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.
-Diagnosis and treatment of pelvic endometriosis, which is common for patients who are trying to conceive.
and treatment of fibroid tumors by medications or surgically (Robotic
and conventional Laparoscopic Myomectomy and Hysterectomy as an
-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.
WHEN GETTING PREGNANT IS A PROBLEM:
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
HOW DOES PREGNANCY OCCUR?
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, 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.
WHAT CAUSES FERTILITY PROBLEMS IN WOMEN?
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
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
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
? 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.
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
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.
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
Less common are disorders present at birth, such as a malformed vagina or uterus or the absence of one or both fallopian tubes.
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
Cervical and Uterine Problems
and uterine abnormalities are also responsible for an inability to
conceive. These disorders, however, are not as common as hormonal and
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.
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.
CAN PSYCHOLOGICAL PROBLEMS PREVENT PREGNANCY?
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.
WHAT ARE THE COMMON CAUSES OF FERTILITY PROBLEMS IN MEN?
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.
(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).
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.
WHEN IS A FERTILITY WORK-UP RECOMMENDED?
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
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
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.
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
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.
This procedure can be performed on any woman forty five years of age or younger.
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.
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
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.
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)
THE OVULATION INDUCTION PROGRAM
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
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
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.
ALL OF THE FOLLOWING ARE AVAILABLE AT GYN & FERTILITY SPECIALISTS
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
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
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.
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.
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.
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