Undiagnosed fertility disorder is 'rampant' in UAE says expert

The majority of women in the country may suffer from a syndrome associated with diabetes and infertility.

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AL AIN // A majority of UAE women may be suffering from an ovarian disorder linked to diabetes and infertility, and may not be aware of their condition. Dr Pankaj Shrivastav, the director of Conceive, a gynaecology and fertility hospital in Sharjah, believes polycystic ovarian syndrome (PCOS) is "sweeping across the Gulf and South Asia and is much more prevalent than in the rest of the world".

Speaking at UAE University to 60 of the world's leading health scientists, researchers and clinicians on the second day of the Global Health and the UAE conference, Dr Shrivastav said social and cultural trends were among the reasons for the high rate of PCOS in the region. No national or regional studies have been done, but he said an examination of 160 of his own patients from the UAE and GCC showed that 63 percent had PCOS.

"Like diabetes, PCOS is a lifestyle disease with genetic predisposition," he said. "It is a metabolic disorder characterised by insulin resistance, and its prevalence increases with adverse lifestyle changes, of which there is a lot in this country." Lifestyle factors such as obesity, weight gain and physical inactivity are the type of risk factors that can lead to PCOS, which can then result in diabetes and can be a reason for infertility.

Diagnosising PCOS, which affects five to 15 per cent of women worldwide, is not easy, Dr Shrivastav said. Two of three criteria must be in place in any particular woman for a diagnosis of PCOS. He said "evidence of an excess in male hormones" in the form of acne, receding hairline, an excess in hair on the face or biochemical evidence in the blood, is one of those three criteria. Another indication is an infrequent or non-present menstrual cycle. The third criterion is the presence of cysts on the ovaries.

"Some women don't know they are ovulating infrequently," Dr Shrivastav said, "because they have a cycle every 50 days regularly and think that's normal. Or don't think they are unusually hairy because their sister or mother is the same when the truth is their sister or mother may have PCOS as well." "There is a much higher incidence of PCOS in this part of the world," Dr Shrivastav said. One explanation could be an increased trend of post-marriage weight gain among women in the UAE, he said. By examining 15 of his own patients, whose weight before marriage was constant, a 5.63kg increase per year was noted after marriage.

"Women putting on weight after marriage is seen so commonly in this part of the world, and the impression I got from patients is that a lot blame it on lifestyle changes," Dr Shrivastav said. "Girls were more active in their parents' house; they had more freedom to come and go. But responsibilities after marriage restrict them to home more, cooking and cleaning, and if they have to work to supplement their income, then the jobs are sedentary."

Another reason that could explain post-marriage weight gain among UAE nationals may be the loose-fitting clothing common to the region. "When you put on a few pounds, you won't notice it because you are wearing loose clothes," Dr Shrivastav said. PCOS is an important public-health issue because of its association with diabetes, which affects at least 20 per cent of people in the UAE. The possibility of health complications is not always enough to prompt weight loss in PCOS sufferers, Dr Shrivastav said.

Experts at the conference said a more effective incentive could involve highlighting short-term benefits. "You can emphasise to a patient that her acne can improve, there will be less hair on her face and she is more likely to get pregnant if she loses weight," Dr Shrivastav said. @Email:hkhalaf@thenational.ae