Infertility - Endoscopy - Gynecology - Pregnancy and Ultrasound Information about infertility-Assisted Reproduction-Ultrasound-Gynecology-pregnancy-laparoscopy and hysteroscopy. en Copyright (C) 2013 layyous.com Assisted Reproduction | Types of assisted reproductive treatment Assisted reproduction technology consists of procedures that involves the handling of eggs, sperm, or both, outside the human body. There are many types of fertility treatments available, procedures to help you to get pregnant https://www.layyous.com/en/assisted-reproduction Mon, 08 Mar 2021 05:25:19 AM The latest technology used in IVF cases The use of PRP (Platelets Rich Plasma) to increase success rate in IVF Repeated failures in IVF have always been a challenge for science and doctors. Many of the world's largest research centers are conducting many researches trying to find out the reasons and causes. One of the latest technologies to increase success in such cases is plasma injection technology (PRP), which treats Weak ovaries and improve the thickness and quality of the endometrium 1. Injection of plasma into the endometrium + GSF (Granulocyte Stimulating Factor) Some cases of failure of IVF is due to a problem in the endometrium, whether the thickness or the quality. In such cases is a PRP injection in the endometrium can be useful. It is a simple procedure that does not require anesthesia and is done in the clinic A blood sample is first drawn from the patient and then treated with specific procedures during which the plasma is extracted and separated from the blood cells and treated in a certain way. The platelet-rich plasma and growth enzymes help regenerate and stimulate the growth of endometrial cells and build a good uterine lining in addition to GSF. 2. cases of low ovarian reserve or premature ovarian failure. The use of PRP in these cases is still under research and it should be noted that the success rates in these cases so far does not exceed 3.50%. This procedure is carried out under general anesthesia in the hospital during which the plasma concentrate is injected into the ovary in a process similar to the process of retrieving the eggs in an attempt to revive the production of eggs in the ovaries and then wait for 2-3 months during which the patient is given multivitamins and then induction of ovulation will be started. https://www.layyous.com/en/assisted-reproduction/the-use-of-prp-platelets-rich-plasma-to-increase-success-rate-in-ivf-improve-endometrium-and-in-premature-ovarian-failure Mon, 08 Mar 2021 05:25:19 AM Assisted Reproductive Technology (ART) This term refers to the methods that are used to help couples with fertility problems to achieve pregnancy and it is used with in some cases where genetic issues are present. In these methods, the sperm is selected in the lab and transferred at the time of the woman's ovulation, either into her uterus or to the fallopian tubes, or directly to the ovarian follicles. The sperm can be injected into the ovarian follicle after it is aspirated outside the woman's body in the process known as InVitro Fertilization (IVF).   Indications of Assisted reproductive technology (ART): Endometriosis. Irregular ovulation, as in polycystic ovarian syndrome. Abnormal semen fluid analysis. Presence of any disorder in the couples that is diagnosed by the physician. Cervical problems such as presence of thickened mucosal discharge, or presence of sperms antibodies. Unexplained infertility. Blocked or damaged fallopian tubes. Women at age of 35-40 years. Men that have anti-sperm antibodies. Semen preparation in assisted reproductive technology (ART): There are several techniques that can be used for semen preparation. Since the introduction of IVF, research is still going on to determine the best method to prepare the semen. Sperm washing is done by removing the chemicals that may cause adverse reactions in the uterus. Bacteria, white blood cells and dead sperm, that can impair egg fertilization will be separated from the fluid portion of the semen. If needed, special additives can be incorporated to increase sperm motility and its ability to fertilize. Before semen preparation, an evaluation of the ability of the sperm to fertilize, is completed. The main purpose of the scientists is to reach the correct diagnosis, and to treat any defect in the production or function of the sperm, and to improve the sperm's ability to fertilize, to increase the rate of pregnancy.   Types of Assisted reproductive technology (ART): The following types of ART are not used now, but they were developed early and were done in the first few years of developing ART Fallopian tube sperm perfusion (F.S.P): This method is done by introducing the whole semen into the uterus to reach the fallopian tubes. The amount of semen used in this method is 4 ml and it is more than the amount of semen used during intrauterine insemination (IUI) which is around 0.3-0.8 ml. Some believe that this method has a higher pregnancy rate than the intrauterine insemination (IUI) because more semen is used and, as it is introduced to more areas, including the uterus and the fallopian tubes. But it is worth mentioning that there are different studies on this topic with different results. The decision to choose between ( IUI) or (FSP) must be taken by the physician. This method has the same indication and the same technique as IUI. Trans-vaginal Intra-Fallopian Insemination (T.V.I.F.I): This is done by introducing a catheter through the cervix to reach the fallopian tube, then the sperm is injected inside the tube. The purpose of this method is to introduce the sperm directly to the natural place of fertilization, which is the fallopian tube. Direct Intra-Fallopian Insemination (D.I.F.I): It is done by injecting the sperm into the ovarian follicle, within the ovary, by using the trans-vaginal ultrasound. Gamete Intra-Fallopian Transfer (G.I.F.T): This method came into use in 1984 and it is done by stimulating egg production in the ovaries by using fertility drugs. The eggs will be collected from the ovaries and placed with the sperm in one of the fallopian tubes The fertilized eggs (zygotes) will travel toward the uterus and will be implanted in the inner lining of the uterus (the endometrium). This method takes about 30 - 60 minutes from the time of removing the follicles until it is placed in the fallopian tube with the sperm. It is done either by laparoscopy or using trans-vaginal ultrasound. Cases that can benefit from this method: Women that have patent and healthy fallopian tubes. Women with endometriosis, if the fallopian tubes were patent and healthy. Men that have Oligospermia, in which the follicles will be aspirated from the ovaries then they will be mixed directly with the semen that is prepared for this purpose. Zygote Intra-fallopian Transfer (Z.I.F.T): This method is similar to (G.I.F.T). The only difference is that the embryo will be transferred to the fallopian tube after the fertilization has occurred in the lab, as in IVF, (while in the G.I.F.T method, the fertilization happens in the fallopian tube), then the zygote will be transferred to the fallopian tube to continue its natural divisions and will migrate towards the uterus where it will be implanted And of course, the fallopian tubes must be healthy. It is worth mentioning that the pregnancy rate in the (G.I.F.T) method, when done for the cases of abnormal semen, is less when it is compared with other fertility problems, such as unexplained infertility, endometriosis, cervical factors…., etc. In addition, using abnormal semen makes it difficult to know if fertilization has occurred or not. For that reason, the scientists developed the (G.I.F.T) method into (Z.I.F.T). Tubal Embryo Transfer (T.E.T) and Pronuclear Stage Transfer (P.R.O.S.T): The difference of names for this method depends on the stage of embryo growth and development before it is transferred to the fallopian tube. The program begins by stimulating the ovaries. Then the eggs are collected from the ovaries and sent, with the sperm, into the lab, where the eggs are fertilized by the sperm to produce embryos. They will then be transferred to the fallopian tube in the same way as in the Z.I.F.T. Method. Then the embryos will continue their divisions, naturally in the fallopian tube, and will continue the journey until they implant in the uterine inner lining. - What is the difference between (T.E.T), (T.U.F.T), (P.R.O.S.T), and (Z.I.F.T) methods? All these methods are the same, in which we stimulate the ovaries to produce mature follicles. Then, H.C.G. hormone is given at the appropriate time. And the mature follicles are collected by trans-vaginal ultrasound and fertilization is carried out in the lab. The only difference in these four methods is the stage at which the fertilized egg is transferred to the fallopian tube. In (Z.I.F.T) and (P.R.O.S.T) the fertilized egg is transferred to the fallopian tube at the Pronuclu stage that is reached after 18 hours of adding semen to the follicles. On the other hand, the fertilized egg is not transferred until 18 hours of adding the semen to the follicles in T.U.F.T and T.E.T methods and at that stage the fertilized egg is divided into 2 or more cells and called a, “Pre-Embryo.” These methods are preferred to be used particularly in cases of male infertility, as the follicles can be exposed to a higher number of sperm and the development of the fertilized egg can be monitored outside, unlike the G.I.F.T method that was mentioned above. The further difference between these four methods and the IVF method is that the fertilized egg is transferred in to the fallopian tube and not to the uterus as in IVF. The egg has more space to develop in its natural environment. And the success rate in these methods is 17-37% during each menstrual cycle. Direct Intra-peritoneal Insemination (D.I.P.I) : In this method, the prepared semen is injected through the vagina into the, “Douglas pouch,” 36 hours after giving the HCG hormone. This method is easy and can be done in the clinic. It may be useful for couples with unexplained infertility, cervical problems, or decrease in the sperm count. The success rate of this method is 10 - 20%. Peritoneal Oocyte and Sperm Transfer (P.O.S.T) : In this method the mature follicles are aspirated after the ovaries have been stimulated and after giving the H.C.G. Hormone. Then, 3 - 4 mature follicles with the prepared semen will be injected into the, “pouch of Douglas,” near the fallopian tubes, that must be healthy and patent. This method may be useful in couples with unexplained infertility and those who have anti-sperm antibodies. The success rate is 20-25% in each menstrual cycle. Direct Oocyte and Sperm Transfer (D.O.S.T) : This method includes ovarian stimulation, Oocyte retrieval, sperm preparation, then direct Oocyte and sperm transfer. After the retrieval of the Oocyte, it will be incubated in culture media for several hours. Then the prepared sperm will be added. When the fusion between the sperm and the outer membrane of the Oocyte is noted, 3 Oocytes (the perfect number) will be transferred into the uterine cavity using the normal embryo transfer catheter that is used in the IVF technique. Trans-uterine Fallopian Transfer (T.U.F.T) : In this method, a very thin catheter in introduced into the fallopian tube using another catheter that passes through the uterus. Then the fertilized egg will be transferred into the fallopian tube. The recent and used Methods of ART are: In Vitro Fertilization - I.V.F Intracytoplasmic Sperm Injection - ICSI Intracytoplasmic morphologically selected sperm Injection IMSI Preimplantation Genetic Diagnosis Selecting the Sex of the Baby    Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/assisted-reproductive-technology-art-in-vitro-fertilization-i.v.f-intracytoplasmic-sperm-injection-icsi-and-intrauterine-insemination-iui Mon, 08 Mar 2021 05:25:19 AM In Vitro Fertilization - I.V.F   Advances in IVF, In Vitro Fertilization The first successful IVF case was in 1978 when a British woman delivered a baby called Louisa Brown on 28 of July 1978 in Oldam in England by cesarean section. I.V.F was developed by the physiologist Robert G. Edward, who was awarded the Nobel Prize in 2010.   What do we mean by In Vitro Fertilization?   After retrieving the Eggs from the ovaries, the eggs are fertilized in the laboratory in a dish.The sperm are added to it (after a special media is used for semen washing). The dishes are put in special incubators until embryos are formed and then transferred into the woman’s uterus (which is done from 2 to 5 days). Advances in IVF, In Vitro Fertilization   Indications of In Vitro Fertilization - I.V.F?   A- Idiopathic causes of infertility: Mainly after 2 years of unprotected intercourse with no obvious cause of infertility. B- Female causes: 1- Problems with the fallopian tubes such as obstruction, or in case of salpingectomy due to ectopic pregnancy, or hydrosalpinx. 2- Endometriosis. 3- Ovulation problems. 4- Antibodies that affects both eggs and sperms. C- Male causes: 1- Defects in sperm quantity and/or quality. 2- In-ability of the sperm to penetrate the cervical mucus. 3- No sperms seen in the semen fluid. D- Pre implantation genetic diagnosis to rule out genetic disorders.   Steps of In Vitro Fertilization - I.V.F procedure?   