Gyn & Fertility Specialists - DNU  
Frequently Asked Questions
Frequently Asked Questions
Healthcare Services

All of the following are available at GYN & Fertility Specialists:
-Routine checkup and physical examination.
-Routine blood work including checking for anemia, cholesterol, and blood sugar.
-Infertility workup.
-Diagnosis and treatment of pelvic endometriosis, which is common for patients who are trying to conceive.
-Diagnosis and treatment of fibroid tumors by medications or surgically (Robotic and conventional Laparoscopic Myomectomy and Hysterectomy as an outpatient procedures).
-Robotic Laparoscopic reversal of tubal ligation (Outpatient procedure).
-Management of heavy menstrual cycles either medically or surgically.
-Intrauterine insemination (IUI).
-Office ultrasound by updated 3D, 2D and color Doppler equipment.
-Ovulation induction program with the most recent programs.
-Management and treatment of abnormal pap smear.
-Management and treatment of acute and chronic abdominal and / or pelvic pain.
-Management and treatment of urinary incontinence (Leakage of urine) medically or surgically.
-Family planning with the most updated methods of contraception.
-Treatment and follow up for osteoporosis.

Fertility Problems


It is not unusual for couples to have problems when they are trying to have a child. If a woman is unable to become pregnant after a year of unprotected intercourse, it may be necessary for a physician to define the problem and take steps to correct it.

Forty percent of the time the inability to become pregnant can be due to the problems of both partners. In the remaining 60% of the cases, the problems may be evenly divided between men and women - 30% are male problems; 30% are female.

The female reproductive system involves different organs that are stimulated by chemical messengers called hormones. Glands such as the hypothalamus, the pituitary, the thyroid, and the ovaries produce several different kinds of hormones that prepare the reproductive system for pregnancy each month.

Each month, the cycle is started by a series of hormones from the hypothalamus and the pituitary that signal the ovaries to begin ovulation (release an egg). About 20 of the 300,000 egg follicles within the ovaries begin to mature in preparation to release an egg. Usually only one follicle fully matures and releases its egg; the other follicles degenerate.

The released egg enters the fallopian tube nearer to the ovary in which the egg was generated and slowly travels toward the uterus. If sperm are present in the fallopian tube, the egg may become fertilized.

Once the egg is fertilized, it continues down the fallopian tube into the uterus where it is implanted in the inner wall, called the endometrium, and begins to grow into a fetus.

Although there can be many reasons why a woman can fail to conceive, three primary causes have been identified:
? Failure to ovulate regularly
? Structural or mechanical problems
? Cervical and/or uterine abnormalities

Irregular Ovulation
The most common cause of female fertility problems is a failure to ovulate regularly or failure to ovulate at all. This problem can often be traced to hormonal imbalance. One type of hormonal imbalance occurs naturally: as a woman ages and approaches menopause, her reproductive hormones tend to diminish and she naturally tends to ovulate less often. This makes women in their 30s and 40s less fertile than those in their 20s.

Other common, hormonal imbalances that disrupt ovulation include:
? A pituitary gland problem, such as elevated levels of prolactin (a hormone that both stimulates breast milk production and blocks ovulation).
? A pituitary tumor that inhibits the release of hormones necessary for ovulation.
? Problems with the adrenal gland leading to increased levels of androgen, a hormone that interferes with ovulation.

In addition, factors such as stress, cigarette smoking, overexercising, nutritional deficiencies, use of certain medications, or being overweight or underweight can easily alter the delicate hormonal balance needed to ovulate.

Finally, disorders of the ovary, such as an ovarian tumor or a cyst, may lead to irregular ovulation or no ovulation.

Structural or Mechanical Problems
Damage to reproductive organs is responsible for a significant proportion of female fertility problems. Pelvic inflammatory disease, a frequent result of sexually transmitted infections, can cause scar tissue that blocks the fallopian tubes and prevents the sperm from reaching the egg.

Structural and mechanical problems may also be caused by endometriosis. This is a common condition in which tissue resembling the interior of the uterus is found on other parts of the body, usually the reproductive organs. This tissue can interfere with release of the egg or block the egg as it travels through the fallopian tube toward the uterus. Endometriosis is the cause of fertility problems in as many as 40% of women who have the condition.

Less common are disorders present at birth, such as a malformed vagina or uterus or the absence of one or both fallopian tubes.

A number of women with fertility problems have abnormal reproductive organs because their mothers took a drug called DES (diethylstilbestrol) while pregnant. DES was given to pregnant women between 1940 and 1971 in the belief that it might help prevent miscarriages.

Cervical and Uterine Problems
Cervical and uterine abnormalities are also responsible for an inability to conceive. These disorders, however, are not as common as hormonal and structural difficulties.

