Lorne Brown 

Welcome to the Conscious Fertility Podcast. Today I have Dr. Elizabeth Stener-Victorian and I am talking to her now because she runs a very busy schedule. She’s driving somewhere in Sweden and I am so happy that you made time for us to have this discussion. We’re going to talk about PCOS. I do want to introduce our audience to Elizabeth because we’ve met on many occasions. She’s spoken at the Integrated Fertility Symposium and we’ve met in, I think somewhere in Rottenberg or somewhere. Our paths have crossed before in person and now I get to interview her and catch up with her on the Conscious Fertility Podcast. So Dr. Elizabeth Stener-Victorian, she studied physiotherapy at Lu University graduating way back in 1985. She completed her doctorate at the University of Gothenburg in 2000 and she was a postdoctoral researcher at the International University of Health and Welfare in Atara Japan.

And that was 2002 and three, and then she became an associate professor in 2004. She established her research group, reproductive Endocrinology and Metabolism at the Department of Physiology and Pharmacology in January of 2015. Elizabeth was previously with the Department of Physiology at University of Gothenburg where she held a VR granted junior research position. And since 2009, a senior research position, I’m her group’s research activities aim to yield new key information on the pathophysiology of polycystic ovarian syndrome, which is the most common female endocrine and metabolic disorder. Its etiology is not well understood, but genetic epigenetic and environmental factors have been implicated in its development. They also investigate the effect and mechanism of acupuncture and or exercise on reproductive function, on high androgens and insulin resistance, as well as on key molecular pathways and epigenetic modifications and adipose and skeletal muscle tissues. Elizabeth, welcome to the Conscious Fertility Podcast.

Elizabet Stener-Victorin

Thank you Lorne for this very long introduction.

Lorne Brown 

Well, you’ve done a lot in this field, so I think that’s brief for so much what you’ve done and what I would like to do today is because you are a researcher and also have been involved clinically to kind of bring this to the public and share kind of what you’ve been doing and why this is relevant to our listeners. So I thought we would just start off. Why would we care about this condition PCOS? What are its implications on the person trying to conceive throat pregnancy? Is there any impact on the child, on the mom to be so why do we care about this and why are you so interested in studying this condition called polycystic ovarian syndrome?

Elizabet Stener-Victorin 

PCOS is the abrogation for polycystic ovary syndrome is so common affects around over 50, 11 to 13% we say is the prevalence, but the prevalence increase with overweight and obesity and in severe obesity is as many as the one in four that actually are affected and it affects in many different ways. As you already mentioned, the reproductive part is maybe the first thing many think of because you get the diagnosis, if you fulfill two out of three criteria, you have high circulating Andre levels or you have disturbing hair growth or acne or boldness, male pattern boldness, and that is also a sign of high Andre levels. So that is one sign and you have irregular cycles, which means that you have infrequent ovations, which makes it more difficult to become pregnant. And you have many small follicles with cytes or eggs, which means that you do have a lot of eggs. It’s not the problem, but they do not mature properly and this is because of a hormonal imbalance. So if you have two out of three criteria, you have a diagnosis and despite that, it is so common we do not really know the underlying pathophysiology and etiology and that is really what’s driving my research and trying to understand the etiology but also the path of physiology.

Lorne Brown

Okay. And you had mentioned one of the things about adipose tissue or being overweight In my clinical practice, I would say I see more thin PCOS than overweight PCOS. So do you have to be overweight for this to have this condition?

Elizabet Stener-Victorin 

No. And sometimes I say that actually it’s maybe the most interesting or best to study is the normal weight or the lean PCOS women because as soon as you are overweight obese, you add on an additional component that is a confounding factor. But maybe you say that you see more mainly normal weight. This is very uncommon. I would say it depends on where you live. Yeah, so

Lorne Brown 

I’m in Vancouver, maybe it’s the active outdoor lifestyle like you, you’re always outdoor doing your wave kite surfing 

Elizabet Stener-Victorin 

I think if you see in the US and you see in California, yeah there you have many normal weight women with PCOS, but the rest of and maybe the big cities, but in the rest of the US I would say the majority are overweight or obese.

Lorne Brown 

And so you can have this condition and have, as you called it, lean PCOS. Are you still seeing the insulin resistance in those issues in these patients then?