First step: Evaluation Any couple undergoing treatment by the InVitro Fertilization technique must be evaluated, certain investigation done to find out if infertility can be treated without resorting to I.V.F. Those include: blood test, semen analysis, fallopian tubes evaluation and ultrasound scan for the ovaries and uterus. Second step: Ovulation Induction The aim is to produce many follicles (good follicles) to be used for fertilization, this is by using short or long protocols, and this is done by daily injections of gonadotropins, regular monitoring by ultrasound scan is done to follow the follicular development and adjust the dose of the injections accordingly, when they reach certain size, the final maturation of those follicles is done by giving HCG. Third step: Egg Retrieval (oocytes) Egg retrieval is done 34 to 37 hours post HCG injection, this procedure is considered as minor surgery, it is done under general anesthesia, using ultrasound guide. It takes 15 to 20 minutes. Not more than two hours are required for the patient to recover. Then, the patient can leave the hospital. A needle is used to aspirate all the follicles. The fluid is passed over to the embryologist, who identifies and separates the eggs. We should mention that not all follicles seen by ultrasound contain eggs which are viable for fertilization. Up to (20-30%) of those follicles are empty. Fourth step: Sperm and Egg Preparation The eggs are prepared and stripped from the surrounding cells. At the same time, sperm preparation is done using a special media. We need from 10,000-100,000 motile sperm to be put beside each egg in a special dish, this is called traditional I.V.F., and it is different from intra-cytoplasmic sperm injection (ICSI, in which we need only one sperm to be injected in the cytoplasm of the egg) ,which is indicated in cases where sperm is present in the testes but the semen fluid does not contain sperm.   Fifth step: Fertilization As mentioned above, after preparing the sperm, and the eggs are put in the same dish, in cases of failed fertilization we use ICSI procedure. Sixth step: After 16 to 18 hours after the eggs, called zygotes, are fertilized, they are cultured in special incubators to support division and development. In this step, if the couple has a history of certain genetic disease and the gene that is causing that problem is identified, we may do pre-implantation genetic diagnosis.   Grading of the embryos is done using specific criteria. Seventh step: Embryo transfer The Embryos are transferred into the uterus after 2 to 5 days from the date of pick up (depending on the quality and quantity of the embryos) using a special embryo transfer catheter. The patient is given drugs to help support the implantation procedure. There is no need for a lengthy hospital stay after the embryo transfer procedure (usually one hour is sufficient). Residents of other countries can travel the next day if they wish. IVF And ICSI Videos Side effects of In Vitro Fertilization - I.V.F procedure? A- During ovulation induction: Ovarian hyperstimulation syndrome: This occurs in less than 10% of ovulation induction cases whether it is for I.V.F or ovulation induction for other treatment methods. Only 1% of these cases need hospitalization. In severe cases, patients complain from: Lower abdominal pain. Nausea and vomiting. Oliguria. Shortness of birth. Accumulation of fluid in the abdominal cavity. B- Complications during Egg Retrieval:   Anesthesia complication. Lower abdominal pain. Mild vaginal Spotting as a result of the needle used for the pick up. Intra abdominal bleeding. Genital tract infection. Intestinal injury or bladder injury in rare cases. C- In case the procedure is successful: There is risk of multiple pregnancies and its complications. Risk of miscarriage. Ectopic pregnancy. D- In case of failure: There is risk of developing depression for both members of the couple. Do not forget the financial burden. 5- When to do the pregnancy test? Two weeks post embryo transfer, if the blood tests give positive result. We can see the pregnancy sac one week after the blood test. 6- What are the percentages of success? This depends on many factors like:   The most important is the woman’s age. As woman’s age advances, the success rate declines. Quality of the eggs and sperm. Number and quality of embryos.   Depending on age it is as follows:   Less than 35 years old (41-43%). In our center, 65-70%. Between 35-37 years old (33-35%). In our center, 50- 55%. Between 38-40 years old (23-27%). In our center, 30-35%. After 41 years old (13-18%). In our center, 20-22%. Another statistic gives increasing the number of embryos transferred, the success rate increases and with it, the risk of multiple pregnancies increases and miscarriage increases. A balance should be taken considering these many factors, such as maternal age, previously failed trials, grades of embryos ..etc. Other factors that play a role in the success of I.V.F: Is there a genetic abnormality which will decrease the rate of implantation? Is the endometrial lining of the uterus of good quality, or not? See our Success rates 7- What happens if ovulation occurs before the eggs are retrieved? In this case we have two choices: 1 - Cancel the cycle and start again the following month. 2 - Do intrauterine insemination, if possible. We must mention that 10 days post embryo transfer, you can do your normal daily activity. You can travel and have intercourse 2 weeks later. Factors that affects the success rate: Regular cycle or not. Semen fluid analysis. Sometimes AMH. Smoking. BMI (body mass index) and percent of fat in the body. Health of the tubes. Technologies that increase IVF success rate: Assisted Hatching Intracytoplasmic morphologically selected sperm Injection - IMSI Men And Women Guide to Preparing for IVF Treating Failed In Vitro Fertilization   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/in-vitro-fertilization-i.v.f Mon, 08 Mar 2021 05:25:19 AM Intracytoplasmic Sperm Injection - ICSI Video Advances in IVF, In Vitro Fertilization ICSI (Intracytoplasmic sperm injection) is a method used to fertilize eggs in the IVF lab and it is very effective. It involves injecting a single sperm into an egg in order to be fertilized. Therefore, it is considered a major development because in this procedure, fertilization is possible even with a very small number of sperm. It involves the use of specialized tools and inverted microscopes to enable the embryologist to pick up a sperm using a specialized ICSI needle that is carefully advanced through the egg membrane then the sperm is injected into the inner part of the egg (the cytoplasm), then fertilization occurs in 75 - 85% of eggs injected with sperm. 3D animation of how IVF works Indications of Intracytoplasmic Sperm Injection ( ICSI )::- Male infertility factors that includes low sperm counts, poor motility or movement of the sperm, poor sperm quality, sperm that lack the ability to penetrate an egg or azoospermia. Failure of fertilization in previous IVF attempts. If the male partner underwent a vasectomy and sperm have been collected from the testicles or epididymis. If male partner has problems in erection or ejaculation. It is used for couples with a small number of eggs at egg retrieval, to get a higher percentage of eggs fertilized than when mixing eggs and sperms together in the IVF procedure. Note: ICSI is recommended by some clinics only for severe male factor infertility. On the other hand, some clinics use it for every case. IVF And ICSI Videos The Procedure of Intra-cytoplasmic sperm injection (ICSI) The ovaries of the female partner will be stimulated to produce more eggs The eggs are then collected by using a fine, hollow needle with ultrasound guidance. A single sperm pick up is done by using a very delicate needle. This needle will be inserted carefully through the shell of the egg into the cytoplasm of the egg and the sperm will be injected. Then the needle is removed. This does not guarantee the fertilization, but it gives an opportunity for that process to commence and to produce embryos. The embryos then will be transferred to the uterus 2 to 3 days after fertilization or 5 days after fertilization when the embryo reaches the blastocyst stage. Pregnancy test should be done 2 weeks after the embryo transfer. Intra-cytoplasmic sperm injection (ICSI) Photos Presperm loading Holding the Egg Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Methods of sperm retrieval which are used for ICSI: If there were sperm in the semen, a sperm sample can be produced by normal ejaculation into a cup on the same day of egg collection. If there is no sperm in the semen, the doctor can extract sperm from the male partner under local or general anesthesia by: Percutaneous Epididymal Sperm Aspiration or Extraction and ICSI (PESA , MESA) It is only required if the husband has one of the following problems: Absence of the vas deferens (through which the sperm passes from the epididymis to the seminal fluid ) . Past Infections that result in obstruction. Cases who have had a vasectomy and surgical reversal failed. Testicular Sperm Aspiration or Extraction and ICSI (TESA, TESE) This is done by obtaining sperm directly from the testes, either by aspiration, using a needle or surgical extraction (Taking a very small piece from the testes ). The sperm are then used to do the ICSI procedure as described above. This method is used in the following cases: Absence of sperms in the epididymis. Absent or obstructed epididymis. TESE might be done before the beginning of the treatment cycle and the collected sperm are then frozen. See our Success rates Disadvantages of Intra-cytoplasmic sperm injection (ICSI) The same risk of multiple births and ectopic pregnancy associated with standard IVF is applied to ICSI. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/intracytoplasmic-sperm-injection-indications-techniques-and-applications-icsi Mon, 08 Mar 2021 05:25:19 AM IVF Related Procedures Cryopreservation   1- Cryopreservation or embryo Freezing:- In this method, the excess embryos derived from an IVF cycle, will be preserved at sub-zero temperatures at an embryo stage ranging from fertilized oocytes to blastocyst stage using special techniques These embryos are used for future embryo transfer, without the need for ovarian stimulation or pickup procedure again. Those frozen embryos can be stored for many years and can still result in healthy children. The success rate of this method depends on the stage of the embryo, and the freezing highest success rate (80%) is reached when the embryo is frozen at the Pronuclear stage and the Blastocyst stage. There is no difference in the pregnancy rate and no increase in chances of having abnormal child when comparing between using frozen embryos or fresh embryos. Embryo cryopreservation procedure Storing the frozen semen in a specialized liquid N2 storage tanks   2- Oocyte Cryo-preservation :- Oocyte preservation can be done in many ways: Cryopreservation of whole or fragment of ovarian tissue. Cryopreservation of immature oocytes. Cryopreservation of mature oocytes.   3- Freezing seminal fluid and testicular tissue: This is done for the following cases: Men who have problems giving a sample when needed on egg retrieval day. When the man has no sperm in his seminal fluid and the sperm has to be obtained from the testes. The sperms or testicular tissue can be frozen to be used at a later date. Men whose sperm are decreasing in number or motility, or both. Men who have testicular disease and may require surgical removal of the testes. Men who have cancer and will need chemotherapy or radiotherapy or both. The success rate of the methods above: The total number of cases that become pregnant by the previous methods is equal to the number of cases that become pregnant spontaneously. However, some factors should be taken into consideration, such as the woman's age and the quality of the man's seminal fluid.   Ovarian hyper stimulation syndrome - OHSS: This happens as a result of taking fertility drugs. The ovaries become painful and swollen, and it is divided into mild, moderate and severe forms. One fourth of women who take fertility drugs develop mild OHSS. It usually resolves after one week, however, it might last for several weeks if a pregnancy occurs. Some women who are taking fertility drugs might develop more severe forms of OHSS.   Symptoms of Ovarian hyper stimulation syndrome: - Mild OHSS: - Moderate OHSS: - Severe OHSS: - Critical OHSS: • Feeling fullness. • Abdominal bloating. • Nausea. • Diarrhea. • Slight weight gain. • The ovaries are enlarged (5-12 cm). • Mild ascites. • Excessive weight gain (more than 2 pounds per day). • Vomiting. • Diarrhea. • Darker urine and less in amount. • Excessive thirst. • Dryness of skin and hair. • Fullness above the waist. • Shortness of breath and respiratory distress. • Pleural effusion. • Darker urination, less in amount. • Chest pain. • Marked abdominal distension and pain. • Hemoconcentration, (hematocrit > 45). • Thrombosis. • WBC >15,000 • Creatinine 1.0-1.5 mg/dl. • Creatinine clearance >50 ml/min. • Liver dysfunction. • Enlarged ovaries. • Tense ascites. • Hydrothorax. • Hematocrit > 55%. • WBC>25,000. • Oligoanuria. • Creatinine > 1.6 mg/dl. • Creatinine clearance < 50 ml. • Renal failure. • Thromboembolic phenomena. • ARDS.   