Definition

In vitro fertilization (IVF) is a complex series of procedures used to treat fertility or genetic problems which assist with the conception of a child. During IVF, mature eggs are collected (retrieved) from your ovaries and fertilized by your husband sperm in IVF lab. Then the fertilized egg (embryo) or embryos are implanted in your uterus. One cycle of IVF takes about two weeks.

IVF is the most effective form of assisted reproductive technology.

Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility.

If more than one embryo is implanted in your uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy).

Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.

Why it's done

In vitro fertilization (IVF) is a treatment for infertility or genetic problems.

Occasionally, IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:

•        Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.

•        Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.

•        Premature ovarian failure. Premature ovarian failure is the loss of normal ovarian function before age 40. If your ovaries fail, they don't produce normal amounts of the hormone estrogen or have eggs to release regularly.

•        Endometriosis. Endometriosis occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.

•        Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.

•        Previous tubal sterilization or removal. If you've had tubal ligation — a type of sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy — and want to conceive, IVF may be an alternative to tubal ligation reversal.

•        Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.

•        Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.

•        A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic diagnosis — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.

•        Fertility preservation for cancer or other health conditions.If you're about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.

Risks

Specific steps of an in vitro fertilization (IVF) cycle carry risks, including:

•        Multiple births. IVF increases the risk of multiple births if more than one embryo is implanted in your uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus does.

•        Premature delivery and low birth weight. Research suggests that use of IVF slightly increases the risk that a baby will be born early or with a low birth weight.

•        Ovarian hyperstimulation syndrome. Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful. Signs and symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it's possible to develop a more severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.

•        Miscarriage. The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15 to 20 percent — but the rate increases with maternal age. Use of frozen embryos during IVF, however, may slightly increase the risk of miscarriage.

•        Birth defects. The age of the mother is the primary risk factor in the development of birth defects, no matter how the child is conceived. Experts believe that the use of IVF does not increase the risk of having a baby with birth defects.

•        Stress. Use of IVF can be financially, physically and emotionally draining. Support from counselors, family and friends can help you and your partner through the ups and downs of infertility treatment.

How you prepare

When choosing an in vitro fertilization (IVF) clinic, keep in mind that a clinic's success rate depends on many factors, such as patients' ages and medical issues, as well as the clinic's treatment population and treatment approaches.

Before beginning a cycle of IVF using, you and your partner will likely need various screenings, including:

•        Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and antimullerian hormone in your blood during the first few days of your menstrual cycle. Test results, often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.

•        Semen analysis. If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.

•        Infectious disease screening. You and your partner will both be screened for infectious diseases, including HIV.

•        Practice (mock) embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.

•        Uterine cavity exam. Your doctor will examine your uterine cavity before you start IVF. This might involve a sonohysterography — in which fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy — in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.

Before beginning a cycle of IVF, consider important questions, including:

•        How many embryos will be implanted? The number of embryos implanted is typically based on the age and number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually implanted. However, most doctors follow specific guidelines to prevent a higher order multiple pregnancy — and in some countries, legislation limits the number of embryos that can be implanted at once. Make sure you and your doctor agree on the number of embryos that will be implanted before they're transferred.

•        What will you do with any extra embryos? Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will. Cryopreservation can make future cycles of IVF less expensive and less invasive. However, the live birth rate from frozen embryos is slightly lower than the live birth rate from fresh embryos.

•        How will you handle a multiple pregnancy? If more than one embryo is implanted in your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks.

What you can expect

In vitro fertilization (IVF) involves several steps — ovulation induction, egg retrieval, sperm retrieval, fertilization and embryo transfer. One cycle of IVF can take about two weeks, and more than one cycle may be required.

Ovulation induction

 You begin treatment with synthetic hormones to stimulate your ovaries to produce multiple eggs — rather than the single egg that normally develops each month. Multiple eggs are needed because some eggs won't fertilize or develop normally after fertilization.

You may need several different medications, such as:

•        Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time.

•        Medications for oocyte maturation. When the follicles are ready for egg retrieval — generally after eight to 14 days — you will take human chorionic gonadotropin (HCG) or other medications to help the eggs mature.

•        Medications to prevent premature ovulation. These medications prevent your body from releasing the developing eggs too soon.

•        Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation.

Your doctor will work with you to determine which medications to use and when to use them.

Typically, you'll need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, your doctor will likely perform:

•        Vaginal ultrasound, a procedure that uses sound waves to create an image of your ovaries to monitor the development of fluid-filled ovarian sacs where eggs mature (follicles)

•        Blood tests to measure your response to ovarian stimulation medications — estrogen levels typically increase as follicles develop and progesterone levels remain low until after ovulation

Sometimes IVF cycles need to be canceled before egg retrieval for one of these reasons:

•        Inadequate number of follicles developing

•        Premature ovulation

•        Too many follicles developing, creating a risk of ovarian hyperstimulation syndrome

•        Other medical issues

If your cycle is canceled, your doctor might recommend changing medications or their dose to promote a better response during future IVF cycles.

Egg retrieval

Egg retrieval can be done in your doctor's clinic 34 to 36 hours after the final injection and before ovulation.

•        During egg retrieval, you'll be sedated and given pain medication.

•        Transvaginal ultrasound aspiration is the usual retrieval method. An ultrasound probe is inserted into your vagina to identify follicles. Then a thin needle is inserted into an ultrasound guide to go through the vagina and into the follicles to retrieve the eggs.

•        The eggs are removed from the follicles through a needle connected to a suction device. Multiple eggs can be removed in about 20 minutes.

•        After egg retrieval, you may experience cramping and feelings of fullness or pressure.

•        Mature eggs are placed in a nutritive liquid (culture medium) and incubated. Eggs that appear healthy and mature will be injected with sperm to attempt to create embryos. However, not all eggs may be successfully fertilized.

Sperm retrieval

your partner will provide a semen sample at your doctor's clinic through masturbation the morning of egg retrieval. Other methods, such as testicular aspiration — the use of a needle or surgical procedure to extract sperm directly from the testicle — are sometimes required. Sperm are separated from the semen fluid in the lab.

Fertilization

Fertilization can be attempted using two common methods:

•        CIVF (Conventional In Vitro Fertilization). During insemination, healthy sperm and mature eggs are mixed and incubated overnight.

•        Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior IVF cycles failed.

In certain situations, your doctor may recommend other procedures before embryo implantation.

•        Assisted hatching. About five to six days after fertilization, an embryo "hatches" from its surrounding membrane (zona pellucida), allowing it to implant into the lining of the uterus. If you're an older woman, or if you've have had multiple failed IVF attempts, your doctor might recommend assisted hatching — a technique in which a hole is made in the zona pellucida just before implantation to help the embryo hatch and implant.

•        Preimplantation genetic testing. Embryos are allowed to develop in the incubator until they reach a stage where one or two blastomeres removed and tested for specific genetic diseases or the correct number of chromosomes, Embryos that don't contain affected genes or chromosomes can be implanted in your uterus. While preimplantation genetic testing can reduce the likelihood that a parent will pass on a genetic problem, it can't eliminate the risk. Prenatal testing may still be recommended.

Embryo transfer

Embryo transfer is done at your doctor's clinic and usually takes place two to six days after egg retrieval.

•        The procedure is usually painless, although you might experience mild cramping.

•        The doctor or nurse will insert a long, thin, flexible tube called a catheter into your vagina, through your cervix and into your uterus.

•        A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter and then delivered through the tube into your uterus.

If successful, the embryo will implant in the lining of your uterus about six to 10 days after egg retrieval.

After the procedure

After the embryo transfer, you can resume your normal daily activities. However, your ovaries may still be enlarged. Consider avoiding vigorous activity, which could cause discomfort.

Typical side effects include:

•        Passing a small amount of clear or bloody fluid shortly after the procedure — due to the swabbing of the cervix before the embryo transfer

•        Breast tenderness due to high estrogen levels

•        Mild bloating

•        Mild cramping

•        Constipation

If you develop moderate or severe pain after the embryo transfer, contact your doctor. He or she will evaluate you for factors such as infection, twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulation syndrome.

Results

Your doctor will take a blood sample to detect whether you're pregnant about 10 days to two weeks after egg retrieval.

•        If you're pregnant, your obstetrician will continue with you for prenatal care.

•        If you're not pregnant, you'll stop taking progesterone and likely get your period within a week. If you don't get your period or you have unusual bleeding, contact your doctor. If you're interested in attempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF.

The chances of giving birth to a healthy baby after using IVF depend on various factors, including:

•        Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby during IVF.

•        Embryo status. Transfer of embryos which are more developed is associated with higher pregnancy rates compared with less developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or other care provider about your specific situation.

•        Reproductive history. Women who've previously given birth are more likely to be able to get pregnant using IVF than are women who've never given birth. Success rates are lower for women who've previously used IVF multiple times but didn't get pregnant.

•        Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility.

•        Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman's chance of success using IVF by 50 percent. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine and certain medications also can be harmful.

Talk with your doctor about any factors that apply to you and how they may affect your chances of a successful pregnancy.

In vitro fertilization is an option for many couples who cannot conceive through conventional therapies. Embryos are put back into the female partner's uterus (womb) after 3 to 5 days of being in the incubator, hopefully they will then grow into a baby. The reasons IVF is done include - poor sperm quality and/or quantity, obstructions between the egg and sperm, ovulation problems, and sperm-egg interaction problems. These problems can prevent couples having a baby naturally, and IVF helps to solve this.

How might we benefit from IVF?

IVF is likely to be recommended for the following fertility problems:

•If you have blocked or damaged fallopian tubes or any other problem where IVF has been identified as the only treatment likely to help you get pregnancy.

•If your partner has a minor problem with his sperm. Major problems are better treated using ICSI.

•If you have tried fertility drugs, such as clomiphene, or another fertility treatment such as IUI, without success.

•If you have been trying to conceive for at least two years and a cause hasn't been found to explain why you have not become pregnant.

How is IVF done?

IVF follows a series of steps, starting with fertility drugs to help you produce as many eggs as possible.

Fertility drugs

You will probably need to take fertility drugs to stimulate your ovaries to develop mature eggs ready for fertilisation. During your normal menstrual cycle you release one egg per month. Your odds of getting pregnant are better with more eggs and using fertility drugs increases the number of mature eggs that are released. It's recommended that IVF be offered with fertility drugs to stimulate your ovaries as you have a better chance of pregnancy as a result.

This is called down-regulation and  usually involves drugs called gonadotrophin-releasing hormone (GnRH) analogues (pituitary agonists) to suppress or stop your cycle. You take these daily for about two weeks by tablet or injection.

