Obstetrical and Gynecological Services


	27790 W. Highway 22, #37, Barrington, Illinois 60010 Phone: 847-382-4406 Fax: 847-382-7098 E-mail: obgpez@aol.com

	Services
	Obstetrics Gynecologic and Breast Exams Initial Infertility Tests Perimenopause/Menopause Treatment Surgical Procedures

The health of both partners before conception is important to the healthy development of a baby. As soon as you and your partner decide to have a child you should assess your lifestyle to determine if any changes are necessary and schedule a visit to see your doctor for prepregnancy planning, counseling, and physical exams. Some of the topics to consider in assessing your lifestyle are listed below.

· Nutrition & Diet: Both partners should eat a well-balanced diet. Women should include adequate folic acid intake (spinach, broccoli, and kale). Folic acid supplements are recommended for all women of childbearing age to help prevent certain birth defects. Better nutrition, for men, helps to assure healthy sperm.

· Smoking: Both partners should stop smoking. In addition to causing many health risks, smoking can lead to decreased fertility in both men and women and is hazardous to a pregnancy. A smoke free environment at home is healthier for any child.

· Alcohol: Both men and women should stop alcohol use when trying to conceive. In women, alcohol can contribute miscarriage, low birth weight, and fetal alcohol syndrome. In men, heavy alcohol use may cause sexual problems that make reduce the number of sperm, make them infertile, and possibly damage sperm.

· Drug abuse: Both partners must stop any illicit drug use. Drug abuse is dangerous to a pregnancy. Drugs may inhibit conception or increase the risk of miscarriage, prematurity, birth defects, and death of the fetus.

· Exercise: Regular exercise is important for both partners. Exercise improves overall health, decreases stress, assists in the loss of excess weight and improves the quality of life. It also helps a woman prepare for the physical requirements of pregnancy and delivery of the baby.

· Exposure to toxic materials: If either partner works with toxic materials or if you live in a particularly polluted area, there may be possible hazards to a pregnancy. Some chemicals, usually in large doses, may be harmful to the ova or sperm or to a developing fetus. Discuss these concerns with your health care provider.

· Genetic counseling: If either partner has any genetic disorder or a family history of a genetic disorder or a related child with a birth defect, discuss this with your health care provider. A genetic counselor may be recommended or medical testing.

· Cystic fibrosis carrier screening: Cystic fibrosis (CF) is an inherited or genetic disease that is passed from the parents to their children. This can occur even when neither parent has the disease, but they carry the gene that can cause the disorder. For a child to inherit CF, both parents must have an altered gene that causes CF; in other words, both parents must be carriers of an altered CF gene. CF screening tells you what your risk is for carrying an altered CF gene. It can also tell you what your chance of having a child with CF is. CF screening does not tell you if your child will have CF. Ask your health care provider for a CF screening brochure.

· Medical conditions: If you have any chronic medical conditions such as asthma, high blood pressure, thyroid disorder, diabetes or a seizure disorder, discuss this with your health care provider in order to plan for a pregnancy. Find out how the medical condition will affect the pregnancy and vice versa, and if any medications you take might affect the pregnancy. The medical condition should be under control before you become pregnant and you must continue good self-care throughout the pregnancy.

· Immunizations: Preconception is a good time to make sure the mother-to-be has her immunizations up-to-date.
·Get a tetanus booster if you have not had one in the past 10 years.
·A rubella infection (German measles) during pregnancy can cause birth defects. A blood test will verify your immunity. If you require a vaccination, it is recommended to wait 3 months after receiving it before trying to conceive.
·Check on your immunity against regular measles, either by prior immunization or by having the measles. If unsure, discuss with health care provider.
·If you are at high risk for hepatitis B, immunization may be recommended.
·The influenza vaccine may be recommended if you are a high-risk patient that may become pregnant during the flu season.
·The varicella vaccine (for chickenpox) should be considered for women who have not had chickenpox (90% of women are immune to chickenpox, even those who do not remember ever having them).
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The pelvic exam is an examination of the female external and internal genitalia. The Pap smear (cervical smear) is carried out during the pelvic exam. It is a laboratory study used to detect cancerous or precancerous cells on the cervix. Annual pelvic exams with a Pap smear are recommended for most women and more often for those in high-risk categories. Gynecologic exams should be completed on all women prior to starting a form of birth control. We offer both the traditional Pap smear and newer Thin Prep. The results of the Pap smear may take up to 2 weeks to receive.

