Garron R Hale, MD

DIPLOMATE, AMERICAN BOARD OF OBSTETRICS & GYNECOLOGY

What is infertility?

Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who handscan get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant:

  • A woman’s body must release an egg from one of her ovaries (ovulation).
  • The egg must go through a fallopian tube toward the uterus (womb).
  • A man’s sperm must join with (fertilize) the egg along the way.
  • The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can happen if there are problems with any of these steps.

Is infertility a common problem?

Yes. About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).

Is infertility just a woman’s problem?

No, infertility is not always a woman’s problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women’s problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

What causes infertility in men?

Infertility in men is most often caused by:

  • A problem called varicocele (VAIR-ih-koh-seel). This happens when the veins on a man’s testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.
  • Other factors that cause a man to make too few sperm or none at all.
  • Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

What increases a man’s risk of infertility?

A man’s sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:

  • Heavy alcohol use
  • Drugs
  • Smoking cigarettes
  • Age
  • Environmental toxins, including pesticides and lead
  • Health problems such as mumps, serious conditions like kidney disease, or hormone problems
  • Medicines
  • Radiation treatment and chemotherapy for cancer

What causes infertility in women?

Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman’s ovaries stop working normally before she is 40. POI is not the same as early menopause.

Less common causes of fertility problems in women include:

What things increase a woman’s risk of infertility?

Many things can change a woman’s ability to have a baby. These include:

How does age affect a woman’s ability to have children?

Many women are waiting until their 30s and 40s to have children. In fact, about 20 percent of women in the United States now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman’s chances of having a baby in the following ways:

  • Her ovaries become less able to release eggs.
  • She has a smaller number of eggs left.
  • Her eggs are not as healthy.
  • She is more likely to have health conditions that can cause fertility problems.
  • She is more likely to have a miscarriage.

How long should women try to get pregnant before calling their doctors?

Most experts suggest at least one year. Women 35 or older should see Dr. Hale after six months of trying. A woman’s chances of having a baby decrease rapidly every year after the age of 30.

Some health problems also increase the risk of infertility. So, women should talk to Dr. Hale if they have:

  • Irregular periods or no menstrual periods
  • Very painful periods
  • Endometriosis
  • Pelvic inflammatory disease
  • More than one miscarriage

It is a good idea for any woman to talk to Dr. Hale before trying to get pregnant. Dr. Hale can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

How will doctors find out if a woman and her partner have fertility problems?

Dr. Hale will do an infertility checkup. This involves a physical exam. Dr. Hale will also ask for both partners’ health and sexual histories. Sometimes this can find the problem. However, most of the time, Dr. Hale will need to do more tests.

In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man’s hormones.

In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:

  • Writing down changes in her morning body temperature for several months
  • Writing down how her cervical mucus looks for several months
  • Using a home ovulation test kit (available at drug or grocery stores)

Dr. Hale can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.

Some common tests of fertility in women include:

  • Hysterosalpingography (HIS-tur-oh-sal-ping-GOGH-ru-fee): This is an x-ray of the uterus and fallopian tubes. Dr. Hale injects a special dye into the uterus through the vagina. This dye shows up in the x-ray. Dr. Hale can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.
  • Laparoscopy (lap-uh-ROS-kuh-pee): A minor surgery to see inside the abdomen. Dr. Hale does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, Dr. Hale can check the ovaries, fallopian tubes, and uterus for disease and physical problems, and  can usually find scarring and endometriosis by laparoscopy.

Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don’t worry if the problem is not found right away.

How does Dr. Hale treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.

Dr. Hale recommends specific treatments for infertility based on:

  • Test results
  • How long the couple has been trying to get pregnant
  • The age of both the man and woman
  • The overall health of the partners
  • Preference of the partners

Dr. Hale often suggests treatment of infertility in men in the following ways:

  • Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.
  • Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
  • Sperm movement: Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem.

In women, some physical problems can also be corrected with surgery.

A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with Dr. Hale about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.

What medicines are used to treat infertility in women?

Some common medicines used to treat infertility in women include:

  • Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
  • Human menopausal gonadotropin or hMG (Repronex, Pergonal): This medicine is often used for women who don’t ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
  • Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
  • Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who don’t ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
  • Metformin (Glucophage): Dr. Hale uses this medicine for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
  • Bromocriptine (Parlodel): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.

Many fertility drugs increase a woman’s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:

  • Mild male factor infertility
  • Women who have problems with their cervical mucus
  • Couples with unexplained infertility

Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman’s body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman’s body.

How often is assisted reproductive technology (ART) successful?

Success rates vary and depend on many factors. Some things that affect the success rate of ART include:

  • Age of the partners
  • Reason for infertility
  • Clinic
  • Type of ART
  • If the egg is fresh or frozen
  • If the embryo is fresh or frozen

The U.S. Centers for Disease Prevention (CDC) collects success rates on ART for some fertility clinics. According to the 2006 CDC report on ART, the average percentage of ART cycles that led to a live birth were:

  • 39 percent in women under the age of 35
  • 30 percent in women aged 35-37
  • 21 percent in women aged 37-40
  • 11 percent in women aged 41-42

ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

What are the different types of assisted reproductive technology (ART)?

Common methods of ART include:

  • In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman’s fallopian tubes are blocked or when a man produces too few sperm. Dr. Hale treats the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man’s sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman’s uterus.
  • Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
  • Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman’s fallopian tube. So fertilization occurs in the woman’s body. Few practices offer GIFT as an option.
  • Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

Surrogacy

Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man’s sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.

Gestational Carrier

Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn’t become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man’s sperm and the embryo is placed inside the carrier’s uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.

Recent research by the Centers for Disease Control showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don’t know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.