Other shorter methods of taking control are available. Some involve the use of GnRH antagonists. These drugs can be taken over a few days, usually after pre-treatment with the contraception pill and at the start of ovulation stimulation. This method is not common  but is suitable for women who are at higher risk of severe side effects of fertility drugs.

If you have endometriosis you may take the GnRH agonist Cetrotide for several months to help improve your egg quality and chances of success.

Hormone injections

You will then have daily hormone injections for about 12 days. These stimulate your ovaries to release a greater number of mature eggs than usual (ovulation induction). The hormones used are gonadotrophins follicle stimulating hormone (FSH) and luteinising hormone (LH).

Women respond to these fertility drugs in different ways, and they may have strong side-effects. Your doctor will closely monitor you to make sure that you are cared for if this happens.

Ultrasound scans and possibly blood hormone tests will be offered to monitor how many and how well your eggs are responding. This is for safety and to check when your eggs are mature.

Egg retrieval and sperm collection

Ultrasound is used to detect when your eggs are ready to be retrieved.

Your doctor will then remove the eggs from your ovaries. Your doctor will use a fine, hollow needle attached to an ultrasound scan probe. The probe helps to locate the follicles that contain the eggs. You may feel mild discomfort during the procedure, but if you feel pain later on your specialist will prescribe painkillers.

While your eggs are being collected, your partner will need to provide a fresh sample of semen. If donated sperm or frozen sperm are being used, the sample is taken from the freezer. The sperm is washed and the best-quality sperm extracted ready to fertilise the eggs. The sperm is then combined with the eggs in a dish and left to culture in an incubator.

Fertilisation and embryo transfer

Within one day of combining the eggs and sperm, the dish is checked to see if any eggs have been fertilised. If they have, they'll be kept for between two days and five days before being transferred back into your uterus.

Any fertilised eggs will each have become a ball of cells called an embryo. They may also be referred to by your specialist as blastocysts, if the embryos are being transferred at the later blastocyst stage, at about day five. The healthiest embryos are chosen to be inserted into your uterus.

Some clinics offer a pre-implantation test called comprehensive chromosome screening (CCS). This screens embryos before they are transferred at the blastocyst stage. Only the embryos that are predicted to have a full set of chromosomes are selected.

CCS may boost your chances of getting pregnant and may also reduce your risk of miscarriage when a single embryo is transferred.

By now you will have been helping your uterus (womb) to prepare for the embryo by taking progesterone, which helps thicken its lining. You receive this by injection, pessary or gel. If your uterus lining (endometrium) is too thin, the embryos are unlikely to implant. If this is the case, the IVF cycle will unfortunately be abandoned.

Usually, one or two embryos are transferred with a thin catheter (tube) through your cervix into your uterus. Your fertility specialist may use ultrasound to guide him.

To avoid the risk of a high order multiple pregnancy, no more than three embryos can be legally transferred. The number of embryos that are transferred will depend on your age and your chances of success. This in turn depends on your particular fertility problem.

Dr. Dabit  recommends a maximum of two embryos transferred to your uterus whatever your age. If you are 39 years old or under and a suitable candidate, you may be recommended for elective Single Embryo Transfer (eSET) in your first and second cycles. If you have one or more top quality embryos, eSET can increase your chance of having a healthy single baby at term, and improve your and your baby's health.

If you are 40 years or more Dr. Dabit supports the transfer of two embryos per cycle.

Repeated cycles

If there are any extra embryos, these may be frozen for future use. This is in case the first cycle doesn't succeed, or you want another baby after your successful treatment.

IVF normally involves transferring embryos at about two to three days after fertilisation. Another option is to wait until about five days after fertilisation when the ball of cells has developed into a blastocyst. Only the healthiest embryos will reach the blastocyst stage in vitro. You may have a better chance of having a healthy pregnancy after blastocyst transfer.

Most clinics offer blastocyst transfer to all patients depending on quality and number of embryos available. However some clinics offer blastocyst transfer only if:

•you have had previous normal IVF with healthy embryos but they have not implanted

•you are under 40

•you have opted for eSET

You can be up and about quite soon after embryo transfer, as resting for more than 20 minutes immediately afterwards makes no difference to the outcome. In a successful cycle, one or more embryos will implant in your uterine wall and will continue to grow. You can take a pregnancy test in about two weeks.

Once your pregnancy has been confirmed following IVF, you should have an early ultrasound scan at about six weeks. This is to check that the embryo has implanted in your uterus.

How long will IVF treatment last?

One cycle of IVF takes between four weeks and six weeks to complete. You and your partner can expect to spend about half a day at your clinic for the egg retrieval and fertilisation procedures. You'll go back between two days and three days later for the embryos to be transferred to your uterus, or between five days and six days with blastocyst transfer.

What's the success rate of IVF?

The success rates depends on your particular fertility problem and your age. The younger you are, and the healthier your eggs are, the higher your chances of success.

You can improve your chances of success by:

•Reaching a healthy weight for your height before you have treatment. IVF is more likely to be successful if your body mass index (BMI) is between 19 and 30.

•Keeping your alcohol consumption to no more than one unit of alcohol per day, as drinking more than this reduces the effectiveness of IVF.

•Stopping smoking (this includes your partner!) Smoking reduces success rates.

•Keeping your caffeine consumption very low. Even low rates of consumption of 2 to 50mg have been linked to lower success rates.

What are the advantages of IVF?

For most children conceived by IVF there are no long-term problems.

IVF can offer you a chance of having a baby if you are unable to conceive naturally, for example if you have blocked, damaged or missing fallopian tubes.

What are the disadvantages of IVF?

IVF increases your risk of certain complications, such as:

•A multiple birth, when more than one embryo is transferred to your uterus. Many couples consider twins to be a blessing. But a multiple pregnancy increases your risk of having a premature baby or a baby with a low birth weight.

•Side-effects from fertility drugs are usually mild, and include hot flushes, headaches and nausea. However, you will need to be closely monitored for signs of ovarian hyperstimulation syndrome (OHSS), particularly if you have polycystic ovary syndrome (PCOS). Having OHSS may mean an interruption or cancellation of the treatment cycle and a stay in hospital while your over-stimulated ovaries settle down.

•An increased risk of ectopic pregnancy, where an embryo implants in a fallopian tube or in your abdominal cavity. This is more likely if you have previously had problems affecting your fallopian tubes.

Despite these risks, many parents still go on to give birth to much-wanted, much-loved babies through IVF. If you are considering fertility treatment, Dr. Dabit clinic offers advice and contact details for counsellors.

Acute pelvic pain is pain that starts over a short period of time anywhere from a few minutes to a few days. This type of pain is often a warning sign that something is wrong and should be evaluated promptly.

Pelvic pain can be caused by an infection or inflammation. An infection doesn't have to affect the reproductive organs to cause pelvic pain. Pain caused by the bladder, bowel, or appendix can produce pain in the pelvic region; diverticulitis, irritable bowel syndrome, kidney or bladder stones, as well as muscle spasms or strains are some examples of non-reproductive causes of pelvic or lower abdominal pain. Other causes of pelvic pain can include pelvic inflammatory disease (PID), vaginal infections, vaginitis, and sexually transmitted diseases (STDs). All of these require a visit to your healthcare provider who will take a medical history, and do a physical exam, which may include diagnostic

Quick Answers to Health Questions :

•Pelvic Pain Causes.

•OA Knee Pain.

•Pain Symptoms.

•Chronic Pain Center.

•Causes Endometriosis.

Women who have ovarian cysts may experience sharp pain if a cyst leaks fluid or bleeds a little, or more severe, sharp, and continuous pain when a large cyst twists or ruptures - this is probably the most common gynecologic cause of acute onset pelvic pain. Fortunately, most small cysts will dissolve without medical intervention after 2 or 3 menstrual cycles; however, large cysts and those that don't rectify themselves after a few months may require surgery to remove the cysts.

An ectopic pregnancy is one that starts outside the uterus, usually in one of the fallopian tubes. Pain caused by an ectopic pregnancy usually starts on one side of the abdomen soon after a missed period, and may include spotting or vaginal bleeding. Ectopic pregnancies can be life threatening if medical intervention is not sought immediately. The fallopian tubes can burst and cause bleeding in the abdomen, if left untreated. In some cases surgery is required to remove the affected fallopian tube.

Acute pelvic pain can also be a symptom of appendicitis.

Chronic Pelvic Pain

Chronic pelvic pain can be intermittent or constant. Intermittent chronic pelvic pain usually has a specific cause, while constant pelvic pain may be the result of more than one problem. A common example of chronic pelvic pain is dysmenorrhea or menstrual cramps. Other causes of chronic pelvic pain include endometriosis, adenomyosis, and ovulation pain. Sometimes an illness starts with intermittent pelvic pain that becomes constant over time; this is often a signal that the problem has become worse. A change in the intensity of pelvic pain can also be due to a woman's ability to cope with pain becoming lessened causing the pain to feel more severe even though the underlying cause has not worsened.

Women who have had surgery or serious illness such as PID, endometriosis, or severe infections sometimes experience chronic pelvic pain as a result of adhesions or scar tissue that forms during the healing process. Adhesions cause the surfaces of organs and structures inside the abdomen to bind to each other.

Fibroid tumors (a non-cancerous, benign growth from the muscle of the uterus) often have no symptoms; however when symptoms do appear they can include pelvic pain or pressure, as well as menstrual abnormalities.

Diagnosis and Treatment of Pelvic Pain

Due to the large number of possible causes of pelvic pain, diagnosis begins by process of elimination. Your physician may order several types of tests to diagnose the problem. It may seem tedious and time-consuming; however, this approach is the best way for your provider to determine the cause of your pelvic pain. Some of the tests that your physician may order include ultrasound imaging, computed tomography (CT), magnetic resonance imaging (MRI), intravenous pyelography (IVP), and

Barium enema. However, these tests cannot detect endometriosis or adhesions and laparoscopy may be necessary to diagnose the cause of your pelvic pain.

What type of treatment you receive depends on the diagnosis. Treatments can vary from medications for urinary tract infections (UTI) or vaginal infections to pharmacologic treatment in the hospital for serious infections such as PID. If a sexually transmitted disease is diagnosed, your partner will also need to be treated to prevent reinfection.

Menstrual cramps can often be relieved with drugs that reduce inflammation, such as ibuprofen, which blocks the production of prostaglandins that cause the uterus to contract. Sometimes the diagnosis will require the use of hormonal therapies including oral contraceptives and other types of hormones. Antidepressants are helpful for some women because they help break the cycle of pain and depression that often occurs in women with chronic pelvic pain.

