Santiago Brugo Olmedo M.D.
Medical Director
Seremas Medicine for men and women
Seremas Home Seremas Specialties Seremas Gynecology

Gynecology

SEREMAS takes care of the woman’s medical assistance all along her reproductive age, for control, counseling and eventual diagnosis and treatment of all that concerning the genital apparatus (gynecology) as well as, once pregnant, for prenatal control, which includes maternal care as well as that of the fetus (obstetrics).

Our aim is not only to diagnose the different pathologies and carry out the proper treatment according to them, but also inform about care to prevent the appearance of these pathologies, through continuous dialogue with patients.

We make a team of professionals where each one of us accomplishes our role and where personalized assistance is absolutely essential, framed by all the human technical resources our Center offers.

Facing the lack of pregnancy, after a prudential period of time, keeping sexual relationships with adequate frequency, and without contraceptive protection, medical consultation with the correct specialist would be convenient.

How long is a prudential period?

In general terms, we speak about one year, given the fact that most fertile couples would achieve pregnancy during it. Nevertheless, it can vary depending on the woman’s age, creating the need, in some cases, of precocious consultation.

Since pregnancy is project which involves the man as well as the woman, it is desirable and necessary that both of them see the specialist.
The first interview is very important; in it the specialist will find out details of gynecological nature, such as the age she menstruated for the first time, quality and quantity of menstruation, relevant gynecological records, like surgeries or infertility cases within the family, moment when they became sexually active, frequency of sexual relationships, and other corresponding details.

Therefore, it is extremely useful to go to the appointment with analysis, previous tests (if any), as well as a detail of mentioned data, in order to optimize the interview. This is valid for both members of the couple.

It is our wish that patients can, after finishing the first interview, have a clear scenario of the way they must follow and a proper and understandable answer to their doubts and questions.

Once these details are loaded onto the medical records, the kind of tests required will be evaluated in order to know the couple’s state of fertility.

In general terms, before a couple with difficulty in conceiving, we ask three questions, which are:

a) How many and what quality of female germ cells (oocytes) do we have?
Being ovaries intra-abdominal organs, that is, relatively inaccessible, we evaluate their functionality with hormonal tests in blood, which are carried out at the beginning of the menstrual period, habitually on the 3-5 day of the cycle, counting as the first day, that one when the bleeding is genuine and there is not only a small amount of blood loss.

This is very important in order to evaluate the ovaries capacity of answer, foreseeing a fertility treatment.

There are predetermined values of certain hormones which form a definite profile which helps to know the ovaries condition and how they would behave in case of potential treatment.

One of the pathologies with more incidence in fertility in which alteration in hormones may be noticed is the presence of some level of what we call “Ovarian Polycystosis”. This disease is characterized by a group of signs and symptoms, especially alteration in menstrual rhythm called oligomenorrhea (menstruation every 60 or more days); it can also come with or without some level of alteration in weight (increase), even if there are a high number of slim patients.

The most important point is that this particular condition of the ovaries predisposes to ovulation alteration, which can get to anovulation (the patient has normal cycles although she does not ovulate) which conditions the impossibility of getting pregnant.

These alterations may be treated with different medicines which stimulate ovulation and allow, under strict medical surveillance, achieving pregnancy. In these cases, a simple ovarian stimulation, controlled by transvaginal ultrasound and hormonal measurement, will lead most times, to a happy end. In these patients, sometimes medication called metformin is indicated. This one acts at the level of ovaries metabolism, improving ovulation and allowing spontaneous pregnancy in many cases. In the same way, if there were alterations in body weight, simple nutritional correction and proper physical activity, would get to change ovarian activity and achieve so desired pregnancy.

b) How many and what quality of male germ cells (spermatozoa) do we have?
In the case of the man, this is tested with a complete spermogram with strict fertility criteria.

c) If both (oocytes and spermatozoa) are well, is there any physical impediment for them to join?
The following will be evaluated through a uterus and tubes ultrasound called Hysterosalpingography (also see surgery).

