Dr Tsuari

Polycystic ovary syndrome (PCOS) is a hormonal disorder that causes women to have infrequent or prolonged absence of menstrual periods (oligo-anovulation), an excess of the male hormone, androgen and polycystic ovarian morphology on ultrasound. Women who have PCOS ovulate infrequently and sporadically, typically, 3-4x a year. Therefore, women with PCO struggle with falling pregnant, but they are not infertile.

PCOS is a heritable condition occurring in 15% of women in the world population. It can present in different phenotypes or morphology, ranging from normal weight to excess central weight as well as acne and excess body and facial hair. It is often but not always accompanied by insulin resistance. If the insulin resistance remains untreated, it will eventually lead to impaired glucose tolerance and eventual type 2 diabetes, fatty liver and obesity. The good news about PCOS is that it is reversible with lifestyle modification (healthy food choices), exercise, and a loss of at least 10% of the body weight can result in regular menstrual cycles. What are the symptoms of PCOS? A diagnosis of PCOS may be made if you experience at least two of these signs:

• Irregular or absent menstrual periods
• Central weight gain and in some cases, excessive weight gain.
• Excess hair growth on the face, chest, abdomen or upper thighs
• Severe acne that occurs after adolescence and does not easily respond to treatment.
• Subfertility or difficulty in falling pregnant
• PCOS is one of the most common causes of female subfertility

Fibroids are solid, abnormal fibromuscular growths in the uterus that are mostly circular in shape and vary in sizes and are benign in nature. In very rare cases(1%), as the woman ages, there may be risk of transformation to cancer. Fibroids are one of the most common causes of pelvic pain and pressure symptoms necessitating a gynaecological visit. Fibroids do not necessarily cause infertility but they may contribute to subfertility, miscarriages and ectopic pregnancy depending on where they are situated in relation to the uterus (womb). Fibroids that are inside the lining of the womb must be removed to achieve a healthy pregnancy. In modern gynaecology this is usually achieved by using hysteroscopy (thin telescope through the cervix) and sometimes laparoscopy(key-hole surgery).

What is cervical smear (pap smear) and cervical screening (HPV)
A Pap smear or cervical smear is a screening test to check if abnormal changes have occurred in cells of the cervix. the cervix is the lowest part of the uterus (entrance of the womb). The current recommendations have moved this screening test to liquid based cytology with Human Papilloma Virus (HPV) screening. Abnormal changes that may lead to cervical cancer if not treated are classified as Low Grade Squamous Intra-epithelial Lesion (LSIL), High Grade Squamous Intra- epithelial Lesion (HSIL), or Atypical Squamous Cells of Undetermined Significance (ASCUS) with or without the presence of high risk HPV. Alternatively, the HPV screen may be positive whilst the cervix does not show any changes. Cervical smears and HPV screening are important because the growth of pre- cancerous cells on the cervix do not usually cause physical symptoms, thus making the screening the only means of detecting pre-cancerous cells. Based on the screening results, a colposcopy and biopsy may be performed with or without immediate removal of the abnormal cells.

A Pap smear or cervical smear is a screening test to check if abnormal changes have occurred in cells of the cervix. the cervix is the lowest part of the uterus (entrance of the womb). The current recommendations have moved this screening test to liquid based cytology with Human Papilloma Virus (HPV) screening. Abnormal changes that may lead to cervical cancer if not treated are classified as Low Grade Squamous Intra-epithelial Lesion (LSIL), High Grade Squamous Intra-epithelial Lesion (HSIL), or Atypical Squamous Cells of Undetermined Significance (ASCUS) with or without the presence of high risk HPV. Alternatively, the HPV screen may be positive whilst the cervix does not show any changes. Cervical smears and HPV screening are important because the growth of pre-cancerous cells on the cervix do not usually cause physical symptoms, thus making the screening the only means of detecting pre-cancerous cells. Based on the screening results, a colposcopy and biopsy may be performed with or without immediate removal of the abnormal cells.

Some couples may experience a difficulty in conceiving a pregnancy. The W.H.O defines infertility as a failure of a couple to conceive after 12 consecutive months of regular vaginal intercourse without use of a contraceptive. The definition of infertility does not change with age, however, in women 35 years and older it is prudent to consult after 6
months of trying. A couple who have never conceived have primary infertility. A couple failing to conceive after a previous pregnancy have secondary infertility. There are many more causes of infertility and subfertility and this can be worked out with your fertility specialist.

