Also known as Premature Ovarian Failure (POF), occurs when the ovaries stop functioning in women under age of 40.

Frequently, many patients find it out several years after symptoms began. The absence of menstruation is often the first sign of POF; later symptoms can be similar to those of menopause such as hot flashes, sweats, vaginal dryness, mood swings and joint pain, among others.

There is a tendency to suffer this failure if someone in your family does, so it is important to check if you have a close relative that has suffered from premature menopause. Research has determined that can be caused by Genetic disorders, autoimmune diseases, patients undergoing cancer treatments, surgery and exposure to toxic materials, however, in most cases the cause cannot be diagnose.

The specialist confirms the diagnosis by measuring a hormone (FSH) levels.

Unfortunately, there is no treatment that will restore normal ovarian function, so that POF women who are seeking pregnancy must resort to egg donation. They also need a long-term hormone treatment to replace the hormones that the ovary no longer produces.

Recurrent abortion is defined as two or more consecutive pregnancy losses.

Although roughly 25% of all pregnancies end in abortion, less than 5% of women will have two consecutive losses and only 1% will suffer three or more. After 3 losses a full evaluation by a specialist should be done, to diagnose and treat the cause. This will increase the likelihood of a normal pregnancy.

Causes of recurrent abortion:

• Chromosome abnormalities in one or both parents
• Hormonal causes (progesterone deficiency, pco syndrome)
• Metabolic abnormalities (such as poorly controlled diabetes)
• Uterine abnormalities
• Antiphospholipid syndrome (abnormal production of antibodies)
• Thrombophilias (predisposition to form clots)
• Sperm defects
• Unknown  (up to 50% of all cases)

The good news is that couples with this problem have 60 to 70% chances that the next pregnancy will be normal.

We recommend a healthy lifestyle; take a daily supplement of folic acid, smoking cessation (both men and women), reducing alcohol and caffeine intake, moderate exercise and proper weight control.

It is a common hormonal problem that affects about 5% of women of childbearing age.

In this syndrome, the ovary has an increased production of androgens, which can cause infertility, menstrual irregularity and hirsutism (excess growth of body hair), and increases the risk of metabolic syndrome (insulin resistance, obesity and hypertension) and type 2 diabetes.

A diagnosis of PCOS requires at least 2 of the following 3 criteria:

1) Chronic anovulation (no ovulation)

2) Chronic hyperandrogenism (elevated androgens)

3) Image of polycystic ovaries on ultrasound.

The treatment consists of diet and exercise to lose weight, ovulation induction if pregnancy is desired and fertility problems are diagnosed, and insulin sensitizers. Excessive hair is treated using some antiandrogens, electrolysis and laser.

This festivity is dedicated to every mother, daughter, sister, grandmother and aunt; that are part of our society. This event is also an encouragement to be happy, free and dreaming; for knowing what they want and fight to achive it.

Clínica Santa María joins the commemoration, not only for being to the service of all the wonderful women, but also for being part of one of the most important desires of every woman: being a mother!

We wish you to continue enjoying the wonder about being a woman and for being always a light in the lives of many, happy International Women’s Day, you deserve it because you make a different world!

In this link, you will find events taking place around the world so you can have a spectacular day.

This is a common question among women who are planning to have children and haven’t achieved pregnancy.

If you have 1 year of exposure to pregnancy and it didn’t happen, it is time to consult a specialist.  Some tests will be perform to assess the adequacy of your reproductive system and your partner’s. For women over age 35 is recommended to consult before completing the year of exposure.

About 30% of women will have problems with the fallopian tubes or pelvis (i.e. endometriosis, adhesions, fibroids), 30% will be cause by male factor, 20% will have ovulation disorders and the rest may present unusual problems such as congenital abnormalies, hypothyroidism, etc.

Fortunately, science has made great strides in the field of reproductive medicine; the birth of many healthy children has been reported even in very difficult cases.

Most couples will get pregnant with a simple treatment and only 20% will need a more sophisticated treatment such as IVF.

