Infertility

Premature ovarian failure (POF) is a primary ovarian defect characterized by absent menarche (primary amenorrhea) or premature depletion of ovarian follicles before the age of 40 years (secondary amenorrhea).

Stein and Leventhal were the first to recognize an association between the presence of polycystic ovaries and signs of hirsutism, amenorrhea, oligomenorrhea and obesity. Subsequently, it was reported that after successful wedge resection of the ovaries in women diagnosed with Stein-Leventhal syndrome, menstrual cycles became regular and these patients were able to conceive.

Polycystic ovary syndrome is characterized by anovulation (irregular or absent menstrual periods) and hyperandrogenism (elevated serum testosterone and androstenedione). Patients with this syndrome may complain of abnormal bleeding, infertility, obesity, excess hair growth, hair loss and acne.

The uterus can lie in different positions in the pelvis, and it may vary from one woman to another. Most commonly, the uterus lies horizontally over the bladder, as do the ovaries. As the uterus enlarges with pregnancy, or perhaps with a large fibroid, it will cause increasing pressure on the bladder, and this results in increasing urinary frequency, pressure symptoms, and perhaps lower abdominal protrusion.

I have been involved in learning about and helping to develop alternatives to hysterectomy for many years. I have been instrumental in refining the use of the laser in an office setting to treat pre-malignant diseases of the cervix. I have treated thousands of women with the laser, many of whom would have otherwise had a more invasive treatment or hysterectomy.

A very common question of perimenopausal women is whether or not they are still able to get pregnant, and this inquiry may originate from one of two concerns. Some women in the perimenopausal range may still want to conceive, either to start a family or to add to an existing one, and are seeking information to help with that decision.

The majority of women in the perimenopausal period have completed their childbearing and resolutely do not want to conceive at this age. This gives rise to the question as to what contraceptive method they should use to prevent an unwanted pregnancy. At this stage in their lives, an unintended pregnancy would be devastating, and it is something they are usually very eager to avoid.

If you have just been told that you may need to have a hysterectomy, what are you feeling? Frightened, uncertain, vulnerable, angry, out of control -- don't panic. I don't think anyone could have had any more of a negative reaction than I did when I was told, "you should probably think about having surgery."

More than 10 million American women suffer from excessive menstrual bleeding or heavy periods, a condition known as menorrhagia. In fact, more than 20 percent of the 600,000 hysterectomies performed annually in the United States treat menorrhagia. But because this health issue is so rarely discussed, few women realize that the condition can be easily treated during a 30-minute outpatient procedure as opposed to having a hysterectomy.

Does hysterectomy mean a woman's sex life is ruined? Here, Paul Indman, MD, shares his take: orgasm is still in the cards for many women.

Patients with endometriosis can have symptoms varying from constant excruciating pelvic pain to no symptoms whatsoever. Paradoxically, the extent of endometriosis has no correlation to the amount of pain a women will experience. Some women with severe endometriosis do not have any symptoms and may not know they have endometriosis until a pelvic mass is detected on a routine pelvic examination or a problem with infertility is discovered.

Advances in technologies have allowed conduct of many procedures by laparoscopy and hysteroscopy. These are the essence of our specialty. Most new technologies foster improved performance. In business term, they are called sustaining technologies. In fact, most technological advances in an industry are sustaining in nature.

In minimally invasive surgery (MIS), complications can occur due to faulty instruments, surgical technique, or inadequate patient election. Surgeons who routinely perform MIS rarely encounter complications. Conversely, practicing gynecologists at large often find that certain procedures or techniques are not as safe as previously reported in the literature by the "experts." One of the reasons is that complications tend to be underreported.

The tragic events of September 11 have, to put it mildly, thrown many people off balance. On a somewhat secondary scale, our Society was affected. The 5th Regional Meeting of ISGE in conjunction with the 2nd Brazilian Congress of Gynecologic Endoscopy took place on September 12-15, 2001.

We are entering a time in the development of the discipline of gynecologic endoscopy where there is an opportunity to build bridges, both ideologically and functionally. The science and practice of endoscopy have progressed to the point where core groups of advanced endoscopic surgeons have organized themselves in every corner of the world, not only to exchange knowledge, but also to set goals and plan for the future of the field.

A fibroid is a benign tumor of the uterus. Various terms are used to refer to the tumor, such as fibromyoma, myofibroma, leiomyofibroma, fibroleiomyoma, myoma, fibroma, and fibroid. Of these, fibroid is the most common term, although myoma is more accurate.

What are Uterine Fibroids?The walls of the uterus are made of smooth muscle called myometrium, and the inside lining, with glandular tissue, is called endometrium. “Uterine fibroid” is a slang term for leiomyoma, or often simply myoma. Fibroids are benign tumors made of smooth muscle cells.

Competing for time and being able to provide timely information is one of the challenges of the 21st century. The Internet can help.

Both types of surgery are complimentary. Each has specific advantages and indications. It is an advantage to have and to be able to use both.

The female reproductive function depends on the healthy ovaries (primary reproductive organ) and genital tract organs. Infertility is one of the main gynecological problems which affect between 10-15% of females in the reproductive age.

Chronic pelvic pain affects a large number of women, and is not often optimally treated within a single specialty. It is responsible for approximately 40% of laparoscopies and 10-15% of hysterectomies in this country. In one survey of 5300 women, more than 16% noted chronic pelvic pain.

Pantaleoni first performed hysteroscopy in 1869, but it was not until the early 1970s that hysteroscopy became part of the gynecologist's armamentarium. The need for visual appraisal of the endocervix and endometrial cavity and technical advances in instrumentation increased the awareness of, and interest in, the advantages of hysteroscopic sterilization techniques.

Women with cervical intraepithelial neoplasia now have a number of treatment options including cold-knife conization, laser ablation, and loop electrosurgery but, all too often, the physician s preference is the determining factor in selection of therapy. This detailed presentation of the advantages and disadvantages of electrosurgery will help the physician to decide whether this procedure truly fits the needs of a given patient.

In this column, subject experts have been invited to provide an annotated guide to some of the most useful health sites on the Internet. In this issue Hans van der Slikke, Consultant Obstetrician at Zaandam Hospital, The Netherlands, and Chairman of the International Council of OBGYN.net, provides a guide to some of the best women's health resources now available on the Internet.

Discussion between Mark Perloe, MD, and Bruno Lunefeld, MD, on the risks associated with ovulation induction in breast cancer and ovarian cancer.