Surgery may be the answer for certain types of pelvic pain. What type of surgery depends on the diagnosis. Surgery such as laparoscopy can be done on an outpatient basis, while other surgeries such as hysterectomy require a stay in the hospital. Your healthcare provider will discuss your options based on your diagnosis, as well as the risks and benefits of these procedures and the chance of them working. Hysterectomy is not always the best treatment, especially in the case of chronic pelvic pain.

Other treatments include heat therapy, muscle relaxants, nerve blocks, and relaxation exercises. If digestive or urinary conditions are diagnosed specific treatments for these conditions will be used.

Determining the cause of pelvic pain can be a frustrating situation for many women, but try not to give up. Even when one specific cause for chronic pelvic pain is not found your healthcare provider has treatments that can help. Maintaining an open working relationship with you physician is the best way to find the treatment that works best for you.

A testicular biopsy is helpful in many cases of azoospermia. If an evaluation of azoospermia is not clearly showing whether there is a problem with sperm production or one of a blockage in the ducts of the reproductive tract, then the next step is to examine the testis itself and assess sperm production.

This can be done in several ways, but the classic approach is to perform a testis biopsy under local anesthesia. This allows for the direct inspection of a small piece of testis tissue to determine whether sperm production is normal or not. Testicular tissue contains

·         sperm-producing cells that are found in tubules called seminiferous tubules, and

·         cells between the tubules that are called interstitial or Leydig cells.

The Leydig cells are the major hormone-producing cells. The biopsied tissue is specially stained and examined microscopically for both cell types by a pathologist. If it shows that sperm production is normal, then a blockage exists in the system, usually beyond the testis. Remember that a biopsy does not tell us where the obstruction is located within the system. The most common testis biopsy patterns observed in a testis biopsy specimen are listed below. Dr Dabit has created a systematic way to interpret the testis biopsy that he has taught others for years to decide what pattern is present (see figure below).

Testis Biopsy Patterns

1) Normal

The testis architecture and sperm production look entirely normal. This means that an absence of sperm in the ejaculate is due to an obstruction or absence of the ducts leading from the testicle to the penis.

2) Maturation Arrest

Sperm are made from early germ cells that develop within the testicle. The process of sperm maturation can be interrupted at several levels and can result in several “arrest” patterns. If the halt in development occurs early in the process of sperm maturation, the prognosis is worse.

3) Hypospermatogenesis

In this pattern, all of the elements of sperm production are present, but there are fewer of them than normal. This will generally result in lower numbers of sperm in the ejaculate.

4) Germ Cell Absence or Aplasia

This pattern is characterized by a complete absence of germ cells and sperm in the testis. When there is no define reason for this pattern, it is also termed Sertoli cell-Only syndrome.

5) Other

Other abnormalities can be detected by examining a testis biopsy, including evidence of previous infection within the testis and abnormalities of the Leydig or interstitial cells. Occasionally, testis cancer can be detected, but this is a rare (less than 1%).

In Dr. Dabit experience, the testis biopsy has several limitations. For one, it is invasive. Second, it only provides information on the area that is biopsied and tells us nothing about sperm production in the rest of the testis. Third, how clinicians read the biopsies varies widely, making the interpretation unclear, a fact that does not help the patient. In fact, Dr Dabit has published on this issue of how testis biopsy interpretations vary in a series of testis biopsies from patients who had had the biopsy procedure done before they consulted with him. In this study, he compared his interpretation of the biopsies from patients to the readings made by the pathologists from the community in which the biopsies were performed. He found that in 40% of cases, the interpretation that he made was different from the pathologist’s interpretation and that in 25% of cases, patient care was altered dramatically as a result of his re-review. An example of a significant alteration in care is a biopsy in which the community pathologist read as having no sperm but Dr. Dabit reading suggested that there were sperm. For these reasons, the testis biopsy currently plays a limited role in the cutting edge care of azoospermic men. In addition, this is why Dr. Dabit offers to re-review the testis biopsy slides that are sent to him as part of his Second Opinion Clinic.

Women and men share many similar health problems, but women also have their own health issues, which deserve special consideration and some of the health issues that affect both men and women can affect women differently.

Women's lives have changed over the centuries. Historically, life was particularly difficult for most women. Most women in the past did not live long enough to be concerned about menopause or old age.

In 1900, a woman's life span was about 50 years. Now, in the new millennium, life expectancy for women is 82 years of age, and continuing to rise. And as we always at KHMC care  we are not only concerned that women live longer, but we also want them to have the possibility of enjoying a better quality of life throughout their span of years. But to do this, it is essential that women take charge of their own bodies and comprehend how they can maximize their health and fitness. It is also helpful that men understand and are supportive of the health concerns of the women. And here comes our role in providing such a pioneered center that provides all what women need in maintaining and monitoring their health in one place.

The Women’s Health Care Cycle

This program focuses specifically on women’s health, and is established with the objective of improving the health and quality of women’s lives worldwide.

The care cycle encompasses the whole continuum of care from prevention, screening and diagnosis to treatment, management and surveillance

 Following this approach provides a greater understanding of the clinical pathways for a particular disease in a particular geographical region, and can show where improvements need to be made.

In our Women’s Health program we focus on three key areas of disease in women: breast cancer, heart disease, and gynecology. All three represent important global health issues.

Breast cancer is the most frequently diagnosed cancer in women worldwide. Because breast cancer presents in many different ways, a multimodality approach is often required for a comprehensive diagnosis. Our center recognised this need and offers a portfolio of imaging systems and healthcare informatics solutions. The center is also actively involved in programs that will add value in other points of the breast cancer care cycle.

Heart disease is the greatest cause of death in women worldwide. The World Health Organization reports that more than 3.4 million women die from heart disease every year. Coronary artery disease in women is often clinically different than in men, and women are more likely to present with atypical symptoms. Our center offers a complete portfolio of solutions to support diagnosis in women, and works closely with leading healthcare organizations to provide solutions that address women’s unique cardiovascular needs and help to improve early detection.

Gynecological conditions include benign conditions such as abnormal uterine bleeding, pelvic floor disorders, and infertility, as well as cancer of the cervix, uterus, and ovaries. There were more than one million new cases of gynecologic cancers worldwide in 2008 .

Our novel technologies for imaging can help to provide earlier diagnosis, at a stage when treatment offers a better chance of success, and novel treatment techniques offer less invasive therapy.

Bone Health for Women

Bone health begins at a young age. A woman acquires about 85 to 90 percent of her bone mass during childhood and adolescence. By about age 20,  bone building is complete but bone-mass continues to increase until the early thirties. Bones become stronger and more dense as more calcium becomes part of the bone matrix. If there is not enough calcium deposited in bones during childhood, they may become weak later in life, leading to bone disease such as osteoporosis. Fragile bones easily fracture or break, especially in the hip, spine and wrist.

Genetics and lifestyle contribute to healthy bones. If healthy, strong bones run in your family, chances are you will have them, too. Good nutrition is the key to building and keeping bones strong for life. Calcium and vitamin D are the major nutrients for making bones hard and healthy.

Healthy Bones and Calcium

It is important to consume enough calcium every day. Women need 1,000 milligrams of calcium a day for healthy bones. After age 50, a woman’s calcium needs jump to 1,200 milligrams a day.

High-calcium Foods

Good sources of calcium include fat-free or low-fat dairy products like milk, yogurt and cheese, tofu made with calcium sulfate, sardines and fortified cereals and juices. Women need at least three servings a day of calcium-rich foods. A serving of calcium is equivalent to:

·         1 cup of low-fat or fat-free milk

·         1 cup of low-fat or fat-free yogurt

·         1 ounce low-fat or fat-free cheese

·         1½ cups cooked edamame (soybeans)

·         1 cup calcium-fortified juice

·         3 ounces canned sardines, with bones.

Reading Food Labels for Calcium

Check the Nutrition Facts Panel on food labels to find good sources of calcium.

If a label reads:

·         30% RDI of calcium = 300 milligrams

·         20% RDI of calcium = 200 milligrams

·         10% RDI of calcium = 100 milligrams

The Role of Vitamin D

As women age, their bodies do not absorb calcium as well. Vitamin D helps bones absorb calcium. There are three ways to get vitamin D: sunlight (ten to 15 minutes outside per day is sufficient for most people), food and supplements.

Vitamin D is only found in a few foods. Sources include fatty fish like mackerel, salmon and tuna, egg yolks, fortified milk, soymilk and some brands of orange juice and cereal. Women who do not consume enough vitamin D from foods need to take a vitamin D supplement each day.

For women younger than 50, the daily recommended amount of vitamin D is 400 to 800 IU; this amount goes up for women older than 50 to 800 to 1,000 IU a day.

Five Ways to Keep Bones Strong

You can keep your bones strong for life. Start by following these key tips:

·         Consume enough calcium and vitamin D every day with food or a combination of food and supplements

·         Participate in regular weight-bearing/strength training activities

·         Avoid smoking and excess alcohol intake

·         Talk with your health care provider about bone health

Have a bone density test if you’re over 50.

For most couples, the first symptom of infertility is when after a year of unprotected sex

Depending on the type of treatment you receive, uterine cancer can lead to infertility. Here's what you can do to prepare for the changes ahead.

Although uterine cancer is not commonly seen in women of child-bearing age, women who do develop uterine cancer during these years will face fertility challenges. Apart from the primary focus of uterine cancer survival, there is the lingering issue of whether or not you will be able to have children, if that was your desire.

"While uterine cancer usually occurs in women over 50 years of age, it can develop in women younger than 40. Uterine cancer "can lead to the possibility that a woman who is of childbearing age will have her uterus removed or will undergo chemotherapy. Infertility — being unable to conceive and bear a child — is a definite outcome of having a hysterectomy and a potential side effect of chemotherapy.

Uterine Cancer Treatment and Infertility

Infertility can result from many different uterine cancer treatments , including:

Hysterectomy. Cancer of the uterus may make it necessary for doctors to remove the uterus, also called the womb, where the baby develops. A hysterectomy takes away all possiblity that you can become pregnant and bear a child. If you were still planning to have children when you were diagnosed, having a frank discussion with your health care team about whether a hysterectomy is critical in your uterine cancer treatment plan should be on the agenda as early as possible.

Chemotherapy. Chemotherapy can damage a woman's eggs or other parts of the female reproductive system and cause difficulty conceiving or carrying a baby to delivery. However, there is still a possibility that a woman may become pregnant after having treatment. In fact, there have been successful pregnancies after chemotherapy using fertility treatments.

Radiation therapy. This treatment option can also cause reproductive damage. While radiation therapy can sometimes be tailored in ways that are more protective of the reproductive organs, in the case of uterine cancer this may be difficult.