The news went round the world. Dr. Robert Edwards pioneered in Human Reproduction studies that led to the birth of Louis Brown the first baby born by In Vitro Fertilization (IVF) in the world, was awarded with the Nobel Prize in Physiology or Medicine 2010.

This is a well-deserved recognition for many years of studies that led to one of the most important advance in the medicine of the 20th century.

IVF has allowed success in more than 4 million couples whom longed for the birth of a child and made it by this treatment.

The treatment consists in the fertilization of eggs by sperms in the laboratory; to 3 to 5 days after, transfer the fertilized eggs to the uterus, with the ultimate aim of achieving the birth of one or two healthy and normal babies.

At the beginning, like any new treatment, it created much controversy. Questions such as artificial intervention could cause an increase in birth defects? Are we playing God? Or, will this provoked an artificially imbalance in natural selection?

There have been more than 30 years of experience in the treatment that have proven to be safe and efficient in cases of infertility. And like any treatment, it has been refined so that today the pregnancy rates are higher than those in nature. And over time, progress in this area will enable more and better choices for couples suffering infertility.

Clinica Santa Maria is proud to offer the latest treatments in IVF, having already contributed to the birth of many Guatemalan children, product of these treatments, in 12 years of work.

We join all those couples that have achieved their dream of parenthood and also congratulate Dr. Robert Edwards for the deserved recognition.

A major concern is the risk of having a baby with a birth defect. Down syndrome is the most common of these defects. Affected children are born with different degrees of mental retardation and physical defects.

However, the risk is less than 1% before 40 years and 2% at 43 years.

* The risk of having a baby with Down syndrome is as follows:

25 years, one in 1,250

30 years, one in 952

35 years, one in 385

40 years, one in 106

45 years, one in 30

49 years, one chance in 11

* Data from the Obstetricians and Gynaecologists College of the United States (American College of Obstetricians and Gynecologists, ACOG).

An important element to consider is the risk of miscarriage or abortion. Most spontaneous abortions occur during the first trimester of pregnancy in women of any age, but the risk increases with age.

Studies suggest that approximately 15% of recognized pregnancies in women between 20 and 35 years end in spontaneous abortion. This percentage increases to 20% for women between 35 and 39 years, approximately 35% at 40 and 41 years and more than 50% by 45. The increased risk of spontaneous abortion associated with age is due to the increased incidence of chromosomal abnormalities.

Women over 35 are more likely than younger women to have a health problem that began before pregnancy. Some problems, like high blood pressure, diabetes and heart and kidney problems can affect pregnancy.

Odds of having a cesarean delivery increase with age. Apparently, the mothers of more than 40 years are twice as likely as mothers under 30 years of having a cesarean delivery.

Despite these obstacles that may arise and for which we must do everything possible to minimize, the more likely it is that you have a normal pregnancy and a healthy baby (or two) at home.

How can a pregnant woman reduce her risk of complications during pregnancy?

Today, most women over 35 years can assume a healthy pregnancy. Women of all ages can improve their chances of having a healthy pregnancy by following these tips:

1. Screening with your doctor BEFORE pregnancy.
2. Have regular PRENATAL CARE from early pregnancy.
3. Take a daily multivitamin containing at least 400 micrograms of FOLIC ACID before conception and during early pregnancy to prevent neural tube defects.
4. Begin the pregnancy at a HEALTHY WEIGHT.
5. Avoid the consumption of excessive ALCOHOL.
6. Avoid smoking and exposure to cigarette smoke.
7. If your doctor does not prescribe them, avoid drugs or herbal medication.
8. Eat NUTRITIOUS FOODS containing folic acid and folate, these are naturally present in fortified breakfast cereals, other products made from fortified cereals, legumes, green leafy vegetables and orange juice.
9. Do not eat undercooked meat or clean cat feces. Both are possible sources of toxoplasmosis, an infection that can cause birth defects.
10. Do not eat fish that may have high mercury content, such as shark, swordfish, king mackerel or tilefish. Limit the consumption to six ounces or less per week of white albacore tuna. Women can safely consume up to 12 ounces per week of other species that contain small amounts of mercury, such as shrimp, salmon, pollock, catfish and low fat tuna. Women are advised to always consult your local health department before eating any fish species.
11. Undergo a test to see if you are immune to rubella and chickenpox before becoming pregnant and consider vaccination against these diseases if you are not immune. After being vaccinated, you should wait a month before becoming pregnant.