Elizabet Stener-Victorin 

I think it is a very important thing to bring up because also the normal weight women with PCOS developed insulin resistance and hyperinsulinemia, so they have high circulating levels of insulin and 40 to 50% of these women develop type two diabetes at an early age and it’s also the normal weight women. And here we believe that it is very much an unwritten of the driving factor.

Lorne Brown 

So the high androgens are the driving factor. So I kind of want to get into the mechanism, but first just the thought I have and I’m curious what your thoughts are is often the women will jump into an ovulation drug protocol when they’re trying to get pregnant, so like CLO/Clomiphene and letrozole or IVF, but I don’t think that solves the problem because there are so many. I think you talk a lot in your research, there’s the mental health or psychiatric disorders that come with it. There’s reproductive disorders and there’s metabolic disorders. And when I was reading through your research recently, having this condition in pregnancy has an impact on the child and I think you talk about even transgenerational impacts. So can you talk a bit about that idea or share about what are the risk factors when you have this metabolic disorder? And again, where I’m thinking and I want to lean into you for this is I think the ovulation drugs with IVF should come later after you’ve done some intervention to try and balance these hormones. But it seems very often that’s the first act that these women do and then if that doesn’t work, they come and see somebody else to try and help balance their hormones. So I just thought you could share a little bit about the mental health reproductive metabolic disorders and then in some of the papers you shared what happens in pregnancy that you have seen in your research when you have this imbalance for the mom and the child, and I think it’s more than one generation your research shared

Elizabet Stener-Victorin 

Regarding this to be transgenerational, it means that it has to be seen in the third generation, and this is on an experimental level, it’s very difficult to study transgenerational mechanisms in humans. So this is based on animal research. We look at the next generation of humans, just to make that clear, it is very important as you bring up the mental health issues and also quality of life. And today we don’t really know whether that is a consequence of having all the symptoms linked to PCOS. You have irregular cycles, you have difficulties in becoming pregnant, you often get miscarriage also and you have your obesity problems. What is the driving factor of their mental health issues? Is it just a consequence of these or is it something that is part of etiology? We still don’t know from our animal research that we have both a normal weight or lean model of PCOS and we have the overweight or and obese models. We can see that both in the normal weight and in the obese model, the mice develop anxiety-like symptoms in this first generation and that can be transmitted transgenerational into the third generation, especially in the females but also in the males. The male seems to be more affected if the mother is obese, whereas the females are more affected by high androgens.

Lorne Brown 

This is what I wanted to just highlight is that you just said the male, because I often think of PCOS going through the female line. So if you have a daughter, there’s issues, but you’re saying that if the mother has PCOS and now I’m hearing and she’s overweight, their son can also have issues, what would these issues be?

Elizabet Stener-Victorin 

The issue is that they normally become obese. They get metabolic syndrome. They have lipid dysfunction but they can also in the mice we can see that they also have reproductive issues. We look at the sperm morphology and also have done molecular analysis of a sperm and the test is morphology. We see that it is altered both in those that are exposed for Andres obesity or the combination.

Lorne Brown 

This is why I like the idea of an intervention through diet, exercise, acupuncture, supplement medications to help with this metabolic disorder, the high androgens. So we can interrupt this epigenetic impact or transgenerational. Can we talk a little bit again about the issues? So you talked about some of the mental health issues and maybe it’s related to the symptoms. I’ve been reading your papers and others that there seems to be an inflammatory component when it comes to PCOS. I even believe maybe some microbiome issues too in the gut. And we now know that a gut microbiome and inflammation can affect our mental health, our mood. Have you guys thought about that whole thing because it’s really a system or that’s why it’s a syndrome, right? It’s not like this one little thing

Elizabet Stener-Victorin 

No, it is really a syndrome and that can be like what we say many different phenotypes and appearance and we have studied the gut microbiome. I had a very talented student who had done, investigated the gut microbiome in women with and without PCOS and found that they have an increase in beta diversity of the gut microbiome. And she contacted me because she wanted to do more mechanistic studies and at the moment we then had our ongoing trial that we exposed the other for either high diet we or without Andres during pregnancy. And then we started the offspring. So we collected their stools and we also collected their intestine and performed this gut microbiota analysis, molecular analysis. And indeed they do develop a very similar gut microbiota phenotype as women with PCOS, but we also try to see whether this has a causative effect of, so it actually can be causing PCOS.