Male infertility is defined as a male who does not have the ability to achieve a pregnancy with a healthy female partner after 12 months of uninterrupted vaginal intercourse.It is a contributing factor in 30% to 40% of all infertility cases. For the healthy male partner, a semen analysis, infectious screen is usually first to be requested. Based on these, further tests and investigations like ultrasound may be required. A single abnormal semen analysis must be repeated 6 weeks later. It is important to refer a male with a history of: genital injury (torsion) delayed secondary characteristics of male development Cryptorchidism childhood mumps Previous STI’s Urogenital surgery Systemic illness such as diabetes mellitus, hypertension, metabolic syndrome History of chemotherapy History of steroid use
Men over the age of 40 who have tried and never achieved a pregnancy

Egg donation is an option of women who have exceeded their fertility period, or women who have ovarian insufficiency due to various reasons. Egg donation requires an altruistic donor who is willing to use hormonal medication to grow multiple eggs, followed by egg collection under deep sedation or general anaesthesia. This process takes exactly two
weeks. The egg donor should be taken care of during the process and afterwards for any medical issues arising from the egg donation. Although egg donation is altruistic, the donor is compensated for time and effort during the process.

Egg banking for own use at a later stage is an option for women not ready to conceive during their fertility years. Further, some women may not wish to have children, but this may change later in life. This process is relatively easy and lasts 2 weeks. Any number of eggs can be frozen/banked but it is better to have more than 8 mature eggs for a possibility of a livebirth. The eggs can stay in storage for many years until the woman is ready to use them.

Surrogacy is a process to assist women who are unable to carry their pregnancy inside their uterus/womb. Some women may have good quality eggs but suffer recurrent pregnancy losses, have auto-immune conditions, blood disorders such as sickle cell disease, and many other conditions.
Surrogacy is more complex than egg donation and it requires a legal agreement that is confirmed in High Court. This is necessary to ensure a smooth transfer of the baby from the surrogate to the recipient. There are several processes required such as psychological assessment, physician assessment and any other requirements needed to proceed. Surrogacy involves obligatory financial compensation that is agreed upon by the parties involved.

Sperm donation is an anonymous process that is required in instances where there is incurable male infertility, or if a male partner is not required. The sperm bank conceals the identity of donors. The create “profile” for each donor which includes biometric data, education level, vocation and interests or hobbies. Some profiles have extended information to allow the recipient to make an informed choice.

There are instances of delayed onset of menses, precocious/early puberty, Mullerian anomalies (abnormalities of the formation of the uterus, cervix, vagina and tube, and genetic disorders of sexual development. Children and young women may present with various signs and symptoms suggestive of endocrinological disorders. This can bee distressing to both child and parents and needs to be handled with care and discretion. Many of the endocrinological conditions are either treatable or managed with success, allowing for normal growth and possible future reproduction,

Menopause is a normal stage of transition from fertility to the end of fertility. It is marked by a cessation of the menstrual cycle for a period of 6 to 12 months. This is due to follicle depletion in the ovary and reduced estrogen production. The age of menopause ranges from 45 years to 55 years with a mean age of 51years. Symptoms of Menopause hot flashes,
night sweats insomnia or trouble sleeping, mood swings and irritability.
And many more… Managing menopause The symptoms of menopause are commonly self-limiting over a period of 5 to 10 years. First line non hormonal therapy should always be attempted.
Non pharmacological interventions include: 
– Lifestyle adjustments such as smoking cessation, exercise and avoidance of triggers such as hot drinks, alcohol, spicy food and caffeine.
– Holistic and alternative therapies such as acupuncture, trained relaxation techniques, cognitive behaviour therapy and paced respiratory training.
Pharmacological treatments that have been used with variable success are:
– Vit E 500-100IU daily
– Vit B6 50 mg daily
– Clonidine 25mg twice daily. Clonidine is an alpha adrenergic agonist that prevents hot flashes
– Vitamin D3 1000mg daily Menopausal hormone replacement (MHT) is indicated in women with intractable symptoms not responding to alternative therapies, women with early menopause (40 -45 years), women with high demand occupation, low libido and women who compete in sport. Early commencement of menopausal hormone replacement is protective to the heart and bone mineral density and prevention of muscle atrophy.