Case Profile:

• A 28-year-old woman presented the clinic with below mentioned history:
• The patient reported infertility issue due to polycystic ovarian syndrome (PCOS) since from 5 years, came with complaints of irregular periods and weight gain.
• She wanted to conceive. 

On examination: 

• During diagnosis via ultrasound sonography(USG), Polycystic ovaries were observed.

Lab Parameters (Pre-treatment):

• The laboratory findings of this patient were as given below: 

1. Insulin level:raised
2. Prolactin level: raised
3. Testosterone level: raised
4. Oestrogen level: decreased
5. FSH level: raised

Diagnosis:

• Polycystic ovarian syndrome (PCOS)

Management: 

• Proper counselling about PCOD focussing on diet and related lifestyle modification was suggested to the patient for weight loss.

Treatment:

• Patient was prescribed for three months:
  • Egrich tablet twice daily
  • M-Torr 800 Capsule twice daily
• Along with other medication as well as with vitamin and protein supplements.
• The patient was advised to continue the treatment until further advice and follow-up at clinic.

Lab Parameters (Post- treatment):

• After three months of medication, levels of all the hormones i.e., insulin, prolactin, testosterone, oestrogen, and FSH were testedagain. 
• The results for all this lab test were came back to normal. 

Further treatment:

• The patient was put on an ovulationinduction cycle for getting conceived.
• During induced cycle, under the observation of follicular study, she got conceived in her 4thmonth of treatment.

Hence, there was marked improvement observed in the patient after three months of treatment with M-Torr 800 and Egrich along with lifestyle modification and was able to conceive during ovulation induction at fourth month.

Feedback message from the physician:

• Thanks to Shield Pharma Pvt Ltd. to make us available such a useful and helpful medications like Mtorr-800 and Egrich.
• I look forward to encouraging my patients to take these medications for their better results.

Discussion

Polycystic ovary syndrome (PCOS) is most common endocrine disorder affecting a woman in her reproductive age. It is characterized by hyperandrogenism, oligo- or anovulation and infertility. However, thepathophysiology of PCOS still remainsunknown. 

The mammalian target of rapamycin, mTOR, is a serine-threonine protein kinase downstream of the phosphatidylinositol 3-kinase (PI3K)-AKT axis. The pathway can regulate cell growth, proliferation, and survival by activating ribosomal kinases.

Recent studies have implicated the mTOR signalling pathway in ovarian neoplasms, polycystic ovary syndrome (PCOS) and premature ovarian failure (POF).

1.The mammalian target of rapamycin (mTOR) is a centralcomponent that regulates various processes including cell growth, proliferation, metabolism, and angiogenesis. mTOR signalling cascade has recently been examined in ovarian follicles where it regulates granulosa cellproliferation and differentiation. mTOR functions as two complexes, mTOR complex 1 and 2.One study provided evidence that mTORC1and mTORC2 may have responsibility in increased ovarian follicular cell proliferation and growth in PCOS.

2.DHEA supplementation has been used to enhance ovarian reserve.DHEA play significantly vital role as intermediates in androgen and estrogen formation. DHEA also have probable ‘oocyte factor’ and behave as endogenous agonists triggering calcium oscillations for oocyte activation.DHEA have been reported to regulate calcium channels for the passage of Ca2+ through the oocyte cytoplasm and for maintaining required threshold of Ca2+ oscillations. This role of DHEA assumes critical significance in assisted reproductive technology and in-vitro fertilization treatment cycles to enhance fertilization rates.

3.Physical exercise is definitely a part of the lifestyle changes.It has been shown that regular, aerobic exercise of moderate intensity does not only contribute to weight loss and improved insulin resistance, but also improves reproductive outcomes, including ovulation and regulation of menstrual cycles. The recommendation for patients with PCOS in view of the improve reproductive and cardio metabolic outcomes is – aerobic physical activity of moderate intensity for 90 minutes per week. The adoption of a healthy lifestyle, composed of a hypocaloric diet and physical exercise that will generate weight loss. Hence, by adopting a healthy lifestyle and weight loss, it would improve the metabolic profile, reduce the risk of diabetes mellitus,cardiovascular disease or endometrial hyperplasia as well as the complete or at least partial disappearance of the symptoms and PCOS phenotypeafter weight loss.

4.References

• Liu J, Wu DC, Qu LH, Liao HQ, Li MX. The role of mTOR in ovarian Neoplasms, polycystic ovary syndrome, and ovarian aging. Clin Anat. 2018 Sep;31(6):891-898. doi: 10.1002/ca.23211. Epub 2018 Oct 18. PMID: 29752839.

• Yaba A, Demir N. The mechanism of mTOR (mammalian target of rapamycin) in a mouse model of polycystic ovary syndrome (PCOS). J Ovarian Res. 2012 Nov 27;5(1):38. doi: 10.1186/1757-2215-5-38. PMID: 23185989; PMCID: PMC3538528.

1. Chimote BN, Chimote NM. Dehydroepiandrosterone (DHEA) and Its Sulfate (DHEA-S) in Mammalian Reproduction: Known Roles and Novel Paradigms. VitamHorm. 2018;108:223-250. doi: 10.1016/bs.vh.2018.02.001. Epub 2018 Mar 16. PMID: 30029728.
2. CringuAntoniu Ionescu, Ina Popescu, MihailBanacu and Mihai Dimitriu (February 14th 2018). Lifestyle Changes and Weight Loss: Effects in PCOS, Debatable Topics in PCOS Patients, Neeraj Kumar Agrawal and Kiran Singh, IntechOpen, DOI: 10.5772/intechopen.73298. Available from: https://www.intechopen.com/chapters/58827