If preserving your fertility is a goal, talking with your doctor about how to choose the best treatment plan is important. Together, you can go over the pros and cons of the various options. A more conservative approach using hormones, rather than chemotherapy or radiation, to fight the cancer may be an option for women concerned about fertility. One recent study of 133 women diagnosed with uterine cancer at age 45 or younger determined that hormonal therapy for an average duration of six months led to successful cure of the disease in 66 percent of the women.

Uterine Cancer Treatment and Other Sexual Changes

In addition to problems with infertility, uterine cancer treatment can also lead to vaginal dryness or narrowing. "Women who develop uterine cancer can have vaginal changes, which may include shortening, narrowing, and decreased lubrication of the vaginal area,"  As a result, a woman can experience problems with intimacy because of pain or decreased sexual desire.

Solutions like vaginal moisturizers or lubricants used during intercourse help relieve some of the pain. Also, vaginal dilators and sexual intercourse itself can help prevent narrowing of the vagina during and after chemotherapy.

What Is an Irregular Period?
When someone says they have an irregular period, they are typically referring to the number of days between cycles or the variation between periods.

Your period is considered irregular if the number of days between periods is either shorter or longer than the normal range. Anything shorter than 21 days or longer than 35 days is considered to be irregular.

It can also be considered irregular if your cycles vary by several days. For example, if your cycle is typically 33 days and it varies by a couple days on either side, that's normal. But if your cycles are unpredictable, with some cycles coming 25 days apart and others 33 days apart, that would be an abnormal variation, even though the number of days between periods is still in the "normal" range.

The 28-Day Myth

You may have heard that a 28-day cycle is normal and anything longer or shorter than 28 days is irregular. This is a common myth.

While a 28-day cycle may be the average, you shouldn't think that a 28-day cycle is the ideal. Your cycle can be longer or shorter than this and you can still have great fertility. By the same token, it's possible for someone with a 28-day cycle to have fertility problems.

The 28-day cycle is not the golden ticket to perfect fertility. You shouldn't be concerned if your cycle doesn't match this textbook model.

Occasional Irregular Period Can Be Normal

If your periods are frequently irregular, this may signal a problem. On the other hand, the occasional irregular period can be normal.

Normal reasons for a missed or irregular period include:

- Illness, including a flu or bad cold

- High stress

- Travel, especially travel that messes with your sleep patterns

- Breastfeeding, which in the early days may cause lactation amenorrhea (a total lack of periods)

- Pregnancy

- Exercise can lead to irregular or even absent periods, and this is common in athletes. If you're not an athlete and you're exercising to the point that your periods become - irregular or stop, you should speak to your doctor.

Some athletes don't know that their fertility can be impacted by their exercise regimen. If you're an athlete and you want to get pregnant, you may need to cut back to restart your periods and ovulation.

When Is Too Much Exercise a Problem for Fertility?

Also, you may experience irregular periods if you lose or gain a significant amount of weight. This is a "normal" reaction, but this doesn't mean that extreme weight loss or gain is good for your health. For women who are overweight, losing weight may regulate the menstrual cycle; for women who are underweight, gaining some weight can help regulate things.

Why Yo-Yo Dieting or Too Much Weight Loss Is Bad for Fertility

Can Being a Little Overweight Harm Your Fertility?

BMI Calculator: Find Out If You're Under or Overweight.

Irregularity Beyond Menstrual Cycle Length

Even though the phrase "irregular periods" refers to cycle length, you shouldn't think this is the only aspect of your period that can go awry.

You can have normal cycle lengths but experience abnormal spotting, too heavy or too light bleeding, severe cramps, extreme mood swings or other abnormal period symptoms.

If you're concerned about any aspect of your period being irregular, speak to your doctor. It's better to ask and receive reassurance that all is well than ignore a potential problem or fail to share a telling symptom that could help your doctor make a diagnosis.

Postpartum depression is the most common problem associated with childbirth. It has been described as afflicting prominent historical figures like author/suffragist Charlotte Perkins Gilman in the 19th century. This illness is characterized by depression that a woman experiences within four weeks of childbirth, affecting about 13% of women who give birth. Postpartum depression is also called major depression with postpartum onset. Delusional thinking after childbirth, called postpartum psychosis, affects about one in every thousand women.

Notably, postpartum depression is not an illness that is exclusive to mothers. Fathers can experience it as well. In fact, it can affect as many as 10% of new fathers. As with women, symptoms in men can result in fathers having difficulty caring for themselves and for their children when suffering from postpartum depression.

What are causes and risk factors for postpartum depression?

Similar to many other mental healthconditions, there is thought to be a genetic vulnerability to developing postpartum depression. Rapid changes in the levels of reproductive hormones that occur after delivery are thought to be biological factors in the development of postpartum depression. Interestingly, men are also known to experience changes in a number of hormones during the postpartum period that can contribute to the development of PPD. Also, the stress inherent in caring for a newborn is a considerable factor.

Further risk factors for developing postpartum depression include marital problems, low self-esteem, and a lack of having social support before and after the birth of the child.

What are postpartum depression symptoms and signs?

Symptoms of postpartum depression begin within four weeks after having a baby and include the following:

•Feelings of severe sadness, emptiness, emotional numbness, or frequent crying

•Feelings of irritability or anger

•A tendency to withdraw from relationships with family, friends, or from activities that are usually pleasurable for the PPD sufferer

•Constant tiredness, trouble sleeping, overeating, or loss of appetite

•A strong sense of failure or inadequacy

•Intense concern and anxiety about the baby or a lack of interest in the baby

•Thoughts about suicide or fears of harming the baby

Postpartum psychosis occurs much more rarely and is thought to be a severe form of postpartum depression. Symptoms of that disorder include the following:

•Delusions (false beliefs)

•Hallucinations (for example, hearing voices or seeing things that are not real)

•Thoughts of harming the baby

•Severe depressive symptoms.

How is postpartum depression diagnosed?

There is no one test that definitively indicates that someone has PPD. Therefore, health care professionals diagnose this disorder by gathering comprehensive medical, family, and mental health history. Patients tend to benefit when the professional takes into account their client's entire life and background. This includes, but is not limited to, the person's gender, sexual orientation, cultural, religious, ethnic background, and socioeconomic status. The health care professional will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and as part of screening the individual for medical conditions that might have mental health symptoms.

Postpartum depression must be distinguished from what is commonly called the "baby blues," which tend to happen in most new mothers. In the brief mood problem of baby blues, symptoms like crying, feeling sad, irritability, anxiety, andconfusion can occur. In contrast to the symptoms of PPD, the symptoms of the baby blues tend to peak around the fourth day after delivery, resolve by the 10th day after giving birth and do not tend to affect the parent's ability to function.

Postpartum psychosis is a psychiatric emergency that requires immediate intervention because of the danger that the sufferer might kill their infant or themselves. Postpartum psychosis usually begins within the first two weeks after delivery. Symptoms of this condition tend to involve extremely disorganized thinking, bizarre behavior, unusual hallucinations, and delusions. Postpartum psychosis is often a symptom of bipolar disorder, also called manic depression. While seasonal affective disorder (SAD) features depression, it takes place at a particular time of year, typically in the darker winter months.

What are the treatments for postpartum depression?

Educational programs and support groups

Treatment of postpartum depression in men and women is similar. Both mothers and fathers with this condition have been found to greatly benefit from being educated about the illness, as well as from the support of other parents who have been in this position.

Psychotherapies

Psychotherapy ("talk therapy") involves working with a trained therapist to figure out ways to solve problems and cope with all forms of depression, including postpartum depression. It can be a powerful intervention, even producing positive biochemical changes in the brain. This is particularly important as an alternative to medication treatment while women are breastfeeding. In general, these therapies take weeks to months to complete. More intense psychotherapy may be needed for longer when treating very severe depression or for depression with other psychiatric symptoms.

Interpersonal therapy (IPT): This helps to alleviate depressive symptoms and helps the person with PPD develop more effective skills for coping with social and interpersonal relationships. IPT employs two strategies to achieve these goals.

•The first is education about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.

•The second is defining specific problems (such as child care pressures or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems. Together, the individual with PPD and his or her therapist will use various treatment techniques to reach these goals.

Cognitive behavioral therapy (CBT): This helps to alleviate depression and reduce the likelihood it will come back by helping the PPD sufferer change his or her way of thinking. In CBT, the therapist uses three techniques to accomplish these goals.

•Didactic component: This phase helps to set up positive expectations for therapy and promote cooperation.

•Cognitive component: This helps to identify the thoughts and assumptions that influence behaviors, particularly those that may predispose the person with PPD to being depressed.

•Behavioral component: This employs behavior-modification techniques to teach the individual with PPD more effective strategies for dealing with problems.

What is the prognosis of postpartum depression?

Women who have suffered from postpartum depression are much more likely to have depression again sometime in the future. Children of mothers with PPD are at risk for emotional challenges as a result of problematic relationships with their mother.

Can postpartum depression be prevented?

Intensive nursing intervention in the form of visits to new mothers by a nurse can help prevent the development of postpartum depression.

•Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis is most commonly found on other organs of the pelvis.

•The exact cause of endometriosis has not been identified.

•Endometriosis is more common in women who are experiencingin fertility than in fertile women, but the condition does not fully prevent conception.

•Most women with endometriosis have no symptoms, in which case therapy is neither appropriate nor necessary.

•Pelvic pain during menstruation or ovulation can be a symptom of endometriosis, but may also occur in normal women.

•Endometriosis can be suspected based on the woman's pattern of symptoms, and sometimes during a physical examination, but the definite diagnosis is confirmed by surgery, usually laparoscopy.

•Treatment of endometriosis includes medication and surgery for both pain relief and treatment of infertility if pregnancy is desired.

What is endometriosis?

Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside or lining the tissue of the uterus, but in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called endometriosis implants. These implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder, although less commonly than other locations in the pelvis. Rarely, endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lung or brain. Endometrial implants, while they can cause problems, are benign (not cancerous).

Who is affected by endometriosis?

Endometriosis affects women in their reproductive years. The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. It is one of the leading causes of pelvic pain and reasons forlaparoscopic surgery and hysterectomy in this country. Estimates suggest that between 20% to 50% of women being treated for infertility have endometriosis, and up to 80% of women with chronic pelvic pain may be affected.

While most cases of endometriosis are diagnosed in women aged around 25 to 35 years, endometriosis has been reported in girls as young as 11 years of age. Endometriosis is rare in postmenopausal women.Studies further suggest that endometriosis is most common in taller, thin women with a low body mass index (BMI). Delaying pregnancy until an older age is also believed to increase the risk of developing endometriosis. It also is likely that there are genetic factors that predispose a woman to developing endometriosis, since having a first-degree relative with the condition increases the chance that a woman will develop the condition.

What causes endometriosis?