Complication of Ovarian hyper stimulation syndrome - OHSS Ovarian torsion. Ovarian rupture. Thrombophlebitis. Renal insufficiency. Note: Symptoms usually disappear in 1 to 2 weeks, but if pregnancy occurs, it may persist longer due to the human chorionic gonadotropin (HCG) hormone that is produced during pregnancy.   Pathophysiology of Ovarian hyper stimulation syndrome: HCG extensive lutenization of the ovary large amounts of estrogen, progesterone, and local cytokines will be released vascular endothelial growth factor (VEGF) vascular hyperpermeability fluid shift from intravascular system to abdominal and pleural cavity If there are too many follicles, the VEGF will be released in large amounts and will lead to accumulation of fluid in the third space, in the form of ascites that may lead to hypovolemia and to an increased risk of respiratory and renal problems and thromboembolism. It can be avoided by using GnRH agonist instead of HCG. Risk factors which increase incidence of Ovarian hyper stimulation syndrome: Polycystic ovary syndrome Young age Previous OHSS Becoming pregnant with more than one baby Low body weight Large number of follicles High level of estradiol before HCG shot Migraine headache Treatment of Ovarian hyper stimulation syndrome:   Treatment of Mild OHSS: It needs only conservative treatment with monitoring of abdominal girth, discomfort and weight, in an outpatient clinic.   Treatment of Moderate OHSS: It's treated by: Bed rest Fluid Monitoring of electrolytes and blood counts Ultrasound monitoring Monitoring of fluid intake and output on outpatient basis (over 1L discrepancy is cause of concern) Fluid aspiration may be necessary. Opioids may be needed for the pain Note: Usually the condition will resolve spontaneously to normal and can be managed on outpatient basis, hospitalization may be needed for intravenous hydration, pain or paracentesis.   Sex Selection Assisted Hatching Finally: In the treatment of infertility, there are no guarantees. But what we can guarantee, is our care for you and the special treatment we give you, in the confidential and caring way in which we deal with all your problems. We are here for you, so do not hesitate to ask whatever you may wish to know, realizing that your success is our success. God be with you.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/ivf-related-procedures-cryopreservation-embryo-freezing-ovarian-hyper-stimulation-syndrome-ohss Mon, 08 Mar 2021 05:25:19 AM Intra Uterine Insemination - IUI   Definition of Intra Uterine Insemination - Artificial Insemination This is a procedure to treat infertility. The seminal fluid is prepared in the lab by washing it with a special media, then it is injected inside the uterus, after stimulating the ovaries to produce more eggs at treatment cycle. The sperm swim towards the fallopian tubes to fertilize the waiting egg, resulting in normal pregnancy. This procedure usually takes 15-20 minutes and it is usually done in the clinic of the doctor.   Indications of Intra Uterine Insemination   Infertility due to abnormal semen: When semen analysis shows decreased count or motility and increased abnormal sperms, but the count should be acceptable, not perfect, but should be enough to do the procedure, and the motility and the number of normal sperms should be acceptable, and this is decided by the doctor, in these cases the solution can be by doing IUI because the preparation of sperms in this procedure can help in separation of the motile and normal sperms from other sperms. Cervical factors: The Cervix is the lower end of the uterus, and it is the opening that is found between the uterus and the vagina. During intercourse, the semen goes inside the vagina and the sperm swims through the cervix in to the uterus, then in to the fallopian tubes to reach the waiting egg. During ovulation period, fluid is secreted in the cervix, and this fluid prepares the perfect environment for the sperm to reach the fallopian tubes. But, if this secretion was too thick it may hinder the journey of the sperm, or, if there is fibrosis in the cervix from previous operations due to endometriosis, IUI can go beyond the cervix by introducing the sperm into the uterus directly. Ovulation problems Semen allergy: Rarely, some women may be allergic to proteins that are found in the husband's semen, and this causes redness, swelling, and pain in the vagina when the semen touches it during intercourse. Using a condom prevents these symptoms, but it also prevents pregnancy. If the allergy was severe, then IUI may be effective as many semen proteins are removed before IUI. Unexplained infertility: IUI is usually used as a first line treatment of unexplained infertility, and sometimes it may be combined with ovarian stimulation. Antisperm Antibodies In these cases sperms won't be able to pass through the mucosal secretion in the cervix, so it will not be able to reach the egg. Therefore, this method enables the sperm to go immediately into the uterus. Erection and Ejaculation Disorders Mild endometriosis   The cases in which Intra Uterine Insemination is ineffective: Blocked or damaged fallopian tubes. Ovarian failure. Severe seminal fluid abnormality. Severe endometriosis. There are basic investigations which should be carried out for the woman before the procedure is performed and it includes checking the ovulation, and the patency or openness of fallopian tubes.   Preparation for Intra Uterine Insemination - Artificial Insemination:   1- Monitoring Ovulation : Previously, ovulation was monitored by recording body temperature and noting any change in the vaginal discharge, or by doing blood and urine tests in the Days 12-16 of the cycle. Now, the monitoring of ovulation is done by vaginal ultrasound after the woman is given ovarian stimulating drugs to make sure of the maturity of the follicles (the eggs), and the doctor usually prefers having at least 1-3 mature follicles to give the HCG injection. Then, the semen sample is taken, (as it will be explained later), and it will be sent to the lab to be prepared. The preparation of semen usually takes 1-3 hours and IUI is done in the time that is decided by the doctor. In general, the duration of time between giving the injection and doing the IUI is 36-44 hours, and IUI in the next day is done 60 hours after the HCG. 2- Preparation of the semen sample: A semen sample can be produced by masturbation in the home, or in a special room in the hospital, after 2-5 days of abstinence. The semen is then washed in the lab thereby isolating the normal motile sperms from the abnormal immotile sperm. Then, the sperm is separated from other components of the semen and concentrated in a small amount. Various media and techniques can be used for Preparation of the semen sample. Sperm Preparation takes about 30-60 minutes.   Intra Uterine Insemination Procedure: IUI is usually done in the clinic of the doctor, and there is no need for medication or an analgesic during the procedure. The speculum is placed in the vagina and cervical area is cleaned, the prepared specimen of highly motile sperm is placed in the uterine cavity using a special flexible catheter. How many times can the IUI be done? The IUI is usually done twice during the treatment cycle, and it has been proved that doing the IUI twice increases the pregnancy rate because it decreases the loss of the fertility period during the ovulation, but there was a study that was done comparing the pregnancy rate after IUI on one time, or two times, and found no difference. After the Intra Uterine Insemination: Usually, the IUI procedure takes from 15-20 minutes. The patient is then asked to lie down on her back for a period of time. If the semen was not washed properly, the injection of semen into the uterus may cause contractions that pushed the semen out and can cause pain due to special enzymes called prostaglandins that are responsible for the passage of blood during menses. The patient can continue her normal life, and passage of a small amount of blood in 1-2 days after IUI is normal. Intra Uterine Insemination Results   Pregnancy test should not be done before 2 weeks have past since the IUI. Doing it before this may cause false negative result (which means that the patient is pregnant while the test is negative), and in the cases where hormones are used for ovulation induction, like HCG, doing the pregnancy test before 2 weeks can cause a false positive result (which means that the patient is not pregnant while the test is positive that is caused by the HCG hormone that is found in the blood). If Intra Uterine Insemination fails, when can it be repeated, and how many times?   If Intra Uterine Insemination (IUI) fails, it can be repeated 3-6 times to increase the pregnancy rate. It can be repeated after at least one month or more, this depends on the doctor's and the couple's mutual decision. It has been proven that the cumulative pregnancy rate after IUI has been repeated 4 times is 50-60%. If IUI fails after 4 trials, it is preferred not to repeat it. The doctor will decide the next step according to the case. Success rate of Intra Uterine Insemination - IUI: -In general, the pregnancy rate of IUI is 10-20% and it depends on the age of the wife, her health situation, and also on the number of motile sperm that is used in each cycle, and the pregnancy rate in 2 IUI cycles using 5 million sperm is more than the pregnancy rate in 1 IUI cycle using 10 million sperm.   For couples of unexplained infertility, trying for 2 years, female age under 35, and normal sperm, the success rate is as follow: 10% chance per month using clomid, and IUI for up to 3 cycles. 15-20% chance per month using injection by FSH medication, and IUI for up to 3 cycles. Our success rate How many inseminations should one try before resorting to IVF?   After 3 failed IUIs. If the female age is 40 or older or if ovarian reserve is low, consider In Vitro Fertilization earlier. Risks of Intra Uterine Insemination - IUI: Rarely, IUI may cause infection in the uterus and tubes, from bacterial contamination that originate either from semen sample, or contamination of sterile catheter in the vaginal or cervical area during the procedure. Careful cleaning of the cervix and cautious technique alleviate this and make it a rarity.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/intra-uterine-insemination-success-rates-risks-uses-iui Mon, 08 Mar 2021 05:25:19 AM Success rates of IVF,ICSI,TESA,TESE and IUI procedures at Dr.Layyous IVF center   Dr Najeeb Layyous IVF Center in Jordan believes in tailoring the treatment for the individual couple entering the IVF program. Consequently, he himself assesses both the female and the male and puts the stimulation protocol according to that particular patient's need. He doesn't believe in factory type stimulation protocols. Our pregnancy rates are one of the highest pregnancy rates Per Embryo transfer . This high rate of pregnancy Per Embryo transfer. reduces the overall cost of treatment and minimizes the discomfort and time away from work associated with multiple egg retrievals. Our Latest Chemical & Clinical Pregnancy Rates for IVF Cycles, including ICSI and PESA ,TESA and TESE 15/6/2008-31/12/2008   Female Age Chemical Pregnancy Rates Per Embryo transfer Clinical Pregnancy Rates Per Embryo transfer 30 and under 76 % 71.43 % 35 and under 68.75 % 62.55% 36 -39 50 % 35.71 % 40 and above 40% 40% Total 60.78 % 53 %   * How did we achieve these results? Our success rates in our IVF programs are considered unique in the middle east as we monitor each case closely and what we mean by the case is the wife and husband as one unit. We tailor the plan for the case according to the medical situation and the need for that particular couple. we don't believe in conveyer belt type factory production. We apply this method in each stage of therapy starting from medical education and ending with delivery. we will mention in details what make our program unique.   1-Health education :- We believe it is the right of the patient to be well-informed and be involved in the process. This is why the website was setup. We have highly trained personal ready to answer any question before, during and after the program. In addition there are many informative brochures setup for the same aim.   2-Clinical examination and diagnosis : Each couple entered in the program are assessed very thoroughly for proper diagnosis. Dr Najeeb Layyous relies on his wide experience in ultrasound examination believing that what you can see with your eyes gives you better information for decision making than a laboratory test.   3-Taloring the treatment : After the examination and assessment, avenues for treatment are put to the couple and discussed. The method of treatment is decided, and the case is prepared from all angles of treatment, Some cases might need surgical intervention before starting the program, e.g uterine adhesions, sub mucous fibroids, uterine septum. Hysteroscopy is done for such cases to prepare the uterus before entering the program. Base line investigations are done so that the couples are studied from all angles. The patient's weight is taken into consideration, and appropriate diet advised . Treatment for the husband is given if needed. If the decision to go ahead with assisted reproductive technology is taken. We prepare the patient in many ways Mock Embryo Transfer is carried out before the start where the length of the uterine cavity is ensured and the angle of the cervix, thus all is taken into consideration avoiding trial and error at the time of the actual transfer. This also benefits in preparing the patient psychologically for the acute transfer thus avoiding possible psychologically induced uterine contractions, which might result in expulsion of the embryos.   