So we tried to do or not try, we did a transfer of a stool into healthy mice and we could transfer the gut microbiota phenotype but not the anxiety like behavior, reproductive dysfunction or obesity. So our conclusion from those studies was that indeed they have an altered gut microbiome but that it’s not causing, it might be a secondary effect. So yeah, that is a gut microbiome. And then we talk about inflammation or the immune system and that is something I have been trying to keep away from because it’s so complicated and difficult, but I had two very talented PhD students and one is still in the lab and they really wanted to go, they are immunologist also. So they really wanted to understand how our mice that are exposed for androgens had a PCOS like phenotype, how their immune system is affected and we have published two papers there and really demonstrated that they have an altered immune function in different tissues and we believe that it’s very important to look into the different tissues to understand the immune function and here is adipose tissue and endometrium the two tissues that are most affected, which is super interesting and they’re not affected in the same way, but it might explain in part their alterations

Lorne Brown 

And because of the inflammation and then you’re just sharing the immune cells a I’ll just say again why I think preconception care doing things like diet lifestyle supplements, acupuncture may be something to do to change this profile, this phenotype before you are pregnant, but what are the implications then to the immune cells that you’re seeing that you find very interesting? And I’ll just add to it just for our audience, what I’m thinking about is if somebody has this syndrome, is it impacting their embryo quality? Is it impacting uterine receptivity and why does it impact the placenta? Does it matter during their pregnancy? So let’s say they get pregnant on Clomid. Are there risk factors during their pregnancy and are there risk factors to the child to be born? Yeah, so that’s kind of my question for you is that holistic view of it. Again, why do we care?

Because I understand the patients we see, they want to get pregnant, they want to get pregnant as fast as possible. My goal is always a healthy baby and a healthy parent. And so I just want to be that voice and I want to hear the research behind that. So I’d love to hear more about this syndrome and how can it affect embryo quality? Can it affect uterine receptivity? You mentioned they have a higher risk of miscarriages. Is it impacting the placenta? And if you get pregnant and you have PCOS through IVF or an ovulation drug, can this syndrome still be impacting you throughout the pregnancy? So just getting pregnant is not the solution or it is the solution and I’d love you to tie in the immune cells inflammation and some resistance. Just let us know from a holistic perspective for our audience why they maybe want to care or do some preconception care.

Elizabet Stener-Victorin 

That was a lot in one question. No, I’m kidding. I’m joking. No, but first of all, I completely agree that the preconception care or what you do before preconception, I think that is very vital and very important and whatever you can do before I think is very good. And then I’m thinking of more lifestyle management, a good diet, talking about diet, I want to emphasize that there is no diet that haven’t been shown to be better than another diet in PCOS, yet there is still the only plate model that is the only one that has been shown to be a good one.

Lorne Brown 

What’s that?

Elizabet Stener-Victorin 

With that said, there is very little and good research in this area and I would say that finding your diet is the most important. I don’t think it matters so much which diet you are on, just that you keep your diet and especially that you do not gain weight. I think that is the key that you go up and then it’s on a very strict diet and you lose weight. You cannot keep this diet and you gain weight that is not good. You go up and down. So that is for the diet. There might be something that we still don’t know but I want to go for the evidence. What we do know is that exercise, whatever exercise there is, also there is no exercise that has been shown to be better than another exercise, but doing exercise is the most important. So both what you eat or how that you have regular meals and so on and of course avoiding too much sugar and so on. I think that is important. You do your exercise and it’s important that you find the type of exercise that you can maintain and do regularly. Not that you do it in periods and then very intensive and then of course you can add on if you would like to try acupuncture to try to induce more regular cycles, that is also something that could benefit and we know that acupuncture can for many women also makes them feel more relaxed and can have positive effects on anxiety.

Lorne Brown 

Question around acupuncture, kind of how we met in the early days from your acupuncture and PCOS research. So I think one of the mechanisms I recall from your talk that you gave at our conference was that it did help do something with the blood sugar or insulin metabolism. Are you still suggesting the electrical acupuncture adding the stim to it? Is that basically what your research has still been or has there been any change? I remember we talked about dosage as in some people they’ll need more than two or three a week outside the research just if it’s stubborn, PCOS. And I remember you used to do electrical stem as well in your research.