The cause of endometriosis is unknown. One theory is that the endometrial tissue is deposited in unusual locations by the backing up of menstrual flow into the Fallopian tubes and the pelvic and abdominal cavity during menstruation (termed retrograde menstruation). The cause of retrograde menstruation is not clearly understood. But retrograde menstruation cannot be the sole cause of endometriosis. Many women have retrograde menstruation in varying degrees, yet not all of them develop endometriosis.

Another possibility is that areas lining the pelvic organs possess primitive cells that are able to grow into other forms of tissue, such as endometrial cells. (This process is termed coelomic metaplasia.)

It is also likely that direct transfer of endometrial tissues during surgery may be responsible for the endometriosis implants sometimes seen in surgical scars (for example, episiotomy or Cesarean sectionscars). Transfer of endometrial cells via the bloodstream or lymphatic system is the most likely explanation for the rare cases of endometriosis that develop in the brain and other organs distant from the pelvis.

Finally, there is evidence that shows alternations in the immune response in women with endometriosis, which may affect the body's natural ability to recognize and destroy any misdirected growth of endometrial tissue.

What are endometriosis symptoms?

Most women who have endometriosis, in fact, do not have symptoms. Of those who do experience symptoms, the common symptoms are pain (usually pelvic) and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience painful sexual intercourse (dyspareunia) or cramping during intercourse, and or/pain during bowel movements and/or urination. Even pelvic examination by a doctor can be painful. The pain intensity can change from month to month, and vary greatly among women. Some women experience progressive worsening of symptoms, while others can have resolution of pain without treatment.

Pelvic pain in women with endometriosis depends partly on where the implants of endometriosis are located.

•Deeper implants and implants in areas with many pain-sensing nerves may be more likely to produce pain.

•The implants may also produce substances that circulate in the bloodstream and cause pain.

•Lastly, pain can result when endometriosis implants form scars. There is no relationship between severity of pain and how widespread the endometriosis is (the "stage" of endometriosis).

Endometriosis can be one of the reasons for infertility for otherwise healthy couples. When laparoscopic examinations are performed for infertility evaluations, endometrial implants can be found in some of these patients, many of whom may not have painful symptoms of endometriosis. The reasons for a decrease in fertility are not completely understood, but might be due to both anatomic and hormonal factors. The presence of endometriosis may involve masses of tissue or scarring (adhesions) within the pelvis that may distort normal anatomical structures, such as Fallopian tubes, which transport the eggs from the ovaries. Alternatively, endometriosis may affect fertility through the production of hormones and other substances that have a negative effect on ovulation, fertilization of the egg, and/or implantation of the embryo.

Other symptoms that can be related to endometriosis include:

•lower abdominal pain,

•diarrhea and/or constipation,

•low back pain,

•chronic fatigue

•irregular or heavy menstrual bleeding, or

•blood in the urine.

Rare symptoms of endometriosis include chest pain or coughing blood due to endometriosis in the lungs and headache and/or seizures due to endometriosis in the brain.

Endometriosis and cancer risk

Women with endometriosis have an increased risk for development of certain types of cancer of the ovary, known as epithelial ovarian cancer (EOC), according to some research studies. This risk is highest in women with endometriosis and primary infertility (those who have never borne a child), but the use of oral contraceptive pills (OCPs), which are sometimes used in the treatment of endometriosis, appears to significantly reduce this risk.

The reasons for the association between endometriosis and ovarian epithelial cancer are not clearly understood. One theory is that the endometriosis implants themselves undergo transformation to cancer. Another possibility is that the presence of endometriosis may be related to other genetic or environmental factors that also increase a women's risk of developing ovarian cancer.

How is endometriosis diagnosed?

Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor's office. Occasionally, during a rectovaginal exam (one finger in the vagina and one finger in the rectum), the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.

Unfortunately, neither the symptoms nor the physical examinations can be relied upon to conclusively establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can be helpful in ruling out other pelvic diseases and may suggest the presence of endometriosis in the vaginal and bladder areas, but still cannot definitively diagnose endometriosis. For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary.

As a result, the only accurate way of diagnosing endometriosis is at the time of surgery, either by opening the belly with large-incision laparotomy or small-incision laparoscopy.

Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia, or in some cases under local anesthesia. It is usually performed as an out-patient procedure (the patient going home the same day). Laparoscopy is performed by first inflating the abdomen with carbon dioxide through a small incision in the navel. A long, thin viewing instrument (laparoscope) is then inserted into the inflated abdominal cavity to inspect the abdomen and pelvis. Endometrial implants can then be directly seen.

During laparoscopy, biopsies (removal of tiny tissue samples for examination under a microscope) can also be performed for a diagnosis. Sometimes biopsies obtained during laparoscopy show endometriosis even though no endometrial implants are seen during laparoscopy.

Pelvic ultrasound and laparoscopy are also important in excluding malignancies (such as ovarian cancer) that can cause symptoms that mimic endometriosis symptoms.

Premature labor is also called preterm labor. It's when your body starts getting ready for birth too early in your pregnancy. Labor is premature if it starts more than three weeks before your due date.

Premature labor can lead to an early birth. But the good news is that doctors can do a lot to delay an early delivery. The longer your baby gets to grow inside you -- right up to your due date -- the less likely he or she is to have problems after birth.

What Increases Your Risk

Lots of different things can increase your risk of premature labor. Some of them are:

·         Smoking

·         Being very overweight or underweight before pregnancy

·         Not getting good prenatal care

·         Drinking alcohol or using street drugs during pregnancy

·         Having health conditions, such as high blood pressure, preeclampsia, diabetes, blood clotting disorders, or infections

·         Being pregnant with a baby that has certain birth defects

·         Being pregnant with a baby from in vitro fertilization

·         Being pregnant with twins or other multiples

·         A family or personal history of premature labor

·         Getting pregnant too soon after having a baby

Symptoms

To stop premature labor, you need to know the warning signs. Acting fast can make a big difference. Call your midwife or doctor right away if you have:

·         Backache, which usually will be in your lower back. This may be constant or come and go, but it won't ease even if you change positions or do something else for comfort.

·         Contractions every 10 minutes or more often

·         Cramping in your lower abdomen or menstrual-like cramps. These can feel like gas pains that may come with diarrhea.

·         Fluid leaking from your vagina

·         Flu-like symptoms such as nausea, vomiting, or diarrhea. Call your doctor even about mild cases. If you can't tolerate liquids for more than 8 hours, you must see your doctor.

·         Increased pressure in your pelvis or vagina

·         Increased vaginal discharge

·         Vaginal bleeding, including light bleeding

Some of these may hard to tell apart from normal symptoms of being pregnant, like backache. But you can't be too cautious. Get any possible warning signs checked out.

How to Check for Contractions

Checking for contractions is a key way of spotting early labor.

1.     Place your fingertips on your abdomen.

2.     If you feel your uterus tightening and softening, that's a contraction.

3.     Time your contractions. Write down the time when a contraction starts, and write down the time at the start of the next contraction.

4.     Try to stop the contractions. Get off your feet. Change your position. Relax.Drink two or three glasses of water.

5.     Call your doctor or midwife if you continue to have contractions every 10 minutes or more often, if any of your symptoms get worse, or if you have pain that's severe and doesn't go away.

Keep in mind that many women have harmless false labor called Braxton Hicks contractions. These are usually erratic, don't get closer together, and stop when you move around or rest. They are not part of labor. If you're not sure about the type of contractions you're feeling, get medical advice.

Cesarean delivery, also called c-section, is surgery to deliver a baby. The baby is taken out through the mother's abdomen. Most cesarean births result in healthy babies and mothers. But c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth.

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. 

Public heath experts think that many c-sections are unnecessary, so it is important for pregnant women to get the facts about c-sections before they deliver. Women should find out what c-sections are, why they are performed, and the pros and cons of this surgery.

What Are The Reasons For a C-Section?

Your doctor might recommend a c-section if she or he thinks it is safer for you or your baby than vaginal birth. Some c-sections are planned, but most c-sections are done when unexpected problems happen during delivery. Even so, there are risks of delivering by c-section. Limited studies show that the benefits of having a c-section may outweigh the risks when:

The mother is carrying more than one baby (twins, triplets, etc.)

The mother has health problems including HIV infection, herpes infection, and heart disease

The mother has dangerously high blood pressure

The mother has problems with the shape of her pelvis

There are problems with the placenta

There are problems with the umbilical cord

There are problems with the position of the baby, such as breech

The baby shows signs of distress, such as a slowed heart rate

The mother has had a previous c-section

Can a Woman Choose to Have a C-Section (Patient Requested C-Section)?

A growing number of women are asking their doctors for c-sections when there is no medical reason. Some women want a c-section because they fear the pain of childbirth. Others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems.

But is it safe and ethical for doctors to allow women to choose c-section? The answer is unclear. Only more research on both types of deliveries will provide the answer. In the meantime, many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits.

Experts who believe c-sections should only be performed for medical reasons point to the risks. These include infection, dangerous bleeding, increased need for blood transfusions, and blood clots. Babies born by c-section have more breathing problems right after birth. Women who have c-sections stay at the hospital longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture in subsequent pregnancies. If the uterus ruptures, the life of the baby and mother is in danger.

Supporters of elective c-sections say that this surgery may protect a woman's pelvic organs, reduces the risk of bowel and bladder problems, and is as safe for the baby as vaginal delivery.

The agree that a doctor's decision to perform a c-section at the request of a patient should be made on a case-by-case basis and be consistent with ethical principles. ACOG states that "if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing" a c-section. Both organizations also say that c-section should never be scheduled before a pregnancy is 39 weeks, or the lungs are mature, unless there is medical need.

Preparation before surgery

Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. So if you were in a labor and delivery room, you will be moved to an operating room. Often, the mood of the operating room is unhurried and relaxed. A doctor will give you medicine through an epidural or spinal block, which will block the feeling of pain in part of your body but allow you to stay awake and alert. The spinal block works right away and completely numbs your body from the chest down. The epidural takes away pain, but you might be aware of some tugging or pushing. See Medical Methods of Pain Relief for more information. Medicine that makes you fall asleep and lose all awareness is usually only used in emergency situations. Your abdomen will be cleaned and prepped. You will have an IV for fluids and medicines. A nurse will insert a catheter to drain urine from your bladder. This is to protect the bladder from harm during surgery. Your heart rate, blood pressure, and breathing also will be monitored. Questions to ask:

Can I have a support person with me during the operation?

What are my options for blocking pain?

Can I have music played during the surgery?

Will I be able to watch the surgery if I want?

What should I expect during a C-section?