4-Close monitoring and psychological support: After starting the ovulation induction program the patient is asked to come back for a second visit 2-5 days later according to the individual case. Vaginal ultrasound examination is carried out, and the dose is adjusted accordingly. Dr. Najeeb relies on ultrasound monitoring and not on hormonal monitoring, he uses his wide experience in the use of ultrasound to judge what happened and what will happen in the patients body as certain doses are given thus avoiding problems of cycle canceling because of over stimulation or low response resulting in low cancellation rate in our centre and also avoiding the patient the psychological and financial burdens .During these visits we try to build rapture with the couple giving them psychological support which, supported success rates. In summary we tailor our treatment for every couple.   5-Oocyte pickup and Embryo transfer : This is carried out in a very advanced centre where the IVF laboratory staffs are experts in the field and highly trained working under excellent laboratory conditions. Generally, speaking the success rate depends to a great degree on the number of embryos transferred, quality and easiness of transfer. This is taken into consideration especially, the number of embryos transferred as we don't adhere to fixed rule and the number is decided according to the quality of embryos, age of the woman, previous attempts failure, all this is discussed with the couple and the decision make together. This is followed by taking drugs for luteal support which helps implantation.   6-After care ( pregnancy and delivery ) : When pregnancy is diagnosed, ante natal care is provided where the both the mother and the fetus are looked after . Ultrasound examination is carried out to assess the health, growth of the fetus and diagnose any abnormalities. The decision taken for a normal delivery or C.S . Finally when science is combined with experience, the results speak for themselves.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/success-rates-of-ivf-icsi-tesa-tese-success-rates-iui Mon, 08 Mar 2021 05:25:19 AM Video clips of the IVF and ICSI procedures (IVF and ICSI video clips https://www.layyous.com/en/assisted-reproduction/ivf-and-icsi-videos-procedure-and-process-involved Mon, 08 Mar 2021 05:25:19 AM A selection of IVF and ICSI Photos   A tour in the IVF Laboratory Oocytes and Sperms Photos Fertilized Oocytes and Embryos Photos ICSI Photos Assisted Hatching Photos Blastocyst Photos https://www.layyous.com/en/assisted-reproduction/ivf-and-icsi-photos-ivf-and-icsi-images-very-nice-scientific-photos Mon, 08 Mar 2021 05:25:19 AM Intracytoplasmic morphologically selected sperm Injection IMSI - and how it improves ICSI results   It was found that only 4.75 percent of spermatozoa are normal. Because we hope to give you the highest rates of success, we try to achieve the best-quality Embryos. A new breakthrough in treating infertility caused by male factor, IMSI is a new vision. Which involves careful selection of the best-quality sperm after magnifying them 6600-8000 times. In conventional procedure of ICSI, sperms are selected by an increase of 200-400 times that can roughly estimate the morphological characteristics of sperm.   Examining the sperm at high magnification (6600-8000x) shows defects in sperm heads, shapes and sizes and any sperm abnormalities associated with high DNA fragmentation that cannot be seen in conventional microscopes used for ICSI, only the best morphological sperms will be micro-injected into the eggs, which would lead to higher pregnancy success. Normal shape Sperm with vacuoles So it might take our expert 2.5 hours from the embryologist to select the best sperms, to give you the best chance for success. Sperm quality is based on the (Vanderzwalmen standard) which states that when a sperm has good morphology, it is more likely to have normal chromosomes and fewer fragmented DNA, which plays a significant role in determining embryo quality implantation and growth.   Mitochondrial function, chromatin structure and lower aneuploidy rates, are better in the selected sperms which will increase the chance of having a healthy normal child following IMSI treatment  as compared to conventional ICSI. Normally shaped nuclei (Smooth, symmetric, oval), depending on these defined by scanning electron microscope, which based on: high-power microscopy single cell examination Observation of only motile sperm cells fine organelle morphology In IMSI, we achieve: lower number arrested embryo that will cause cycle arrest Higher pregnancy rate and higher implantation Increase the rate of successful pregnancy, better embryo development in couples with male infertility less poor embryo development Lower rates of arrested embryos following prolonged 5 days culture in previous ICSI Higher rates in case of repeated failures in ICSI Improved outcomes for patients with male infertility and high Teratozoospermia, ie, an increase in the number of abnormal forms of spermatozoa. IMSI Video - Do you know what IMSI is? IMSI Video - Intracytoplasmic Morphologically Selected Sperm Injection Dr Najeeb Layyous F.R.C.O.G   Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/intracytoplasmic-morphologically-selected-sperm-injection-imsi.-recent-ivf-technology-and-how-it-improves-icsi-results Mon, 08 Mar 2021 05:25:19 AM Embryo glue   IVF technologies and developments are considered one of the most useful technical and scientific revolutions at the medical and social levels, because it mimic the natural instinct and it concentrate on one aim which is for parents to have a baby. EmbryoGlue increases take-home baby rate Since the beginning of successful IVF trials, multiple researches were done in an attempt to increase the success rate for a healthy pregnancy and delivery. One of these researches that were declared on (2003) is embryo glue, this was done on 141 IVF cases that used this substance, and it has been studied long enough to know its actual benefit. These cases were chosen according to certain identical criteria, age, FSH level on the third day of cycle, number of embryos transferred, and same general conditions, these cases were divided randomly into two groups, in the first group, embryo glue was used, but in the second group no glue used. The results were amazing, pregnancy rate increased by 21%, and embryo implantation rate increased by 34% as compared to previous rates. In IVF these are great percentages. What is embryo glue? Embryo glue is a chemical substance composed mainly from hyaluronan, this substance is normally found in fallopian tubes, uterus, and follicles it has a major role in changing the endometrium into a layer that is rich in its blood supply, with more active glands and increases their secretions in order for the endometrium to receive the pregnancy and continue to nourish the embryo. This material is responsible for preparing the uterus to receive the fetus just before implantation and during incubation. It also contains other nutrients such as albumin, water and bicarbonates, all these ingredients helps to nourish the fetus from the moment of transfer till implantation. It is noticed that embryo glue works on two axes, the first one is prepare the uterus to receive the embryos in the same natural ways, the second axis is the proper nourishment for the embryo from the second of transfer till implantation. How does it work? The process of implantation has three stages: 1- Contact stage: After embryo transfer to the uterus, with the use of glue, the high viscosity of this substance helps to extend the glue into the natural secretions present inside the uterus, the similarity between the glue and natural secretions helps the embryos to find the area of the uterus suitable for implantation. 2- Adhesion stage: In this stage the glue helps the embryos to cleave more steadily, by working on certain specialized enzymes secreted by the uterus which increase the adhesion rate. 3- Implantation: It is the stage when the embryos are implanted in the endometrium and cohesion between the cells of the embryo and endometrial linings. In conclusion, embryo glue increase pregnancy rate by 21% as compared to cases without using embryo glue, and it helps also in the continuity of pregnancy.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/embryo-glue-increasing-ivf-success-recent-ivf-technology Mon, 08 Mar 2021 05:25:19 AM Assisted Hatching Failure of the implantation of embryos, after its transfer to the uterus, is one of the most common obstacles that we face in the IVF program. And this happens usually with couples who have undergone recurrent IVF trials that have failed, in spite of the transfer of embryos of good quality, and usually the negative pregnancy test. In those cases, can be caused by failure of embryo implantations, for unknown reasons. For these cases, the science has found a new method to increase the chances of success of embryo implantation by what is called, Assisted Hatching. The wall of the egg in the human female, has an important role in protecting the egg and the embryo from dissociation by immunity cells or by toxic vital materials. In the early 90's, researchers have found that creating a hole in the wall of the embryo that is produced by IVF, before its transfer to the uterus, when during its early division stages, has increased the chances of the embryo implantation, and the chances of this embryo being damaged and losing its criteria after creating a hole in its wall, is very rare. However, creating a hole in the wall of a non-fertilized egg puts it under 4% risk to be damaged and that is because the wall of the embryo is more elastic than the non fertilized egg. In that technique, the hole is created by a thin microscopic needle or by using chemical materials, or by laser. Assisted Hatching by Mechanical Method     Assisted Hatching Using the Laser   It should be taken into consideration that the most common cause of implantation failure is the presence of abnormal chromosomes in the embryo. In those cases, the preimplantation genetic diagnosis can be beneficial and increase the chances of pregnancy.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/assisted-hatching-ivf-assisted-embryo-hatching Mon, 08 Mar 2021 05:25:19 AM Blastocyst Culture - Best Time For Embryo Transfer - Fifth Day Embryo Transfer In each IVF cycle, the fertilized egg will pass through different stages of division in the lab, and it continues these divisions inside the uterus after it is transferred to the uterus. Usually, the egg is fertilized, either by in vitro fertilization (IVF) or by intra cytoplasm sperm injection (ICSI), and then it is left to undergo the stages of division. In the first three days of fertilization, the fertilized egg is divided up to (4-8) cells that will be transferred inside the uterus and it is now known as the embryo. After that, no one can guess if that embryo will continue its divisions, and then to be implanted in the endometrium, (the inner wall of the uterus). After the first 3 days, (stage of 4-8 cells), the number of cells will be increased and there will be thinning in the wall of the fertilized egg that will increase its ability for implantation. And that is what happens inside the uterus. But, in special cases, the fertilized egg will not be transferred to uterus at that stage but will be left in the lab to continue its division under the supervision of a lab technician, so its ability for division can be observed. The embryo will not be transferred until it divides up to the blastocyst stage, and the embryos at that stage have the best chances for implantation and success. What are the factors that should be taken in to consideration to decide the time of embryo transfer, at the 2nd or 3rd day (stage of 4-8 cells), or to be transferred at 5th or 6th day (stage of Blastocyst)? The number of IVF trials (in the cases of recurrent IVF failures, the embryo is usually transferred at the stage of blastocyst) The number of embryos ( the chance to transfer the embryo at the level of blastocyst is limited as the number of embryos is less) The quality of embryos ( only the embryos of good quality at the 3rd day can be left to reach the blastocyst stage) Inner Cell Mass of Blastocyst Magnified Hatching Blastocyst Magnified Expanded Blastocyst with clear Inner Cell Mass Hatching Blastocyst Expanding Blastocyst Less magnified Expanded Blastocyst Completely Hatched Blastocyst Expanded Blastocyst with clear inner cell mass Early expanding Blastocyst Compacted to Early Blastocyst Blastocyst with very clear Inner Cell Mass Early expanding Blastocyst Blastocyst with different grading The advantages of transferring the embryos at blastocyst stage are: The ability to choose the best embryos to be transferred. Increase the chance of implantation and occurrence of pregnancy. Decrease the incidence of multiple pregnancies as the number of embryos to be transferred is limited. The ability to do prenatal screening at day 5 (to determine the health and condition of an embryo before its transfer) to avoid transfer of abnormal embryo. The