCIETY Next annual meeting of AEPCOS Society will be held

The conference venue is the Mantra Lorne Resort, Mountjoy Parade, 3232 Lorne, Victoria,

The Mantra Lorne Resort is located along the Great Ocean Road, one of the most famous

It is the only property in Lorne that has direct beach access and represents an ideal base

2 14th ANNUAL MEETING OF AEPCOS SOCIETY Next annual meeting of AEPCOS Society will be held November 10-12, 2016 in Lorne, Victoria, Australia. The conference venue is the Mantra Lorne Resort, Mountjoy Parade, 3232 Lorne, Victoria, Australia. The Mantra Lorne Resort is located along the Great Ocean Road, one of the most famous attractions of Australia. Melbourne airport is one hour away. It is the only property in Lorne that has direct beach access and represents an ideal base for exploring the Twelve Apostles, some wonderful beaches and Erskine Falls. The Twelve Apostles Melbourne For meeting registration and hotel reservation, please check our website: or contact: Lorne 8

3 14th ANNUAL MEETING OF AEPCOS SOCIETY THURSDAY, NOVEMBER 10 th, 2016 ANUJA DOKRAS, M.D., Ph.D. 2:00 2:15 pm President of AEPCOS Society SELMA WITCHEL, M.D. WELCOME Chair of Annual Meeting Committee HELENA TEEDE, M.D. President, Australian Society of Endocrinology SESSION I 2:15 3:55 pm ETHNIC VARIATIONS OF PCOS PHENOTYPES 2:15 2:40 pm ANUJA DOKRAS President of AEPCOS Society, Department of Obstetrics and Gynecology,, University of Pennsylvania, Philadelphia, PA, USA PCOS PHENOTYPES IN USA: INFLUENCE OF ETHNIC MINORITIES 2:40 3:05 pm JACQUELINE BOYLE Monash Centre for Health Research Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. PCOS PHENOTYPES IN INDIGENOUS POPULA- TIONS 3:05 3:30 pm JIE QIAO Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China PCOS PHENOTYPES IN HAN CHINA POPULA- TION 3:30 3:55 pm DURU SHAH President of India PCOS Society, Mumbai, India PCOS PHENOTYPES IN INDIAN SUBCONTI- NENT 3:55 4:20 pm COFFEE BREAK SESSION II 4:20-5:20 pm ORAL PRESENTATIONS 1 5:20-5:50 pm RICARDO AZZIZ DISTINGUISHED CAREER AWARD 7:00 10:00 pm WELCOME DINNER 9

4 FRIDAY, NOVEMBER 11 th, :30 10:20 am SESSION IV NEUROENDOCRINOLOGY OF PCOS 8:30 8:55 am 8:55 9:20 am 9:20 9:45 am 9:45 10:10 am IAIN CLARKE Monash University, Department of Physiology, Clayton, Australia SELMA WITCHEL Division of Pediatric Endocrinology Children s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA DIDIER DEWAILLY Service de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHU de Lille, Lille 59037, France ENRICO CARMINA Reproductive Endocrinology Unit, Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy. CONTROL OF GONADOTROPIN RELEASING HORMONE SECRETION WITHIN THE MEDIAN EMINENCE ONTOGENY OF ABERRANT HPG AXIS FEED- BACK IN PCOS ANTI-MÜLLERIAN HORMONE: AN UNEXPECTED REGULATOR OF GNRH NEURON ACTIVITY? FUNCTIONAL HYPOTHALAMIC AMENORRHEA AND PCOS: WHAT IS THE LINK? 10:10 10:40 am COFFEE BREAK SESSION V 10: am GENETICS OF PCOS 10: am MARK GOODARZI Division of Endocrinology, Diabetes, and Metabolism, Cedars-Sinai Medical Center, Los Angeles, California, United States of America GWAS IN PCOS 11:05 11:30 am JOOP LAVEN Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands GWAS RELATED TO TIMING OF PUBERTY AND MENOPAUSE 11:30 11:55 am RICARDO AZZIZ Depts. of Ob/Gyn, and Medicine, Augusta University, Augusta, GA, USA PUTTING GWAS AND EPIDEMIOLOGICAL DA- TA INTO PERSPECTIVE 10