Reasons for Gynecologic Exam
·Routine diagnostic check.
·Investigate the cause of abdominal or pelvic pain.
·Unexpected vaginal bleeding
·Unexpected discharge (vaginitis).
·Bladder problems
·A general check before prescribing any form of contraception.
·Pain during intercourse.
·Suspected sexually transmitted disease.
·Confirmation and initial assessment of pregnancy.
·Screening test for cancer.

A frequently asked question is, "When should a female start seeing a gynecologist and have her first exam?" We recommend at the age of 18, earlier if she is having any problems or has become sexually active.

· Endometriosis: Is a disorder in which tissue resembling the inner lining of the uterus called the endometrium grows elsewhere in the body. The tissue may be found: on the surfaces of the ovary; behind the uterus; low in the pelvic cavity (bowel, bladder, rectum); on the intestinal wall; and rarely at other far away sites. This endometrial tissue outside the uterus responds to monthly changes in hormones the same way it does inside the uterus. This tissue also breaks down and bleeds. This bleeding may cause pain, especially during your period. The breakdown and bleeding of this tissue each month can cause scar tissue called adhesions. Other symptoms may include: pain with sexual intercourse, pelvic pain/pressure, premenstrual spotting, back pain, and pain with having a bowel movement. Endometriosis may also cause infertility. The only way to confirm the diagnosis of endometriosis is to look directly inside the body. This is usually done by laparoscopy under a general anesthetic. Treatment options include medications and/or surgical options. Talk with your health care provider for further information.

· Fibroids: This is an abnormal growth of cells in the muscular wall (myometrium) of the uterus. Uterine fibroids are common and almost always benign (not cancerous). Fibroids are the most common cause of abnormal uterine bleeding. Menstruation may be more frequent with heavy bleeding. Bleeding may occur between periods and you may feel pressure on the bladder or rectum. If heavy bleeding occurs over a period of time, anemia may result; feelings of weakness, fatigue, and looking pale). Treatment options are individualized and may include surgery and/or medication. Talk with your health care provider for more information.

· Premenstrual syndrome (PMS): is a term used to describe a cyclic recurrence of physical and/or behavioral changes that some women go through before their periods begin each month. These changes always occur during the second half of the menstrual cycle and are repeated each month. To be called PMS, symptoms must follow a certain pattern: women with PMS may have discomfort during the last 3-14 days before their period; they usually gain rapid relief of symptoms once their period starts; this pattern must be repeated for at least 2 cycles; women with PMS should be free of the symptoms for at least 2 weeks a month. Symptoms include: breast swelling and tenderness, lower abdominal bloating and constipation, loose stools or diarrhea 24 hours prior to menses; and for the first 1 to 2 days of menstrual bleeding, increased appetite and cravings, fatigue, emotional lability and depression, irritability, insomnia, menopausal-like hot flashes, night sweats, and migraine-like headaches. Treatment may include medications, change in diet, and regular exercise. Talk with your health care provider regarding further information.

· Premenstrual dysphoric disorder: Is a more severe form of PMS. Antidepressants may be utilized for more severe symptoms and possibly a mental health referral.

· Human papillomavirus (HPV): Is the common name for a group of related viruses, some of which cause genital warts. HPV is one of the most common sexually transmitted diseases. There are many types of HPV. The types of HPV that are found in the genital area cause condylomas, or genital warts. These growths may appear on the outside or inside of the genital area and can spread to nearby skin or to a sexual partner. While most HPV infections are not a serious threat to your health, some can increase your risk of cancer. This is why regular checkups that include Pap smears are so important for women. HPV can appear as a diagnosis on a Pap smear. If your Pap smear suggests a HPV infection, doctor may check your cervix, vagina, and vulva by doing a colposcopy. The colposcope magnifies these areas making it possible to biopsy and/or treat. Other treatment procedure options are available, depending on the individual case. Talk with your health care provider for more information.
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We are committed to addressing concerns involving the breasts in a very systematic fashion. We will perform and/or order diagnostic tests as needed and make surgical referrals if necessary. All of our patients are encouraged to perform monthly self-breast examinations, as well as yearly mammography after the age of forty. Patients with specific risk factors such as a family history of breast cancer may need screening mammography even earlier than forty.

We include a professional physical breast exam as part of an annual physical. Every woman should have a physical exam (including a Pap smear for most women) every year. If it has been a year or more since your last physical exam and Pap smear, we invite you to call our office and make an appointment.

