Anugerah Children and Maternity Hospital
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What are Urogynecologic Disorders?
Lily Arya, MD, MS:
Sacral nerve stimulation is a minimally invasive outpatient procedure for the treatment of urge incontinence and urinary frequency. It is performed in two parts. Part one involves testing to see if patient is eligible for the procedure. It is performed under local anesthesia. Two weeks later, if the patient is eligible, the placement of the pulse generator is done under sedation and local anesthesia. Studies show that it is successful in 75-85% women in curbing the "urgency" to urinate
FIRST TRIMESTER PREGNANCY
Definition:
The first trimester of pregnancy begins when a fertilized egg implants into a woman's uterus. This occurs about 7 days after the egg is fertilized.
The first trimester ends when the fetus is about 12 weeks old. (This is about 14 weeks from the first day of the last normal menstrual period.)
Molar 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.”
Miscarriage
Why do miscarriages occur?
The reason for miscarriage is varied and most often, the cause can not be identified. During the first trimester, the most common cause of miscarriage is chromosomal abnormality-meaning that something is not correct with the baby's chromosomes. Most chromosomal abnormalities are the cause of a faulty egg or sperm cell or due to a problem at the time that the zygote went through the division process.
What is menopause?
Menopause is the permanent end of a woman's monthly period. A woman has reached menopause when she has ceased having periods for one year. In North America, women usually go through menopause between the ages of 45 and 55. When menopause occurs before age 40, it is considered premature.
As menopause nears in a healthy woman, the ovaries begin to gradually reduce the amount of estrogen, progesterone and androgens they produce.
Estrogen is the main female sex hormone, and it controls the development of a woman's secondary sex characteristics. Estrogen also prompts the growth of a uterine lining during a woman's menstrual cycle and maintains that lining during pregnancy.
Weight and Fertility
Body mass index and its effect on in vitro fertilization pregnancy rates
A woman's weight can affect her fertility. We know that at both extremes, very thin and obese, that there can be disruption of the normal process of regular, consistent ovulation. Anovulation can often result. Medications can be used to induce ovulation in these women in an attempt to become pregnant.
Body mass index, or BMI, is an index of a person's relative "skinniness or fatness". The BMI factors in a person's weight as well as their height to give an overall "index". A high BMI indicates obesity.
Intrauterine Insemination: IUI
Intrauterine insemination (IUI) is a procedure which involves placing sperm inside a woman’s uterus to facilitate fertilization. This fertility treatment does not involve the manipulation of a woman’s eggs, and therefore is not considered an assisted reproductive technology (ART) procedure.
What is Infertilty ?
Infertility is a condition of the reproductive system that impairs the conception of children, and it affects approximately 6.1 million individuals throughout the United States. The diagnosis of infertility is usually given to couples who have been attempting to conceive for 1 year without success.
Unexplained Infertility
Unexplained infertility simply means we do not know why the couple is infertile - it is a confession of medical ignorance. Patients with unexplained infertility fall into two groups. One is the group who really have no infertility problem whatsoever, but are just plain "unlucky". The other is the group which do have a reason for their infertility - but the reason is so subtle, that with present-day medical technology, we cannot find it.
Infertility may be said to be 'unexplained' if the woman is ovulating regularly, has open fallopian tubes with no adhesions or endometriosis ; if the man has normal sperm production; and the postcoital test is positive. Intercourse must take place frequently, particularly around the time of ovulation, and the couple must have been trying to conceive for at least one year.
FEMALE INFERTILITY
Infertility is a condition that affects approximately one out of every six couples. An infertility diagnosis is given to a couple who is unsuccessful with their attempts to get pregnant over the course of one year. When the problem exists within the female partner, it is referred to as female infertility. Female infertility factors contribute to approximately 50% of all infertility cases, and female infertility alone accounts for approximately one-third of all infertility cases.
What causes female infertility?
Female infertility usually occurs when there is a problem with ovulation, a damaged fallopian tube or uterus, or there is a problem with the cervix. Age may also contribute to fertility struggles because as women ages, her fertility decreases.
Ovulation problems may be caused by one or more of the following:
- A hormone imbalance
- A tumor or cyst
- Eating disorders such as anorexia or bulimia
- Alcohol or drug use
- Thyroid gland problems
- Overweight
- Stress
- Intense exercise causing a loss of body fat
- Extremely short menstrual cycle
Damage to the fallopian tubes or uterus may be caused by one or more of the following:
- Pelvic inflammatory disease
- A previous infection
- Polyps in the uterus
- Endometriosis or fibroids
- Scar tissue or adhesions
- Chronic medical illness
- Surgery to remove a tubal pregnancy
Abnormal cervical mucus may be the cause of your infertility. Abnormal cervical mucus may prevent the sperm from reaching the egg or make it more challenging for the sperm to penetrate the egg.
More...
What is Fibroids
Fibroids are classified by their location (see figure), which effects the symptoms they may cause and how they can be treated. Fibroids that are inside the cavity of the uterus (intracavitary myomas) will usually cause bleeding between periods (metrorrhagia) and often cause severe cramping. Fortunately, these fibroids can usually be easily removed by a method called "hysteroscopic resection," which can be done through the cervix without the need for an incision.
Adenomiosis
Adenomiosis may be felt during a pelvic exam, but many times myomas that are causing symptoms can be missed if the examiner relies just on the examination. Also, other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids. For this reason, I routinely do an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination. Vaginal probe ultrasound only takes a few minutes to do, is not uncomfortable, and rapidly provides invaluable information if the examiner is experienced in looking at uterine abnormalities.
Ectopic Pregnancy
An Ectopic Pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in a fallopian tube, and are thus sometimes called tubal pregnancies. The fallopian tubes are not designed to hold a growing embryo; the fertilized egg in a tubal pregnancy cannot develop normally and must be treated. An ectopic pregnancy happens in 1 out of 60 pregnancies.
What is Polycystic Ovarian Syndrome (PCOS)?
PCOS is a health problem that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance. Women with PCOS have these characteristics:
- high levels of male hormones, also called androgens
- an irregular or no menstrual cycle
- may or may not have many small cysts in their ovaries. Cysts are fluid-filled sacs.
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