Erika P. NewREI, University of South Florida
- University of South Florida
- United States of America
About Erika P. New
Fellowship - University of South Florida
Residency - University of South Florida
Medical School - Virginia Commonwealth University SOM
Undergraduate and Masters - University of Georgia
I am excited to hear more about people's experience with virtual interviews this past application cycle and what you are planning to change for this go around.
Also, please share this article with fellows and PDs who may find it helpful!
Excellent article! Thank you for your contribution, and I am also curious to hear best practices and plans for improvement for the 2021 interview season. A few years ago we found that REI applicants spent on average $5,600 for the REI Fellowship interview season in 2018. What a difference with virtual interviews last year and a reported median of $100!
Insulin Resistance and PCOS.
We read with considerable interest the Reflections on Insulin Resistance in PCOS.
Insulin Resistance has been implicated in the etiopathology of PCOS, Type 2 Diabetes Mellitus and the Metabolic syndrome, Fatty Liver and Coronary artery disease. The precise mechanism by which Insulin Resistance leads to all these clinical conditions is not clear. Insulin levels are variable in all these patients and do not correlate with the clinical condition.
Insulin Resistance is a nebulous entity and is not used in routine clinical practice in the management of PCOS, Type 2 Diabetes Mellitus or Metabolic syndrome. The inconvenient truth about Insulin Resistance seems to be that the so called Insulin Resistance may well be the consequence of Hyperglycemia and not the cause of it. (1 )
PCOS is primarily due to Abnormal weight gain in adolescence or adult life. Most of the patients with PCOS are either overweight or obese. The few who are so called normal weight or thin also seemed to have gained significant weight in adulthood though they may still be in the normal weight or thin weight range. ( 2 )
Weight loss by modification of diet and exercise seems to be the Only logical step in the management of PCOS, Type 2 Diabetes Mellitus and Metabolic syndrome. Drugs for Induction of Ovulation in infertile PCOS patients should be the second line of management. Metabolic surgery and burning of the ovaries by Laparoscopic Endocautery of the ovaries would be futile and can cause more harm than good.
Insulin estimation will not yield any useful information and will cause more confusion than clarity. We reiterate that the primary focus should be on weight loss.
1) Anand Chockalingam, Pandiyan Natarajan, Puvithra Thanikachalam, Radha Pandiyan.
Insulin Resistance: The Inconvenient Truth.
Missouri Medicine 2021; 118:2; 119.
2) Puvithra T, Pandiyan N.
Is weight gain the Precipitating Factor for Polycystic Ovarian Syndrome? A Hypothesis Based on Retrospective Study.
Chettinad Health City Medical Journal 2015; 4;3; 120-124.
Professor Dr Pandiyan Natarajan,
Professor and Head of the Department of Andrology and Reproductive Medicine.
Chettinad Super Speciality Hospital,
Chettinad Academy of Research and Education,
An interesting discussion. The group of PCOS patients who are normal weight have always been of interest to me. In my experience, the normal weight PCOS patients have not gained significant weight in adulthood. This phenotype of PCOS is likely related to the metabolic factors such as insulin resistance as are discussed in the reflection. But with the tests for insulin resistance not being very practical in reality, maybe the take away is to remember to counsel all PCOS patients, not just those who are overweight or obese, on healthy diet and lifestyle. Many may already do this, but I definitely think it is more in the forefront of our minds when our patients are overweight or obese.
Thank you for an excellent, very educational video! When taking care of any patient with ovaries that are difficult to reach vaginally (large fibroid uterus, prior ovarian transposition, etc), it is important to be able to perform transabdominal oocyte retrieval when indicated. Since this is performed infrequently, I appreciate you sharing your video to help other providers learn more about this technique.
Sounds like an interesting book full of great ideas for how to make the infertility journey less of a burden on our patients. Some of the mentioned advancements may be a sooner reality than others, particularly concerning frequent blood draws. The article, “Concordance of Fingerstick and Venipuncture Sampling for Fertility Hormones,” published in the Green Journal February 2019 showed that hormonal results for AMH, E2, FSH, LH, PRL, testosterone, TSH, and free T4 were concordant between venipuncture and fingerstick samples! While home sonography for follicle monitoring seems unbelievable, with the advances in automated, 3D follicular monitoring with SonoAVC, perhaps this really could become a reality in the future. A low-tech but welcome change I have noticed during the coronavirus pandemic is that it is encouraging clinics to very much reconsider whether each ultrasound, blood draw, or clinic visit is absolutely necessary, to minimize unnecessary risk to our patients.
Burke EE, Beqaj S, Douglas NC, Luo R. Concordance of Fingerstick and Venipuncture Sampling for Fertility Hormones. Obstet Gynecol. 2019 Feb;133(2):343-348. doi: 10.1097/AOG.0000000000003066. PMID: 30633131.