For more information

You can find out more about infertility by contacting womenshealth.gov at 1-800-994-9662 or the following organizations:

Food and Drug Administration (FDA)
Phone Number(s): (888) 463-6332
Internet Address: http://www.fda.gov

The Centers for Disease Control Division of Reproductive Health
Phone Number(s): (800) CDC-INFO
Internet Address: http://www.cdc.gov/Reproductivehealth/DRH/index.htm

American College of Obstetricians and Gynecologists (ACOG) Resource Center
Phone Number(s): (800) 762-2264
Internet Address: http://www.acog.org

American Society for Reproductive Medicine
Phone Number(s): (205) 978-5000
Internet Address: http://www.asrm.org/

RESOLVE: The National Infertility Association
Phone Number(s): (888) 623-0744
Internet Address: http://www.resolve.org

InterNational Council on Infertility Information Dissemination, Inc.
Phone Number(s): (703) 379-9178
Internet Address: http://www.inciid.org/

American Fertility Association
Phone Number(s): (888) 917-3777
Internet Address: http://www.theafa.org

Fertile Hope
Phone Number(s): (888) 994-HOPE
Internet Address: http://www.fertilehope.org

All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women’s Health in the Department of Health and Human Services; citation of the source is appreciated.

Reviewed by:
Esther Eisenberg, MD, MPH
Reproductive Sciences Branch
Eunice Kennedy Shriver
National Institute of Child Health and Human Development
Bethesda, MD

Kelly Brumbaugh, MPH, CHES
Renee Brown-Bryant, MS
Lee Warner, PhD
Division of Reproductive Health
Centers for Disease Control and Prevention
Atlanta, GA

Osteoporosis means “porous bone.” If you looked at healthy bone under a microscope, you would see that parts of it look like a honeycomb. If you have osteoporosis, the holes and spaces in the honeycomb are much bigger than they are in healthy bone. This means your bones have lost density, or mass. It also means that the structure of your bone tissues has become abnormal. As your bones become less dense, they become weaker.

For some people affected by the disease, simple activities such as lifting a child, bending down to pick up a newspaper or even sneezing can cause a bone to break. Because osteoporosis is a disease of the bones, it is important to know some basics about your bones. Your bones are made up of three major components that make them both
flexible and strong:

  1. Collagen, a protein that gives bones a flexible framework
  2. Calcium-phosphate mineral complexes that make bones hard and strong
  3. Living bone cells that remove and replace weakened sections of bone

How Bones Change and Grow
Throughout life, your skeleton loses old bone and forms new bone. Children and teenagers form new bone faster than they lose the old bone. In fact, even after they stop growing taller, young people continue to make more bone than they lose. This means their bones get denser and denser until they reach what experts call peak bone mass. This is the point when you have the greatest amount of bone you will ever have. It usually happens around age 20.

You can also think of your bones as a savings account. There is only as much bone mass in your account as you deposit. The critical years for building bone mass start before your teen years and last until around age 20.

After you reach peak bone mass, the balance between bone loss and bone formation might start to change. In other words, you may slowly start to lose more bone than you form. In midlife, bone loss usually speeds up in both men and women. For most women, bone loss increases after menopause, when estrogen levels drop sharply. In fact, in the five to seven years after menopause, women can lose up to 20 percent or more of their bone density.

Osteoporosis happens when you lose too much bone, make too little bone or both. The more bone you have at the time of peak bone mass, the better you will be protected against weak bones once bone loss begins.

Overview

Have you experienced some loss of bladder control lately? Have you felt a pressure in your pelvic area that won’t go away? Pain or discomfort during sexual intercourse? Does it constantly feel like you are wearing a tampon, and it’s falling out?

If so, you may be suffering from pelvic organ prolapse (POP), a common but rarely discussed condition in which organs in the seniors3pelvic region shift out of their normal position, or prolapse.

Pelvic organ prolapse, sometimes known as “dropped bladder,” can be uncomfortable both physically and emotionally. Women with pelvic organ prolapse tend to limit their daily activities and avoid sex because of pelvic pain and the need to urinate frequently.

What are common symptoms of pelvic organ prolapse?

  • Loss of bladder or possibly bowel control
  • Difficulty completely emptying your bladder
  • Increased need to urinate
  • Feelings of pelvic or vaginal heaviness, bulging, fullness and/or pain, or a feeling that something is “dropping”
  • Recurrent bladder infections
  • Excessive vaginal discharge
  • Pain or lack of sensation during sex

Causes of Pelvic Organ Prolapse

The organs in your pelvic area — uterus, vagina, bladder and rectum — are held in place by a web of muscles and connective tissues that act like a hammock. When this web becomes weakened or damaged, one or more pelvic organs shift out of normal position and literally “fall,” or prolapse, into the vagina.

As a result, organs may press against the vaginal wall and produce a hernia-like bulge, causing discomfort and limiting physical and sexual activity.

The major risk factor for pelvic organ prolapse is having delivered a baby vaginally. Other risk factors include:

  • Obesity
  • Menopause
  • Loss of muscle tone with aging
  • Hysterectomy
  • Genetics

Types of Pelvic Organ Prolapse

There are several different types of pelvic organ prolapse, defined by which organs are involved. It’s also possible to have more than one type of prolapse.

  • Bladder: The most common type of pelvic organ prolapse is cystocele (pronounced sis-tuh-seel) and is often called “dropped bladder.” As the front wall (or roof) of the vagina stretches or loses its attachment to the pelvis, it drops into the vaginal opening. The bladder, which rests on this area of the vagina, similarly “drops” out of position.
  • Intestines: For women who have had hysterectomies and no longer have a uterus, the intestines and the top of the vagina push into the lower vagina. This is called an enterocele (pronounced en-tro-seel).
  • Rectum: As the back wall (or floor) of the vagina loses its support, the rectum can protrude into the vaginal opening, creating a “pocket” called a rectocele (pronounced rek-tuh-seel).
  • Uterus: Prolapse of the uterus (and cervix) into the vagina is called uterine prolapse.

Stop Coping. Start Living.

Maybe you’ve been too embarrassed or confused by how you feel to seek medical help. You may even have wondered if your symptoms would just go away.

But pelvic organ prolapse is a real, common and treatable problem. Consider this:

  • About half of all women over age 50 suffer from some degree of pelvic organ prolapse.
  • One in 10 women undergo surgery for pelvic organ prolapse by age 80.

You don’t have to accept the limits that pelvic organ prolapse can put on your lifestyle.