Elizabet Stener-Victorin 

Yeah. First of all, we have done several studies with acupuncture to endure more regular cycles. Now I go out from the car

Lorne Brown 

Right? Elizabeth has been so kind to find time and so she was being driven by the way. She was not the one driving that car. She was being driven. So yeah. I’d love to hear a little bit more about the acupuncture and what your thoughts are as a way to help

Elizabet Stener-Victorin 

From the basics or the beginning. I started off my research doing acupuncture research within IVF we saw that we could increase the uterine artery blood flow by acupuncture and then at the same time we also started to do studies that we investigated whether acupuncture could be a tool to use as in pain relief during egg collection. And in all that we did show in all these studies, we did see that it increased uterine artery blood flow, which is something positive if you do IVF, but we have not shown that it can increase the pregnancy outcome. I think this is something that is very important to inform your patient that we prepare but we do not treat infertility and then at the same time, we saw that it could be used as a pain reliever.

Lorne Brown 

Can you clarify that? When you say we prepare but we don’t treat infertility, can you elaborate or clarify what you mean by that?

Elizabet Stener-Victorin 

You prepare the uterus, you get a better blood flow, you might also actually affect the endometrium, but we don’t know that yet because there is still no research about that. So I think it is more that you prepare the uterus, you can say that you also prepare the person so that you reduce the stress. We have shown in our studies in PCOS that we can, if you have very regular cycles, we can trigger the ovulation

Lorne Brown

So the acupuncture can help regulate the ovulation

Elizabet Stener-Victorin 

Yes. Now to your other question, whether we still use electro acupuncture, is it needed or not? I would say we, I don’t know honestly if we need it. For me we use it very much still in our clinical trials because it’s easier to standardize. You know where you place the needles and then you know how you stimulate the needles. So it’s very much also to get a standardization, but I cannot tell whether it’s better or not compared to manual stimulation.

Lorne Brown 

I wanted to pick your brain on a few things that we’ve talked about. So in your papers you talk about this high androgen environment and how this can impact the placenta health and uterine receptivity and then obviously the health of the mom and the baby. It sounds like because of this high androgenic male hormone level, you’re having these follicles not able to mature. So if you’re doing the acupuncture and it helps regulate ovulation, I’m deducting then that we’re somehow maybe we’re helping lower the androgenic level but we’re balancing the hormones and if somebody’s coming in ovulating every 50 or 60 days and now they’re ovulating every 35 days, I would deduce that you’ve changed the hormonal environment evidenced by their maturing eggs in a more periodic timeframe, like a healthy timeframe and that means that that would not have the negative effects. So it would be positive on uterine receptivity? On the placenta health.

Elizabet Stener-Victorin 

Yeah, I would say that regarding that they get more regular cycles and we have also seen that it also lower their Andy levels, both exercise and electroacupuncture lower their Androgenic levels and exactly as you say, we get the more, not a normalized hormonal milieu, but it is better, it’s improved so that all this is positive.

Lorne Brown

And so with acupuncture it’s another thing hard to do that random RCT randomized control trial, it’s very for the to blind, the practitioner, the practitioner knows they’re using a needle or not. It’s difficult to blind the patient. I’m curious, maybe that’s why we don’t have so much research. We’re always trying to do it as an RCT and some therapeutic modalities don’t fit well into an RCT.

Elizabet Stener-Victorin 

No, I would say that any physical intervention, it can be exercise, it’s the same. You cannot placebo control exercise, you cannot placebo control acupuncture. In my mind, I think all this, when you place a superficial needle or use placebo needles, it’s just enough kind of sensory stimulation. So no, it is very difficult to get a high score in a review because there is also a lot of bias and you never have a completely blinded intervention. So it is a problem for all kinds of physical intervention and then for some reason I would say acupuncture, maybe it is because it’s an ancient agent and also that you involve the Jin and Jang and theory of traditional Chinese medicine. It makes it very difficult for general orthodox medicine to understand. I think that is one thing, maybe they have easier to understand and bring in the laser more.

Lorne Brown 

Well you can definitely blind it. They did do one study way back in an IVF setting because the patient doesn’t feel the laser and it just beeps. And so they had a mechanism where the laser would beep but it wouldn’t give off any photons. So neither the patient nor the practitioner knew who was getting it. So there was one group and in that group they showed an increase in implantation in the IVF setting. So they did it on transfer day before and after they did the typical polish protocol back then when they did the study in 2008 ish and they did the before and after and they had an acupuncture group, they had a laser group laser acupuncture and they had a sham laser acupuncture and a control group and the laser acupuncture group outperformed the acupuncture control and sham group. What I liked about this is it wasn’t just placebo or anything because the sham didn’t do anything, the sham laser.

