Augusta Women Health Center Blog

Infertility is far more common than most people think. According to the American Society of Reproductive Medicine, approximately 6.1 million couples in the U.S.—about 10 percent of the reproductive-age population—experience fertility problems. For these couples, becoming pregnant is far from easy.

The truth is that hundreds of variables must coincide precisely for conception to occur and for a woman’s body to successfully maintain a pregnancy for nine months. The average couple between ages 29 and 33 with no fertility problems has about a 20 to 25 percent chance of getting pregnant in any given month (or menstrual cycle).

There is no “typical” infertile patient. Ovulation and sperm deficiencies are the most common infertility problems, accounting for two-thirds of all cases.

Ovulation is a complicated communication process between the hormones in a woman’s brain and the hormones in her ovaries. To understand ovulation problems related to infertility, you must first understand ovulation. As your menstrual cycle begins (day one of your period), your estrogen levels are low. Your hypothalamus (the area of your brain responsible for maintaining hormone levels) tells your pituitary gland to start producing a hormone called follicle stimulating hormone (FSH). The FSH triggers a few of your follicles to develop into mature eggs. One of these follicles produces the dominant mature egg and the others disintegrate.

Mature follicles produce estrogen, and estrogen tells your hypothalamus and pituitary gland that there is a mature egg ready to be released. The pituitary gland then produces a hormone called luteinizing hormone (LH) that causes the egg to burst through your ovary wall and begin its 24-36 hour journey through the fallopian tube to be fertilized.

Ovulation problems can occur due to a number of factors:

• The ovaries may no longer contain fertilizable eggs,
• Ovulation is disrupted because of a breakdown in the hormonal communication cycle
• Scar tissue prevents ovulation from occurring (a rare occurrence)

Age is also a major factor in a woman’s fertility. After age 35, a woman’s fertility rapidly declines. By age 43, she has relatively little fertility left because her ovaries now produce fewer viable eggs.

The quality of a woman’s eggs is critical to her chances of becoming pregnant. Egg quality is particularly important when a couple is considering in vitro fertilization or other assisted reproductive technology (ART) procedures. These procedures rely on the availability of multiple, high-quality eggs. Thus, in women older than 42, physicians may recommend using donor eggs.

While an older woman is more likely to have poor egg quality than a younger one, the condition can also affect younger women. In women age 35 who have been diagnosed as infertile, about 4.5 percent use donor eggs.

Less common identifiable fertility problems for women include structural problems or scarring of the fallopian tubes and/or uterus caused by pelvic inflammatory disease (PID) or endometriosis (a condition causing adhesions and cysts), uterine fibroids or, very rarely, birth defects.

Sperm deficiencies can include low sperm production (oligospermia) or lack of sperm (azoospermia). Sperm may also have poor motility—they don’t move properly once inside the female reproductive tract to achieve fertilization. Additionally, sperm cells may be malformed or may die before they reach the egg.

About one-third of infertility cases are due to male factors and about one-third to factors that affect women. Roughly one-third of infertility is couple-related, with a combination of problems in both partners preventing conception.

An estimated 10-20 percent of infertility cases are unexplained; the source of the problem cannot be identified. However, with today’s technology, diagnoses of unexplained infertility are declining.

Eighty-five to 90 percent of infertility cases are treated with medication or surgery. In vitro fertilization (IVF) and other types of assisted reproductive technologies (ART)—in which barriers to successful conception are overcome in the laboratory—account for only about five to 10 percent of infertility treatments.