Treatments for Pelvic Organ Prolapse

Pelvic organ prolapse (POP) can be treated with a variety of methods, including nonsurgical and surgical procedures, depending on the severity of the prolapse and the associated symptoms.

Nonsurgical treatment options

  • Behavioral/Muscle Therapy: If symptoms are mild, therapy often starts with Kegel exercises to help strengthen the pelvic floor muscles.
  • Pessary: This device can be inserted into the vagina to support the pelvic area and help relieve mild symptoms of pelvic organ prolapse, including incontinence.Dr. Hale  may recommend using vaginal estrogen along with the pessary. In some instances, a pessary may make urinary incontinence worse; if this happens, see Dr. Hale to discuss other treatment options.
  • Biofeedback: In this method, the patient exercises the pelvic floor muscles while connected to an electrical sensing device. The device provides “feedback” to help you learn how to better control these muscles.Over time, biofeedback can help you use your pelvic muscles to decrease sudden urges to urinate and lessen certain types of pelvic pain.

Surgical Options

For women whose symptoms don’t respond to nonsurgical methods, Dr. Hale may recommend pelvic reconstructive surgery. With this technique, the surgeon repositions the prolapsed organs and secures them to the surrounding tissues and ligaments.

  • Synthetic Mesh Repair: Using very small incisions inside the vagina, the surgeon repositions the prolapsed organs and secures them to surrounding tissues and ligaments using a soft mesh – a material similar to that used for abdominal hernia repair. This is an effective treatment with a success rate ranging from 87-91%, depending on the type of prolapse. Learn more.
  • Posterior and Anterior Colporrhaphy (pronounced kol-por’e-fe): These procedures involve folding and then suturing, or stitching, the back (posterior) or front (anterior) wall of the vagina to support prolapsed organs.Colporrhaphy can be effective for patients with pelvic organ prolapse; however, up to 40% of colporrhaphies fail to treat symptoms, and 29% of patients require repeat surgeries to treat their symptoms effectively.
  • Hysterectomy: A hysterectomy may be done in combination with other pelvic floor repair procedures, depending on the type of pelvic organ prolapse.  Ask us about your hysterectomy options to learn about less invasive treatments that offer shorter recovery times.

Stop Coping. Start Living.

If you’ve been told that pelvic organ prolapse is an inevitable part of getting older, you should know that you don’t have to cope with it – treatment may help.

Frequently Asked Questions

General Topics

Why do I have to fill out paperwork at each visit when I have been seen by Dr. Hale for over 20 years?
How does exercise help me stay healthy?
How do I start to exercise?

How can I prevent fatigue and exhaustion?
What can I do to prevent getting STDs?
Is urinary incontinence a natural consequence of aging?
I have a teenage daughter. When should she have her first Pap smear?
Her Option®, in-office cryoablation for the treatment of heavy periods
What are the risk factors for breast cancer?

What does smoking have to do with abnormal Pap tests?
What changes should I expect with the onset of menopause?
What are hot flashes?
What is the treatment for hot flashes?
My spouse and I are thinking about permanent sterilization. What should we know before making a decision?
What is amenorrhea?

What can be done to prevent missing a period?

Pregnancy Topics

What is prenatal care?
What are prenatal exams, tests and procedures?
What are the routine tests and procedures?
When should I see my healthcare provider?

What will happen at the first prenatal visit?
What will happen at other prenatal visits?
What meds can I take in pregnancy?
What is all the hype about folic acid in pregnancy?
What signs and symptoms of pregnancy will my healthcare provider check?
What is gestational age?
Why is it important to know the gestational age?

How is gestational age calculated?
What foods do I need to eat?
Is it okay to eat fish during pregnancy?
What about heartburn during pregnancy?
What is morning sickness?
Is it okay to exercise during pregnancy?

18 week ultrasound instructions
Are there risks with 3D or 4D?
What is a 4D ultrasound?
When is the best time to have a 4D?
How long is a 4D ultrasound?
What are the advantages of a 4D ultrasound?

What about the postpartum blues?
What is postpartum depression?

Infertility Topics

My husband and I have been trying to get pregnant for the past six months without luck. When should we seek medical help for infertility?
What is infertility?
How is infertility diagnosed?

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General Topics

Why do I have to fill out paperwork at each visit when I have been seen by Dr. Hale for over 20 years?

We all know how frustrating it can be to fill out the mounds of paperwork given to us at a doctor’s visit. However, this paperwork is very important for you to receive quality care and to ensure your visits are filed properly with your insurance carrier. For some people, information such as phone numbers, address and insurance changes frequently. Likewise, health information may also change from visit to visit. Surgeries, family illnesses, and treatment received by other specialists will help Dr. Hale diagnosis a problem more quickly. Accuracy is extremely important in healthcare.

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How does exercise help me stay healthy?

Exercise helps both your body and your mind. It helps lower your risk or disease. It helps you feel better. When you exercise every day, you can lower your chances of having: a stroke, heart disease and diabetes. Exercise can lower your blood pressure, blood cholesterol and blood sugar. Exercise helps your mood. It changes how you feel and gives you more energy and helps you to sleep better.

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How do I start to exercise?

Always check with your healthcare provider before you start an exercise program. If you have any health problems, talk to you provider about what exercises would be right for you. Choose exercises that: you enjoy, fit into your schedule, and that allow for any health problems. Do warm up exercises every time you exercise. Gently stretch your muscles for five to 10 minutes. When you stretch, you make your muscles less tight. You are less likely to hurt yourself. You can walk to warm up. It gets your blood flowing.

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How can I prevent fatigue and exhaustion?

For many mothers the first weeks at home with a new baby are often the hardest in their lives. You will probably feel overworked, even overwhelmed. Inadequate sleep will leave you fatigued. Caring for a baby can be a lonely and stressful responsibility. You may wonder if you will ever catch up on your rest or work. The solution is asking for help. No one should be expected to care for a young baby alone.
Every baby awakens one or more times a night. The way to avoid sleep deprivation is to know the total amount of sleep you need per day and to get that sleep in bits and pieces. Go to bed earlier in the evening after your baby’s final feeding of the day. When your baby naps you must also nap. Your baby doesn’t need you hovering while he or she sleeps. If sick, your baby will show symptoms. While you are napping take the telephone off the hook and put up a sign on the door saying “mother and baby sleeping”. If your total sleep remains inadequate, hire a babysitter or bring in a relative. If you don’t take care of yourself, you won’t be able to take care of your baby.