The doctor will make an incision that is about 6 inches long and goes through the skin, fat, and muscle. Most incisions are made side to side and low on the abdomen, called a bikini incision. Once inside the abdominal cavity, the doctor will make an incision to open the uterus. The opening is made just wide enough for the baby to fit through. One doctor will use a hand to support the baby while another doctor pushes the uterus to help push that baby out. Fluid will be suctioned out of your baby's mouth and nose. The doctor will hold up your baby for you to see. Once your baby is delivered, the umbilical cord is cut, and the placenta is removed. Then, the doctor cleans and stitches up the uterus and abdomen. The repair takes up most of the surgery time. Questions to ask:

Can my partner cut the umbilical cord?

What happens to my baby right after delivery?

Can I hold and touch my baby during the surgery repair?

When is it okay for me to try to breastfeed?

When can my partner take pictures or video?

What should I expect after surgery?

You will be moved to a recovery room and monitored for a few hours. You might feel shaky, nauseated, and very sleepy. Later, you will be brought to a hospital room. When you and your baby are ready, you can hold, snuggle, and nurse your baby. Many people will be excited to see you. But don't accept too many visitors. Use your time in the hospital, usually two to four days, to rest and bond with your baby. C-section is major surgery, and recovery takes about six weeks (not counting the fatigue of new motherhood). In the weeks ahead, you will need to focus on healing, getting as much rest as possible, and bonding with your baby — nothing else. Be careful about taking on too much and accept help as needed.

How To Detect This Under Cover Pregnancy?

Many of you might wonder what is Ectopic pregnancy or what so called tubal pregnancy. It’s the pregnancy that takes place outside the uterine cavity,mainly in the fallopian tubes. This high risk complication of pregnancy is now reporting to occur in 2% of the pregnancies.

The most important thing about this pregnancy is to diagnose it AS SOON AS POSSIBLE to avoid life threatening complications for the mother. So how do we diagnose this kind of pregnancy?

Usually the first step in diagnosing Ectopic pregnancy is to do a pelvic examination for the mother that can detect tenderness in the area of the uterus and the fallopian tubes, less enlargement of the uterus than expected for pregnancy, or a mass felt in the pelvic area.

The very following thing to do is the pelvic ultrasound whether abdominal or transvaginal, but we prefer transvaginal ultrasound as it’s the most dependable way to show where a pregnancy is. A pregnancy in the uterus is visible 6weeks after the last menstrual period.  An Ectopic pregnancy is likely if there are no signs of an embryo in the uterus but hCG levels are elevated.

Later on , two or more blood tests of the pregnancy hormone hCG levels are taken 48 hours apart. During the early weeks of a normal pregnancy hCG levels double every 2 days, so low or slowly increasing levels of hCG in the blood suggests an early abnormal pregnancy, AKA Ectopic pregnancy or miscarriage.

Sometimes a surgical procedure using laparoscopy is used to look for and Ectopic pregnancy. An ectopic pregnancy after 5 weeks can usually be diagnosed and treated with a laparoscope, but laparoscopy is not often used to diagnose very early ectopic pregnancy because Ultrasound and blood pregnancy tests are very accurate.

After the diagnosis and treatment has been achieved, the hCG blood levels are tested several times as a part of the follow_up.  Usually we will be looking for a drop in the hCG levels which is a sign that the pregnancy is ending. In some cases hCG testing continues for weeks to months until hCG levels drop to Zero.

So I recommend all pregnant ladies to keep up with their prenatal visits to detect any abnormality in their pregnancies such as ECTOPIC pregnancy.

A molar pregnancy is an abnormality of the placenta, caused by a problem when the egg and sperm join together at fertilization. Molar pregnancies are rare, occurring in 1 out of every 1,000 pregnancies. Molar pregnancies are also called gestational trophoblastic disease (GTD), hydatidiform mole or simply referred to as a “mole.”

What is a molar pregnancy?

A molar pregnancy is the result of a genetic error during the fertilization process that leads to growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, and the growth of this material is rapid compared to normal fetal growth. It has the appearance of a large and random collection of grape-like cell clusters. There are two types of molar pregnancies, “complete,” and “partial.”

What is a complete molar pregnancy?

Complete molar pregnancies have only placental parts (there is no baby), and form when the sperm fertilizes an empty egg. Because the egg is empty, no baby is formed. The placenta grows and produces the pregnancy hormone, HCG. Unfortunately, an ultrasound will show that there is no fetus, only a placenta.

What is a partial molar pregnancy?

•Partial Mole occurs when the mass contains both the abnormal cells and an embryo that has severe defects. In this case the fetus will be overcome by the growing abnormal mass rather quickly.

•An extremely rare version of a partial mole is when twins are conceived but one embryo begins to develop normally while the other is a mole. In these cases, the healthy embryo will very quickly be consumed by the abnormal growth.

Who is at risk for a molar pregnancy?

•White women are at higher risk than black women.

•Women over the age of 40.

•Women who have had a prior molar pregnancy.

•Women with a history of miscarriage.

What are the symptoms of a molar pregnancy?

•Vaginal spotting or bleeding.

•Nausea and vomiting.

•Develop rare complications like thyroid disease.

•Early preeclampsia (high blood pressure).

•Increased HCG levels.

•No fetal movement or heart tone detected.

How do I know if I have a molar pregnancy?

•A pelvic exam may reveal a larger or smaller uterus, enlarged ovaries, and abnormally high amounts of the pregnancy hormone HCG.

•A sonogram will often show a “cluster of grapes” appearance, signifying an abnormal placenta.

How is a molar pregnancy treated?

•Most molar pregnancies will spontaneously end and the expelled tissue will appear grape-like.

•Molar pregnancies are removed by suction curettage, dilation and evacuation (D & C), or sometimes through medication. General anesthetic is normally used during these procedures.

•Approximately 90% of women who have a mole removed require no further treatment.

•Follow-up procedures that monitor the HCG levels can occur monthly for six months or as your physician prescribes.

•Follow-up is done to ensure that the mole has been removed completely. Traces of the mole can begin to grow again and may possess a cancerous-type threat to other parts of the body.

•Pregnancy should be avoided for one year after a molar pregnancy.

•Any birth control method is acceptable with the exception of an intrauterine device.

How will I feel emotionally after a molar pregnancy?

Although the removal of a molar pregnancy is not the termination of a developing child, it is still a loss. Even when an embryo is present, it does not have the opportunity to develop into a child. Most women discover that they are dealing with a molar pregnancy after the discovery and anticipation of being pregnant. Dreams, plans and hopes are cancelled all at once; it is still a significant loss.

•.There will have to be healing time for all involved, and grief will be experienced.

•.Recognize that people may try to console you with statements like, “Well at least it wasn’t a baby.” This doesn’t help, but at least know that they are trying. Let them know what you need.

•.What makes this type of loss further different from a “normal miscarriage” or loss is the continued concern of the mother’s health. Make sure that you stick with your follow-up appointments.

•.Support groups and counseling may prove beneficial.

Can I have another molar pregnancy?

•If you had a molar pregnancy without complications, your risk of having another molar pregnancy is about 1-2%.

•Genetic counseling prior to conceiving again is helpful for some couples.

What Is High Blood Pressure?
Blood pressure is the amount of force exerted by the blood against the walls of the arteries. A person's blood pressure is considered high when the readings are greater than 140 mm Hg systolic (the top number in the blood pressure reading) or 90 mm Hg diastolic (the bottom number). In general, high blood pressure, or hypertension, contributes to the development of coronary heart disease, stroke, heart failure and kidney disease.

What Are the Effects of High Blood Pressure in Pregnancy?

Although many pregnant women with high blood pressure have healthy babies without serious problems, high blood pressure can be dangerous for both the mother and the fetus. Women with pre-existing, or chronic, high blood pressure are more likely to have certain complications during pregnancy tha those with normal blood pressure. However, some women develop high blood pressure while they are pregnant (often called gestational hypertension).

The effects of high blood pressure range from mild to severe. High blood pressure can harm the mother's kidneys and other organs, and it can cause low birth weight and early delivery. In the most serious cases, the mother develops preeclampsia - or "toxemia of pregnancy"--which can threaten the lives of both the mother and the fetus.

What Is Preeclampsia?

Preeclampsia is a condition that typically starts after the 20th week of pregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain. When preeclampsia causes seizures, the condition is known as eclampsia--the second leading cause of maternal death is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth.

There is no proven way to prevent preeclampsia. Most women who develop signs of preeclampsia, however, are closely monitored to lessen or avoid related problems. The only way to "cure" preeclampsia is to deliver the baby.

Who Is More Likely to Develop Preeclampsia?

•           Women with chronic hypertension (high blood pressure before becoming pregnant).

•           Women who developed high blood pressure or preeclampsia during a previous pregnancy, especially if these conditions occurred early in the pregnancy.

•           Women who are obese prior to pregnancy.

•           Pregnant women under the age of 20 or over the age of 40.

•           Women who are pregnant with more than one baby.

•           Women with diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma.

How Is Preeclampsia Detected?

Unfortunately, there is no single test to predict or diagnose preeclampsia. Key signs are increased blood pressure and protein in the urine (proteinuria). Other symptoms that seem to occur with preeclampsia include persistent headaches, blurred vision or sensitivity to light, and abdominal pain.

All of these sensations can be caused by other disorders; they can also occur in healthy pregnancies. Regular visits with your doctor help him or her to track your blood pressure and level of protein in your urine, to order and analyze blood tests that detect signs of preeclampsia, and to monitor fetal development more closely.

How Can Women with High Blood Pressure Prevent Problems During Pregnancy?

If you are thinking about having a baby and you have high blood pressure, talk first to your doctor or nurse. Taking steps to control your blood pressure before and during pregnancy - and getting regular prenatal care - go a long way toward ensuring your well-being and your baby's health.

Before becoming pregnant:

•           Be sure your blood pressure is under control. Lifestyle changes such as limiting your salt intake, participating in regular physical activity, and losing weight if you are overweight can be helpful.

•           Discuss with your doctor how hypertension might affect you and your baby during pregnancy, and what you can do to prevent or lessen problems.

•           If you take medicines for your blood pressure, ask your doctor whether you should change the amount you take or stop taking them during pregnancy. Experts currently recommend avoiding angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II (AII) receptor antagonists during pregnancy; other blood pressure medications may be OK for you to use. Do not, however, stop or change your medicines unless your doctor tells you to do so.

While you are pregnant:

•           Obtain regular prenatal medical care.

•           Avoid alcohol and tobacco.

•           Talk to your doctor about any over-the-counter medications you are taking or are thinking about taking.

Does Hypertension or Preeclampsia During Pregnancy Cause Long-Term Heart and Blood Vessel Problems?