waiting period to test for pregnancy is less. The disadvantage of transferring the embryos at blastocyst stage: Sometimes the embryos will not be able to continue their divisions either due factors related to the embryos ( weak embryos or embryos of poor quality), or because they can't continue their divisions outside the uterus due to the natute of the media that is used in the lab and because of that, the trial of IVF may end without transfer of embryos and that will not be accepted by the couples, therefore the decision should be taken by the doctor after discussing it with the responsible person in the lab and this decision should be discussed also by the couples. Videos Showing Blastocyst culture Blastocyst culture Blastocyst culture Video Highly expanded blastocyst showing inner cell mass and thinning of the EP Video Hatched blastocyst showing the empty zona with few blastomeres were not compacted   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/blastocyst-culture-extended-culture-up-to-the-blastocyst-stage-fifth-day-embryo-transfer Mon, 08 Mar 2021 05:25:19 AM IVF Failure - Treating Failed In Vitro Fertilization   It refers to infertile patient who have undergone many IVF cycles and produced good embryos but the embryos have failed to implant for unexplained reason   Methods to improve success in IVF failure Transfer of many embryos: Many embryos can be transferred for difficult cases (Except for fertility clinic in UK and Australia where the number of embryos that can be transferred is limited by law). While transferring many embryos increases the risk of multiple pregnancies, this risk is negligible for difficult cases, and it can be decreased by fetal reduction. Aggressive Superovulation: High dose of HMG is used in order to help patients with a poor ovarian response to grow more eggs to have more embryos to transfer. Difficult embryo transfer: That’s why we do artificial transfer for each patient by inserting a catheter into the uterus to measure its length and depth to know where to insert the embryos. PCOD (Polycystic ovarian disease):For these patients, ovulation induction is done carefully to have an average number of follicles only so we don’t end up by super ovulating them. OHSS is avoided by aspirating each follicle carefully until it collapses completely. In case of any further risk, the embryos are frozen for future use. Chromosomal abnormalities:It has been found that chromosomal abnormalities can be found in 50% of embryos even in good-looking ones. Blastocyst transfer (Rather than transferring them on day 2 or 3) : The rate of blastocyst development is only (30%), therefore it is not the best for patients with repeated implantation failure, especially those who have few embryos available. Immune system (ANA, APL antibodies, NK cells, antithyroid antibodies): Sometimes, an immune system can have a bad effect on an individual by different mechanism and can cause infertility and recurrent pregnancy loss, but abnormal results are often found in normal fertile women as well, and although there is no evidence to suggest that immune therapy will result in successful pregnancy, but we are still considering it in cases of IVF failure. Thrombophilia: Thrombophilia is conditioned that result in an increased chance for clotting of blood. Although it's not yet confirmed that thrombophilia can cause implantation failure, there has been widespread use of the anticoagulant's heparin and aspirin for women with IVF implantation failure with varying results. IMSI (Intracytoplasmic morphologically-selected sperm injection) IMSI is done by using an extremely high-powered microscope to select the sperm cells with the best morphological quality to be injected into eggs, by magnifying the actual size of the by 8000 times, we can detect the abnormal sperm. Usually, abnormal sperms are identified if they were magnified 400 times their actual size. Many patients have finally conceived after multiple IVF attempts even though there was no change in treatment protocol in all IVF clinics so sometimes it just needs a bit of luck, patience and perseverance.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/ivf-icsi-failure-treating-failed-in-vitro-fertilization-what-is-ivf-failure Mon, 08 Mar 2021 05:25:19 AM Preimplantation Genetic Diagnosis   Genetic diseases are considered to be a major problem. Concentrated efforts have been done by scientists to solve the problem. We will mention a few of the steps taken. Pre-implantation diagnosis by embryo biopsy: This is done by taking one or more cells from the embryo. Then, scientists try their best to take as many cells as possible to reach a diagnosis or identify a disease. The best time to do this is after the division of the fertilized egg by IVF, until it reaches the stage of 8 cells. That usually occurs on Day 3 after fertilization. The lab technician creates a hole in the embryo wall by using a very thin microscopic needle or chemical substance, or laser. Then, one cell will be taken without causing damage to the embryo by taking the cells that have no effect on the embryo (nonessential cells) in an advanced stage of the embryo's development (the blastocyst stage), and after that, the diagnosis is done in 2 ways:   2. FISH (fluorescence in situ hybridization): In this technique, the normal embryos can be selected to be transferred to the uterus as in the case of IVF. It should be taken in to consideration to select the best time to take the biopsy from the embryo and to avoid occurrence of damage to the embryo. In that way, we can achieve the best results in diagnosis which will lead to a healthy, successful pregnancy.   1. Genetic diagnosis of pre-implantation embryo: This technique is used to diagnose the inherited diseases and has been developed recently, by using a special test called PCR (Polymerase Chain Reaction) and the number of human genetic diseases that can be diagnosed is increased. We hope, in the future, scientists will be able to diagnose all the genetic diseases in that way. This technique is useful for couples that may have a child who is effected with an inherited disease. In that way, only the normal embryos can be transferred to the uterus. This is much better than the occurrence of a pregnancy than the diagnosis of a genetic disease by Amniocentesis (taking sample of the amniotic fluid), or by Chorionic villous sampling.   Gene disorders transmittable to the offspring, which can be analysed by genetic diagnosis after oocyte and embryo biopsy. Achondroplasia Central core disease Agammaglobulinemia Gaucer’s disease Sickle-cell anemia Huntington’s disease Fanconi’s anemia Alport’s disease Spinal/bulbar muscular atrophy Tay-Sachs’ disease Alpha1- antitrypsin deficiency MELAS Long chain hydroxyacyl CoA dehydrogenase deficiency X-linked myotubular myopathy Ornithine transcarbamilase deficiency Neurofibromatosis I and II Deficiency of the mitochondrial trifunctional protein Multiple endocrine neoplasia type II Multiple epiphyseal dysplasia Osteogenesis imperfecta I and IV Myotonic dystrophy Familial adenomatous polyposis coli Becker’s muscular dystrophy Rhetinitis pigmentosa Duchenne’s muscular dystrophy Rhesus (Rh D) Haemofilia A and B Tuberous sclerosis Epidermolysis bullosa Crouzon’s syndrome Exclusion HD Di George’s syndrome FAP-Gardner Hunter’s syndrome MPS II Phenylketonuria Lesch-Nyhan’s syndrome Cistic fibrosis Marfan’s syndrome X-linked hydrocephalus Digital oro-facial-syndrome type 1 Incontinentia pigmenti Stickler’s syndrome Hyperinsulinemic hypoglycemia PHH1 Fragile X syndrome Early onset Alzheimer’s disease Wiskott-Aldrich syndrome Charcot-Marie-Tooth’s disease 1 and 2A Thalassemia List of some of the genetic diseases that can be diagnosed by PGD   2. FISH (fluorescence in situ hybridization): Normal embryos can be selected to be transferred to the uterus, as in the case of IVF. It should be taken in to consideration to select the best time to take the biopsy from the embryo, and to avoid the occurrence of damage to the embryo. We can then hope for the best results in diagnosis, leading to a healthy and successful pregnancy.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/preimplantation-genetic-diagnosis-overview-indications-and-conditions-process-pre-implantation-diagnosis-by-embryo-biopsy Mon, 08 Mar 2021 05:25:19 AM In Vitro Fertilization - I.V.F Patients Frequently Asked Questions 1 - How to make an appointment to start the IVF program? Is there waiting list? Without waiting simply call us at phone No: +9626565575.   2 - What is the best time to start the management program, and the best time of the first visit? You can visit us at any time for a general evaluation and choose a suitable program for yourself. The best time for starting the ovulation induction program is the second day of your menstrual cycle.   3 - Shall we stay in Jordan all through the program, and / or when can we leave? If the evaluation is done beforehand and an injection program has been given to you, you can return home. You will need to return to evaluate your response on Day 5 or 6 of your cycle. Then you will need another 10 days for completing the egg retrieval and embryo transfer. In total, you need around 20 days from the second day of your cycle.   4 - Does the procedure need general anesthesia and hospitalization? Egg retrieval is done under general anesthesia, and in rare conditions under local anesthesia. It is an outpatient procedure. Embryo transfer is usually done without anesthesia.   5 - After embryo transfer, do we need complete bed rest? What about sexual intercourse? Embryo transfer does not interfere with your daily activity. We advise not to have intercourse for at least one week after the procedure.   6 - Does the husband needed to be available all through the program? The husband is needed only on one day, the day of pickup to give semen, unless he needs TESA or TESE under general anesthesia. If this is the situation, we need him one day before.   7 - What does the procedure cost? ICSI 1800 JD = 2535 US$ including assisted hatching   This does not include the cost of medication. TESA 450JD = 634 US$. TESE 800JD = 1127 US$. Micro-TESE 1100JD= 1550 US$   8 - What can we do if we have too many embryos? We can freeze the extra embryos for the next trial or embryo transfer.   9 - Is their a warranty for success? And what are the percentages of success? The success rate is not 100%. The rate of success depends on many factors like the quality of embryos and Number of them. There are also factors with the semen.   10 - Is it possible to cancel the program? Many factors may play a role which lead to cancelling the program like: If there is no response for ovulation induction. Weak response. Bad quality of eggs which lead to fertilization failure. No division development after fertilization. Ovarian hyperstimulation.   11 - Are there any side effects due to using ovulation induction? Those side effects are mainly due to ovarian hyperstimulation, which are: Abdominal distension, heaviness and abdominal pain. Nausea and vomiting with stomach ache. In the case of shortness of breath or fluid accumulated in the abdomen you must call your doctor.   12 - Does receiving medicine interfere with ovarian response? You must inform your doctor about your medications as some of them interfere with the ovulation induction medication.   13 - Is it true that all through the program we must avoid intercourse? Not true, as there is no relation between intercourse and ovarian response.   14 - Does a retroverted uterus interfere with implantation in In Vitro Fertilization, and does it have any effect on pregnancy? No, it does not. About 20% of women have a retroverted uterus and become pregnant without any complication.   15 - Does age have any effect on success? One of the most important factors is age, as the fertility rate decreases with a woman's increasing age.   16 - Does obesity interfere with pregnancy and lead to infertility? Indirectly, it can as it may be associated with Polycystic ovary syndrome.   17 - Is there any hope for those with premature ovarian failure? This condition, at the current time, has no solution. Their condition is associated with high FSH and low estrogen resulting in the inability of the ovary to produce follicles.   18 - Excessive weight loss, dose it causes amenorrhea? Yes, in some condition like anorexia nervosa.   19 - Does heavy exercise cause amenorrhea? Sometimes, and it depends on the type of exercise and woman herself.   20 - I was married 5 months ago and I have bad azoospermia, what can I do? We advise you to have a fine needle aspiration of the testes, then depending on the result, hopefully positive, then we can start an ICSI program. If it is negative, we will discuss stem cells with him.   21 - I was married 17 years ago with our first baby born when I was 22 years old. The second, at 26 years and then I used contraception pills for 5 years. After that, I tried to get pregnant but was not successful. An HSG was done and it said,” blocked tubes.” Now what can I do? We have two solutions. The first is to do laparoscopy to re-open the tubes, if possible, or consider the ICSI program.   