QUESTIONS ON OB-GYN

August 19, 2014 2:13 pm

Kindly answer the following questions with explanations:

1.What is the link between Fibroid removal and miscarriages?
Fibroids are benign tumors that grow from the muscle layer of the uterine wall. They are found very often in women, at different ages of their reproductive life, and can vary in size and localization. Uterine fibroids are considered a hazard only when they start growing, causing subjective symptoms to the patient, or excessive bleeding during menstrual periods.
 
Fibroids are not considered to be a reason for infertility. The presence and size of a fibroid, can almost never interfere in a female becoming pregnant, since they rarely, if ever, can block the passage of the fallopian tubes, through which the semen, then a fertilized egg, migrates from, and back to, the uterine cavity.
 
On the other hand, and pretty much depending on the size, multiplicity, and localization of fibroids, they can cause early miscarriage of an otherwise normal pregnancy, as well probable complications in later stages of the pregnancy- premature labor, complications of the placenta, etc.
 
Miscarriage of an early pregnancy, occurs due to unfortunate implantation of the early pregnancy in proximity to the fibroid inside the uterine cavity, or, if the fibroids are large and multiple, which might lead to disturbance in the cavity lining of the uterus, which might, in its turn, disrupt, causing bleeding and an early miscarriage.
 
Surgical removal of fibroids-Myomectomy-, is an option to help a female pertain her pregnancy, and to prevent such complications, as mentioned previously. This is indicated especially if the patient does have a history of recurrent early miscarriages, or a complicated pregnancy due to the presence of fibroids/myomas. The surgical procedure can be done through laparoscopy (keyhole surgery), or open surgery (laparotomy).
 
This kind of surgery -Myomectomy-, is debated of possibly affecting the integrity of the uterine wall, from which a fibroid/myoma is removed, and where a “scar” is formed. The opinion objecting to this surgery -Myomectomy-, suggests, that possible risk of rupture of the scar during a coming pregnancy is very actual, and that it can jeopardize the outcome of a normal pregnancy after such surgeries. The logic behind this opinion is similar to the belief, that consecutive cesarean sections (more than 2 in general), will weaken the wall of the womb, and might cause rupture of the scar in coming pregnancies.
 
However, this opinion has not been medically validated, since no comprehensive, and thorough scientific research has ever been made to prove such theory.
 
It is still the common belief, and practice, in modern medicine, that surgical removal of uterine fibroids should be done when indicated, and that the benefit of such surgical treatment outweighs the risk of such surgeries for future pregnancies.
 
There is no direct relationship between surgical removal of fibroids and miscarriages, as a matter of cause and consequence. The risk of a female to get a miscarriage is significantly decreased with removal of uterine fibroids, that are large, or located within the uterine cavity, but is not totally absent.
 
Another issue, not less significant in this debate, is the technique with which fibroids are removed, and more importantly, the way the uterine wall defect is closed. Open surgery in many cases can be mandatory over keyhole technique in order to insure the future integrity of the scar, and to avoid complications as rupture of these scars during future pregnancies. Such decision on the adequate, and right technique of the surgery, is what marks a surgeon as professional.
 
2.How does Billings Ovulation work in postponing or achieving pregnancy? What is the success rate for the same?
Billing Ovulation Method (BOM), is described by The World Organization of Ovulation Method Billings (WOOMB), as “natural fertility regulation”. The method is based on the subjective sensation of a woman, of the physiological changes occurring in the vulva and the vagina towards the approaching time of her ovulation-mid cycle. The method is considered as an approach for fertility awareness, as well as natural family planning.
 
The method was suggested, and developed, by Dr. John Billings (1918-2007), motivated by his religious beliefs to create a suitable, and more accurate, method of birth control amongst followers of the Catholic Church’s teachings, in using natural ways to avoid unwanted pregnancies.
 
The BOM is based, and explained, by the anatomical changes reached in the female organs prior the ovulation phase, when pregnancy is most probable to occur. The effect of the hormone Estrogen at this point, stimulates the production of cervical mucous into the vagina, which helps sustaining the viability and motility of the sperm in its act of approaching the ovaries, and fertilizing the mature egg/follicle. This phenomenon is as well called “crystallization” of the mucous. Billings method helps women recognize this anatomical change in a mode of a repetitive pattern, that allows the couple to adjust their life style to their needs of conceiving, or avoiding pregnancy.
 