A hostile environment in the cervix, such as poor or abnormal mucus production or a bacterial infection, can actually kill or immobilize sperm so they cannot fertilize an egg. In rare cases, the female may actually be allergic to her partner's sperm; her antibodies will attack or immobilize the sperm in the cervix.

In the uterus, benign (non-cancerous) tumors called fibroids can prevent the fertilized egg from being implanted and interfere with the development of the fetus. In rare cases, the lining of the uterus becomes inflamed and interferes with the growth of the fertilized egg.

Psychological problems play a smaller role in fertility problems than was once believed. The emotional strain of trying to become pregnant can indeed disrupt the delicate hormonal balance needed for ovulation and pregnancy to occur. However, psychological problems are more often a result of the failure to become pregnant than a direct cause.

In approximately a third of all couples experiencing fertility problems, the male partner may be the source of the problem. These are some common causes of male fertilty problems:

Pituitary failure; Thyroid disorders; Adrenal disorders.

Genital Disease
Infection (gonorrhea, other sexually transmitted diseases); Injury to testes; Hydrocele (fluid accumulation in the scrotum); Orchitis (inflammation of the testicles); Prostatitis (inflammation of the prostate gland).

Low sperm count; Defective sperm; Impotence; Ejaculatory disorders; Undescended testicles; Varicocele (a swollen vein in the testicle, reducing sperm count); Underdeveloped testicles.

Overweight; Underweight; Excessive smoking; Excessive alcohol use; Chromosomal abnormality (Klinefelter's syndrome); Stress.

A woman's age at the time a fertility problem is suspected should determine when medical help is necessary. Older women should seek help earlier than younger women.

Generally, if a woman under the age of 30 has been unsuccessfully trying to conceive for about 2 years, a consultation with a gynecologist or other primary care physician is recommended to determine if the source of the problem lies with the male, the female, or with both partners. Women between 30 and 35, however, should probably wait only 1 year before seeking medical help and those over 35 should visit a physician after 6 months of unprotected intercourse without conception.

The problem usually can be resolved by the gynecologist or other primary care physician without an extensive fertility examination. Very often the failure to achieve pregnancy is due to a nonmedical problem, such as poor timing of intercourse.

If a complete fertility workup is necessary, the gynecologist or other primary care physician will test both partners or refer the couple to a fertility specialist for this workup. The specialist will test both partners and attempt to diagnose and correct their particular fertility problems.

Hope For Couples Who Want A Child
The cause of a fertility problem can be determined in approximately 90% of couples; in the remaining 10% the reason underlying the inability to conceive is extremely difficult to explain. Drug or surgical treatments, or a combination of both, and changes in lifestyle (for example, reducing stress or altering dietary patterns) are often effective in helping to achieve pregnancy. Today, in fact, there is more hope for couples to conceive a child than ever before.

Fertility Solutions

You had your tubes tied, burned, or clamped and your current social status has changed for one reason or another and you want to have a baby. We have the answer for you. We can reverse your tubes successfully.

How It's Done
Tubal reversal is done through a bikini cut in the lower part of the abdomen. By using a special micro instrument, operative microscope and very fine absorbable (dissolves by itself) sutures, the scarred part of the tubes will be removed and the two ends of the tubes will be connected together with fine sutures, then the tubes will be tested by a special dye. The small incision in the abdomen will be closed by subcuticular (under the skin) sutures which leave very little scar, if any.

Age Range
This procedure can be performed on any woman forty five years of age or younger.

The patient's husband needs to be sure that he is fertile and that his sperm count is good. The patient can bring her husband to her office visit and watch a video of Dr. Hanafi's actual surgery. We can do a semen analysis in the office, which takes about 45 minutes.

We have had very good success of pregnancy after this procedure, especially so in the recent past due to the advancement of the instruments and equipment and experience due to the increasing demand for tubal reversal.

Length of Stay in the Hospital
The patient is admitted the morning of surgery. This is an open abdomen surgery which takes about 2 hours. Average length of stay in the hospital is two days, including the day of surgery.

How Much Time to Take off Work
It depends on the nature of the work, but it averages 3 to 4 weeks.
No heavy lifting for 3 to 4 weeks.

Dr. Hanafi requires the use of contraception for at least 3 months after the surgery to avoid the risk of having an ectopic (outside the uterus) pregnancy.

is specifically tailored for those patients who are unable to conceive because their ovaries are not functioning well, and are not producing an egg in a monthly fashion, as normally they would do. Treatment can be accomplished by medication. This medication can be given in two ways:

I. Oral medication called clomid or serophene at the dosage depending on each individual's condition. This medication usually is given for 5 days, starting on the third day of the menstrual cycle. An ultrasound will be performed 4 days after the course of medication is completed. The ultrasound is to measure the size of the follicle (a collection of fluid around the predicted egg on the ovary). If the size of the follicle is mature enough for the egg to come out, then an injection of hormone will be given to the patient at that time to trigger the production of that egg from the follicle. The egg will come out from the follicles (of ovulation) in 36 hours from the time the injection is given.

