June 21, 2013

Questions Upon Questions

posted by Swearer Center

 

Hasina Maredia ’14 is a Royce Fellow examining how metabolic disorders, including obesity, negatively influence women's reproductive health.

As I head down the hill to 121 South Main, I do my routine CNN Health perusal. The American Medical Association is officially classifying obesity as a “disease,” emphasizing the “range of medical interventions” needed for this complex condition. The co-morbidities are numerous and, for women, include dire reproductive health consequences that can lead to infertility. With my specific research interests lying in maternal and child health, I am working to better understand this obesity-mediated infertility in Samoan women this summer, with hope that such research can contribute to an effective treatment of this devastating condition that is increasingly affecting both developed and developing countries.

The Samoan population, residing on islands in the South Pacific Ocean, is marked by very high levels of obesity. From preliminary work, it is evident that these women are also experiencing relatively high levels of irregular menstruation, which can often lead to difficulties conceiving. However, there are currently no treatments, let alone effective diagnostic tools. Examining this issue in Samoan women will hopefully provide insight into underlying mechanisms that may be at play in these women, as well as women globally. One potential mechanism that may be involved is polycystic ovarian syndrome (PCOS), a hormonal disorder in women where male hormones are abnormally elevated.

For the first few weeks of this summer, I have been working towards dissecting this larger goal and better understanding the inherent components. Given the limited access to clinical resources for many in Samoa, women are unable to have ultrasounds to definitively establish whether they are experiencing PCOS. Thus, one of the first questions I am attempting to tackle is, how can we assess the risk or likelihood of PCOS in these women with irregular menstruation? Well, by detecting whether their hormone levels are abnormal, of course! Not so easy, I am finding. This requires digging deeper and asking a series of questions: what’s considered normal vs. abnormal? Are there important ethnic differences to take into account in establishing these normal values? Should we take into consideration the high body mass index of the Samoan population we are considering?

After digging into literature, I was ecstatic to find a previous study on how to determine normal hormone levels. One of the criteria for establishing a normal reference group is to exclude women with high insulin resistance as this may be indicative of PCOS and hence abnormal hormone levels. Well, what’s considered high insulin resistance as opposed to normal in our Samoan population? Are there important ethnic differences to take into account in establishing normal values? Should we take into consideration the high body mass index of the Samoan population we are considering? A similar set of questions, but for a completely different measurement.

Just in the first few weeks, I am appreciating the meticulous approach required in simply outlining and approaching questions that are just one component in the overall picture.

To the Swearer Center community: How do you navigate the complexities of such questions upon questions that come up in your own work and disciplines?  What are your strategies in approaching the vast body of literature pertaining to your projects? Moreover, what do you find is the most fulfilling part of this search?

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