Advanced OB-GYN News

NUTRITION FOR FERTILITY

By Joseph Hazan,M.D., FACOG

NUTRITION FOR FERTILITY

Regular menses and normal weight

is important before conception,

indicating the need to have the

proper nutrition for fertility.

In cases of PCOS

(Polycystic ovary syndrome)

either associated

with obesity or obesity

alone fertility is compromised

and the

chances of conception are decreased.

Therefore weight control

by means of exercise and diet

are helpful in restoring normal

ovulation is very helpful.

The optimal dietary composition

and caloric intake to enhance

fertility function is outlined in a

study of 17,544 married women

over a study duration of eight years.

Reduction of transfats, animal protein

was essential.

Additionally,

vegetables, legumes, high fiber

intake and low glycemic foods are

very helpful.

Vegetable proteins such as beans,

peas and nuts increase the chances

of conception. Use of multivitamin

supplements is very helpful also.

Folic acid, B vitamins in general

are important.

REFERENCE

Chavarro JE, Rich-Edwards JW,

Rosner BA et al. Use of multivitamins,

intake of B vitamin, and risk of

ovulatory infertility.

Fertil Steril. 2o08;

89:668-676.

UTERINE FIBROIDS

By Joseph Hazan, M.D., FACOG

Uterine fibroids are smooth muscle

cell tumors which are benign.

They could be large and multiple.

They are more common during

the forties. 70% of women at age

45 have fibroids detected by

ultrasound.

Black women are twice as likely

to have fibroids than

white women.

The most common symptoms

are heavy periods and pain or pressure.

Treatment is recommended in cases

where heavy bleeding cause anemia or

pain.

Additionally infertility may be the result

of fibroids.

Treatments are medical and at times

surgical as myomectomy.

URINARY TRACT INFECTION

By Joseph Hazan, M.D., FACOG

Urinary Tract Infection is the growth

of pathogen bacteria in the

urinary tract and this can be in

the bladder (cystitis) or in the

kidneys (pyelonephritis).

Half of all females develop a

urinary tract infection at some point.

Most common bacteria found is E. coli.

The incidence of this in

urinary tract infection cases is 85%.

Most common symptoms are frequency,

burning or pain during

or after urination and urgency.

Sometimes bloody urine can be seen.

Some of the same symptoms can be

present in cases of interstitial cystitis

or overactive bladder.

Treatment of the Urinary

Tract Infection should be individualized.

REFERENCE

Hooten TM. Recurrent urinary

tract infection in women.

Int J Antimicrob Agents. 2001;17:259-268

SLEEP PROBLEMS

By Joseph Hazan,M.D.,FACOG

Sleep problems can be related to

falling asleep,

continuation of sleep

or inadequate rest.

It can be related to the quality

of sleep due to sleep

apnea with frequently waking up

or restless leg syndrome.

This can lead

to chronic sleep deprivation

and depression.

It is also found that SDB (sleep

disordered breathing) is much more

common after menopause along with

night sweats and hot flashes.

Besides RLS restless leg syndrome

which can interfere with the

quantity and quality of sleep,

the problems of SRLC (sleep related

leg cramps) which are mostly encountered

during pregnancy,

PLMD

(periodic limb movement disorder)

and PLMS periodic limb movements

of sleep which are more common

after menopause.

SDB Sleep disordered breathing is

mostly associated with obesity and

metabolic syndrome,

high blood pressure and

heart disease and stroke.

FM (Fibromyalgia) causes pain

along with RLS restless leg syndrome and

is related to sleeplessness.

About three fourths of fibromyalgia patients

are women.

RLS can be related to anemia in

some cases.

FOR RESTFUL SLEEP

One of the interventions is going

to bed to sleep at a regular time and

avoiding distractions such as TV

at bedtime, also avoidance of sleeping

on your back, avoidance of alcohol,

caffeine, nicotine and sedatives at

bedtime. Weight loss and exercise

are also helpful.

