What’s new in Obstetrics / Infertility, Gynaecology?

• What’s New in Obstetrics?
• What’s New in Gynaecology?
• What’s New in Infertility?

What’s New in Obstetrics?

Preparing for Pregnancy- The Latest Information Many factors influence fertility and if you are planning a pregnancy, it is a good idea to be well prepared.

General Health Check

First of all, you should visit your GP for a general health check, blood pressure, weight screening, blood tests and lifestyle advice. Book a long appointment and your GP will check these issues in detail.

Folate

Folate supplementation is recommended at least 1 month prior to pregnancy and for 3 months into the pregnancy as this reduces the chance of the baby having a defect in the neural tube, such as spina bifida. Folate can be taken alone or with other pre-pregnancy supplements.

Rubella

A blood test can show if you are immune to rubella. If not, you should be immunised. You should also have a blood test to check your immunity to chicken pox (varicella). If you are not immune, you can be immunised to reduce the risk of infection in pregnancy.

Weight

Weight issues are important for both men and women when considering fertility. If you are overweight, your body mass index (BMI) will be more than 25. BMI is determined by your weight in kg divided by your height (in metres squared). If your BMI is over 25, try to lower it. The closer to BMI 25 the better, and remember any weight loss in this situation will improve your fertility. See a dietician if you feel you would like expert one-on-one advice.

Smoking

Smoking is hazardous to your fertility, your general health and your baby. Quit now by whatever means you think will work.

Alcohol

There are no safe levels of alcohol consumption for women trying to conceive and during pregnancy. Men should aim to keep to current safe drinking guidelines which are an average of 2 drinks per day maximum, with several alcohol free days each week and no more than 4 standard drinks in one session.

Fitness

You will benefit from being fit prior to pregnancy. For women who are unfit, developing at least a moderate level of fitness is advisable-perhaps build up to 45 minutes of brisk walking 5 days per week.

If you are very unfit, start with a 10 minute walk twice a week at a moderate pace, and each week increase the time and frequency of your exercise. It is best to limit intense or high impact exercise, and no more than 4 hours of high intensity exercise per week is recommended.

Men should also try for a reasonable level of fitness.

Caffeine

Both men and women need to aim for less than 200mg of caffeine a day, which equals a maximum of 1 to 2 coffees or glasses of cola/energy drinks, or 2 to 3 teas – and not too much chocolate either!

If you need to cut down, do it slowly to reduce the impact of withdrawal symptoms.

Heat

It is best to avoid excessive heat from saunas, spas etc. when you are trying to conceive and during pregnancy. Men should also avoid situations where their scrotal area is unable to keep cooler than the rest of the body.

Pap smear

Be sure to update your smear test if it is nearly due. It is better to have one a bit early than be due in the middle of a pregnancy and find out that you have an abnormality on your smear that needs attention.

Healthy diet

A healthy diet includes fruit and vegetables each day and good quality protein such as in lean meat, fish, and eggs. You also need to consume complex carbohydrates, whole grains and plenty of calcium, preferably in the form of low fat dairy products. If possible, avoid excessive additives such as colours, flavours and preservatives. Try to keep to a relatively low fat diet, and to include mainly healthy fats such as olive oil.

Fish oil supplements can be good for fertility and in pregnancy, and may reduce the risk of postnatal depression.

When you are pregnant, remember to avoid eating food that could contain listeria, which can cause serious problems for the unborn child. These foods include soft cheese such as feta, pate, cold meats, pre-prepared salads and raw or smoked seafood. You should also limit amounts of fish known to have high levels of mercury, such as swordfish, shark/flake, orange roughy, tuna and catfish.

Non Invasive Pre-Natal Screening

There are a number of non-invasive pre-natal blood tests that have been shown to detect the risk of certain foetal chromosome abnormalities.

Other screening tests such as serum blood tests and ultrasound are also non-invasive but have false positive rates of up to 5 per cent and miss detection of up to 30 per cent of foetal trisomy 21 cases. Such tests may falsely report a pregnancy as positive for a foetal trisomy when it is in fact negative (a false positive). Or they may falsely report a pregnancy as negative for a foetal trisomy when it is in fact positive (a false negative).

The false positive and negative rates are significantly lower for the new pre- natal screening blood test.