Fibrocystic breast diseasse (FBD): Is a common condition of the female breast characterized usually by nonmalignant lumps and pain. If can affect females from puberty to around age 50 (about 20% of premenopausal women have this disorder). It often disappears after menopause (unless estrogen replacement therapy is used). Lumps are usually in both breasts. Solitary lumps may occur, but multiple lumps are common. Lumps offer resistance when pressed with fingertips; they may be tender. Frequently women with FBD will have generalized breast pain and/or enlargement of lumps prior to starting their period. These lumps may appear and dissolve; some remain permanently. It is important to have routine mammogram studies and to do monthly breast self-examination. Report any lumps or changes in lumps after diagnosis to your health care provider. Medications and dietary changes may be helpful. Contact your health care provider for further information.

The following list contains some internet sites dealing with breast disease and cancer that may be helpful:

The definition of infertility is unprotected sexual intercourse for 1 year without conception. The cause of infertility is discussed in terms of male and female.

· Some infertility tests are for women only, others are for men only, and still others cannot be done without the cooperation of both partners.
· An initial workup for a woman can take as little as six to eight weeks, or as much as three months or longer because some of the tests may have to be repeated for verification at different specific times in her menstrual cycle.
· The initial workup for a man can be done faster both because men have no monthly cycles and because there are fewer tests for men.
· Diagnostic surgical procedures may be suggested for both men and women to look directly at reproductive structures and to obtain small tissue samples for laboratory analysis.

· Basal body temperature: One of the most popular techniques for pinpointing ovulation relies on the slight rise in resting body temperature midway in the menstrual cycle, signaling that ovulation has recently occurred. A woman's body temperature fluctuates throughout her menstrual cycle, and she is instructed to record these fluctuations on a chart after taking her temperature each morning before getting out of bed. If the chart, called a basal body temperature, or BBT, chart, indicates that the woman has been ovulating, it can often be used to predict when ovulation will happen during subsequent menstrual cycles. The couple can then use the information to attempt to time conception. Several urine test kits for sale over the counter can be used to supplement the temperature chart.

· Hormone tests: Laboratory blood and urine studies to measure hormones that play a role in fertility. Tests may be done at the beginning of the menstrual cycle, in the middle or at the end. Progesterone increases in plasma after ovulation. It can be measured to confirm that ovulation has occurred. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) help stimulate ovulation. If their levels are low or high, or if they do not fluctuate properly, infertility can occur. Other hormones measured include prolactin, testosterone, and thyroid-stimulating hormone (TSH). In addition blood studies can detect the presence of antibodies to sperm.

· Cervical mucus: Other methods widely used to predict ovulation rely on examinations of the cervical mucus, which undergoes a series of hormone-induced changes at various times in the menstrual cycle. Some versions of these tests require a health professional's expertise. There are, however, versions of them that some women, with the help of their health care provider, can learn to do themselves.

· Hysterosalpingogram: This is an x-ray study of the uterus and fallopian tubes. It is done just after a woman's menstrual period so there is no danger of her being pregnant and thereby exposing the fertilized egg or embryo to radiation. A dye containing iodine, technically called a contrast medium, is injected through the cervix. It spreads into the uterus and the fallopian tubes, allowing them to be visualized on x-ray. Among other things, this study often enables the physician to determine if the fallopian tubes are open. It is usually done without an anesthetic in the x-ray department of a hospital or clinic.

· Hysteroscopy: The patient's uterus is filled with a liquid or gas, instilled through the cervix. A small lighted telescope called a hysteroscope is then inserted into the uterus through the cervix, enabling the physician to look directly inside. Many hysteroscopes have a separate channel through which instruments can be passed, often making it possible to immediately correct abnormalities seen. Patients undergoing hysteroscopy are usually given an anesthetic, which may be local or general.

· Laparoscopy: A laparoscope, like a hysteroscope, is a small lighted telescope. It is slipped into the abdominal cavity through a small incision in or near the navel. For a clearer view of the woman's reproductive tract, the cavity is filled with gas during the procedure, and a colored solution, usually blue in color, is injected into the uterus and fallopian tubes. A general anesthetic is required. Advanced operative techniques may allow the repair of defects in the reproductive tract to be made at the same time as the examination.

Male Tests

(We do NOT perform these tests, but will refer you to specialists who will).
·Semen analysis
·Testicular biopsy
·Other special tests

· Postcoital test: This test requires participation of both partners, as it has to be done after intercourse, which has to take place at the most fertile time in the woman's cycle. The test is done at the physician's office, 2 to 12 hours after intercourse. Several samples of cervical mucus are taken. Laboratory analysis determines whether sperm and mucus have been able to properly interact.