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What can I do to prevent getting STDs?

The only sure way to prevent most STDs is not to have sex. If you do have sex, the following may help reduce your risk of getting an STD.

  • Know and limit partners – your partner’s history is just as important as your own.
  • Talk with your partner – shame and fear can hinder open and honest communication.
  • Know the symptoms and seek medical care if you develop a problem.
  • Use a latex condom and avoid use of oils or petroleum jelly.
  • Spermicides may help guard against some STDs.
  • Avoid risky sex practices.

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Is urinary incontinence a natural consequence of aging?

Studies reveal that 30 percent of all women report episodes of urinary
incontinence, which is the involuntary loss of urine from the bladder. However, only one half of these women report this condition to their physicians because it is either socially embarrassing or they believe that no treatment option is available. Urinary incontinence is not a natural consequence of aging. Pelvic exercise (for example, Kegels and biofeedback), medication, and outpatient minimally invasive surgical procedures offer excellent cure rates. If you have urinary incontinence, take charge of your health care and discuss it with your physician. Effective treatment options are now available for you.

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I have a teenage daughter. When should she have her first Pap smear?

Since most abnormal Pap smears are attributed to human
papilloma virus (HPV), which is predominantly transmitted through
sexual activity, it is felt that Pap smears should begin when a young
woman is involved in sexual activity. In addition, a young woman
should be seen by a physician or other health care provider if she
experiences other symptoms related to her female organs, such as
irregular bleeding, pelvic or abdominal pain, or vaginal discharge.
Certainly, most women should obtain a Pap smear by age 18 – 21
regardless of whether or not they have become sexually active.

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Her Option®, in-office cryoablation for the treatment of heavy periods

  • Do you suffer from heavy or long periods?
  • Are you past childbearing age?

If you answered “YES” to both of these questions, then you may be a candidate for a procedure known as cryoablation.
Her Option cryoablation therapy from AMS is a treatment option for excessive menstrual bleeding (menorrhagia) that ablates endometrial tissue through subzero temperatures, using ultrasound guidance to monitor the safety and extent of treatment.
Her Option is a comfortable treatment for menorrhagia because the natural anesthesia effects of cold eliminate the need for IV sedation in most cases, and allows the patient to be treated in the comfort of the office versus scheduling and waiting for an operating room.  This procedure significantly reduces and in some women, totally eliminates bleeding.
The procedure takes less than 30 minutes and is performed in the Greenville OB/GYN surgical suite by the physicians of Greenville OB/GYN.  The patient is released to recover at home and able to resume normal activity the next day.  In-office cryoablation is covered by most major PPO insurance companies as well as Medicare.
To learn more about this procedure and to establish if you would be a candidate, please speak with your physician.

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What are the risk factors for breast cancer?

Several risk factors have been identified with the development of breast cancer. The incidence of breast cancer obviously increases with advanced age in women. In addition, hormone replacement, especially when it combines of estrogen and progesterone may increase the risk of cancer.

Other risk factors include:

  • Family history of breast cancer
  • An early age of menarche (when the period starts).
  • Late age of menopause
  • Later age of first live birth
  • Any history of benign breast disease which has been biopsied increases risk of breast cancer

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What does smoking have to do with abnormal Pap test?

Women who smoke are more likely to have abnormal Pap tests. The Pap test detects cellular changes. Most abnormal cell changes are caused by infections with human papillomavirus. HPV infection is very common. Most of the time, the immune system gets rid of HPV before it can cause abnormal cell changes. In smokers, HPV infections are more likely to cause cell changes that can eventually become cancer. In addition, smoking lowers the ability of the immune system to get rid of HPV. Stopping smoking markedly improves the immune system, allowing the body to clear the virus naturally.

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What changes should I expect with the onset of menopause?

Menopause is a natural part of aging. The lower amounts of estrogen that come with menopause will cause various changes in your body. These changes will occur slowly. It is important to remember that menopause is different for everyone. Some women notice little difference in their bodies or moods, while others report substantial changes.
Possible changes include: hot flashes, sleep problems, vaginal and urinary tract changes, bone changes, emotional changes, and changes in sexuality. You should see Dr. Hale if any of your symptoms become particularly bothersome.

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What are hot flashes?

Hot flashes are sudden sensations of flushing and heat that some women feel when they are going through menopause. They are one of the most common and earliest signs of menopause.
Hot flashes result from a decrease in the female hormone estrogen. Their exact cause is not completely understood, but it is believed that estrogen production affects the part of the brain that controls the body’s temperature. Blood vessels in the face, chest, and body widen and make you feel warmer.
Hot flashes usually appear suddenly and without any warning but they may be triggered by emotional stress, excitement, anxiety, alcohol or some foods.
Symptoms include redness and warmth on the skin of your face, neck, shoulders and upper chest, a pounding heartbeat and sweating followed by a slight chill. Hot flashes may last a few seconds or as long as 30 minutes. Most last no longer than two or three minutes. Hot flashes are most troublesome at night and interrupt your sleep.

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What is the treatment for hot flashes?

If your hot flashes are mild and infrequent, use a fan or sip a glass of cool water or juice when a hot flash begins. Some natural remedies may help give some relief of hot flashes. For example, soybeans contain isoflavones, which are similar to the hormone estrogen. If your hot flashes are frequent and severe, and if you have night sweats severe enough to keep you from sleeping, your healthcare provider may suggest some hormone therapy. This treatment involves taking the two hormones estrogen and progesterone if you still have your uterus. You may take estrogen without progesterone if you no longer have your uterus. The hormones can be prescribed as pills that you swallow, skin patches, creams, vaginal suppositories, vaginal rings, shots, or pellets placed under the skin. Depending on your age, treatment with estrogen and progestin may increase the risk for heart disease. It may also increase your risk for stroke, breast cancer, blood clots, some gallbladder problems, and possibly dementia. Also, estrogen taken without progestin increases the risk of uterine cancer if you still have your uterus. Discuss the risks and benefits with your healthcare provider. Other medicines your provider may prescribe are Catapres (clonidine) or Bellergal, a medicine that contains Phenobarbital. Talk to your provider about what might be the best treatment for you.