Hysterosalpingography
Hysterosalpingography

If it became necessary to evaluate the cavity directly, it would be done via endoscopic view called hysteroscopy (also see surgery).

The technique allows, in an ambulatory way (without confinement), through introduction of a thin optic fiber inside the uterus, seeing absolutely all the uterine cavity and performing corrections of existent pathologies or taking biopsies for diagnosis (also see surgery).

Hysteroscopy instrumental
Hysteroscopy instrumental

In this way we can diagnose functional alterations of the endometrium, which is the inner cover of the uterus bound to hold the pregnancy. It becomes, with proper hormonal correction, apt for the normal process of reproduction.

In this same way we can detect polyps, tissue formations which get spread towards the cavity, altering functional and mechanically the endometrial function.

Through the same procedure, and without needing another surgery, it is possible to remove them leaving the endometrial cavity repaired.

As a consequence of previous surgeries, the presence of synechias can be observed. They are zones of adhesions among the uterine walls, which are normally separated. They may condition alterations in menstruation, getting sometimes to the total lack of them.

These synechias are one of the pathologies which may be solved by surgical hysteroscopy, in a fast way, without confinement and with immediate return of the patient to her habitual activities.

View of the Hysteroscopy
 
Hysteroscopical endometrial image
View of the Hysteroscopy
 
Hysteroscopical endometrial image

Some affections can produce anatomical or functional alterations of the female genital apparatus, which make conception difficult.

Endometriosis: it is about the presence of endometrial tissue, which normally covers the inner walls of the uterus but this time in other organs, such as ovaries, Fallopian tubes, peritoneum, etc.

This can condition the presence of cysts of hemorrhagic content, or adhesions among genital organs, which decrease or prevent pregnancy.

For these cases, different diagnostic resources must be used, and they can be direct or indirect.

The gynecological ecography, which through ultrasound swept, allow discerning indirectly, the integrity of the female genital apparatus and organs nearby.

Gynecological ecography where we see the endometrium
Gynecological ecography where we see the endometrium

If intra-abdominal direct view is required, it can be done via laparoscopy. In this technique, with modern optic fibers, and equipments with very good angle of vision, lesions can be diagnosed with total certainty and eventually, through the same procedure, we can operate and remove or eradicate them usually allowing recovering function and future pregnancy.

Graphic of a pelvic laparoscopy
Graphic of a pelvic laparoscopy

Therefore, through this procedure, myomas (fibromas) can be removed, uterine malformations can be corrected and adhesions, separated.
This technique, minimally invasive, allows a very important decrease in discomfort and post-surgical complications of gynecologic surgery.
It improves the patient’s quality of life, as it decreases dramatically the number of necessary days for post-surgery recovery.

Image of a trans-laparoscopic surgery
Image of a trans-laparoscopic surgery

Certain infections can generate lesions that condition alterations in the uterus or tubes, which delay or prevent pregnancy.

A gynecological medical check-up is convenient, and eventually, a deeper test, cultivating genital secretions in order to discard infections because of germs of the gender Mycoplasm or Chlamydia, which can impact on fertility.

These affections, most times, are asymptomatic; this means they may not cause symptoms, which makes it necessary to discard its presence, through specialized tests since they are totally eradicable with specific medication.

Finally, we underline general gynecologic preventive check-ups, such as:
1. Cervical Vaginal Exfoliative Cytology (Papanicolau)
2. Colposcopy: it is the direct view of the uterine cervix and localization and screening of eventual lesions.

Both techniques used together allow preventing most of the uterine cervix oncologic affections.

The correct use of mammography, just like the mammary ecography, allows individualization and treatment of all the mammary affections, which are convenient to be diagnosed before pregnancy.

SeremasSeremas | Medicine for men and women
SEREMASArenales 1954, 1st floor
Buenos Aires City
Phones: (00 54 11) 5032-3358 / 59 / 60 (Rotative lines)
E-mail: info@seremas.com
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