Infertility treatments such as: endometrial biopsy, ultrasound for follicle presence, artificial insemination, in vitro fertilization, gamate intrafallopian transfer (GIFT), or zygote intrafallopian transfer (ZIFT), tubal ovum transfer, embryo lavage, and intracytoplasmic sperm injection are NOT performed in our office. We will be happy to refer you to the appropriate infertility specialist as needed.
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· Perimenopause/Menopause: Perimenopause is a term used to define the period of
time surrounding the menopause. Perimenopause begins with changes that indicate a transition is occurring, and ends after the cessation of menses and perimenopausal symptoms. Some signs and symptoms of perimenopause include: irregular bleeding (prolonged, infrequent, heavy or intermenstrual), hot flashes, skin changes, bloating in upper abdomen, breast tenderness, pronounced tension/anxiety, urogenital changes (less vaginal lubrication, increased susceptibility to infection, bladder irritability, vaginal itching/burning, or discomfort during intercourse), decreased grip strength, headaches, dizziness, memory problems, difficulty concentrating, rapid or irregular heart beat, depression, sleep changes (fatigue), and visual changes. These symptoms may occur anytime between 35 and 50, (before the onset of menopause) due to declining estrogen and progesterone levels.

Menopause is the permanent cessation of menstruation. This occurs as early as age 40 or as late as age 55 and usually spans 1 to 2 years. Average age for women in the United States is age 51. Menopause is caused by a normal decline in ovary function, resulting in decreased levels of the female hormones, estrogen and progesterone, or by surgical removal of both ovaries. Frequent signs and symptoms of menopause include those perimenopausal symptoms listed above.

Menopause is a normal process, not an illness. It cannot be avoided, but its effects may be controlled or moderated by the use of hormone replacement therapy (HRT) or estrogen replacement therapy (ERT). Estrogen is given as a replacement for the estrogen that is lost when the ovary quits functioning. The goal is to duplicate the normal levels of estrogen that are present in women prior to menopause. Women that do not take replacement estrogen undergo some of the bodily changes noted above under signs and symptoms (as well as osteoporosis), that can be prevented by appropriate therapy. Because hormone treatment has benefits as well as some risks, learn all you can about replacement therapy before deciding on a treatment. Consider investigating natural hormone replacement (plant estrogens and progesterone creams.) as well. Natural treatments may help treat some of the symptoms. Discuss HRT/ERT options with your health care provider.

· Diagnostic laparoscopy: Laparoscopy is often used to find the cause of abdominal pain, infertility, or other problems in the reproductive organs. A look inside the body is needed. It is done with a laparoscope. This is a small, lighted telescope that is inserted through a small incision in or near the navel. For a clearer view of the woman's reproductive tract, the cavity is filled with gas (carbon dioxide or nitrous oxide) during the procedure. If needed, surgical instruments can be inserted through the laparoscope or another small incision lower in the abdomen. With the aid of the laparoscope and these instruments pelvic organs can be seen, adhesions can be separated, and tissue can be sampled. Once the procedure is completed the incisions are covered with bandaids. Most women are ready to go home 2-4 hours after the procedure. Some mild discomfort may last for a few days. Talk with your health care provider for further details.

· Laparoscopic Tubal Ligation: Is a surgical procedure (sterilization) to prevent a woman from getting pregnant. The laparoscope, as discussed above, is inserted into the abdomen near the navel. A second instrument is inserted either through the laparoscope or through a small second incision made near the pubic hairline. The fallopian tubes are grasped and sealed by using bands, clips, or electricity (electrocoagulation). In the nonelectric techniques, a clip or band is put around each tube. Some doctors may also cut the tubes and tie the ends. Most women are ready to go home 2-4 hours after the procedure. Some mild discomfort may last for a few days. Talk with your health care provider for further information.

· Hysteroscopy: Can be used to diagnose and/or treat some problems in the uterus, such as abnormal uterine bleeding, infertility, repeated miscarriages, adhesions, abnormal growths such as polyps or fibroids, and displaced IUDs. Hysteroscopy is best done during the first week or so after a period. This allows a better view of the inside of the uterus. The uterus is filled with a liquid or gas, instilled through the cervix. A small lighted telescope called a hysteroscope is then inserted into the uterus through the cervix, enabling the physician to look directly inside. Many hysteroscopes have a separate channel through which instruments can be passed, often making it possible to immediately correct abnormalities seen. Talk with your health care provider for more information.