Today, many women choose to become mothers after their 35 years. Depending on the country, on average in five women, one has their first child after this age.

Fortunately, most women enjoy healthy pregnancies and babies!

Women over 35  are exposed to some special risks during pregnancy that are very important to know.

Generally, women start to experience a decrease on their fertility after their  30`s. It will take longer to become pregnant a woman over 35 than a younger woman. Men can also experience a decrease in fertility as they approach their 40´s.

In some cases, the decline of fertility in women over 35  is because they tend to ovulate less frequently and the quality of eggs also decreased compared with younger women. Certain health problems also interfere with conception, being more common after this age, such as endometriosis, blocked fallopian tubes (in some cases as a result of past infections) and fibroids (tumors of the uterus).

If a woman over 35 has not become pregnant after trying for six months, should consult her doctor. Studies suggest that approximately one third of women between 35 and 39, and about half of women over 40, have fertility problems, and many of these problems can be treated effectively if they consult a specialist center.

In Guatemala there are specialized centers dedicated to diagnosis and treatment of couples with fertility problems. They have the knowledge and modern technology to achieve, as we say in Clínica Santa María, the miracle of life, even in some complicated cases.

Although women over 35 years can present more difficulties to became pregnant, and automatically it is increased the likelihood of undergoing fertility treatment to achieve it, they also have a greater chance of having twins. This probability increases naturally with age.

Before trying to conceive, regardless of age, every woman should consult her doctor. A visit to the doctor before you conceive will help ensure that it is in the best possible condition to do so. The visit to the doctor before conceiving is especially important when a woman has a chronic health problem.

Your doctor can treat this problem and make the necessary changes in medication to ensure you have a healthy pregnancy. Your doctor may also recommend taking a daily multivitamin containing at least 400 micrograms of folic acid to prevent certain birth defects in the brain and spinal cord (neural tube defects).

Some of the most common complications that can happen after 35 years are: gestational diabetes, hypertension, previous placent, premature birth and low birth weight. Fortunately there are ways to minimize these complications during and before pregnancy.

continues

Juan Francisco Solís Bercián MD. Clínica Santa María Director. 2010

One of the most common questions that are made to specialists in fertility is: What changes to my diet can I do to improve my fertility?

Few studies have been strictly scientific fact of the matter. One of the most complete built on large-scale study of women is the NURSES HEALTH STUDY (120,000 married nurses between the ages of 30 to 55 years), which began in 1976, updating the information every two years. Taking advantage of this large population, scientists at Harvard (Jorge Chavarro and Walter Willett) published in 2008 a book, The Fertility DIET, where are their results.

We must clarify that these advices help significantly in improving fertility when ovulation is the problem, it means, those women who can not achieve pregnancy because they are not ovulating or have an imbalance in the ovulatory process.

It would be incorrect to believe that these changes will solve fertility problems caused by tubal blockage, endometriosis, severe male factor, etc. However, these general tips can be harnessed for good overall health and improve the ovulatory process.

On the other hand, it is important to note that if you have fertility problems, i.e. one year of exposure to pregnancy and did not happen if you are under 30 years; or 6 months if you are over 30 years, you should consult your physician as soon as possible to initiate a basic research of your reproductive system and correct the factors involved if they are diagnosed.