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My spouse and I are thinking about permanent sterilization. What should we know before making a decision?

Sterilization is a big decision and should not be done on a whim. While people choose sterilization for various reasons, you should be certain that you do not want children in the future, as attempts to reverse the procedure may not work and are very costly. In addition, many insurance carriers do not cover the reversal process. Take
time to learn about your options. There are many short-term birth control methods on the market today, such as birth control pills, IUDs, injections and various barrier methods that are very effective, which you can use until you decide.

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What is amenorrhea?

Amenorrhea is when a woman does not have her periods. There are two kinds of amenorrhea. The first kind is when you haven’t had your period at all by the time you are 16 years old. The second kind is when you are used to having periods and you stop having them for three months in a row.
If you’ve never had periods you may have late puberty. This may happen if you are very thin or very athletic. Some other causes may be that you have a hormone problem or there may be problem with your uterus, vagina or ovaries. It’s a good idea to get a check-up. Your healthcare provider can make sure you do not have any of these problems.

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What can be done to prevent missing a period?

To keep your periods normal, it is important to stay healthy. Eat and exercise to keep a healthy weight. Don’t use alcohol or street drugs. Medicines like sleeping pills can also make your periods stop. Don’t smoke. Get the help you need to lower stress and problems in your life. Talk to friends, family, or a counselor for support. Try to balance your work, play and rest.

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Pregnancy Topics

What is prenatal care?

Prenatal care is the care you receive when you are pregnant. It includes care given by your healthcare provider, support from your family and an extra focus on giving yourself the care you need during this special time. Good prenatal care gives you the best chance for a healthy pregnancy and healthy baby.

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What are prenatal exams, tests and procedures?

Various exams, tests, and procedures are a part of your checkups during pregnancy. Prenatal tests can help both the baby and the mother. Some tests check for diseases that the mother may have so she can be treated. Other tests look for birth defects. Still other tests are used to confirm the age, weight and health of the baby. Some tests are routine and usually done for all pregnant women. Other tests are optional and usually done only if concerns or problems arise and you agree to having them.
At each visit your healthcare provider will discuss with you any problems you are having, such as headaches, swelling of your hands or feet, contractions, or bleeding. Keep all of your appointments. Regular checkups with your provider allow prevention and early detection of any problems. Your provider can then adjust the plan for your care as needed.

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What are the routine tests and procedures?

The routine tests and procedures done during prenatal visits include: urine or blood test at your first visit, pelvic exam to determine the size of your pelvis and a Pap test of the cervix (usually done only very early in the pregnancy), physical exam including a breast exam, calculation of the gestational age of the baby, measurement of your height, weight and blood pressure, tests of a sample of your urine to look for bacteria, measurement of the height of the fundus (top of your uterus), determination of the size and position of your baby, test of a sample of your urine to look for bacteria in the urine, blood tests to check for anemia, blood tests to check for diabetes when you are 28 weeks pregnant, blood tests for blood type and RH antibodies and to see if you are immune to rubella (a type of measles), blood test for sexually transmitted infections, cultures of cells from your cervix to test for infection, blood test for hepatitis, skin test for tuberculosis, cultures of swabs of the vagina and rectum to test for Group B streptococcus in the 35th and 37th weeks of pregnancy, examination of your ankles and lower legs for swelling.

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When should I see my healthcare provider?

Good care during pregnancy includes regularly scheduled prenatal exams. You should schedule your first prenatal visit with your provider as soon as you think or know that you are pregnant. Depending on your health and health history, your provider will then schedule visits at least once a month for the first six months. During the seventh and eigth months you may see your provider every two weeks and during the last month once a week until your delivery date. If you are over 35 or your pregnancy is high risk because you have certain health problems, your provider will probably want to see you more often. In some cases your provider may refer you to a medical specialist for more help with special needs such as diabetes.
Your healthcare provider will check at each visit to make sure that you and the baby are healthy. By seeing you regularly, your healthcare provider has the chance to find any problems early so that they can be treated as soon as possible. Other problems might be prevented. In addition to meeting your medical needs, your provider will help you know how to take care of yourself, including having a healthy diet, getting plenty of exercise and rest, and dealing with the emotional changes that can happen during pregnancy.

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What will happen at the first prenatal visit?

Your first visit may be as long as an hour. Your provider will ask for history of your health, the father’s health, your family’s health, and the health of the father’s family. This information can help give your provider an idea of any problems you might have during your pregnancy. You will have a physical exam, including checks of your height, weight and blood pressure and a pelvic exam. You will have a Pap test, urine tests, blood tests, tuberculosis tests, and cultures of the cervix and vagina.
Your provider will calculate your due date and the age of your baby. How the pregnancy is going can be judged as normal or abnormal only when the age of your baby is clearly known. If your periods were regular before you became pregnant, and you are sure of the first day of your last period, your due date will be estimated to be 40 weeks from the day you started your last period. Your provider will talk to you about how to stay healthy during your pregnancy.

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What will happen at other prenatal visits?

Your provider will check how you are doing and how the baby is developing. He or she will discuss how you are feeling, ask if you have any problems, and answer your questions. During each prenatal visit your provider will weigh you, take your blood pressure, check your urine for sugar, protein, or bacteria, check your face, hands, ankles, and feet for swelling, listening to the baby’s heartbeat, measure the size of the uterus to be sure the baby is growing well. At different times during the pregnancy, additional exams and tests may be done. Some are routine and others are done only when a problem is suspected or you have a risk factor for a problem. Examples of other tests you might have are: chrionic villus sampling of cells from the placenta between the 10th and 12th weeks of pregnancy for information about your baby’s chromosomes and detection of some birth defects, amniocentesis between the 15th and 18th weeks for testing of the fluid around the baby for chromosome information and detection of some birth defects, blood tests, such as the triple or quad screen tests, to check for genetic problems or birth defects, ultrasound scans to check the baby’s growth and health and to look at your uterus, the amniotic sac, and the placenta, blood tests to check for diabetes, nonstress tests that use electronic monitoring to check the health of the baby, and other types of tests using electronic monitoring to check the baby.