5 FRIDAY, NOVEMBER 11 th, :55 am -12:55 pm SESSION VI ORAL PRESENTATIONS 2 1:00 2:30 pm LUNCH MEET THE PROFESSOR SESSION VII 2:30 4:35 pm NATURAL HISTORY OF PCOS ACROSS THE LIFE CYCLE 2:30 2:55 pm 2:55 3:20 pm 3:20 3:45 pm MARTHA HICKEY Department of Obstetrics and Gynecology, University of Melbourne, Royal Women s Hospital, Parkville, Victoria, Australia ALEXIA PENA Department of Endocrinology/Diabetes, Women s and Children s Hospital, The University of Adelaide, Adelaide, SA, Australia RICHARD LEGRO Department of Obstetrics and Gynecology Pennsylvania State University School of Medicine, Hershey, PA, USA FETAL AND CHILDHOOD ORIGINS OF PCOS HYPERANDROGENIC STATES IN ADOLES- CENT GIRLS. WHAT IS ADOLESCENT PCOS? PCOS AND MENOPAUSE 3:45 4:10 pm COFFEE BREAK LISA MORAN 4:10 4:35 pm 4:35 5:00 pm 5:00 5:30 pm 5:00 5:30 pm Monash Centre for Health Research Implementation, School of Public Health, Monash University, Clayton, Victoria, Australia NIGEL STEPTO College of Sport and Exercise Science and Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Victoria, Australia ANUJA DOKRAS President, AE-PCOS Society, Department of Obstetrics and Gynecology,, University of Pennsylvania, Philadelphia, PA, USA LIFESTYLE AND THE NATURAL HISTORY OF PCOS PHYSICAL EXERCISE AND THE NATURAL HIS- TORY OF PCOS SESSION VIiI PRESIDENTIAL TALK TOPIC TO BE ANNOUNCED 6:30 8:00 pm POSTER CANAPE NIGHT 11

6 SATURDAY, NOVEMBER 12 th, 2016 SESSION IX 8:30 9:45am THE OVARY IN PCOS 8:30 8:55 am RICHARD L STOUFFER Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon; USA LOCAL ACTIONS OF ANDROGENS TO CON- TROL THE SURVIVAL, GROWTH AND MATURA- TION OF MACAQUE FOLLICLES IN VITRO AND 8:55 9:20 am REBECCA LOUISE ROBKER Robinson Research Institute, University of Ade- METABOLIC DISRUPTION IN OVARIAN FOLLI- 9:20 9:45 am KIRSTY A WALTERS Andrology, ANZAC Research Institute, University ROLE OF ANDROGENS IN NORMAL AND 9:45 10:05am COFFEE BREAK SESSION X 10:05 am 11:00 am FERTILITY AND PREGNANCY IN PCOS 10:05 am 10:30 am ROBERT NORMAN Professor of Reproductive - Periconceptual Medicine, University of Adelaide Adelaide, SA, Australia WHEN LIFESTYLE AND ORAL OVULATION DRUGS FAIL 10:30 am 11:00 am BART FAUSER Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, PREGNANCY PROBLEMS IN PCOS SESSION XI 11:00 am 12:00 pm ORAL PRESENTATIONS 3 SESSION XII 12:00 pm 1:00 pm DEVELOPMENT OF INTERNATIONAL GUIDE- LINES FOR PCOS DIAGNOSIS AND TREAT- MENT HELENA TEEDE 12:00 pm 12:30 pm President Elect, AE-PCOS Society President, Australian Endocrine Society Monash University, Clayton, Victoria, Australia PCOS GUIDELINES AROUND THE WORLD: NEXT STEPS, AND NEED FOR CONSENSUS, EDUCATION, AND DISSEMINATION 12:30 pm pm ENRICO CARMINA Professor, Reproductive Endocrinology Unit, Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy. NCAH GUIDELINES 12:45 pm pm ENRICO CARMINA Executive Director, AE- PCOS Society ANNUAL BUSINESS MEETING OF THE AN- DROGEN EXCESS & PCOS SOCIETY 12