 Information taken from www.healthywomen.org

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Our gynecology services cater to all problems women may have related to their bladder or female organs. Some primary urogynecology disorders are:

• Urinary incontinence 
  • Stress incontinence - involuntary loss of urine caused by strenuous physical activity, laughing, coughing or sneezing 
  • Urge incontinence or overactive bladder - involuntary loss of urine that occurs due to a sudden urge to urinate 
• Fecal incontinence - the involuntary loss of solid or liquid stool that can result in impaired quality of life for an individual 
• Pelvic organ prolapse - described as a fallen bladder, uterus, vagina or rectum 
• Fistulas: vesicovaginal or rectovaginal - an opening between the wall of the vagina and the wall of the bladder or rectum which can lead to urine leakage 
• Complex benign conditions of the vagina and urethra such as vaginal cysts, absence of vagina, and urethral diverticulums 
• Other problems with urination or pelvic floor

A variety of therapies can be used to treat or manage these problems. Bladder or pelvic problems should not be considered as a result of the aging process.

Information taken from Penn OB/GYN Care, please refer to this site for further information.

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Obstetrics and Gynaecology (often abbreviated to OB/GYN or O&G) are the two surgical specialties dealing with the female reproductive organs, and as such are often combined to form a single medical speciality and postgraduate training program. This combined training prepares the practicing OB/GYN to be adept at the surgical management of the entire scope of clinical pathology involving female reproductive organs, and to provide care for both pregnant and non-pregnant patients.

• Reproductive Endocrinology and Infertility - gynaecologic subspecialty focusing on the medical and surgical evaluation of women with problems related to the menstrual cycle and fertility
• Gynaecological Oncology - gynaecologic subspecialty focusing on the medical and surgical treatment of women with cancers of the reproductive organs
• Urogynaecology and Pelvic Reconstructive Surgery - gynaecologic subspecialty focusing on the diagnosis and surgical treatment of women with urinary incontinence and prolapse of the pelvic organs. Sometimes referred to (incorrectly) by laypersons as “Female Urology”
• Advanced Laparoscopic Surgery
• Family Planning - gynaecologic subspecialty offering training in contraception
• Pediatric and Adolescent Gynaecology
• Menopausal and Geriatric Gynaecology

Information taken from www.Wikipedia.com 

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Choosing a birth control method is one of the most personal health care decisions a woman makes. In nearly four decades of childbearing years, your need for birth control will most likely change many times. But at each life stage, you can make informed decisions by learning about all your contraceptive options and selecting one or more that best fits your reproductive health needs.

Many women are not adequately protected from an unwanted pregnancy by their choice of birth control method. In fact, about half of all pregnancies (49 percent) are unplanned. Of these unplanned pregnancies, more than half (53 percent) of the women were using some form of birth control, reports the Alan Guttmacher Institute (AGI), a non-profit organization that focuses on reproductive health research.

According to AGI, there are two main reasons for contraceptive failure. One is inconsistency—for example, forgetting to take your birth control pills or not using a condom every time you have sex. The other is incorrect use of contraception—for example, not inserting a diaphragm the right way or not using enough spermicide.
Myths or personal concerns about the risks and safety of certain birth control options also contribute to incorrect use of birth control. Women may use a particular method only occasionally, for example, thinking that less frequent use is safer than continuous use. Or they may stop using a particular method because of bothersome side effects.

Age-related changes can lead women to believe they no longer need to use contraception. For example, women nearing menopause may mistakenly think they are no longer fertile because their menstrual cycles are no longer regular. However, the AGI notes that as many as half of all pregnancies that occur in women over age 40 are unintended. Although menopause does mark the end of a woman’s childbearing years, you have not gone through “menopause” until 12 consecutive months without a period. You can get pregnant even if your periods are irregular.

Today, American women have more contraceptive options to choose from than ever before. So you should be able to find one that works well for you and fits your lifestyle.
Other things to consider before making a contraception choice:

• Find out how much the contraceptive costs. Do you have to pay for it all at once or can the cost be spread out over a year? Will your health insurance cover it?
• Ask yourself if you can realistically use this method. Are you sure you understand how to use it properly? Will this method embarrass you or your partner? Does it fit with your lifestyle? 
• Find out how to use the method correctly and what to do if you forget to use it occasionally. 
• Ask your health care professional about side effects. What should you expect? What should you do about them if they occur and when should you expect them to stop? 
• Will this method cause any unacceptable weight gain?