The effects of high blood pressure during pregnancy vary depending on the disorder and other factors. According to the National High Blood Pressure Education Program (NHBPEP), preeclampsia does not in general increase a woman's risk for developing chronic hypertension or other heart-related problems. The NHBPEP also reports that in women with normal blood pressure who develop preeclampsia after the 20th week of their first pregnancy, short-term complications--including increased blood pressure--usually go away within about 6 weeks after delivery.

Some women, however, may be more likely to develop high blood pressure or other heart disease later in life. More research is needed to determine the long-term health effects of hypertensive disorders in pregnancy and to develop better methods for identifying, diagnosing, and treating women at risk for these conditions.

Even though high blood pressure and related disorders during pregnancy can be serious, most women with high blood pressure and those who develop preeclampsia have successful pregnancies. Obtaining early and regular prenatal care is the most important thing you can do for you and your baby.

Premature Ovarian Failure

Definition
Premature ovarian failure is defined as the cessation of menstrual periods before the age of 40. It occurs in 1 in 1,000 women between the ages of 15 and 29 and 1 in 100 women between the ages of 30 and 39. The average age of onset is 27 years. A family history of POF is found in about 4% of the women experiencing the condition. Premature Ovarian Failure may occur abruptly over one to two months or gradually over several years. Some women may experience symptoms of menopause such as hot flashes, no menses, and vaginal dryness. Usually, if a woman has POF, she begins to have irregular periods which will eventually stop. Either her cycle day 3 FSH or her estrogen levels may be elevated. In most cases of POF, no cause is ever identified. Pelvic surgery, chemotherapy and radiation therapy can cause POF, as can uncommonly severe pelvic inflammatory disease. Premature ovarian failure is a difficult and disturbing diagnosis for most women.

Causes
Premature ovarian failure may be caused by factors occurring prior to birth or after the onset of puberty. Factors occurring prior to birth may be related to defects in the ovary, oocyte, or ovarian follicle. These defects usually occur as a result of a chromosomal abnormality in the fetus, as seen in several inherited disorders, one of which is Turner's syndrome.

Factors that result in ovarian failure after puberty or in the late 20's and early 30's may be associated with specific disorders, such as ovaries that are resistant to the hormones necessary for ovulation and menses. A biopsy of these abnormal ovaries will show follicles that do not respond normally to the hormones FSH and LH.

A rare syndrome is associated with a defect in the enzyme 17 hydroxylase, which affects the formation of hormones necessary for ovulation and also results in premature ovarian failure.

Destruction of eggs from radiation of the ovaries occurs during cancer therapy and results in permanent loss of menstrual periods. Several anti-tumor drugs, such as cyclophosphamide, are also associated with ovarian failure.

Diagnosis/Evaluation Recommended:

• Complete history and physical examination
• Chromosome study (karyotype)
• Complete blood count with additional studies as determined
• Thyroid studies
• Parathyroid studies
• Ovarian antibodies test (if available)
• Serum LH and FSH and estradiol values in the follicular phase of the cycle (at least two samples should be performed to rule out intermittent ovarian failure and to confirm the diagnosis)
• Possible ovarian biopsy
• AMH
• Ovarian ultrasound

Treatment
unfortunately, there is no proven method of stimulating the ovaries if POF is diagnosed. However, when the diagnosis of premature ovarian failure is made, therapeutic regimens are considered.

• If you have untreated hypothyroidism, your physician will place you on thyroid medication.
• If associated autoimmune problems are found, steroid therapy may be used for some individuals.
• A short course of estrogen replacement therapy may lower the FSH to an acceptable value before attempting ovulation induction with human menopausal gonadotropins. Administration of high dose human menopausal gonadotropins (Gonal F™, Follistim™, Repronex™) after priming with estrogen/progestogen replacement therapy has resulted in pregnancy in a small number of cases.
• Important in the treatment procedure and protocols has led to better pregnancy rates in POF patient such as ovarian cortex, oocyte, and embryo cryopreservation.

Urinary incontinence is the unintentional passing of urine. It is a very common problem and is thought to affect millions of people worldwide.

Urinary incontinence affects about twice as many women as men and becomes more common with age.

What are the symptoms of urinary incontinence?

The symptoms of urinary incontinence depend on the type of condition you have.

There are several types of urinary incontinence, but the most common are:

1- stress incontinence :

 when the pelvic floor muscles are too weak to prevent urination, causing urine to leak when your bladder is under pressure, for example when you cough or laugh

2- urge incontinence :

 when urine leaks as you feel an intense urge to pass urine, or soon afterwards

These two types of urinary incontinence are thought to be responsible for over 9 out of 10 cases. It is also possible to have a mixture of both stress and urge urinary incontinence.

What causes urinary incontinence?

The causes of urinary incontinence depend on the type of condition.

- Stress incontinence:

is usually the result of the weakening or damaging of the muscles that are used to prevent urination, such as the pelvic floor muscles and the urethral sphincter.

- Urge incontinence:

 is usually the result of overactivity of the detrusor muscles, which control the bladder.

Certain things can increase the chances of urinary incontinence developing, including:

- pregnancy and vaginal birth.

- obesity.

- family history of incontinence.

- increasing age.

How is it diagnosed?

Urinary incontinence can usually be diagnosed after a consultation with your GP, who will ask about your symptoms and may carry out a pelvic examination.

Your GP may suggest you keep a diary in which you note how much fluid you drink and how often you have to urinate.

If your GP thinks a urinary infection might be the underlying cause, they will test a sample of your urine.

How is urinary incontinence treated?

Urinary incontinence can be an uncomfortable and upsetting problem. Though it is more common as you get older, many people wrongly believe that it is an inevitable part of ageing.

There are several forms of effective treatment, including:

lifestyle changes, such as losing weight

pelvic floor muscle training (exercising your pelvic floor muscles by squeezing them)

bladder training, so you can wait longer between needing to urinate and passing urine

If these measures are not effective, medication may be used to treat stress and urge incontinence.

You may also benefit from the use of incontinence products, such as absorbent pads and hand-held urinals (urine collection bottles).

If these treatments are not successful, a number of different surgical techniques can be considered.

Surgical treatments for stress incontinence, such as tape or sling procedures, are used to reduce pressure on the bladder, or strengthen the muscles that control urination.

Operations to treat urge incontinence can include the enlargement of the bladder or the implanting of a device that stimulates the nerve that controls the detrusor muscles.

Preventing urinary incontinence

It is not always possible to prevent urinary incontinence, but there are some steps you can take to reduce the chance of the condition developing, such as:

- controlling your weight

- reducing or stopping your alcohol consumption

- keeping fit

Bacterial vaginosis is the most common type of vaginal infection.

What is bacterial vaginosis?

Bacterial vaginosis is a mild infection of the vaginacaused by bacteria. Normally, there are a lot of "good" bacteria and some "bad" bacteria in thevagina. The good types help control the growth of the bad types. In women with bacterial vaginosis, the balance is upset. There are not enough good bacteria and too many bad bacteria.

Bacterial vaginosis is usually a mild problem that may go away on its own in a few days. But it can lead to more serious problems. So it's a good idea to see your doctor and get treatment.

What causes bacterial vaginosis?

Experts are not sure what causes the bacteria in the vagina to get out of balance. But certain things make it more likely to happen. Your risk of getting bacterial vaginosis is higher if you:

•           Smoke.

•           Douche.

You may be able to avoid bacterial vaginosis if you limit your number of sex  and don't douche or smoke.

Bacterial vaginosis is more common in women who are sexually active. But it is probably not something you catch from another person.

What are the symptoms?

The most common symptom is a smelly vaginal discharge. It may look grayish white or yellow. A sign of bacterial vaginosis can be a "fishy" smell, which may be worse after sex. About half of women who have bacterial vaginosis do not notice any symptoms.

Many things can cause abnormal vaginal discharge, including some sexually transmitted infections (STIs). See your doctor so you can be tested and get the right treatment.

How is bacterial vaginosis diagnosed?

Doctors diagnose bacterial vaginosis by asking about the symptoms, doing a pelvic exam, and taking a sample of the vaginal discharge. The sample can be tested to find out if you have bacterial vaginosis.

What problems can bacterial vaginosis cause?

Bacterial vaginosis usually does not cause other health problems. But in some cases it can lead to serious problems.

•If you have it when you are pregnant, it increases the risk of miscarriage, early (preterm) delivery, and uterine infection after pregnancy.

•If you have it when you have a pelvic procedure such as a C-section, abortion, orhysterectomy, you are more likely to get a pelvic infection.

•If you have it and you are exposed to a sexually transmitted infection (includingHIV), you are more likely to catch the infection.

Getting treated with antibiotics can help prevent these problems.

How is it treated?

Doctors usually prescribe an antibiotic to treat bacterial vaginosis. They come as pills you swallow or as a cream or capsules (called ovules) that you put in your vagina. If you are pregnant, you will need to take pills.

Urinary tract infections (UTIs) are responsible for more than 8.1 million visits to physicians' offices per year and about five percent of all visits to primary care physicians. Approximately 40 percent of women and 12 percent of men will experience at least one symptomatic urinary tract infection during their lifetime. How do you know if you have one? What is the best treatment? The following information should help you.

What happens under normal conditions?

The urinary tract makes and stores urine, one of the waste products of your body. Urine is made in the kidneys and travels down the ureters to the bladder. The bladder serves as a storage container for urine, which is then emptied by urinating through the urethra, a tube that connects the bladder to the skin. The urethra connects to the end of the penis in a male and connects to an area above the vagina in a female.

The kidneys are a pair of fist-sized organs located in the back that serve as a filtration system to filter liquid waste from the blood and remove it from the body in the form of urine. Kidneys adjust the body's balance of various chemicals (sodium, potassium, calcium, phosphorous and others) and monitor the blood's acidity. Certain hormones are also produced in the kidneys. These hormones help regulate blood pressure, stimulate red blood cell production and promote strong bones. The ureters are two muscular tubes that transport the urine down to the bladder.

Normal urine is sterile and contains no bacteria. However, bacteria may get into the urine from the urethra and travel into the bladder. A bladder infection is known as cystitis and a kidney infection is known as pyelonephritis. Kidney infections are much less common — but often more serious — than bladder infections.

What are the symptoms of a urinary tract infection?

When you have a urinary tract infection (UTI), the lining of the bladder and urethra become red and irritated just as your throat does when you have a cold. The irritation can cause pain in your abdomen and pelvic area and may make you feel like emptying your bladder more often. You may even try to urinate but only produce a few drops and/or feel some burning as your urine comes out. At times, you may lose control of your urine. You may also find that your urine smells unpleasant or is cloudy.

Kidney infections often cause fevers and back pain. These infections need to be treated promptly because a kidney infection can quickly spread into the bloodstream and cause a life-threatening condition.