Snoring, SDB, Sleep apnea and

other issues require testing and

appropriate

management.

HYPERLIPIDEMIA

By Joseph Hazan,M.D.,FACOG

Hyperlipidemia is having abnormally

high blood levels of

fats such as lipoproteins,

triglycerides and LDL cholesterol.

This could be due to hereditary

or intake factors.

One in five women under 44 have

this condition.

About half of women over 65

have this problem.

Women who have this condition

are prone to heart attacks and

500,000 women die every year

in the US due to to heart attacks.

Heart attacks are the leading cause

of death of women in the US.

It is known that 38% of women

die within a year after a heart attack.

Smoking, high blood pressure,

overweight,diabetes, family history are

among risk factors.

Related diseases are atherosclerosis,

coronary heart disease, metabolic

syndrome,carotid artery disease,

abdominal aortic aneurysm,peripheral

artery disease and polycystic ovary

syndrome.

Primary intervention has to do with

lifestyle factors of diet and activity.

Cholesterol intake in the daily diet

should be less than 200 milligrams.

Saturated fat intake should be no

more than 7% of daily calories.

Weight loss and increased physical

activity are most important.

30 grams of soluble fiber intake

daily is recommended.

Transfats should be avoided.

Flaxseed can help lower LDL and

total cholesterol.

Oats, oat bran, red yeast,sitosterol

and sitostanol are natural forms

that can lower LDL cholesterol.

Monounsaturated fats such as olive

oil are beneficial and should be increased.

Dietary and medical consultation

should be arranged.

GLYCEMIC INDEX AND YOUR HEALTH

By Joseph Hazan,M.D., FACOG

Glycemic index (GI) has to do with

how quickly the foods you eat

are broken down into glucose.

Fast is bad and slow is good.

Foods that have a high Glycemic Index

break down into glucose

quickly and cause a sudden surge

in your blood glucose-

blood sugar level.

This causes a big insulin surge or

spike which

then leads to a drop in your blood

sugar and causes you to feel

hungry for more sweet foods.

This, then becomes a vicious cycle,

which causes diabetes and metabolic

syndrome, the leading cause

of illness and death in this country.

What, then, are the High GI foods

we should avoid?

These are:

Snacks and drinks made with

sugar and flour

Breads

Potatoes

Pasta

Rice

Most cereals

Fruit juice

These should be avoided.

Instead, the type of foods that

break down into glucose slowly

and steadily should be chosen.

These are the LOW GLYCEMIC

INDEX foods.

By eating more of these foods you

have a slow and

steady rise in your blood sugar level

and stay full longer and eat less.

This keeps your insulin level in check

and your cholesterol

also tends to improves.

The reason that sugar levels are related

with high cholesterol is because

excess sugar and extra calories

are stored as LDL cholesterol

which is the type that is related to

atherosclerosis, with the increased

risk pf heart disease and stroke.

So, which are the LOW GI foods

we should prefer?

Here is a brief list:

Vegetables ( avoid root vegetables)

Green leafy vegetables are best

Salads

Beans

Legumes

Salmon

Peas

Fruits (avoid dried fruit because

of their high sugar content)

Lean proteins (lean chicken,

turkey, fish, low

fat yogurt and cheese)

Monounsaturated oil (olive oil)

Nuts

Seeds especially flaxseed

THE ISSUE OF FISH

The reason salmon is singled out

is due to the fact that

cold water fish contain OMEGA-3 EFA’s

(essential fatty acids)

and in a 20 year sudy of 20,000

male physicians

who ate fish once a week their risk of

dangerous arrythmias

and heart attack was cut by 50%.

BUILDING BONES

By Joseph Hazan,M.D., FACOG

Your bones are constantly undergoing

turnover. On the one hand some bone

content is being resorbed and on the

other hand more is being built.

Building bones is a normal function

that goes unnoticed.

There is normally a balance between

building and resorbing. When this balance

is upset there could be osteoporosis and

fractures.

If this happens in the vertebrae it causes

the back to be bent over or hump back.