There are 10 simple strategies that will improve your fertility, uncovered by this study:

1. Avoid trans fats (margarine, chips, fast food)

2. Use unsaturated vegetable oil for cooking, such as olive oil and canola oil

3. Eat more vegetable protein such as beans and nuts, and less animal protein (red meat)

4. Choose whole grains and other carbohydrate sources that raise sugar and insulin more slowly than highly refined sugars that rapidly increase glucose and insulin in the body (cakes, brownies, donuts, pies, etc)

5. Drink a glass of whole milk or a small bowl of ice cream or a glass of whole milk yogurt, daily. In this diet is recommended to temporary avoid skim milk or dairy “light” products such as cottage cheese. Of course, if you are not intolerant to milk!

6. Take a multivitamin containing at least 40 to 80 mg of iron, 400 mcg of folic acid and other B complex vitamins.

7. Eat iron from fruits, vegetables, beans, and supplements and less red meat.

8. Drink water. Coffee, tea and alcohol can be drink in moderation. Avoid sodas. A normal soda is equivalent to eating 12 teaspoons of sugar! This is one of the biggest causes of overweight.

9. Maintain a healthy weight. If you are overweight, losing between 5 to 10% of your current weight can significantly improve ovulation.

10. Exercise. A daily plan of exercise or at least three times a week for a period of 1-2 hours per session, especially aerobic exercise, improves ovulation. Overdoing exercise can have an opposite effect.

Tobacco consumption deserves special mention because it is more than proven that smoking is has extremely negative effects on fertility and pregnancy. This is to both in men as in women. The women who smoke find it harder to get pregnant spontaneously, even when they resort to assisted reproduction and have higher risk of spontaneous abortion and congenital anomalies. If you smoke and plan to become pregnant, you should stop smoking.

As you can see these recommendations work well for good overall health, so try to take into account these recommendations if you plan to conceive and wants to help improve your fertility and reduce further complications.

The semen analysis is the most important diagnostic test for the study of male fertility and greatly complements the diagnosis for the couple. It is a simple analysis that allows to observe the male reproductive capacity, through the assessment of physical aspects of semen: volume, pH, appearance and consistency; cellular aspects of spermatozoa in relation to the number, motility and morphology, and the presence of other cells such as leukocytes or erythrocytes.

It is important to emphasize that the seminal fluid is a mixture of spermatozoa suspended in secretions from the testis and epididymis, which at the time of ejaculation, are combined with secretions from the prostate, seminal vesicles and bulbourethral glands. The final product is the material of evaluation and corresponds to a viscous fluid which is obtained in each ejaculation, commonly known as Semen.

The results of the semen analysis guide the type of treatment to follow, in terms of fertility, so that the semen analysis must be undertaken by properly standardized procedures in an Andrology Laboratory, guidelines required by the World Health Organization (WHO) regarding collection and sample processing.

In Clinica Santa Maria we have our own Andrology Laboratory, where samples are evaluated under the guidelines of WHO, so that we guarantee our patients the quality of the results.  However to accomplish our goal, all of our patients must follow some guidelines for sample collection and delivery:

• The sample should be obtained by self-stimulation or masturbation.  Coitus interruptus has the disadvantage that can lead to loss part of the sample and contamination of seminal fluid with normal secretions of the vagina. It is important to remember that before collecting the sample hands should be properly washed and dried.
• Following the recommendations of the World Health Organization (WHO), the sample should be collected with an abstinence period of 2-7 days, it should be placed in a sterile or clean, wide-mouthed container, in order to collect all the sample, this is very important because the first portion of ejaculate contains about 50% of total spermatozoa.
• Remember that a balanced diet with foods rich in antioxidants with vitamins C and E may improve semen quality by reducing free radicals that can cause damage to the membrane. Other supplements such as selenium, zinc and fish oil are equally of great benefit.
• Avoid the use of potentially toxic substances for spermatozoa as nicotine, marijuana, alcohol and anabolic steroids.

These recommendations should be part of the routine of the couple who wish to undergo fertility treatment and not only as restrictions prior to semen analysis.  Remember that a healthy lifestyle provides a firm basis for work, especially in the field of fertility.