You can probably think of many more questions about the birth control method you’re currently using or one you’re considering. Learn as much as you can about your options and make an informed decision about which method is the best and safest for you. Consider your needs and discuss them with your health care professional during your next medical appointment.

To get you started, here is some basic information about contraceptive options approved by the U.S. Food and Drug Administration (FDA), and resources you can use for more in-depth research. For a comparison of how effective each type of contraception is for preventing pregnancy, please see the chart, “Contraceptive Failure Rates” at the end of this entry.

Information taken from www.healthywomen.org

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Each year, about 14,000 women are diagnosed with cervical cancer in the U.S. Cervical cancer may be fatal, but, in some cases, it can be prevented. You can help reduce your risk of cervical cancer by having Pap tests regularly; quitting smoking, if you smoke; and using latex condoms during sex to protect yourself against sexually transmitted infections. January is Cervical Health Awareness Month, so visit the following Web sites for more information about what you can do to stay healthy.

“Genital Warts”: familydoctor.org – Genital warts are caused by the Human papillomavirus (HPV). Some types of HPV are directly related to cancer of the cervix. You can learn more about genital warts and what you can do to protect yourself on familydoctor.org. “Human Papillomavirus Testing” provides information about HPV testing. “Pap Smears: When Yours is Slightly Abnormal” can help you understand what abnormal Pap smear results mean.

http://www.nccc-online.org/patient.php: National Cervical Cancer Coalition – What is a Pap test? Why should you have one? This Web site answers these questions and more. On the National Cervical Cancer Coalition Web site, you can also find lots of helpful information about HPV infection and its association with cancer of the cervix. Information about early detection and treatment of cervical cancer is also available on the site.

http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=8: American Cancer Society – Visit this site to learn more about how HPV infections can lead to cervical cancer. The American Cancer Society Web site also provides information about who should have an HPV test and how to prepare for it. Do you know the difference between a Pap smear and an HPV test? Find the answer on this Web site.

http://www.cancer.gov/cancertopics/understandingcervicalchanges: National Cancer Institute – The National Cancer Institute Web site can help you understand what cell changes in your cervix mean. On this site, you can also find information about Pap smears and HPV tests. Visit (http://www.cancer.gov/cancertopics/wyntk/cervix) to learn more about risk factors, screening, diagnosis and treatment of cervical cancer.

Information taken from FamilyDoctor.org. Visit this site for more information.

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Routine care is the best way to keep you and your breasts healthy. Although detecting breast cancer at its earliest stages is the main goal of routine breast care, other benign conditions, such as fibrocystic breasts, are often discovered through routine care.

Step 1. Breast Self-Examination (BSE)

A woman should begin practicing breast self-examination by the age of 20 and continue the practice throughout her life - even during pregnancy and after menopause. BSE should be done regularly at the same time every month. Regular BSE teaches you to know how your breasts normally feel so that you can more readily detect any change. Changes may include:

• development of a lump
• a discharge other than breast milk
• a discharge other than breast milk
• swelling of the breast
• nipple abnormalities (i.e., pain, redness, scaliness, turning inward)
• If you notice any of these changes, see your healthcare provider as soon as possible for evaluation.

Step 2. Clinical Examination

A breast examination by a physician or nurse trained to evaluate breast problems should be part of a woman’s physical examination. The American Cancer Society recommends:

• Between the ages of 20 and 39, women should have a clinical breast examination by a health professional every three years.
• After age 40, women should have a breast examination by a health professional every year.

Step 3. Mammography

Mammography is a low-dose x-ray of the breasts to find changes that may occur. It is the most common imaging technique. Mammography can detect cancer or other problems before a lump becomes large enough to be felt, as well as assist in the diagnosis of other breast problems. However, a biopsy is required to confirm the presence of cancer.