There are a number of companies that can perform the test. It can be performed as early as 10 weeks gestation.

The results, usually within 10 days, also include the gender of the baby. It is anticipated that the test will significantly reduce the need for invasive diagnostic testing such as Amniocentesis and Chorionic Villus Sampling, which carry a risk of miscarriage of about 1in 150.

Family Cord and Cord Blood banking

Cord blood banking is the process of collecting the blood from the umbilical cord immediately after birth and cryogenically storing it for potential medical uses. Family banking means your baby’s cord blood can be stored for use by your baby and other compatible family members.

Cord banking enables you to store your baby’s birth stem cells so that they are available for possible future medical treatment for his or her lifetime. By storing these stem cells you are ensuring that he or she has a reserve of stem cells for life that are a perfect genetic match.

Cord blood is currently used as an alternative to bone marrow transplants in the treatment of certain cancers. Potentially, however, cord blood and cord tissue may play a role in stem cell medicine.

Details are available at

• Cell Care – Australia’s Family Cord Bank

What’s New in Gynaecology?

Endometrial Ablation using radio frequency

Heavy menstrual bleeding is diagnosed if your period lasts seven or more days per cycle, or is so heavy that you need to change protection every one or two hours. Heavy menstrual bleeding affects one out of every five women. Many women begin to experience heavy and/or irregular bleeding in their late 30′s and 40′s. Endometrial Ablation works by permanently removing the lining of the uterus (endometrium) that sheds causing menstrual bleeding.

The Novasure procedure delivers radio frequency energy to ablate the endometrium.The procedure is performed under a light anaesthetic, in hospital, and takes approximately 15 minutes.After the procedure 97 percent of patients do not experience pain.It can be performed at any time of the menstrual cycle.

No pre-treatment with hormones is required.

95 percent of patients are very satisfied with the results.
Importantly endometrial ablation is not a contraceptive procedure. A pregnancy after an ablation is very dangerous for both the mother and baby. Birth control will still need to be used.

Dr Mark Lawrence is proficient in performing the Novasure procedure.

Non Hormonal HRT

Livial(tibolone) is a HRT designed to relieve menopausal symptoms in post-menopausal women.Livial is not a hormone. It does not contain oestrogen, but mimics the action of the hormones produced by the ovaries prior to menopause.

Livial acts like oestrogen in the brain, bone and in vaginal tissue.Livial also acts like progesterone in the uterus to prevent overgrowth of the lining that May result in bleeding.

Livial also has testosterone like activity that appears to play a role in enhancing a woman’s mood and libido.

Please speak to Dr Mark Lawrence regarding Livial.

What’s New in Infertility?

Embryo Genetic Testing

Pre implantation Genetic Diagnosis (PGD) and pre implantation genetic screening (PGS) are treatment options for couples at increased of passing a chromosome abnormality or specific genetic disease on to their children.

These treatments involve screening IVF generated embryos for genetic conditions prior to embryo transfer, with only unaffected embryos transferred.

This provides the opportunity to screen embryos for genetic conditions before a pregnancy is established.

SNP array technology represents the latest advance in PGS testing. This technology screens all human chromosomes as well as detecting the genetic source of any abnormal chromosomes (i.e. whether from the sperm or the egg), as well as determine whether these abnormalities occurred before or after fertilisation. This information may be useful to assist couples with future reproductive decision making, including consideration of donor egg or donor sperm treatments.

Embryos are created using ICSI, which involves the injection of a single sperm into the egg.

Embryo biopsy is usually performed on day 5. Because of the time taken to perform the genetic testing, normal embryos are frozen for use in a subsequent thaw cycle.

SNP arrays have improved diagnostic capabilities compared with other PGS/PGD technologies, and are capable of screening all chromosomes with an accuracy typically exceeding 99 percent.

This testing may be appropriate for – female age greater than 36 years – recurrent pregnancy miscarriage – repeated unsuccessful IVF treatment due to implantation failure – a previous pregnancy with a chromosome abnormality – an altered sex chromosome in one partner – couples where one partner carries a balanced chromosomal rearrangement – couples at risk of having children with a particular X linked disorder – couples at risk of passing a single gene disorder on to their children

Please speak to Dr Mark Lawrence about SNP array testing