· Hysterosalpingography (HSG): A special x-ray procedure in which a small amount of fluid is injected into the uterus and fallopian tubes to detect abnormal changes in their size and shape or to determine whether the tubes are blocked.

· Endometrial Biopsy: Is a diagnostic procedure that involves removal of tissue from the endometrium, the inner lining of the uterus. Endometrial biopsy is used to investigate the fertility in a patient who has been unable to become pregnant; or to investigate bleeding between periods or postmenopausal bleeding. Laboratory examination of the removed tissue aids in diagnosis. If appropriate, endometrial biopsy is performed during the last 2 weeks of the patient's menstrual cycle. This is the best time to identify possible hormonal problems and to determine if ovulation is occurring. It is usually performed in the doctor's office with little or no anesthesia necessary. A speculum is inserted into the vagina to bring the cervix into view. A biopsy instrument is inserted through the cervix into the uterus. It is gently scraped against the inner lining of the uterus to gather tissue. An alternate method involves obtaining the tissue sample with a suction instrument. The procedure may cause slight pain, but it is usually temporary and minor. Talk to your health care provider for further information.

· Thermal Balloon Ablation (TBA): The lining of the uterus, the endometrium, is shed by bleeding each month during a woman's period. Sometimes the bleeding is too much or too long and treatment is needed. If bleeding does not respond to medication, your health care provider may suggest endometrial ablation. This procedure treats the lining of the uterus to control or stop the bleeding, it does not remove the uterus. Frequently a hysteroscopy, ultrasound and/or an endometrial biopsy may be performed prior to TBA. Ablation destroys a thin layer of the lining of the uterus. This stops all menstrual flow in many women. After ablation, some women still have light bleeding or spotting. A few women may have regular periods. If ablation does not control heavy bleeding, further treatment or surgery may be necessary. Most women are not able to get pregnant after ablation, so if you might want to become pregnant, you should not have endometrial ablation.
With thermal ablation, a device or fluid is inserted into your uterus. Heat and energy are applied to increase the temperature and destroy the lining. The procedure is done on an outpatient basis, so you will go home the same day. Minor short-term side effects such as cramping, frequent urination, nausea, and a small amount of vaginal discharge are common. Talk with your health care provider for further details.

· Hysterectomy: Is the surgical removal of a woman's uterus (only). A hysterectomy ends a woman's ability to become pregnant and menstruate. Total hysterectomy and bilateral (both sides) salpingo-oophorectomy means removal of the uterus, both fallopian tubes and both ovaries. The uterus may be removed through an abdominal incision, through the vagina or laparoscopic assisted vaginal hysterectomy (LAVH). The surgical method used is determined by several factors, including the reason for the surgery and findings of the pelvic exam. Some of the medical reasons for a hysterectomy include: unusual bleeding not controlled by other treatments, severe endometriosis, bleeding, painful or enlarging uterine fibroids, early malignancy, and defects in pelvic supports.
Although a woman who has had her uterus removed will no longer have periods,
this does not mean she will be undergoing hormonal changes related to menopause. A
natural menopause occurs when the ovaries stop producing hormones in this case. If
the ovaries are removed with the uterus prior to menopause, there are hormone-
related effects. These effects may usually be treated with estrogen therapy.
The hospital stay is approximately 1-3 days, (depending on surgical method) with some postoperative discomfort afterwards. Normal activities, including sexual activity, can usually be resumed in 4 - 8 weeks. Talk with your health care provider for further information.

· Dilation and Curettage (D & C): is often done as both a diagnostic and a therapeutic procedure. Reasons for a D&C include: diagnosis of abnormal bleeding or possible uterine cancer, incomplete spontaneous miscarriage, treatment of minor diseases of the uterus, elective abortion early in pregnancy, and removal of membranes and placenta after childbirth in cases where they fail to deliver spontaneously. The procedure is performed in a hospital or surgery center with an anesthetic. The cervix is carefully opened with dilators, and a curette is inserted into the uterus. The curette can be a suction device or a looped knife. The curette is used to scrape the endometrium from the uterine wall. The tissue may be removed and sent to the laboratory for examination and diagnosis, or for treatment of heavy or irregular uterine bleeding. Mild discomfort and vaginal spotting may last for several days after the procedure. Contact your health care provider for further information.

The type of anesthetic used will be discussed with you by the anesthesiologist. The anesthetic used is based on your personal health history and your personal preference. Together you and your anesthesiologist will determine what is best for you and for your procedure.

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