22 - We have three girls. What is the best method to have a baby boy, and what is the percentage of success? Would it harm the embryo, or not? The best method is by ICSI PGD. In this method, if pregnancy occurs, the baby will be male, 100%. This procedure takes 22-25 days from the second day of your cycle and is done by taking one cell from the embryo and it does not harm the fetu   23 - Does taking a biopsy from the testes have side effects on the testes in the future? No, it does not harm the testes now or in the future.   24 - Is their special nutrients to increase the level of estrogen to increase the endometrial thickness? There is no special nutrient, but we have pills used for increasing the thickness of the endometrium   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/ivf-in-vitro-fertilization-frequently-asked-questions Mon, 08 Mar 2021 05:25:19 AM Fertilized Oocytes and Embryos Photos Magnified 3 Pronuclei in abnormally fertilized Oocyte Fertilized Oocyte with clear two Pronuclei and 2nd polar body Fertilized Oocyte with abnormal wide perivitelline space A fertilized egg non natural Abnormal Fertilization with Multiple Pronuclei Two Gametes with clear Fertilization Embryos Bouklitin Embryo Bouklitin enlarged 2-cell embryos 4-cell embryos 4-cell embryos enlarged 4-cell Embryo 4-cell Embryo day 2 5-4 cells embryos 5 cells embryos 6-7 cells embryos 8-cell Embryo on day 3   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/fertilized-oocytes-and-embryos-photos Mon, 08 Mar 2021 05:25:19 AM IVF Laboratory Tour   Different procedures done in the IVF Laboratory Preparation of the Dishes Looking for oocytes in follicular fluid (ovum pick up procedure) Semen assessment and treatment Specialized CO2 – Incubators Checking CO2 concentration in the incubator Culture Media Preparation Intra- Cytoplasmic Sperm Injection Procedure (ICSI) Mechanical Assisted Hatching Procedure Partial removal of the zona pellucida for blastomere biopsy using laser system Blastomere biopsy for pre-implantation genetic diagnosis PGD Embryo cryopreservation procedure Karyotyping of human chromosomes Pre-implantation genetic diagnosis using fluorescent microscope Storing the frozen semen in a specialized liquid N2 storage tanks   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/ivf-laboratory-tour-different-procedures-done-in-the-ivf-laboratory Mon, 08 Mar 2021 05:25:19 AM Oocytes at different stages Sperm photos before the ICSI procedure   Cumulus Cells surrounding the oocyte (undissected oocyte) Immature Oocyte in Metaphase I Stage Immature Oocyte with the germinal vesicle Mature Oocyte showing the 1st polar body and Cytoplasmic Granulation Oocytes with thick zona pellucida and irregular perivitelline space Abnormal Oocyte with Multiple Polar bodies a mature Oocyte after injecting the immobilized sperm in it through the needle The location of the injected sperm in the Oocyte after ICSI Immobilization by hitting the sperm's tail with the injecting needle Getting the sperm for ICSI Progressive sperms Motile sperms sperm inside the needle sperm entering the needle sperm getting inside the ICSI Needle Loading of the sperm Loading of the sperm after immobilization Active sperms after treatment Loading of the sperm after immobilization Treated sperms Courtesy of Dr.Ghada Al-Hayaly and Nevin Zahdeh   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/oocyte-maturation-and-development-oocytes-at-different-stages-sperm-photos Mon, 08 Mar 2021 05:25:19 AM Physiological Selection of sperm for ICSI ( PICSI )   Is a new method to assess the strength and quality of the sperm? The traditional ways to check the good sperms depends on the appearance and the motility of sperms, this new method assesses the function of the sperms. PICSI assess the ability of sperms to attach to the protein Hyaluranon, Hyaluranon is a material that normally present on the external surface of the eggs and aids in attachment between sperms and egg that happens usually before fertilization of eggs, if the sperm is able to attach well to hyaluranon then it is good functioning, strong and mature sperm. That will result in a good quality embryos and increase in pregnancy rate by 20 %. Studies show no harm from using this technique. PICSI recommended to be used in these cases: Old maternal age more than 38 years old. History of recurrent abortions. Poor quality embryos. Recurrent IVF failure. Failure of fertilization. Failure of division. Poor quality sperms, morphology and motility. Sperms that were frozen before.   If sperms were aspirated from testes, by TESA and TESE, this technique cannot be done unless the sperm moves by treating it after aspiration. 3D video on PICSI - Physiological Intra Cytoplasmic Sperm Injection   Dr Najeeb Layyous F.R.C.O.G   Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/physiological-icsi-physiological-selection-of-sperm-for-icsi-picsi Mon, 08 Mar 2021 05:25:19 AM Microsurgical Sperm Retrieval from the Testicle (Micro-TESE)   Azoospermia,is defined as the absence of spermatozoa in the ejaculate after assessment of semen on at least two occasions, is observed in approximately 1% of the population and in up to 15% of infertile men. Non-obstructive azoospermia (NOA), which is diagnosed in about 60% of azoospermic men, can be detected clinically in men with small-volume testicles, elevated follicle-stimulating hormone (FSH) and azoospermia. Micro-TESE stands for Microsurgical Sperm Retrieval from the Testicle. This involves a small midline incision in the scrotum, through which one or both testicles can be seen. The surgeon examines the testicle(s) under the microscope, which provides up to 20x magnification, in search of areas where the seminiferous tubules – small areas of testicular tissue – are dilated and therefore more likely to contain sperm. The surgeon then removes these areas, and examined in laboratory for the presence of sperms.It allows the removal of tiny volumes of testicular tissue in areas of active sperm production by microscope, improving sperm yield compared to traditional biopsy techniques. This approach has a number of advantages over other sperm retrieval techniques. It maximizes the yield of spermatozoa and minimizes the amount of testicular tissue required and vascular injury created, by making identification blood vessels easier. Minimally invasive, safe and limits the disruption of testicular function. With micro-TESE, successful sperm retrieval has been reported in up to 63% of men, whereas conventional sperm retrieval procedures have reported success rates from 20% (percutaneous testicular biopsies) to 45% (open testis biopsies).   Sperm processing The mechanical processing of testicular tissue samples in the operating room involves cutting tissue samples and passing the sample through a fine catheter. This process increases the yield of testicular by 300-fold, facilitating early identification of sperm in the operating room. Each specimen should be examined for the presence of sperm in the operating room; the procedure is terminated once sperm are found. Sperm are not always identified in the operating room; meticulous laboratory-based, including enzymatic treatment is performed to improve the chances of finding sperm. The chance of finding spermafter chemical digestion when sperm were not initially found is 25%–30%. Although men with NOA have different pathological patterns that can be treated with this approach, the technique of finding areas of the testicle with sperm production is important in determining the success of an IVF cycle. Multiple techniques for sperm retrieval have been described including fine needle aspiration (FNA), percutaneous testis biopsy, open testicular biopsy or testicular sperm extraction (TESE) and microdissection testicular sperm extraction (micro-TESE). While the success of micro-TESE compared to other sperm retrieval techniques has been accepted, prediction preoperativelyto whom the procedure willto be successful remainscontroversial. Preoperative variables such as age, FSH, testicular volume, inhibin B, genetics, Klinefelter syndrome, history of varicocele,cryptorchidism, as well as intaoperative variables such as histopathology and tubular diameter . These variables were determined by reviewing the available literature on prediction of success in sperm retrieval techniques, with a focus on those reviews that are dedicated to micro-TESE.   Previous biopsy A single biopsy is inadequate to retrieve sperm and more extensive testicular evaluation may be needed before sperms are found. Multiple random biopsies will carry the risk of creating intratesticular scar, decreasing androgen levels and future sperm production. A diagnostic testicular biopsy provides limited evaluation of testicular function; it cannot determine which men with NOA will have successful sperm retrieval. Patients who undergo one to two biopsies with no spermatozoa identified, the success rate of micro-TESE is close to 60%. There is no threshold for the number of negative biopsies that permits sperm retrieval using micro-TESE.For men who had previously conventional TESE and fail to have sperm retrieval, a repeat conventional TESE causes further testicular damage with limited success. In case of a failed conventional TESE, micro-TESE can be offered and spermatozoa retrieval is possible with sperm retrieval rate of 45%. Previous micro-TESE seems to have little effect on the success of future microdissection. A repeat micro-TESE in men who underwent one successful microdissection attempt carries a sperm retrieval rate of 82%. If a complete micro-TESE procedure is done by examining the deeper tissues of the upper and lower poles of both testes, the operation should not be repeated. Sperm retrieval rate for repeating previously failed ‘micro-TESE' procedures done elsewhere is 10%. A high sperm retrieval rate with micro-ESE is clearly demonstrated in men with Klinefelter syndrome, cryptorchidism, and prior history of chemotherapy and Y chromosome microdeletions as well as idiopathic NOA. It is possible that the chance of sperm retrieval rate can be maximized by pre-treatment of patients to optimize hormonal levels, especially in men with Klinefelter syndrome.   Follicle-stimulating hormone (FSH) Follicle-stimulating hormone (FSH) is a glycoprotein produced in the pituitary gland .Many theories suggest that FSH may be useful in predicting the outcome of sperm retrieval procedures, in that patients with very high levels of FSH would tend to have a global failure of sperm production within the testis. While the success of micro-TESE compared to other sperm retrieval techniques has been accepted, a full understanding of predicting preoperatively to whom the procedure will to be successful remainscontroversial. Preoperative variables such as age, FSH, testicular volume, inhibin B, genetics, Klinefelter syndrome, history of varicocele, cryptorchidism, as well as intaoperative variables such as histopathology and tubular diameter . These variables were determined by reviewing the available literature on prediction of success in sperm retrieval techniques, with a focus on those reviews that are dedicated to micro-TESE.   Post-Surgery Most men are surprised by the minimal pain they have after this surgery. The scrotum is one of the fastest healing parts of the body and theclosure of the layers used helps to ensure that men do not have infections or bleeding after the surgery. Most men use an ice pack for the first 24 hours after the surgery with no need of analgesia later. Men are advised to avoid sex, masturbation, or vigorous exercise for 10 days after the surgery. It typically takes 10–14 hours of searching for sperm under the microscope to determine if any sperm were found. Microdissection Testicular Sperm Extraction (Micro-TESE) MICRO TESE   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/microsurgical-sperm-retrieval-from-the-testicle-microsurgical-testicular-sperm-extraction-micro-tese Mon, 08 Mar 2021 05:25:19 AM The ART of In vitro Fertilization   IVF operations came to sow hope in the hearts of couples who suffer from infertility or delayed childbearing. Science and technology has evolved in this field so that we can choose the gender of the newborn according to the family’s desire and the ability to examine a number of chromosomal syndromes and inherited genetic diseases. This type of development has brought about a paradigm shift in its medical precedent. IVF is not a constant mathematical equation, which is the activation of ovaries, egg retrieval and embryo transfer, but rather an interconnected series of events that are drawn by multiple factors by a skilled doctor. The couple’s journey begins from the first moment they enter the clinic, where the medical history of both of them is reviewed with their precise details to determine the factors that will raise the success rate. Then, the clinical examination and the necessary laboratory and radiological examinations are done. After that, all these details will be collected and taking shape from the point of view of the treating specialist, choosing the type of induction required and determining the initial dose in proportion to the lady. In continuous follow-up and consecutive visits, the course -of which varies from patient to patient- and doses are adjusted according to the response of the ovaries   For example, in cases of polycystic ovarian syndrome (PCOS) which are common and prevalent at the present time, care should be taken in the given doses to prevent the occurrence of ovarian hyper stimulation syndrome (OHSS), which may end in severe complication which could lead to the patient entering the intensive care unit. Likewise, cases of Poor ovarian reserve, which should not be completely judged by the AMH or FSH laboratory tests only, but by the expertise of the specialist doctor and the accurate ultrasound examination. These cases and many others require different protocols and techniques how to use, medicines and treatments to suit each couple individually. When we talk about the pickup of eggs, the date will not be determined in advance, it’s not a set hour, but will be determined after giving the necessary injections (ovulation triggering) and will be 34 to 37 hours after that, depending on the case. Then the process of ICSI and fertilization and division in special equipments and incubators in the laboratory for a period ranging between two to five days. And do not forget about the needs to plant in fertile soil; the endometrium needs to be prepared in advance to receive the embryos and ensure the readiness before the embryo transfer, at the appropriate time and in the best way and without harming the endometrium, which may lead to reducing the success rate or failure of the process. The explanation goes on in this area full of details. The IVF process has dimensions and horizons, the couple may not be aware of all its details, but always in the doctor's imagination. The idea and the focus of the conversation is that it is a sensitive process in which the finer things should be taken into account in order to be a unique journey and a successful experience with the expertise of the doctor, the team’s help, and the will of God. https://www.layyous.com/en/assisted-reproduction/the-art-of-in-vitro-fertilization-the-a.r.t.