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What meds can I take in pregnancy?

It is best to not take any medications but acetaminophen (Tylenol) in the first 14 weeks of pregnancy. If you need symptom relief here are some medications that are safe to take when pregnant. For a stuffy, runny nose: Chlorpheniramine, Diphenhydramine (Benadryl). The side effects of those two medications include drowsiness and dry mouth. Pseudoephedrine HCL (Sudafed) which keeps you awake at night. Also, saline spray may help and is totally safe. For cough: cough medicine with the expectorant guaifensin. Other ingredients are not safe to use. If you cannot sleep due to your cough, consider calling for a prescription medicine with a narcotic cough suppressant. Cough drops with natural ingredients like menthol are safe. Also try half and half honey and lemon juice.
For fever, headache, or muscle aches take acetaminophen (Tylenol). Do not take aspirin or ibuprofen. Do not let your fever go above 101 degrees. For sore throat: non-medicated throat lozenges are fine. Try acetaminophen for the pain and try gargling with salt water. For nausea: Vitamin B-6, Emetrol, Ginger, Seaband acupressure bands, Acupuncture, and take prenatal vitamins with dinner, not in the morning. It is important to avoid severe dehydration. For heartburn: Tums are safe to try. For diarrhea: Avoid dehydration by drinking plenty of fluids, eat easily digestible foods like white bread, bananas, applesauce and white rice. Also, Kaopectate is safe to use. Do not use Pepto-Bismol when pregnant.

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What is all the hype about folic acid in pregnancy?

Folic acid can help reduce the risk of neural tube defects; including spina bifida, a birth defect in which the bones of the spine do not form properly around the spinal cord, and anencephaly, a disorder involving the incomplete development of major parts or all of the brain. Because of this, all women of childbearing age should take 0.4mg of folic acid daily. If you cannot consume enough folic acid through your diet, you should take supplements. Foods high in folic acid are: dark leafy greens/vegetables, whole grain bread/cereals, citrus fruits/juices, dried pea/beans and folic acid-fortified breakfast cereals.

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What signs and symptoms of pregnancy will my healthcare provider check?

Your healthcare provider will look for various signs of pregnancy and ask about your symptoms at different stages of your pregnancy. These signs and symptoms include: nausea, fatigue, breast tenderness or enlargement, and urinary frequency in early pregnancy, an embryo that can be seen in an ultrasound scan as early as five to six weeks after your last period, enlarged uterus at about 6 to 8 weeks, enlarged abdomen at about 14 weeks, parts and movements of the baby that can be felt by your healthcare provider at about 18 weeks, the baby’s heartbeat heard by a Doppler fetoscope at 12 to 14 weeks, or by an ordinary fetoscope at about 19 weeks, movement by the baby felt by you at about 20 weeks if this is your first pregnancy, or as early as 16 weeks if you have been pregnant before, changes in the color of your vagina, cervix, and skin.

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What is gestational age?

Gestational age is the age of an unborn baby, or fetus. It is measured in weeks and days and is based on the date of your last menstrual period. Your healthcare provider will talk about your pregnancy in terms of weeks, not months. There are three stages of each pregnancy, called trimesters. The first trimester is from the 1st week through the 13th week. The second trimester is from the 14th through the 27th week, and the third trimester is from the 28th week to delivery.

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Why is it important to know the gestational age?

At specific stages of the pregnancy, certain things are expected. For example, first hearing the heartbeat, or feeling the baby move, is expected to happen at a certain time of the pregnancy. How the pregnancy is going can be judged as normal or abnormal only when the age of your baby is correctly known. It is very important to know your baby’s age if problems occur and the baby needs to be delivered early. It is also important to know when a baby is overdue so the health of the baby can be more carefully watched.

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How is gestational age calculated?

The age of your baby and your due date may be calculated from the date of your last menstrual period. If your periods were regular before you got pregnant, and you are sure of the first day of your last period, your due date is estimated to be 40 weeks from the day you last started your period. An early exam of the uterus and an early positive pregnancy test also can help determine your baby’s age.
Ultrasound can be used to confirm your baby’s age. The baby can be measured with ultrasound as early as 5 or 6 weeks after your last menstrual period. This method is most accurate in the first half of the pregnancy. The best time to date a pregnancy with ultrasound is between the 8th and 18th weeks of pregnancy.
If you have had a special procedure to become pregnant, such as artificial insemination or in vitro fertilization, you will know when your baby was conceived. In these cases there is no doubt about the baby’s age.
It can be hard to determine accurately a baby’s age and your due date if: your periods were irregular, you cannot remember your last period, the baby is unusually large or small, the due date based on the last menstrual period does not correspond with the size of the uterus early in pregnancy or with measurements of your uterus later in pregnancy.

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What foods do I need to eat?

Eating regular, well-balanced meals is more important when you are pregnant than at any other time of your life. What you eat provides food for you baby as well as yourself.
You need about 300 more food calories a day than when you were not pregnant. Most pregnant women need about 2200 to 2700 total calories each day. Your healthcare provider will suggest a range weight that you should gain. The usual recommended gain is about 20 to 25 pounds.
Your need for protein increases to about 60 grams a day when you are pregnant. Many women already eat this amount of protein daily when they are not pregnant. However, if you are a vegetarian or eat little meat or dairy, you may not be getting enough protein in your diet. You may also need more vitamins and minerals, especially folic acid and iron. These nutrients are important for your baby’s growth and development. They give your baby strong bones and teeth, healthy skin, and a healthy body.
Foods that are excellent sources of protein and vitamins are: beans and peas, nuts, peanut butter, eggs, meat, fish, poultry, cheese, milk and yogurt.
Good sources of folic acid (also called folate) are: leafy green vegetables, broccoli, asparagus, fortified breakfast cereals and grains, beans, oranges and strawberries, yellow squash, tomato juice.
Foods rich in iron are: lean red meat, pork, chicken and fish, fortified cereals, dried fruit, leafy green vegetables, beans, eggs, liver, kidneys, whole-grain or enriched bread.