7 AEPCOS is Seeking a new Editor of AEPCOS Newsletter With Professor Enrico Carmina leaving his position of Editor, AEPCOS is seeking a new Editor of AEPCOS Newsletter Qualified candidates should have a: Doctoral degree in a biomedical field A broad understanding of reproductive sciences Outstanding verbal and written communication skills Please, send a short bio and a letter by to: Anuja Dokras, President of AEPCOS Society: ADokras@obgyn.upenn.edu OTHER FUTURE MEETINGS EUROPEAN SOCIETY OF ENDOCRINOLOGY, MUNICH, GERMANY, MAY 28-31, 2016 JOINT INDIA PCOS SOCIETY AND AEPCOS SOCIETY CONFERENCE, MUMBAI, INDIA, JUNE 17-19, 2016 ESHRE, HELSINKI, FINLAND, JULY 3-6, 2016 ASRM, SALT LAKE CITY, UT, USA, OCTOBER 15-19, 2016 ENDOCRINE SOCIETY, ORLANDO, FL, USA, APRIL 1-4,

ANDROGEN EXCESS & PCOS SOCIETY DIET IN WOMEN WITH PCOS 12520 Magnolia Boulevard, North Hollywood, CA 91607, USA Email : info@ae-society.

8 ANDROGEN EXCESS & PCOS SOCIETY DIET IN WOMEN WITH PCOS Magnolia Boulevard, North Hollywood, CA 91607, USA info@ae-society.org In this issue, Enrico Carmina has interviewed the AEPCOS experts who gave the main presentations at the session about Diet in women with PCOS of the Boston Update Meeting, March 31, 2016: Questions for Helena Teede, MD, Professor of Endocrinology at Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia and President Elect of AEPCOS Society 1. Helena, is there any specific diet that may be more useful in women with PCOS? Current evidence suggests that a balanced high quality diet high in fruit and vegetable intake is the optimal diet in PCOS. No specific diet delivers more health benefits than others. Low GI diets may offer marginal benefits however overall there is no one magic diet to recommend in PCOS. Healthy lifestyle skills including self monitoring of weight to aid weight management are important. Women with PCOS are also at high risk of poor dietary habits. These include skipping meals, binge eating and laxative abuse and these should be addressed also. Helena Teede, M.D. 2. Helena, what are the realistic outcomes of a diet program or of a lifestyle program? The key aim should be prevention of weight gain, no matter what the starting weight. For those who are overweight aiming for a 5-10% loss is a feasible and delivers health benefits. Aiming for weight maintenance after loss is very important also and requires weight monitoring and vigilance.

ANDROGEN EXCESS & PCOS SOCIETY 12520 Magnolia Boulevard, North Hollywood, CA 91607, USA Email : info@ae-society.org 3.

9 ANDROGEN EXCESS & PCOS SOCIETY Magnolia Boulevard, North Hollywood, CA 91607, USA info@ae-society.org 3. Helena, should patients with severe obesity be treated with a lifestyle program or is better to send directly these patients to a surgeon for bariatric surgery? Where BMI exceeds 35 kg/m2 with comorbidities, adjunct medical or surgical therapy should be considered in addition to lifestyle to deliver health benefits. Bariatric surgery requires close follow up for nutritional deficiencies especially preconception and during pregnancy. Questions for Poli Mara Spritzer, MD, Gynecological Endocrinology Unit, HCPA and Department of Physiology, University of Rio Grande do Sul, Porto Alegre, RS, Brazil 1. Poli Mara, what is the evidence that a diet is useful in PCOS? Evidence indicates that different diet intervention leading to weight loss seem to effectively improve reproductive and metabolic parameters in PCOS and many dietary options are available for weight loss. However, evidence from a specific diet composition in PCOS is limited by the few number of randomized clinical trials, the small sample sizes, short trial duration and high rates of loss to follow-up. In this context, lowpowered data suggest benefits of diets with lower glycemic index/glycemic load. 2. Poli Mara, what is your advice for a diet plan in PCOS? Poli Mara Spritzer, M.D. My advice is for a diet with low calorie intake (for overweight/obese patients), that should be a nutritionally complete diet and appropriate for life stage; healthy food choices and regular physical activity are also strongly recommended. Additionally, decreasing glycemic index or carbohydrate intake could add some benefit on insulin sensitivity and reduction in testosterone levels.