-of-making-babies-hope-in-the-hearts-of-couples-who-suffer-from-infertility Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/infertility/how-to-increase-fertility-for-men-and-women-for-natural-conception-and-ivf-increase-ivf-success-rates Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/pregnancy/sex-selection-before-pregnancy-how-to-get-pregnant-with-a-boy-or-girl-gender-selection-choosing-the-sex-of-your-child Mon, 08 Mar 2021 05:25:19 AM Bed Rest After Embryo Transfer Beneficial or Harmful??     Embryo Transfer is the final and most critical step in an Assisted Reproductive cycle, strategies that improve success include avoidance of uterine contractility, using soft catheter, getting rid of cervical mucus and Ultrasound guided placement of embryo in mid cavity to optimize out comes. Bed rest and immobilization after Embryo Transfer has been practiced for long with intention to improve pregnancy rate. However, studies didn’t show any significant change in clinical pregnancy rate. Likewise, no difference was found in live birth, ongoing pregnancy rate, miscarriage rate, multiple pregnancy rate or implantation rate. findings showed that immediate mobilization after an Embryo Transfer doesn’t have negative influence over the success rate of IVF. Therefore, bed rest should not be recommended. In fact, more recent studies have indicated that extended bed rest   may contribute to negative outcomes, it was determined that bed rest and inactivity, combined with increased estrogen led to increased blood clot formation and insulin resistance. Ultimately, these blood clots may disturb the growth and development of the fetus by halting blood flow to uterus when it’s very much needed. On the other hand, light activity increase blood flow, reduces inflammation, lower stress hormones and promotes healthy blood flow. These factors are associated with better fetal development and improved health for mother- to-be. Normal activities after an Embryo Transfer should be resumed in general. However vigorous work out or activity that may cause discomfort (include heavy lifting and Jumping activities) should be avoided. Avoid having intercourse afterwards since this may disturb the implantation of the embryo in the uterus. Avoid heat too, such as hot baths. However, a regular shower is permitted.  It’s important to follow any instruction provided by the medical team, as they know you and your fertility journey best and can give relevant advice for your specific situations. https://www.layyous.com/en/assisted-reproduction/bed-rest-after-embryo-transfer-beneficial-or-harmful Mon, 08 Mar 2021 05:25:19 AM Microfluidic Innovation for sperm sorting (MFSSI) Latest techniques for managing sperm DNA fragmentation   Assisted reproductive technologies are very important tools to deal with infertility. About 50% of cases of infertility are due to male infertility, that’s why sperm selection is important for its use in IVF, ICSI and IUI. The currently available methods for sperm sorting are expensive, labor-intensive, and technician-dependent.    Microfluidic chips play a crucial role in biology and medicine. Owing to their micron-sized features and the possibility of sample manipulation and application of external stimulants, e.g.: acoustic waves, chemotaxis, and thermotaxis, it allows for processing low volume samples in a fast 10 minutes, low-cost fashion. Infertile men tend to have a higher ratio of abnormal sperms morphologically and with higher DNA fragmentation rate, a new technology was introduced to overcome this issue, it’s called fertile ultimate sperm sorting chips. Fertile ultimate sperm sorting chips are chips that extract sperms with better morphology and DNA quality i.e.: removing low quality sperms. This method increased the non-fragmented sperm count from 45% to 98%. **Does using this technique cause physical harm to sperms? The answer is no, it is completely safe. **How does it work? Semen sample given by male partner Sample is inserted into centrifuge device to separate sperm cells from seminal fluid Sperm cells are injected into the chip canal Healthy sperms swim into the other end of the canal and are separated from dead or damaged sperms **what distinguishes the fertile ultimate sperm sorting chip from other methods of sperm sorting (density method, swim up method)? Other methods select sperms based on better motility and better morphology, the chip technique also chooses sperms with less DNA fragmentation and least exposed to free oxygen radicals which was proven by studies to affect sperm health and ICSI success rate. **does the success of the chip technique depend on pre-treatment with vitamins and anti-oxidants? What distinguishes this technique is that it doesn’t need pretreatment with vitamins or anti-oxidants. **can the chip technique be used for intrauterine insemination (IUI)? Yes , it can be used. ** if I had a failed IVF/IUI cycle before, does using the chip guarantee success later on? There are many reasons for IVF/IUI failure, thorough assessment should be done and if the reason was found to be related to abnormal sperm quality or morphology or increased DNA fragmentation then the chip technique may increase success rate. ** is this technique useful for female infertility related to low ovarian reserve? It is only used for male partners with low sperm quality, but if the female partner is also complaining of low ovarian reserve then the chip method can be used for her male partner aiming to increase IVF success rate. ** In case the male partner had normal sperms, can we use the chip method to increase success rate in IVF? IVF success is increased with better embryo quality, the chip method improves embryo quality hence it will improve success rate in IVF even with normal sperms. **what about using this treatment for azoospermia? Unfortunately, this method won’t succeed unless there are normal healthy sperms in the sample as it only sorts healthy sperms from unhealthy sperms. **to sum up, this method is used to select healthy sperms in order to improve embryo quality and increasing the success rate of IUI/IVF in assisted reproduction without inflicting any harm on the sperms.   Fertile Plus Microfluid Sperm Sorting Chips Video Techniques Microfluidic sorter chips needs to be safe for sperms such that it will not alter their specifications, such as motility, morphology, DNA integrity, and acrosome. This can be achieved using channels and chambers with sperm-friendly size, length, shape, and coatings. Microfluidic chips for sperm sorting rely on either active or passive methods. A brief discussion about the most popular active and passive approaches is available in the following section. Active method:  In this method, external stimulators, such as the heat of chemicals or an active fluid flow, are applied to perform the sorting. These strategies allow for sorting the high-quality and progressively motile sperms. 1.1. Acoustic waves 1.1.1. Surface acoustic wave/Sperm size/Motility pattern: This is an invasive and precise control of sperm selection process. It needs additional equipment. Working time: 50 minutes.   1.1.2. Bulk acoustic wave/Pressure distribution through the fluid /Addition of polystyrene beads: This is an invasive procedure that is used in sexual assaults investigations. It isolates scarce number of sperms from female DNA samples. Need for additional equipment. Working time: 15 minutes. 1.2. Chemotaxis 1.2.1. Progesterone gradient concentration, Sperms’ chemo-attractant behavior: this is a noninvasive. Unfortunately, this is a Low efficiency method. 1.2.2. Acetylcholine and rat oviductal fluid gradient concentration, Sperms’ chemo-attractant behavior: This is a Stationary fluidic environment using Biomimetic strategy and Eliminates rheotactic and chemokinetic behavior of sperms as selection criteria. Like the one mentioned above; it has Low efficiency. 1.3. Chemotaxis and thermotaxis: 1.3.1. AcetylCholine gradient concentration, Temperature gradient, and Sperms’ chemo-attractant and thermo-attractant behavior. This chip has a Complicated design and fabrication due to complex high-aspect-ratio geometry. Optimized temperature gradient: 0.154 ◦C/mm from 35 to 37 ◦C. Passive method: This was developed for high quality sperm sorting. It relies on the inherent behavior and movement of sperms in the absence of any external stimuli. 2.1. Geometry 2.1.1. Swimming behavior of sperms, micro-pillar arrays: It’s noninvasive, less complex structurally, and mimics filtering characteristics of female reproductive tract. In this method there is 5-fold enhancement in morphology, 3-fold enhancement in Nuclear Maturity, and 2-4 fold enhancements in DNA integrity. Throughput: 99%.  Working time: 10 minutes. 2.1.2. Velocity shear gradient and Hydrodynamic profile of fluid micro-confinement:  This is a Simple working procedure. Retrieval efficiency: 44% increased. Throughput: 80%. 2.1.3. Hydrodynamic profile of fluid within the channel and Fluid flow mechanics, Shear rate butterfly-shape structure: this mimics the variable width of the junctions within the female reproductive tract. It’s a Simple chip design and fabrication. The only disadvantage of this method; is that the accumulation of a large population of sperms in front of the stricture leads to reduced efficiency of sorting highly motile sperms. In this method highly progressive motile sperms swim to the fertilized site while Non-motile and slow sperms accumulate in front of the stricture. 2.2. Rheotaxis 2.2.1. Rheotactic behavior of sperms, Corrals inside micro-channels: Adding sperm retainer is the advantage of this method. Throughput: 100%. Working time: 45 min 2.2.2. Fluid flow, Rheotactic behavior of sperms, and Gravity: This is an automated procedure, fast sorting. This method eliminates the use of additional tools, such as a pump. It’s a simple chip design. One of the disadvantages of this method is that it misses some of the potentially high-quality sperms due to the rapid pace. Working time: 80 seconds. 2.2.3. Fluid velocity inside the channel /Designing a diffuser-type channel: It’s a simple chip design. Performance based on continuity equation in fluid dynamics. Disadvantage of this method: Imprecise collection of sorted sperms in appropriate region. Working time: 10 minutes. 2.3. Fluid Flow: 2.3.1. Three different parallel laminar flows with variable semen flow rate: The ability of sperms to cross streamlines in laminar flow mimic the viscous environment of female reproductive tract. This is a simple chip design. One disadvantage is that it might miss some of potentially high-quality sperms due to time dependency of migration in laminar fluid. 2.3.2. Diffuser-type channel with Fluid dynamics production (Enabling cross-passage of sperms through laminar flow streamline): This chip has a complicated design and fabrication due to complex high-aspect-ratio geometry. After testing different methods in this innovation there were 44% improvement in the efficacy of sorted sperms without affecting their DNA integrity. Fortunately, this new innovation is now available at our clinic for our ICSI patients.          https://www.layyous.com/en/assisted-reproduction/microfluidic-innovation-for-sperm-sorting-mfssi Mon, 08 Mar 2021 05:25:19 AM ROSI (round spermatid injection) ROSI (round spermatid injection) is a method in which precursors of mature sperm obtained by ejaculated specimens or testicular sperm extraction (TESE) are injected directly into oocytes and used in the place of mature spermatozoa in the cases of last resort as treatment for male infertility. Men with azoospermia are commonly referred to male fertility specialists who may recommend surgical sperm extraction procedures in order to obtain spermatozoa for use in fertilization. Unfortunately, even with these extraction procedures, many men do not possess mature spermatozoa which can be successfully isolated. 