So talking to my colleagues, they’re showing that there was at least some type of impact when you put photons into that acupuncture point in that study. Anyhow with, and I always say I don’t know how you feel about this, but always it kind of drives me a little crazy when I see a research study and it says acupuncture works or acupuncture, we kind of got to say this acupuncture protocol worked or didn’t. It’d be like saying you give somebody a prescription drug and then you say all prescription drugs work or all antibiotics work or no antibiotics work acupuncture is like a category like antibiotics, but we got to know what antibiotic and what dosage and we often say like acupuncture dosage matters, right? So what would you be recommending if you’re in clinical practice? We know that this metabolic disorder, this syndrome of PCOS because of the high androgens and other implications because of that inflammation, insulin resistance, there is an impact on the O site impact on embryo quality.

It impacts your research, tell me if I’m interpreting this wrong, impact on uterine receptivity impact on placenta. So it impacts you even during your pregnancy if you do Clomid or IVF and you get pregnant, you still have this condition and then it’s transgenerational that it can impact your future children. So what are the things that there is data to say that this can help you, that we’d want to recommend to these women to make sure they’re doing this to help them before they go in. And I still think that preconception would be key then to see if you can get your ovulation more regular.

Elizabet Stener-Victorin

I do agree that I believe that the preconception is detrimental and very important you ask for the evidence. Unfortunately there is no evidence yet because it’s very difficult to study. Also, if I would give an advice to a woman with PCOS, I would definitely say, and you feel that it’s not an extreme stress given the age, I would say, okay, give it four to six months, live a healthy lifestyle, try to do regular exercise, keep a good diet, try acupuncture. If you have irregular cycles or and or insulin resistance to try to regulate your hormonal imbalance and improve your insulin sensitivity and hopefully you become pregnant naturally. If not, you start with your letrozole. That letrozole is the first line treatment today and the next step is IVF and I will say unfortunately many skip both the firsts and go directly to IVF. And I think that is completely wrong, will win with PCOS.

Lorne Brown 

I see after they’ve done the IVF and it’s not successful, they’ll come off and they’ll, when I do the history taking, they did IVF, they developed ovarian hyperstimulation syndrome, which is dangerous and uncomfortable and then the transfers haven’t worked or they’ve had miscarriages. And as I shared, even though we don’t have research on this, I’ll give you my anecdotal, we have seen, I always share when I talk about PCOS because she’s my favorite case where she would not ovulate on her own even with the letrozole and Clomid, they tried either they couldn’t get her to ovulate while she’d have a withdrawal bleed with the progesterone. So she went through IVF and the first transfer was negative, the second one was chemical. So she came because she heard maybe it’ll help with uni receptivity, can you help with blood flow? Can you lower my inflammation, regulate my hormones to help my uterus be more receptive, help lower those androgen levels.

And after about four and a half months she finally ovulated and ended up conceiving naturally in having a child. And then we have a few other cases similar to that. And so what I’ve heard today is there’s not great evidence for a lot of things, but there’s still some common sense and the preconception part because there are risk factors that come with this metabolic disorder that if your cycles are irregular and if there are things that you do that will then lead to more regular cycles, this is pushing you in the better direction to have better pregnancy outcomes, better chance of getting pregnant and pregnancy outcomes. And we’ve seen this, we know that if you’re very overweight and you lose a percentage of your weight, 5% or maybe 10% that there’s an increase in ovulation. We’ve seen it with acupuncture to help support augment auditor disorders as well and certain diet and exercise of course as well. So there’s things that people can do to help balance their hormones, lower their stress levels because stress leads to cortisol levels and blood sugar dysregulation and insulin again, which is the chicken or the egg. I guess my broken record and I’m curious what your thoughts are. No harm’s going to come from living a healthy lifestyle. So eating well, like nourishing your body with good food, moving your body, finding time to rest and having good sleep, right?

Elizabet Stener-Victorin 

Yeah, that’s the key.