ANDROGEN EXCESS & PCOS SOCIETY 12520 Magnolia Boulevard, North Hollywood, CA 91607, USA Email : info@ae-society.

10 ANDROGEN EXCESS & PCOS SOCIETY Magnolia Boulevard, North Hollywood, CA 91607, USA info@ae-society.org Questions for Angela Grassi, MS, RDN, LDN, Founder of PCOS Nutrition Center, Bryn Mawr, PA, USA 1. Angela, what nutrition supplements may be useful in women with PCOS? Vitamin B12. There is good evidence now that Metformin reduces vitamin B12 levels. It is recommended that women with PCOS have their vitamin B12 levels checked annually if they take metformin and supplement their diets as appropriate. The sublingual form of methylcobalamin is best absorbed. Inositol. Myoinositol may improve ovulation and metabolic features in PCOS as well as improve egg quality and reduce the risk for gestational diabetes. Supplementation with a combination of myo to DCI in a 40:1 ratio to mimic the levels in the body is recommended. N-Acetylcysteine (NAC) N-Acetylcysteine (NAC) is an amino acid and potent antioxidant that may be useful for improving cholesterol in PCOS women. Fish Oil. Fish oil is effective at reducing triglycerides and even hormones such as testosterone. Fish oil may also help with insulin resistance. Research does show that fish oil can also improve non-alcoholic fatty liver disease. Angela Grassi, RDN

11 ANDROGEN EXCESS & PCOS SOCIETY Questions for Felice Gersh, MD, Integrative Medical Group of Irvine, Irvine, CA, USA Magnolia Boulevard, North Hollywood, CA 91607, USA info@ae-society.org 1. Felice, what is the significance of the gut microbiome? The metabolic functions which the gut microbiome controls are vast, including the production of vitamins, amino acid synthesis, bile acid transformation, and also the production of short chain fatty acids (SCFA) from the fermentation of resistant carbohydrates. These SCFA s are critically involved in energy metabolism, appetite regulation, play a key role in glucose metabolism, and are immunomodulatory, playing an essential part in the development and support of the immune system. 2. Felice, how does diet impact the gut microbipme in PCOS women? A high fat, high simple sugar diet alters the gut microbiome. The overgrowth of pathological Gram negative bacteria increases the passage of lipopolysaccharides (LPS) from the gut barrier and may determine or worsen the systemic inflammation and insulin resistance that are typical of PCOS. Recent studies confirm (Zhu et al, January 2016) that women with PCOS, across the entire weight spectrum, have higher systemic levels of LPS compared with matched women without PCOS. 3. Felice, what diet best improves the status of the gut microbiome? Felice Gersh, M.D. A vegan diet composed of an extremely high carbohydrate percentage of 70%, with low protein and fat may help to recover our gut microbiome. The carbohydrates must be primarily organic, whole foods and plant based, heavily comprised of resistant starch from whole, unprocessed grains, beans and lentils, root vegetables, leafy greens, fermented vegetables, and a small amount of raw nuts and seeds. Initially, fruit is very limited, as would be flours. No dairy, processed grains, animal products, or sweets, real or artificial, can be eaten. A great variety of vegetables is needed, to provide a large array of phytonutrients, along with supplemented probiotics and Omega 3.

12 PICTURE FROM AEPCOS BOSTON BOARD RETREAT MEETING March 31, 2016 From the left: Ricardo Azziz, Sharon Oberfield, Selma Witchel, Enrico Carmina, Ethel Codner, Helena Teede, Anuja Dokras, David Abbott, Marla Lujan, Antoni Duleba and Elisabet Stener Victorin 18

Finally AEPCOS is seeking a new Editor of AEPCOS Newsletter. V o l u m e 4, I s s u e 1 M A R C H 3 1,

Finally AEPCOS is seeking a new Editor of AEPCOS Newsletter. V o l u m e 4, I s s u e 1 M A R C H 3 1, M A R C H 2 0 1 6 n e w s l e t t e r A E P C O S N e w S L E T T E R A N D R O G E N E X C E S S & P C O S S O C I E T Y E N D O M E T R I A L C A N C E R I N P C O S This issue is dedicated to possible