Interview with Dr. Serena Chen for PCOS Awareness Month

September is PCOS Awareness Month. Polycystic Ovary Syndrome is the most common ovulatory disorder but is often either misdiagnosed or there is a tremendous delay in a proper diagnosis.

Polycystic Ovary Syndrome, affecting roughly one in ten women and girls, is a genetic, hormone, metabolic and reproductive disorder that affects women and girls. It is the leading cause of female infertility and if not treated properly, can cause other serious conditions including obesity, type 2 diabetes, cardiovascular disease and endometrial cancer.

PCOS Awareness Month is a federally designated event created to increase awareness of this condition to help both patients better advocate for themselves and educate medical professionals on how to recognize PCOS and properly diagnose and treat it. The ultimate goal is to improve the lives of those affected by PCOS, help them to overcome their symptoms, and prevent or reduce their risks for other potential life-threatening illnesses.

In light of these goals, ConceiveAbilities spoke to Dr. Serena Chen. Dr. Chen serves as Director for the Division of Reproductive Medicine in the Department of Obstetrics and Gynecology at Saint Barnabas Medical Center, and the Institute for Reproductive Medicine and Science at Saint Barnabas, and is a Clinical Associate Professor at Rutgers, UMDNJ Medical School and Saint George’s University School of Medicine.

She loves empowering her patients with information and ideas about their mental and physical health in an interesting, accessible and practical way. She feels privileged to be at a program that is a leader in Assisted Reproductive Technology (ART), IUI, IVF, Single Embryo Transfer, LGBT family building, surrogacy, and PGT (Preimplantation Genetic Testing), offering individualized counseling, advice and treatment for a wide spectrum of reproductive issues. She strongly supports her patients’ right to be informed and involved in their treatment decisions and is an advocate of access to reproductive care for all. We were happy to help further her message with this interview.

ConceiveAbilities: First, there are several statements I hear about PCOS that I was hoping you can clear up. They are mostly around weight and PCOS. It’s either that if you lose weight, you can get rid of PCOS or that PCOS only affects overweight women. Can you address that?

Dr. Chen: It’s a lot more complicated than that. Polycystic ovary syndrome on the surface may seem like it’s exclusively just deals with ovaries, but it has to do with insulin resistance as well. The majority of people with PCOS have insulin resistance or high insulin. So having a higher level of insulin resistance can affect your metabolism and does make it easier to gain weight and harder to lose weight. Still, you can be on the leaner side or on the heavier side and still have an insulin resistance issue, so you can’t base the diagnosis just on weight.

Having said that, when it comes to weight, there are other things that can affect your metabolism. No matter where you are on the scale, it is helpful to do strength training or cardio as you’re burning excess calories and building muscle mass. Especially if you have PCOS, I always recommend hiring a motivating personal trainer (anything to keep you motivated and engaged!) to work on building that muscle mass. Even with a genetic condition that won’t shift with weight, exercise can improve your symptoms.

ConceiveAbilities: On that same note, I’ve spoken to many with PCOS patients who are trying to conceive that have been told by their doctors that they won’t cycle them unless they lose weight. It’s frustrating for them because they feel like they are in a catch-22 since difficulty losing weight is one of the symptoms of PCOS. Have you heard of this? Is this fair?

Dr. Chen: My approach with every single couple is that unless you’re at an extreme, meaning you’re at a weight or have such high blood pressure or diabetes that it could be potentially dangerous, I say: “Let’s work on all of your health concerns at the same time.” We can try and work as a team at getting pregnant and getting healthier at the same time. Again, it depends on factors like weight, age and time and you have to look at the pros and cons to make an informed decision.

An example is if you have a female patient who is 42 years old who is a little overweight. We should try to be aggressive to get healthy and get her weight down. We can weigh the pros and cons and it has to be an informed decision. She should be aggressive and try to get healthy while working to get pregnant, but with the understanding that should she get pregnant, she should continue to stay healthy and double her efforts to not gain more weight than recommended by her OB. If you have a younger patient who is overweight, you have a bit more time to perhaps give her to get healthier, lose some weight and then pursue fertility treatment. Ultimately though, every patient and every doctor is different and everyone has to feel comfortable – patient and doctor.

ConceiveAbilities: What are some of the less obvious symptoms of PCOS that get missed or you feel don’t get mentioned often enough?

Dr. Chen: Overall, I feel people focus too much on weight, when it should be about being healthy. If that was the priority, everything else (including the weight) will most likely fall into place. Some things I recommend is looking at your diet (healthy foods, veggies, etc.), making sure you are getting enough sleep (sleep is often something that gets overlooked) and exercise (again, I recommend cardio and strength training).
ConceiveAbilities: Another thing I’ve heard often is how many PCOS patients are misdiagnosed or not properly diagnosed right away. What advice would you give to a woman if they sincerely feel they have PCOS but are not being properly diagnosed?

Dr. Chen: That, to me, is an unfortunate function of our broken healthcare system. Patients naturally see their OB/GYN and they barely have time to write you a prescription for birth control pills let alone to really talk about a healthy lifestyle. What I find Is people with PCOS are typically just given pills or their cycles are regulated and that’s it because your doctor has twenty other patients they need to see so it’s not really addressing things. They don’t always have the time to look at your “story” over a period of years, and they need to investigate and see if there’s a pattern through puberty, if it’s a thyroid issue, etc.
I feel like many patients truly don’t get a diagnosis until they really see a reproductive endocrinologist as it’s usually when they are trying to get pregnant that they are properly diagnosed. Conversations about reproductive health, history, patterns in family history, your period, overall health to wellness, diet, exercise all need to happen but it’s usually just a pap smear and contraception, so it’s not a good system.

ConceiveAbilities: What’s difficult is some RE’s won’t see a patient unless they are trying to conceive too. What would you offer as a solution?

Dr. Chen: You’re absolutely right! Some do though thankfully. I think the solution is to be proactive and to educate yourself as much as possible about your own healthcare to find your own OB/GYN and look into an RE if need be that WILL see you. A pap smear simply doesn’t solve all of your problems or answer all of your questions.

ConceiveAbilities: You have been very active both in overall infertility advocacy but also, in advocating for PCOS research as well as endocrine disorders. How would you encourage those reading this to raise awareness around PCOS or advocate either for themselves or this condition?

Dr. Chen: I feel like social media is a great tool as it’s a great way to communicate with a lot of people so take a look at Resolve: the National Infertility Association or an advocacy group. One of the biggest issues is to raise awareness because too many don’t know about or understand infertility. If you want good healthcare, it cannot be a passive process. ASRM and Resolve are both excellent sources because their information is really well vetted!

Please follow her on Twitter and Instagram @DrSerenaHChen or visit her at www.sbivf.com.