II. A course of hormonal medication by injection in the muscles. These courses of injection are tailored to each patient's condition. At the end of the course of hormone injections, like the injections explained above in number I., another injection of hormone will be given to the patient to trigger the egg to come out of the follicles (ovulation in 36 hours).

I usually advise my patients to have sexual relations or artificial insemination (either by husband specimen or a donor specimen) 36 hours after the injection that triggers ovulation.

A blood test will be done a week from the time of the injection to make sure a certain hormone, called Progesterone, is at an adequate level. These measurements give us an idea about the lining of the uterus, which will hold the fertilized egg to settle and implant in the uterine cavity where the baby grows to full maturity. The ovulation induction program is specially targeted to those patients who are not passing an egg monthly at all, or are producing an egg in an irregular fashion.

Video Operative Laparoscopy is usually performed under general anesthetic. Occasionally a regional, or local anesthetic maybe used. Once the anesthesia has taken effect, a small incision is made in the lower edge of the navel. This is why laparoscopy is sometimes called "belly button surgery." A second, smaller incision may be made in the lower portion of the abdomen as well. A harmless gas is injected into the abdomen, to lift the abdominal wall. Then the laparoscope is inserted. An instrument, called a cannula, may also be inserted into the cervix, so that the physician can move the uterus.
When the examination and /or treatment is completed, the gas is released from the abdomen and the laparoscope is removed. The small incision is closed with sutures and covered with an adhesive bandage, then the patient goes to the recovery area where the anesthesia will wear off and the patient will then be discharged the same day.

We attach equipment to the laparoscope, and we use the laser to dissolve endometriosis, cut adhesions (fibrous bands), unblock the. tubes, remove ovarian cysts, etc.

Routine checkup, fertility workup, diagnosis and treatment of endometriosis such as medication and surgery, diagnosis and treatment of fibroid tumor with medication or surgery, tubal reversal by Microsurgical technique. Dr. Hanafi has performed several hundred of these procedures since 1979.

Also available: management and treatment of irregular or heavy periods including medication and hysteroscopic surgery, artificial insemination of donor specimen, estrogen replacement therapy, office ultrasound (abdominal or vaginal route), ovulation induction program (fertility) by mouth or injectable, management and treatment of abnormal Pap smears including office laser treatment or LEEP procedure, management and treatment of acute or chronic abdominal and/or pelvic pain by medication or surgery if needed, management and treatment of urinary incontinence by medication, biofeedback, and/or surgery, family planning. Treatment and follow-up of osteoporosis.

For information regarding your health, especially gynecological or infertility, please call our office. Our staff is available to supply you with all of this information. I always appreciate you allowing me to be your physician and to contribute to the healthcare, which you need and deserve.

Care Philosophy

I cannot emphasize enough the importance of an annual checkup: Pap smear for females over eighteen years of age, mammogram if you are over 40, and occult blood in the stool if you are 50 or over. Regular yearly cholesterol and total lipid profile are essential to maintain a good healthy heart and blood vessels to reduce your chances of having a heart attack, stroke and hypertension.

Preventive medicine is the key to staying in good health. When any abnormalities are discovered early, they can be easily treated to avoid the development of diseases such as heart disease, hypertension, kidney disease, or stroke. Having a mammogram can detect abnormalities such as fibrocystic changes or early cancer of the breast, so they can be treated early with a very high cure rate. Occult blood in the stool is essential to detect any colon or rectal cancer in the early stages. This can be easily done and is not expensive.

I urge every person to put her health as her first priority in life.

All of the following are available at GYN Fertility Specialists:

? Routine check ups and pap smears.

? Family planning including birth control pills and injectable medication every three months (Depot Provera).

? Infertility workup.

? In office ultrasound (abdominal and vaginal route).

? Diagnosis and treatment of endometriosis including medications and surgery.

? Diagnosis and treatment of fibroid tumors including medications and surgery.

? Tubal reversal by microsurgery (Dr. Hanafi has done several hundred of these procedures since 1979).

? Ovulation induction program (fertility drugs, oral and injectable medications).

? Artificial insemination by husband or donor specimen.

? Management and treatment of irregular or heavy periods including medications and hysteroscopic surgery.

? Management and treatment of acute or chronic abdominal and/or pelvic pain, including infections, by medication or surgery if needed .

? Management and treatment of abnormal pap smear including office laser surgery or LEEP procedure.

? Management and treatment of urinary incontinence by medication, biofeedback, and/or surgery.

? Hormonal replacement therapy (estrogen treatment for peri and post menopausal women).

? Treatment and follow up of osteoporosis.

For information regarding your health, especially gynecological or infertility, please call our office. Our staff is available to supply you with all of this information. I always appreciate you allowing me to be your physician and to contribute to the healthcare which you need and deserve.