During menopause approximately 35 %

of bone mass can be lost.

To determine this a Bone Mineral Density

(BMD) x-ray is done.

The results are analyzed and reported as

normal, osteopenia (low density)

or osteoporosis (critically low).

Regular physical activity, Vitamin D3

and Calcium intake, and if needed

medical treatment will help

protect your bones.

It is important to avoid smoking,

alcohol, caffeine and steroids.

OSTEOPOROSIS RISK

Joseph Hazan, M.D., FACOG

Osteoporosis risk factors are well

known:

1) Smoking

2) Low calcium and Vitamin D 3 intake

3) Menopause

4) Small body size

4) Steroids and some anticonvulsants

5) Family history

6) Lack of exercise

7) Alcohol intake

8 ) Coffee, soda, caffeine

9) Estrogen deficiency

Tomorrow we will look into the

bone density factors.

TUBAL REVERSAL

By Joseph Hazan, M.D., FACOG

Tuboplasty is the microsurgical

procedure to

accomplish tubal reversal.

Tuboplasty as microsurgical

tubal reanastomosis,

especially of the midsegment has

high success rate.

The vast majority of midsegment

occlusion cases

are due to previous tubal ligation

of different types.

Varieties of tubal ligations include s

egmental tubal

excision,ring sterilization,

clip sterilization and coagulation.

Microsurgical tubal reanastomosis

when successfully performed

has the triple success rate of IVF in

terms of pregnancy.

In terms of reaching the success of

tuboplasty in these cases

three IVF attempts would be needed.

Certainly the tuboplasty

would be more economical,

convenient and less risky for these

cases.

REFERENCES

1) Gordts Sylvie, Campo R, Puttemans P,

Gordts Stephan

Clinical factors determining

pregnancy outcome after

microsurgical tubal reanastomosis.

Fertility and Sterility Vol.92,

No.4, October 2009:

( pages 1198-1202)

2) Boeckxtaens A, Devroey P, Collins J,

Tournaye H.

Getting pregnant after tubal sterilization:

surgical reversal

or IVF? Hum Reprod 2007;22: 2660-4.

3) Cheung AP.

Assisted reproductive technology:

both sides now.

J reprod Med 2006; 51: 283-92.

TUBOPLASTY

By Joseph Hazan,M.D.,FACOG

About a third of female infertility is caused by

tubal factors and endometriosis.

In some cases the tubal problem is

caused by pelvic inflammatory

disease, previous ectopic pregnancy,

obliterative fibrosis, tubal polyps, fibroids,

salpingitis isthmica nodosa ,fimbrial agglutination

or adhesions and hydrosalpinx.

However the most common reason

for tubal infertility is previous

tubal ligation for sterilization.

This could be at the proximal

(close to the uterus), midsegment

(mid-portion) or distal ( the last

third) of the tubes.

Tubal reversal is accomplished by tuboplasty.

Tuboplasty with the use of operating

microscope, loupes results in improved and

precise reapproximation and reanastomosis

of the tubal portions that are undamaged.

Microsurgical reanastomosis has been

successful in most cases with resulting

restoration of fertility in our experience.

In cases where the tubal occlusion is at

the tubocornual segment (the portion

of the tube closest to the uterus),

microsurgical tubocornual reanastomosis

is done.

At the midportion tubal isthmic-isthmic

reanastomosis is done with the greatest

success rate. Tubal isthmic-ampullary

reanastomosis, neosalpingostomy and

fimbrioplasty are performed for more

distant tubal occlusion or obstruction

cases.

Tomorrow we will look at most recent

data on this topic.

Advanced OB-GYN News

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NUTRITION FOR FERTILITY

UTERINE FIBROIDS

URINARY TRACT INFECTION

HYPERLIPIDEMIA

GLYCEMIC INDEX AND YOUR HEALTH

BUILDING BONES

OSTEOPOROSIS RISK

TUBAL REVERSAL

TUBOPLASTY

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