The success/failure rate is very different according to different studies, or reports. A total pregnancy rate varies between 1-25%. The higher failure rate is mostly related to factors like misunderstanding the way the method works, ambivalence, or risk taking.
 
In other studies from China, a comparative group using BMO with a group using IUD registered a pregnancy rate of 0.5%, which is very similar to the IUD prevention rate.
 
3.Kindly enumerate what couples need to know about Vitrification?
Vitrification is the process of rapid freezing of oocytes – female eggs- for the purpose of future use in assisted fertility.
 
This process of freezing, or so called cryopreservation, is aimed for the interest of cancer patients, who are about to undergo a treatment rendering their ovaries dysfunctional, thus unable to produce mature eggs, which can allow them to become pregnant in the future, if so they wish.
 
The method can also be used with females, willing to delay decision on fertility, until later age. Thus, freezing eggs, similar to freezing embryos, can allow them to pertain a possibility of becoming pregnant in a much later stage of their reproductive life.
 
Vitrification is different from usual freezing in that rapid freezing is used in order to avoid damage to the cell components of the eggs, which usually contain much higher amount of fluid, thus taking more risk of such damage, if processed with slow freezing.
 
4.How do you advice couples to address the fear of being pregnant (Tocophobia), especially when the husband wants to start a family? Noted
 
Tokophobia, or fear of delivery, is becoming much more and more an actual problem for women, and couples, planning on having children. Most of the cases facing this dilemma, consists the females, who had in the past a traumatic experience of a painful, long, or/and bad outcome of the delivery, whether concerning the health of the mother, the newborn, or both. Some of the cases can, as well, involve women with certain susceptibility for becoming psychologically morbid under stressful conditions, like pregnancy and delivery. Nowadays, there are certain units, teams and specialized mid-wife’s, that are trained and equipped for the purpose of early detection of pregnant women with this kind of morbidity- so called ” horror pro partus”- and to try and find the ultimate planning for the pregnancy and delivery in accordance with the wish and capabilities of the patient.
 
Tokophobia is officially one of the registered medical indications/diagnosis for an elective cesarean section option of delivery.
 
5.Kindly indicate at least 5 of the common misconceptions on fertility and explain why they are false.
Birth control pills affects future fertility:<span > The new “generations” of contraceptive pills are shown to have no significant effect on the future of fertility and capability of becoming pregnant after terminating their use. Numerous studies, including EURAS-OC study (European Active Surveillance Study on Oral Contraceptives), concluded no difference was noticed in achieving pregnancy between oral contraceptive users after cessation of administering OC, and non-users.
 
Stress impedes conception:Stress certainly affects fertility, although is not proven to cause infertility. Whether infertility causes stress, or stress can impede infertility is still an open debate. However, it is quite a common concept, that stress, amongst other psychological factors, can enhance the role of other biological factors causing infertility.
 
A woman can’t conceive whilst having her period
 
Very much true.if, and when, a woman is having a menstrual flow/bleeding, in its regular timing, and within the frames expected (duration and quantity), there exists no conditions that can allow for a woman to become pregnant.
 
Infertility cannot happen after having your first baby
 
Not true. There is the concept of secondary infertility. this includes infertility due to secondary factors, that did not exist prior to the previous pregnancies/deliveries. Amongst these factors is mechanical obstruction of the fallopian tubes due to adhesions/infection, hormonal shift causing lack of ovulation, etc.
 
Fertility treatments are very expensive
 
Very much true, both financially and mentally.
 
6.What are the early signs of pregnancy that are not as common as the usual morning sickness? Why do the woman’s body react in such a way?
Other than morning sickness and vomiting, early symptoms of pregnancy include, but are not limited to:

– Fatigue and dizziness

– Food aversion or cravings.

– Swelling and congestion of the breast

– Hypersalivation (excess secretion of the saliva)

– Frequent urination

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