Since there is controversy among cancer organizations regarding when to begin having mammograms, as well as how often, talk with your physician about a mammography schedule that is appropriate for you based on your overall health and medical history, risk factors, and personal opinion or preference.

According to the National Cancer Institute, women in their 40s and older should begin having a screening mammogram on a regular basis, every one to two years. But, the American Cancer Society recommends that by age 40, women should have a screening mammogram every year. (A diagnostic mammogram may be required when a questionable area is found during a screening mammogram.)

Both organizations suggest that women who may be at increased risk for breast cancer should talk with their physicians about whether to begin having mammograms at an earlier age.

For best treatment and all women ailments visit www.augustawomencenter.com

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Women who are looking for a permanent form of birth control may choose to have a tubal ligation, also known as getting your “tubes tied” or female sterilization. This surgical procedure to make a woman sterile is very effective at preventing pregnancy , with a failure rate as low as 0.4%.

What Is It?
A tubal ligation is a surgical procedure whereby a woman’s fallopian tubes are cut, clamped, blocked or tied to prevent her eggs from traveling down to her uterus. It also blocks the sperm from traveling along the tube to meet the egg. In some cases, a woman may choose to have a hysterectomy. This is when the entire uterus (and possibly the fallopian tubes, ovaries and/or cervix) is removed. Unlike a tubal ligation, a hysterectomy is not reversible.
While a tubal ligation is generally regarded as a permanent type of birth control, tubal ligation reversal surgery is available. However, depending on how your tubal ligation affected your fallopian tubes, you may not be a candidate for reversal surgery. Even if you do have your tubal ligation reversed, you may still not be able to get pregnant. Success rates for pregnancy after a tubal ligation reversal range between 70% and 80%. Additionally, there is an increased risk of experiencing an ectopic pregnancy.
 

How it is Done
Tubal ligations are usually done nowadays through laparoscopic surgery. This type of surgery involves making a small incision just under your navel and inserting small, thin instruments through a tiny tube to perform the procedure. The operation can be done under general or local anesthetic and is usually an outpatient procedure. In some cases, a hospital stay of one night may be required. Women can usually return to their normal activities after a week.
In 2002, a new, non-surgical method of blocking the fallopian tubes was put on the market. Essure has the same effectiveness rate as surgical sterilization and the procedure can be done in your doctor’s office. This method of tubal ligation involves having a small coil placed into your fallopian tubes thereby creating a barrier. It takes between three and six months before this type of tubal ligation becomes effective. To have the barriers removed, though, will require surgery. Therefore, this method of tubal ligation should be considered just as permanent a solution as surgical sterilization.
 

Risks of Tubal Ligation
As with any type of surgery, there are risks involved with having your tubes tied, including infection and uterine perforation. Additionally, women who have had their tubes tied and become pregnant are more likely to experience an ectopic pregnancy. Other possible risks associated with having your tubes tied include menstrual cycle disturbances and gynecological problems.

While a tubal ligation is an effective way of preventing pregnancy, it offers absolutely no protection against sexually transmitted diseases (STDs). Therefore, it will still be necessary to use condoms unless you are in a relationship with someone that has tested negative for STDs.
 

Costs
The initial cost of a tubal ligation can be expensive, ranging between $1,000 and $3,000. However, because the effects are permanent and long lasting, it may be a more cost-effective solution for some women. Some private insurance companies may also cover some of the cost. Check with your insurance provider to see if you are covered.
For women that are sure that they do not want any more children, or any children at all, having a tubal ligation can be a successful means of birth control. Although tubal ligation reversal surgery is available, all women should consider having their tubes tied as a permanent solution. Therefore, it is best to take your time and talk with your doctor as well as your partner so that you can be sure that this is the right decision for you.

Information taken from Epigee Women’s Health. Visit their site for further information.

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