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Is it okay to eat fish during pregnancy?

Fish and shellfish are an important part of a healthy diet. They contain high-quality nutrients. They are low in saturated fat and contain omega-3 fatty acids that can contribute to heart health.
However, nearly all fish and shellfish contain traces of mercury. Some fish and shellfish contain higher levels of mercury that may harm an unborn baby’s developing brain and nerves. The Food and Drug Administration (FDA) advises women who may become pregnant, pregnant women, nursing mothers and young children to avoid some types of fish with high mercury levels. Instead, they should eat fish and shellfish that are lower in mercury.
Here are some guidelines for eating fish and other types of seafood:
Do not eat shark, swordfish, king mackerel, or tilefish (white snapper) because these fish contain high levels of mercury. Do not eat more than six ounces of canned white (albacore) tuna, tuna steak, or halibut each week. Do not eat more than two servings or a total of 12 ounces of fish each week. Choose shrimp, scallops, salmon, pollock, cod, catfish, or light canned tuna. These types of fish and seafood contain less mercury. Eating oysters and clams may increase your risk for infection. Do not refrigerate smoked seafood unless it is contained in a cooked dish, such as a casserole. Check local advisories about the safety of fish caught in local lakes, rivers and coastal areas.

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What about heartburn during pregnancy?

For heartburn you should: eat five or six small meals a day. Avoid foods that commonly cause symptoms such as spicy and fried foods, orange and grapefruit juices. Cut down on soft drinks, chocolate, coffee and other drinks with caffeine. Instead, drink water, milk, and apple or cranberry juice. Don’t lie down for at least one to two hours after you eat. If heartburn gets worse when you lie down, raise the head of your bed four to six inches. Ask your healthcare provider which antacids you can take.

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What is morning sickness?

Many women have morning sickness during the early months of pregnancy. In most cases, symptoms of nausea and vomiting are less common by the second trimester. In early pregnancy, the changes in your body can cause you to feel nauseated when you eat or smell certain foods or when you get tired or anxious. It may help if you eat crackers, pretzels or dry cereal before you get out of bed in the morning. Eat small meals often. Avoid greasy, fried or spicy foods that may upset your stomach. Drink plenty of liquids, but between meals rather than with them. Try crushed ice, fruit juice, or fruit-ice pops if water makes you feel nauseous. Avoid unpleasant odors and get enough rest. Ginger has been shown to help some women have less nausea, but you should talk to your healthcare provider about this before you add ginger to your diet.

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Is it okay to exercise during pregnancy?

It is not only okay to exercise during pregnancy, but it is encouraged.
The American College of Obstetrics and Gynecology recommends healthy
pregnant women get 30 minutes of moderately vigorous activity most days of the week.

Exercise tips:

  • Increase your daily activities (walk more, use stairs)
  • The best exercise is the one you enjoy (sports, walking, running, swimming, aerobics, yoga, Pilates)
  • Use the talk test to gauge intensity. If you can talk during activity, it is not too intense
  • As your body changes, you may have to change activities
  • Have fun

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18 week ultrasound instructions

Ultrasound technology has been available since the 1970’s. Ultrasound is a safe procedure that has been used to diagnose and detect fetal problems, allowing for prompt treatment to be available at the time of delivery if needed. Advances in ultrasound technology have revolutionized modern obstetics. At Greenville OB/GYN we have excellent ultrasound capability, allowing us to diagnose many (not all) conditions as well as provide your baby’s first picture. It is recommended that all moms have an ultrasound exam between 16-18 weeks of pregnancy. At this time, measurements will be made of your baby’s head, abdomen and legs. We will also look at the brain, heart, spine, kidneys, and bladder. Measurements can allow us to confirm your due date with the one given to you at the beginning of the pregnancy. Many times we can also see the sex of the baby so let us know if you do or do not want to know.
To prepare for your ultrasound, please start one hour and fifteen minutes before your appointment by empting your bladder. Then drink 16 ounces of water or another beverage. Make sure you finish this amount at least one hour before the appointment. Your bladder will be quite full and may be uncomfortable, but it really helps us to see the baby. We try to run on time for all OB ultrasounds, but please let us know if you can’t hold it anymore. Partners and other family members are welcome to come in for the ultrasound. Finally, ultrasound pictures will yellow and fade with time. To have long-term copies, bring them to Kinko’s and have color copies made, they come out great and last for a long time.

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Are there risks with 3D or 4D?

No. 3D and 4D Ultrasound utilize sound waves to look inside the body, technology similar to radar.  A probe placed on the body emits sound waves into the body, listens for the return echo and then generates an image.

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What is a 4D ultrasound?

4D means 4-Dimensional–the fourth dimension being time.  4D Ultrasound, the latest in ultrasound technology, combines 3D picture with time, resulting in “live action” images of the unborn child.

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When is the best time to have a 4D?

This optional service is best performed around 27 to 30 weeks gestation and affords an opportunity to obtain three and four dimensional images of your baby, particularly of it’s face and heart.  The study provides an opportunity for you to see your child’s growth and development early in the third trimester and to look for heart and facial defects that might not be apparent in the routine ultrasound offered at 18 weeks of gestation.

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How long is a 4D ultrasound?

There are many factors that impact the length of an ultrasound, including the position of the baby in the womb.  A typical ultrasound exam for an expectant mother will last approximately 20-40 minutes.

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What are the advantages of a 4D ultrasound?

In contrast to 3D imaging diagnostic processes, 4D imaging affords Dr. Hale the ability to visualize internal anatomy as it is moving in “real-time.”  The movement patterns of fetuses help physicians to draw conclusions about the fetal development.  Also, 4D imaging increases the accuracy of ultrasound-guided biopsies thanks to the visualization of the needle movements in “real-time” in three planes.  With 4D imaging, physicians and sonographers can now detect or rule out issues, such as anomalies and genetic syndromes.