Lorne Brown

That’s the key, right? And then you can add some people add supplements, some people will add acupuncture. I’m going to have to send you some of my literature on the low level laser therapy that I’ve come across and then we both have seen it and we agree with it integration. So I never tell somebody don’t do letrozole, don’t do Clomid, don’t do IVF. My goal is a baby, my goal is a healthy baby for the women I see and a healthy mom. I think it’s just the order that we both agree on that

The diet lifestyle exercise, the acupuncture would come before you would do the egg retrieval, the IVF, the months leading up to it and before if you’re still having your regular cycles signs of high androgens, then maybe before you do that frozen embryo transfer to get things in order. And we talked about the age earlier. I’m seeing somebody now that just came in and she has frozen embryos, so I feel that we have some luxury with time now because she already has the embryos. So now we’re just going to help Ute receptivity in that she has really delayed cycles up to 60 days. So our goal is what can we do over a couple of months to see if we can help with the androgens, the insulin resistance and evidenced by her cycles becoming more regular. Does that make sense to you? I’m coming from your scientific mind here. I’m going from a theoretical here

Elizabet Stener-Victorin 

But I think everything we can do before you start with any medical treatments for ovulation induction or IVF full protocols and so on could be good. It is vital. I would say we know exactly as you said that if you are slightly overweight or obese, just losing a couple of kilograms can make a big difference. And it is important also, I would like to say to stress that women with PCOS, they get their wanted children. There is no difference in the number of children a PCOS woman gets compared to a non PCOS woman, but they have lots more problems. They need assistance many times and they miscarry to a much higher degree. So there are problems with implantation even though many gynecologists claim that PCOS, it’s no problem, we just stimulate them and they become pregnant. But many of them have implantation problems and they get miscarriages, not just early miscarriage, they get relatively late miscarriages also. So preparation before is vital I would say.

Lorne Brown

 

Can we talk just a bit about the acupuncture protocol for increasing blood flow and supporting or reducing ovulation? I remember originally we met, you were doing, and this is because we have acupunctures that listen to the podcast as well, like bladder 23, 27, 57 and spleen six. And then later when we met over in California at a conference you were doing kind of like spleen six, spleen nine with the two hertz and then the abdominal points like stomach 29, REN four, re six. And then at my IFS you talked about, I think it was stomach 34, I’m using the acupuncture points because that’s what they’re familiar with. For your blood flow protocol as of now, what’s the one that you favor or if you were clinically going to be treating people the one that you would like to use, what kind of points and what kind of hurts would you be putting on the needles at this point in time?

 

Elizabet Stener-Victorin 

First of all, why we actually moved more to place the needles in the abdomen. It was based on my postdoc studies on rats that we measured the ovarian blood flow changes and we placed the needle in abdominal muscle, therefore we moved to place the needles in the abdomen because when we did that we could see an increase in ovarian blood flow. So therefore we moved to place the needle in the abdomen and it’s also more easy to get them laying on their back and they can relax better and so on. And then spleen six, spleen nine or liver free, they’re all in the same innovation area as uterus and ovaries and also the points in the abdomen. But you can still use bladder points. I think the most important thing here is that the woman can relax.

So if she preferred to be laying on the side, that’s fine. The stimulation of needles before, if you ask me a couple of years ago, I would say you must go with no frequency electrical stimulation. But given what we actually saw in the big jamma paper that we have with more than a thousand women, we see absolutely no difference when we place a needle deep and stimulate with electrical stimulation compared to superficial stimulation and placement and very weak stimulation. So I cannot say that it is more effective to place a needle deep and do electrical stimulation. Still in an ongoing trial we use more or less to say a very similar protocol that we aim to increase the insulin sensitivity and there we stimulate in the big quadriceps muscle. And there I think it’s more important to get the muscle contraction more to mimic the exercise. So I think sensory stimulation, if it is strong stimulation with electrical stimulation or just manual stimulation or superficial, I cannot say that one is better than the other.

Lorne Brown 

I’m sure at one point we’ll find out again based on the patient, the individuals, some respond better based on them, right? Based on their constitution that’s going on

 

Elizabet Stener-Victorin

Yes.

Lorne Brown

And that’s the power of Chinese medicine where they don’t like to do protocols, they use it as a guide, but then what’s on your table and then treat what’s on your table. So your battery’s dying. We’re going to wrap up and you’ve given me so much of your time today, which I appreciate. So if I can recap that this PCOS condition can impact the placenta and the health of the baby in pregnancy. So preconception care is something you want to do before you are pregnant. And if you don’t have frozen embryos, you’re not just looking at uterine receptivity but you’re looking to get pregnant naturally or through do an egg retrieval or ovulation drugs, you’re still of the idea that do some of this preconception over that three to six months before going in there to have a better or positive impact so you can have better pregnancy outcomes.