UTIs are often categorized as simple (uncomplicated) or complicated. Simple UTIs are infections that occur in normal urinary tracts. Complicated UTIs occur in abnormal urinary tracts or when the bacterium causing the infection is resistant to many antibiotic medications.

What causes urinary tract infections?

Large numbers of bacteria live in the rectal area and also on your skin. Bacteria may get into the urine from the urethra and travel into the bladder. It may even travel up to the kidney. But no matter how far it goes, bacteria in the urinary tract can cause problems.

Just as some people are more prone to colds, some people are more prone to UTIs. Women who have gone through menopause have a change in the lining of the vagina and lose the protective effects of estrogen that decrease the likelihood of UTIs. Postmenopausal women with UTIs may benefit from hormone replacement. Some women are genetically predisposed to UTIs and have urinary tracts that allow bacteria to adhere to it more readily. Sexual intercourse also increases the frequency of UTIs.

Women who use diaphragms have also been found to have an increased risk when compared to those using other forms of birth control. Using condoms with spermicidal foam is also known to be associated with an increase in UTIs in women. Women are more prone to UTIs because they have shorter urethras than men so bacteria have a shorter distance to travel to reach the bladder.

You are more likely to get a UTI if your urinary tract has an abnormality or has recently been instrumented (for example, had a catheter in place). If you are unable to urinate normally because of some type of obstruction, you will also have a higher chance of a UTI.

Disorders such as diabetes also put people at higher risk for UTIs because of the body's decrease in immune function and thus a reduced ability to fight off infections such as UTIs.

Anatomical abnormalities in the urinary tract may also lead to UTIs. These abnormalities are often found in children at an early age but can still be found in adults. There may be structural abnormalities, such as outpouchings called diverticula, that harbor bacteria in the bladder or urethra or even blockages, such as an enlarged bladder, that reduce the body's ability to completely remove all urine from the bladder.

How are urinary tract infections diagnosed?

If you are concerned about a UTI, then you should contact your doctor. Frequently, you can be diagnosed and treated without going to your doctor's office. Ways to diagnose a UTI are via urinalysis and/or urine culture. A sample of urine is examined under a microscope by looking for indications of infection — bacteria or white blood cells in the urine. Your physician may also take a urine culture if needed. If you ever see blood in your urine, you should contact your doctor right away. Blood in the urine may be caused by a UTI but it may also be from a different problem in the urinary tract.

If you are having fevers and symptoms of a UTI, or persistent symptoms despite therapy, then medical attention is advised. You may need further tests, such as an ultrasound or CT scan, to assess the urinary tract.

How are urinary tract infections treated?

A simple UTI can be treated with a short course of oral antibiotics. A three-day course of antibiotics will usually treat most uncomplicated UTIs. However, some infections may need to be treated for several weeks. Depending on the type of antibiotic used, you may take a single dose of medication a day or up to four daily doses. A few doses of medication may relieve you of the pain or urge to urinate frequently but you should still complete the full course of medication prescribed for you even if all symptoms have been relieved. Unless UTIs are fully treated, they can frequently return. You should also remember to drink plenty of liquids, especially around the time of a UTI.

If the UTI is a complicated UTI, then a longer period of antibiotics is given and usually is started intravenously in the hospital. After a short period of intravenous antibiotics, then the antibiotics are given by mouth for a period up to several weeks. Kidney infections have usually been treated as a complicated UTI.

What can be expected after treatment for urinary tract infections?

Simple UTIs routinely improve with the three days of oral antibiotics and you do not need a urine culture to prove that it is gone. If you have a complicated UTI, however, you should have a urine culture to show that the UTI is gone. If your symptoms continue even with medication, then you may need a longer course of medications, a different drug or different delivery method (for example, if you are taking medication by mouth, then you may need it intravenously).

Frequently asked questions:

Will a UTI cause damage to the kidneys?

If the UTI is treated early, then there will probably be no lasting influence on your urinary tract. Recurrent or unrecognized UTIs could cause damage if not remedied expeditiously.

Why do I get UTIs?

Most UTIs are solitary events that, if treated, will not recur. Some patients have anatomical and genetic predispositions that tend to make one person more susceptible than another. 

How do I avoid UTIs?

There are some simple steps women can use to avoid UTIs. Women who have gone throughmenopause and have lost the normal estrogen output have a change in the lining of the vagina.Estrogen replacement under the guidance of a gynecologist and/or primary care doctor can be a simple solution. Since certain patients cannot take estrogen replacement, you should contact your doctor prior to beginning any regimen. 

Urination after sexual intercourse may also decrease the risk of UTI because it can flush out any bacteria that were introduced during intercourse. Sometimes a dose of antibiotics after intercourse can help prevent recurrence of UTIs.

Certain forms of birth control, such as spermicidal foam and diaphragms, are known to increase the risk of UTIs in women who use these as their form of contraception.

You should also drink plenty of fluids to keep well hydrated.

You should not delay urinating and should not rush when urinating. Also, holding in urine and not emptying your bladder completely can increase your risk of UTIs.

You should wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.

When should I be concerned?

If you have symptoms of a UTI and are being treated without improvement in your symptoms or you have symptoms of a UTI accompanied by nausea and vomiting, then you should seek medical attention. If you ever see blood in your urine, you should contact your doctor immediately.

What if I am pregnant?

If you are pregnant and have symptoms of a UTI, then you should contact your doctor immediately. UTIs during pregnancy can put both mother and baby at risk if not addressed quickly and properly.

If UTIs are recurring, can I get over them?

If you are having recurrent UTIs (three or more per year), then you should see your doctor for possible further testing like a urinalysis. You may also need an ultrasound or CT scan to look for any abnormalities of the urinary tract. If you continue to have UTIs, you may benefit from a longer course of low-dose antibiotics or by taking an antibiotic after sexual intercourse. There are also methods of self-testing that your urologist may help coordinate with you to institute both diagnosis and treatment of UTIs at home.

What is Hyperprolactinemia? Is it common? What caused it? What maybe its complications? And many more questions about this subject that tackles a very serious and common problem facing the Arab women whether married or single. I will explain to you in this article a little about this phenomenon starting with what is it exactly?

   Hyperprolactinemia is the presence of high prolactin level in the blood, the normal level of prolactin varies around 500 mIU/L [20 ng/mL or ug/L] for women, and less than 450 mIU/L for men.

What caused it exactly? Hyperprolactinaemia can be a part of normal body changes during pregnancy and breastfeeding. It can also be caused by diseases affecting the hypothalamus and pituitary gland. It can also be caused by disruption of the normal regulation of prolactin levels by drugs, medicinal herbs and heavy metals. Hyperprolactinaemia may also be the result of disease of other organs such as the liver, kidneys, ovaries and thyroid.

    How do I know I have Hyperprolactinemia? Well this differs from a single lady to a married lady and even differs with a nursing mom. In women, a high blood level of prolactin often causes hypo estrogenism with anovulatory infertility and a decrease in menstruation. In some women, menstruation may disappear altogether (amenorrhea). In others, menstruation may become irregular or menstrual flow may change. Women who are not pregnant or nursing may begin producing breast milk. Some women may experience a loss of libido (interest in sex) and breast pain, especially when prolactin levels begin to rise for the first time, as the hormone promotes tissue changes in the breast. Intercourse may become painful because of vaginal dryness.

   How can your doctor diagnose it? Since it’s a very common situation nowadays so it’s considered to be a simple one, the first thing your doctor will do when suspicious about your hormone levels is asking for the prolactin and the thyroid hormones in a blood test, the second thing will be examining your breast for milky discharge. The third and not so common test will be the MRI to confirm the presence of a micro or macro adenoma in the pituitary (the home of producing prolactin).

    Alright, I have high prolactin level, what will I do next? This is a very common question asked, as people think it’s a very complicated situation, but relax ladies, the answer is simple. Your doctor will prescribe to you a medication called Dostinex, the doses will differ from each person to another.

I hope I could help some of you ease the stress and not worry. Whenever you have any of the symptoms please contact your gynecologist for medical advice.

In vitro maturation of human oocytes (IVM) was developed to provide a safer and a cheaper alternative to conventional IVF. Improved IVM techniques are developing rapidly and an increasing number of fertility clinics are offering IVM .The concept of IVM technology remains attractive. However, its introduction in routine clinical IVF program is at present, a distant goal.

Immature eggs are collected from unstimulated or minimally stimulated ovaries under ultrasound scan guidance. The immature eggs are then matured in the laboratory for24-48 hours using culture medium with added small quantities of hormones.

Intracytoplasmic sperm injection (ICSI) is used for fertilization of the matured eggs.

Stimulated IVF is associated with the risk of developing ovarian hyper stimulation syndrome (OHSS) which is a potentially fatal condition and IVM eliminates this risk because it does not involve ovarian stimulation.  Also , IVM is less expensive than IVF because it does not involve taking costly gonadotropin injections and involve less monitoring.

A number of people may benefit from IVM treatment:

·         As an alternative to IVF for women with PCOS.

·         As an alternative to IVF for younger women with normal menstrual cycles, IVM being less costly and safer.

·         Fertility preservation in young cancer women who are going to receive chemotherapy or radiotherapy.

·         Salvaging immature eggs collected during a standard IVF/ICSI .

Clinical pregnancy rates of 38% for women aged 35 years or under having IVM has been reported which compares favorably with that of conventional IVF.

Infertility treatments make it more likely that you will become pregnant with twins, 

Three dimensional ultrasonography is still relatively diagnostic imaging technique undergoing rapid advance in recent few years, particularly in the field of obstetrics and prenatal diagnosis.   

 The lining of the uterus (endometrium) responds to hormones made in the ovary.

New IVM babies were registered in the global registry of IVM, as professor Ri-Cheng Chian of McGill University in Canada has informed the centers involved.

Fertility-preserving options for men such as, protection of the testes from radiation therapy,

•Mirena is a hormone-releasing system placed in your uterus to prevent pregnancy for up to 5  years.

Who should take vitamin?     Women who are preparing to conceive   naturally should take vitamins to promote blood flow,

Scince spermatogenesis takes at least 74 days to complete; it is recommended that vitamins should be taken for at least 3 months, while some will see the benefits as early as one month, most will require at least three to six months to show definitive improvement

Dr. Dabit Suleiman, the head of the fertility and genetics departments 

With increasing utilization of assisted reproductive technologies (ART), scientists and clinicians have been able to study extensively the process of in vitro fertilization (IVF). Critical analysis of each step has improved outcomes and led to a greater understanding of reproductive physiology.

Acetyl-L-carnitine: help increase motility and count and reduce oxidative stress. Glutathione: Improves motility, morphology and decrease DNA fragmentation. Oral administration of vitamin C and vitamin E with glutathione improved serum concentration of antioxidant and decreased sperm DNA damage .