Family Ties

Who doesn't remember de sitcom Family Ties broadcasted by NBC for seven seasons, starting in 1982 and concluding in 1989. The series dealt with a typical U.S. phenomenon—the move from the cultural liberalism of the 1960s and 1970s to the conservatism of the 1980s. This was particularly expressed through the relationship between young Republican Alex P. Keaton, portrayed by Michael J. Fox, and his ex-hippie parents, Steven and Elyse Keaton, portrayed by Michael Gross and Meredith Baxter. Much of the humor of the series focuses on the cultural divide during the 1980s when younger generations rejected the typical hippie culture form the roaring sixties. Instead they embraced the materialism and conservative politics which came to define the 1980s. In contrast with this movement is the strong family bond they share with each other and elicits a kind of continuing internal and mental conflict between freedom of thoughts and speech and familial ties (1). Every physician treating women with polycystic ovary syndrome (PCOS) is frequently witnessing a similar problem since PCOS runs within families. Mothers with PCOS not only worry that their daughters might have the same syndrome, but they struggle with the knowledge that a condition they have passed on could have a negative impact on their daughter's health. As reproductive endocrinologists will attest, PCOS has a high degree of heritability, affecting about half the daughters of mothers with PCOS. In about 25% of these affected daughters, the symptoms are similar to those of the mother or they manifest as a more severe phenotype; in the other 25% of daughters, the signs are less severe than the mother's. As for the remaining half of daughters, they may appear unaffected. Dunaif and Legro and colleagues (2) also discovered that the sons of mothers with PCOS to some extent share the symptom of hyperandrogenism, although large series dealing with the fathers or brothers of mothers or sisters with PCOS have been lacking. We recently took a different approach: we assessed the cardiovascular and metabolic health of the fathers and mothers of women with PCOS (3). Our study showed that type 2 diabetes among the mothers of PCOS patients results in excess mortality compared with female diabetics from the general population. Our findings justify screening for type 2 diabetes mellitus among the mothers of women with PCOS to ensure that timely preventive and therapeutic measures can be taken according to the appropriate guidelines. The currentmeta-analysis by the group of Dr. Bulent Yildiz of Ankara, Turkey (4), summarizes a selection of studies to provide an evidence-based assessment of the metabolic syndrome, hypertension, and hyperlipidemia in the first-degree relatives of women with PCOS. Their results show evidence of a statistically significant clustering for the metabolic syndrome, hypertension, and dyslipidemia in the mothers, fathers, sisters, and brothers of women with PCOS. The risk for the metabolic syndrome is nearly twice as high in mothers and 1.5 times higher in fathers and sisters compared with a control group. Similarly, the prevalence of dyslipidemia was about 20% higher in the fathers and mothers of daughters with PCOS.