A patient of mine who regularly reads the forum recently asked me about board certification for Ob/Gyn doctors. She explained that there is a lot of confusion about this issue, and that many women's magazines and other media tell women to always seek out the services of an Ob/Gyn who is board certified. So, this looked like a good opportunity to review the board certification process.
Uterine fibroids ( "fibroid tumors";" leiomyoma"; "myomas") are benign, (non-cancerous) growths present in about 30% of women over the age of 30. They are usually detected on pelvic examination, which may reveal the uterus to be enlarged and/or irregular in configuration. The vast majority of cases are absolutely silent and cause no symptoms. The size of a single fibroid may be smaller than a pea, or larger than a melon. In a given patient, there may be a single fibroid, or multiple fibroids of varying size. In the latter situation, the summation of the fibroids of varying sizes will lead to an aggregate size increase.
Pelvic adhesions cause many problems for millions of women. From obstructed tubes associated with infertility, to pelvic tenderness, and painful intercourse, to chronic pelvic pain. Curiously, adhesions can be very extensive, yet relatively silent. They may remain silent indefinitely, or long after the causative event, become symptomatic. The causes of adhesions are multiple but basically the tissue irritation that produces the adhesive process arises from an inflammatory event, or from trauma (i.e. post surgical).
"Abnormal Uterine Bleeding" or "AUB" is a relatively common condition. Normal menstrual flow produces less than 3 ounces of blood, in a maximum of 7 days. AUB patterns are characterized by flows that are heavier, and/or more prolonged or more frequent than a 21-28 day interval. AUB can cause anemia, embarrassment, or marked inconvenience. It has been said by many so afflicted women-" I have to plan my life around my period".
Fibroids and Hysterectomies used to go together like Rogers and Hammerstein. Not anymore. If your physician recommends removing your uterus as the most effective treatment for severe fibroids without first considering less invasive therapies, start singing another tune and get a second opinion!
Many gynecologists will remove laparoscopically ovaries/ovarian cysts and treat ectopic pregnancies as well as endometriosis. Hysterectomies, bladder suspension surgeries and pelvic floor repair can also be treated by laparoscopy but these procedures are more advanced and may require additional training.
Hysteroscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (hysteroscope) through the cervix into the uterus. The hysteroscope allows the surgeon to visualize the inside of the uterine cavity on a video monitor. The uterine cavity is then inspected for any abnormality. The surgeon examines the shape of the uterus, the lining of the uterus and looks for any evidence of intrauterine pathology (fibroids or polyps). The surgeon also attempts to visualize the openings to the fallopian tubes (tubal ostia).
Questions on Laparoscopy & Hysteroscopy
At the time I was starting this blog two patients with similar fibroids came to see me. Both were severely anemic, and one was hemorrhaging and in shock.
This random retrospective cross-sectional study was preformed to determine the frequency of uterine malformation in restricted gene pool communities. In 4 groups of women desiring to conceive during their reproductive years, all women lives in lacrete, a community in north Alberta, Canada
Three-dimensional ultrasound (3D US) is a new imaging modality, which is being introduced into clinical practice. Although this technique will not probably replace two-dimensional ultrasound, it is being increasingly used.
A 29-year-old gravida 10, para 3 (1 term gestation, 1 preterm gestation of twins, 1 stillbirth at 5 months, 2 spontaneous abortions, and 4 elective abortions) presented to the clinic at about 5 weeks’ gestation with abdominal pain and vaginal bleeding. She described the pain as sporadic, mostly on the left side, exacerbated by movement, and resolving with rest, and the bleeding as initially intermittent but then heavier “like a period.”
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome affects at least 1 in 4500 female births.1 The syndrome consists of vaginal aplasia with other müllerian duct abnormalities. The characteristic feature of MRKH syndrome is congenital absence or underdevelopment of the upper vagina and uterus; it is rarely associated with unilateral renal agenesis, ectopia, or horseshoe kidney.
Uterine fibroids that are completely or partially inside the cavity of the uterus (submucous myomas) can often be removed through the cervix by using an instrument called a resectoscope.
Advances in successful assisted reproductive technologies have enabled clinicians to further aid their patients who would otherwise be unable to conceive. However, little is known about this trend and its continued future growth.
Should I have my fibroids removed before I try to get pregnant? That is one of the most difficult questions I have to answer! Here is what we know.
A 37 year old woman came to me in July, 2009 with a prolapsing 8 cm. fibroid. She had been seen by her HMO doctors multiple times for heavy bleeding, had 15 ultrasounds, but nothing was done.
Infertility is the inability to conceive despite frequent and unprotected intercourse between a man and his female partner for at least 1 year.
With more than 7 million infertile women in the United States, the need and demand for effective IVF treatment remains high. Unfortunately for these women/couples, the cost for such treatment is also relatively high.
After peaking at 4,316,233 births in 2007, the birth rate in the United States fell 4 percent by 2009, and a provisional count in 2010 indicates the number is continuing to decline, according to a March data brief released by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.
One in 8 women and men are diagnosed with infertility. In honor of National Infertility Awareness Week, RESOLVE is busting myths and misconceptions about infertility. Click through the slideshow to learn more about these misconceptions and share some myths you've heard in our comments section.
Higher serum polychlorinated biphenyl (PCB) concentration levels that are within the normal range for women in the general U.S. population are associated with failed implantation in women undergoing in vitro fertilization (IVF), according to a study published online Feb. 24 in Environmental Health Perspectives.
The 2009 H1N1 pandemic caused anxiety and concern, especially for pregnant women and their physicians. The Centers for Disease Control (CDC) recognized this special patient population and the increased risk for serious problems and negative outcomes-both for the women and their unborn babies. As such, the CDC advised doctors to provide antiviral medicines to those with symptoms of the flu and vaccines to those pregnant women who were eligible. They further partnered with the American College of Obstetricians and Gynecology, the American Medical Association, and the American Academy of Family Physicians to educate clinicians and urge their participation in the 2009 H1N1 vaccination programs.
Is there a way to predict which patients will have the best outcomes following an assisted reproductive intervention? Dr William Gibbons, director of the Family Fertility Program at Texas Children’s Hospital and professor of obstetrics and gynecology at Baylor College of Medicine, and colleagues examined birth weight and gestational age of singleton pregnancies from in vitro fertilization, donor egg, and gestational carrier cycles to determine which factors most influence outcomes.
Progesterone support during the luteal phase is needed to allow for implementation in medically assisted cycles. To date, available options have not met all of the ideals of the “perfect” progesterone strategy-easy to administer, safe with minimal adverse effects, and effective in producing pregnancies.