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What about the postpartum blues?

More than 50 percent of women experience postpartum blues on the third or fourth day after delivery. The symptoms include tearfulness, tiredness, sadness and difficulty in thinking clearly. The main cause of this temporary reaction is probably the sudden decrease of maternal hormones. Since the symptoms commonly begin the day the mother comes home from the hospital, the full impact of being totally responsible for a dependent newborn may also be a contributing factor. Many mothers feel let down and guilty about these symptoms because they have been led to believe they should be overjoyed about caring for their newborn. In any event, these symptoms usually clear in one to three weeks as the hormone levels return to normal and the mother develops routines and a sense of control over her life.
There are several ways to cope with the postpartum blues. First, acknowledge your feelings. Discuss them with your husband or a close friend as well as your sense of being trapped and that these new responsibilities seem insurmountable. Don’t feel that you need to suppress crying or put on a “supermom show” for everyone. Second, get adequate rest. Third, get help with all of your work. Fourth, renew contact with other people; don’t become isolated. If you don’t feel better by the time your baby is one month old, see your healthcare provider about the possibility of counseling for depression. If the blues are making it impossible for you to care for yourself and your baby, get help as soon as possible.

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What is postpartum depression?

After childbirth, many mothers feel more emotional. They may feel sad, afraid, or angry. This is called postpartum blues or the baby blues. For most women these postpartum blues are mild and go away within a week. Postpartum depression lasts longer and is more severe. About 10 to 20 percent of women, especially very young mothers, have the more severe form.
Postpartum may develop within a few days to a few weeks after giving birth or having a miscarriage. For about 60 percent of women, it is your first episode of depression. While hormone changes after giving birth seem to play a part, the full causes are not known. Risk factors that increase your chances of getting postpartum depression are: having been depressed sometime before you got pregnant, having been depressed after the previous pregnancy, having family members who were depressed, especially after pregnancy, returning home with your baby to a very stressful home or relationship, having a baby with health problems or who cries often, having a miscarriage late in pregnancy or a stillbirth. If your pregnancy was unwanted you are also at risk for post partum depression.
Besides feeling sad and uninterested in activities, you may also: feel unable or unwilling to care for you baby.

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Infertility Topics

My husband and I have been trying to get pregnant for the past six months without luck. When should we seek medical help for infertility?

Approximately fifteen percent of couples in the United States struggle with infertility and are unable to get pregnant. Typically, infertility is diagnosed after twelve months of trying to conceive without the use of birth control. I would encourage you and your spouse to keep trying. If you aren’t pregnant after six more months, you may want to see Dr. Hale and have an infertility evaluation. Tests can be done to find the cause of
Infertility after which you can discuss treatment options if necessary.

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What is infertility?

Infertility is usually defined as not being able to get pregnant after trying for at least one year. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile. Infertility is a problem for one of every six couples. It can be caused by problems in a man’s or woman’s reproductive system. Problems in the woman’s body are responsible for about half of the cases of infertility.
Often the reason for infertility in a woman is that her ovaries are not releasing eggs. For example, when a woman gets older, the ability of the ovaries to release healthy eggs declines, especially after the age of 35. Other things that may affect the eggs and the release of eggs (ovulation) are: hormone problems, overweight or underweight, smoking, too much stress, unhealthy diet, ovarian tumors or cysts, intense exercise, abuse of alcohol or drugs, tumors in the pituitary gland, chronic illness, such as diabetes and some medicines.
A woman who is not ovulating normally may have irregular or missed menstrual periods.
An abnormal or damaged fallopian tube or uterus can be another cause of infertility. When an egg is released, it must pass through a fallopian tube to the uterus. A man’s sperm must join with (fertilize) the egg along the way. The fertilized egg must then attach to the inside of the uterus. A fallopian tube or uterus may be damaged by an infection, such as a sexually transmitted disease, a birth defect in the female organs, growths in the uterus, such as polyps or fibroids, scar tissue from surgery (called adhesions), endometriosis which is tissue from the uterus growing outside the uterus, DES syndrome, which you may have if your mother took the medicine DES when she was pregnant with you.
You may have problems with your cervix that make it hard for the sperm to reach and fertilize the egg, such as cervical stenosis (a cervix that is very narrow or closed), abnormal cervical mucous, cervicitis, which is inflammation or infection of the cervix.
In rare cases, a woman’s body is allergic to sperm and destroys it. Some rare genetic problems also cause infertility. Thirty percent of infertility cases have no known cause.

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How is infertility diagnosed?

You and your partner will have thorough exams. You will be asked about: your sexual history, including previous pregnancy, miscarriage, or abortion, your medical and family history, your diet and exercise habits, stress, your use of drugs, alcohol and tobacco, your sexual intercourse practices, such as how often you have sex and whether you use lubricants. You may need to find out if you are ovulating each month. Your healthcare provider can tell you how to take and chart your body temperature each morning. Your temperature will rise after ovulation. You can buy kits at the drugstore that can help predict ovulation. Blood test and an ultrasound of the ovaries can also be used to see if you are ovulating.
Other tests that may be done are: urine and blood test to check for infections and a hormone imbalance, test of samples of cervical mucus and tissue from the lining of your uterus, tests of your partner’s semen to check the number and quality of sperm in the semen.
You may have the following procedures to check for a blockage in your tubes or uterus, scar tissue, or endometriosis: hysteroscopy, laparoscopy, hysterosalpingogram.

About Us

Scottsdale North Obstetrics, Gynecology & Wellness Center is a full service practice, which includes consultation, screening and referral for a full range of treatments. We will provide care without regard to race, creed, religion, color, gender, national origin or economic status. We treat all patients and their families with compassion and consideration and provide a physical environment and facility which is attractive and conducive to patient care and comfort. Please make an appointment to see Dr. Hale today. You will enjoy his compassionate, experience, and friendly approach.

9070 E Desert Cove Ave
Building A - # 103
Scottsdale, AZ 85260
Phone 480-946-4774
Fax 480-946-4999