Because our goal is always to have a healthy baby. And we talked a little bit about acupuncture and in the acupuncture you’re talking about that can help with the insulin resistance, it can help with blood flow, it can help with regulating ovulation. And then we deduce that if we can help regulate ovulation, there’s lots of positive impact by lowering the Amgen levels or having balanced hormones through more regular ovulation. What is next for you? What are you studying? And you talked about the immune also how it impacts the immune cells too. So it’s really, really interesting. And diet lifestyle exercise is something that nobody can ignore when you’re looking to address this condition. What else is in the pipeline for you, Elizabeth? And then I’ll get from you in our email just where we can direct people if they want to learn more about you or follow stuff that you’re doing. But please give a shout out to any links and what’s coming up for you now.

Elizabet Stener-Victorin 

Yeah, we have an ongoing trial that we, it’s a free arm trial on women with PCOS that are overweight or obese and they’re randomized to receive lifestyle management, which is a very light variant. That way they get the information that it’s important to do regular exercise and have a regular diet and how they eat, but it’s no specific diet. All women received this lifestyle management and then one group received on top of that metformin and the third group received on top of that electro acupuncture for 16 weeks and before and after 16 weeks. And after 16 weeks we follow up again. We take tissue biopsies, we take endometrium fat and muscle biopsies and we perform detailed molecular analysis on single cell levels. So we do single cell RNA sequencing and to really try to understand more mechanisms and which cell types are affected in women with and without PCOS, we do oral glucose tolerance tests.

We do DEXA to look at the fat and muscle moss and bone moss and a lot of hormonal analysis in these women. We also look at the immune function because in these tissues we get all the immune cells and we analyze the immune inflammatory panels with a method, what we call olink. So that is in the human studies we look into trying to understand the pathophysiology in each of the different organs and on the whole body. And then we in the animal studies, we move on with it, try to understand the mechanism behind the immune dysfunction. And in a lab project we try to continue with this and understand if it is the in neutral environment that actually triggers the offspring developed PCOS and the transferred across generations or it is the fact that it is actually the oocytes that are affected in the woman with PCOS. So here we have a mice model that developed PCOS with or without PCOS and then we treat this model with anti andrean flutamide that blocks the effect of the androgen receptor. The treatment that women with PCOS can get is they have hyper androgens and the fourth group we are letting them exercise for five weeks and then we do a superovulation, collect the oocytes and fertilize them with healthy sperm. And then we do embryo transfer into a surrogate mother and study the offspring, the first generation and the second generation. And this is an ongoing trial, these are mice

We do this to try to disentangle and dissect the mechanism. Is it the uterine environment or is it actually the, that you have the programmed cytes? It is the eggs that actually transfer. That is what we want to understand. We still don’t know that.

Lorne Brown 

And this is what you’re studying, you don’t have conclusions yet?

Elizabet Stener-Victorin 

No.

Lorne Brown 

So we are going to have you back on the podcast. We’ll study that again.

Elizabet Stener-Victorin 

Yeah.

Lorne Brown 

Elizabeth, I want to thank you very much for making the time today to chat and always sharing your research and your unbiased, right? Just tell us what’s happening, what it is, and that diet lifestyle. I just want to emphasize that the things that people can do is regulate their blood sugars, reduce stress, doing things like exercise, rest, good sleep, and eating a healthy diet, right? You talked diet, wasn’t researched well, but there are certain diets that are just highly inflammatory and can affect your blood sugar and we’re looking to not do that. So a healthy diet, that’s great news. I really appreciate everything you shared. Where do people find you? Are you on Instagram? Where do you want people to find you? If they’re looking to see what you’re up to

Elizabet Stener-Victorin 

Research wise, I usually share it on Twitter and on LinkedIn.

Lorne Brown 

So we’ll grab that from you and I’ll put that in the show notes. Alright, until next time, enjoy the rest of your evening there over in Sweden. And again, thank you so much for your time. I really appreciate it.

Elizabet Stener-Victorin 

Thank you. Good to talk to you again, Lorne.