1 out of 100 healthy men is azoospermicand that about 70–80% of those are nonobstructive azoospermia cases. Micro‐TESE is the sole treatment to find spermatozoa. The incidence of detecting testicular spermatozoa is about 30–60%,but about half of those spermatozoa found are immotile or have deformities. Among men with nonobstructive azoospermia where neither mature spermatozoa nor late-stage spermatids were isolated from testicular samples, it has been reported that approximately 30% of patients will possess round spermatids in their surgical samples. The rationale of ROSI is that round spermatids  develop after two times of meiosis and have the same number of chromosomes and same contents of DNA as those of matured spermatozoa. Round spermatid has a haploid set of chromosomes 23 and 1N DNA content just as a mature spermatozoa. So, if round spermatid can be injected directly into the oocyte with the same technique as ICSI, it can fertilize the oocyte and deliver a baby. Round spermatid is found in the ejaculate or testis. Those  in ejaculate are considered to be an inadequate sample for ROSI in comparison with testicular one due to the high possibility of apoptotic change of round spermatid Studies showed that the pregnancy rate per couple was 13.4% and delivery rate per couple was 8.1% . ROSI has resulted in clinical pregnancies and live births, but success rates are considerably lower than those achieved with mature spermatozoa ROSI appears to result in offspring without any unusual physical, mental, or epigenetic problems Follow up of ROSI babies (physical and cognitive development) showed that their development was the same as naturally conceived babies except the baby’s response to parental interaction between 12-18 months, furthermore the weight gain of ROSI babies was the same as naturally conceived babies but we noticed that male babies were somehow lighter at the age of 1.5 years old compared to their naturally conceived counterparts, they eventually caught up at the age of 2 years old. ROSI babies are not at increased risk of chromosomal/genetic or congenital anomalies and they give a proportion of infertile men the chance to propagate their genetic material throughout generations. This technique has been applied by Dr. Najeeb since early 2000s (2001 and 2002). A total of 1170 cases were done in Jordan overall many years ago but none of them resulted in a successful pregnancy (only biochemical pregnancies resulted) and that’s why using the technique was abandoned. Recently new techniques were added for better preparation of round spermatids like electrical activation thus improving the success of ROSI hence ROSI has been reintroduced into clinical practice thanks to advances in science. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/rosi-round-spermatid-injection Mon, 08 Mar 2021 05:25:19 AM Oocyte cryopreservation (freezing Oocytes) Oocyte cryopreservation (freezing) is a procedure to "keep" a woman's eggs for later use, this method enables women to postpone motherhood to a later date due to medical or social reasons, nowadays it plays a crucial role in assisted reproductive technology as it provides women with greater reproductive autonomy and increases their chances of having a healthy pregnancy later in life. **Indications of oocyte freezing: To preserve fertility for patients undergoing gonadotoxic treatment (chemotherapy and radiotherapy) To surpass age-related infertility To preserve fertility for those susceptible to early loss of ovarian function To preserve future fertility for those who still haven’t found a partner In patients using ART and who are against embryo freezing due to religious or cultural reasons. Women who are positive for breast cancer gene mutation and are planning prophylactic oophorectomy. Fertility preservation for patients with severe endometriosis When sperms can't be obtained on the day of oocyte retrieval in IVF cycles **How is oocyte freezing performed? Ovulation induction using hormonal injections to produce multiple eggs. When multiple eggs are mature an injection is given for final maturation induction Eggs are retrieved through transvaginal or transabdominal route under sedation. Eggs are immediately frozen. Oocytes have high content of water thus freezing leads to formation of ice crystals which destroys cell integrity, thus the egg must be dehydrated before freezing thus inhibiting the formation of ice crystals. **Risks of the procedure: Ovarian hyperstimulation syndrome Bleeding and infection related to egg retrieval procedure. Ovarian torsion due to enlarged ovaries. Giving false sense of security for the woman to further delay conception and pregnancy **For how long can oocytes be frozen? Up to 10 years and it can be extended under certain circumstances. **Is oocyte freezing associated with increased incidence of chromosomal abnormalities? The answer would be no, it doesn’t increase chromosomal abnormalities. **What interventions can be done to assess egg quality before proceeding to egg freezing? Visualization of spindles in metaphase 2 oocytes Measuring the size of spindle Polar body biopsy (to make sure that embryos will be euploid) **What happens when it's time to use frozen eggs? Eggs are thawed and ICSI follows. **Why do we have to perform ICSI when using frozen eggs? Egg freezing makes the outer layer tougher, and it becomes difficult for sperms to penetrate it. **Success rate mainly depends on (ovarian reserve) and the woman's age (higher success in age less than 38 years) , and many studies have shown no difference in fertilization rates and clinical pregnancy rates between fresh and frozen oocytes. In conclusion, oocyte freezing is not a guarantee of future pregnancy, but it offers women the opportunity to have biological children later in life and has the potential to revolutionize the way we think about fertility and reproduction. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/oocyte-cryopreservation-freezing-oocytes Mon, 08 Mar 2021 05:25:19 AM Electrical activation of the Oocytes Intracytoplasmic sperm injection (ICSI) has become the most effective therapeutic treatment for male-factor infertility However, total failure of fertilization still occurs in some cases, teratozoospermia , immotile spermatozoa , and even in some  unexplained cases . The failure of fertilization after ICSI may result from either the lack or deficiency of activating factors in spermatozoa or may result from the inability of the oocyte to respond to the injected sperm. Because the spermatozoa is injected inside the ooplasm, failure of division most probably is the result of the failure of oocyte activation.  The key event of oocyte activation is a temporal rise in the intracellular Ca2+ concentration. Electro activation of the oocyte results in a rapid rise in Ca2+ inside the oocyte, which decreases gradually to the original level in about 300 seconds. it was demonstrated that oocyte activation enabled normal fertilization and pregnancy  It has been reported that about 70%–80% of unfertilized oocytes after ICSI responded to electro activation. Oocytes that fail to fertilize by 24 hours after ICSI can resume apparently normal fertilization and early embryonic development in response to electrical stimulation. Moreover, the degree of cytoplasmic activation as determined by the number of pulses applied affects fertilization efficiency and early embryonic development. electrical stimulation resulted in a significant improvement in the fertilization rate after ICSI, in cases with previous total failure of fertilization or limited fertilization and in cases of oligoasthenoteratospermia and nonobstructive azoospermia. What is an oocyte activation defect?  At fertilization, oocyte activation is triggered by sperm (releasing calcium in specific patterns within the oocyte). A deficiency in this process underlies most cases of fertilization failure How does egg activation occur? The activation of all eggs appears to depend on an increase in the concentration of free calcium ions within the egg. Such an increase can occur in two ways: calcium ions can enter the egg from outside, or calcium ions can be released from the endoplasmic reticulum within the egg. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/electrical-activation-of-the-oocytes Mon, 08 Mar 2021 05:25:19 AM Methods to improve the uterine lining before embryo transfer   The uterine lining is one of the most important factors that determine the success of embryo transfer in IVF programs, as it must be of a suitable thickness and have tissues rich in blood vessels for the embryo to attach and pregnancy to occur. A thin or weak uterine lining can lead to implantation failure, even with high-quality embryos. Therefore, the uterine lining must be prepared to ensure the highest chances of a successful pregnancy, and this may be achieved through medications or specific techniques. And in the following article we are going to talk briefly about novel technologies that are used to improve uterine lining and increase success rates such as growth factors and PRP.     What is the definition of growth factors? They are natural proteins that stimulate cells to repair and generate.   What is the role of growth factors in human body? ** development ** wound healing ** maintenance of tissue   Do abnormalities in the level or signaling of growth factors affect fertility? Yes, in both men and women   What is the role of growth factors in fertility? ** regulate ovarian processes (egg maturation and survival) ** regulate processes in testis (sperm maturation and motility) ** regulate processes in endometrium (receptivity and growth) ** plays an important role in early embryo development   Does administration of growth factors enhance endometrial function? Yes, as altered levels of growth factors lead to implantation failure and recurrent miscarriage.   What are the uses of growth factors in fertility domains (ICSI/IVF)? ** in patients with poor ovarian response to enhance follicle growth and maturation ** in patients with recurrent failure to enhance endometrial proliferation, receptivity and embryo implantation ** in patients with poor sperm quality to enhance sperm development and motility   What is PRP therapy? Platelet-rich plasma therapy, a concentrate of platelets derived from patients own blood through centrifugation, injected into the ovaries or uterus and contains many growth factors.   Are there synthetic growth factors to use in infertility? Yes, there are many preparations that are produced and are showing satisfactory results. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/methods-to-improve-the-uterine-lining-before-embryo-transfer Mon, 08 Mar 2021 05:25:19 AM Unveiling the male factor: how aging and sperm defects influence IVF success The Impact of Male Age on Sperm Quality and IVF Success Rates   While most discussions about fertility focus on female age, recent research confirms that male age also plays a significant role in fertility and the outcomes of assisted reproductive technologies such as in vitro fertilization (IVF). Although men are capable of producing sperm throughout their lives, advancing age can lead to changes in sperm quality and function.   First: The Impact of Age on Sperm Quality: With advancing age, several biological changes occur in the male reproductive system, the most important of which are:   1. Decreased Sperm Count Studies indicate that sperm count may gradually decrease with age, reducing the chances of natural fertilization.   2. Reduced Sperm Motility Good sperm motility is essential for sperm to reach the egg. With age, both total and progressive sperm motility decline.   3. Increased Sperm DNA Fragmentation One of the most significant age-related changes is the increased rate of DNA fragmentation in sperm, which can affect embryonic development and increase the likelihood of miscarriage.   4. Increased Genetic Mutations Recent studies have shown that the sperm of older men may carry a greater number of genetic mutations, which could be linked to an increased risk of certain genetic disorders in children.   5. Decreased sperm quality with age   6. Increased incidence of birth defects   7. Reduced semen volume   8. Poor embryo quality   9. Reduced likelihood of implantation   10. Increased miscarriage rate   11. Increased genetic risks such as mutations, autism, and birth defects     How does sperm morphology affect IVF success?   ** Reduced fertilization rate ** Reduced embryo quality ** Increased embryo stillbirth rate ** Slower embryo growth rate ** Reduced implantation rate ** Increased biochemical pregnancy rate and early pregnancy loss     Second: The Impact of Male Age on IVF Success While the woman's age remains the most important factor in the success of assisted reproductive technologies, the man's age can affect some outcomes:   • Fertilization Rates and Embryo Quality In most cases, the fertilization rate is not significantly affected by the man's age alone, especially when the woman is young.   • Increased Risk of Miscarriage Advanced male age is associated with a higher rate of miscarriage after conception, often linked to increased DNA fragmentation in sperm.   • Lower live birth rates in older men:  Some studies indicate that IVF success rates may decrease in men over 50, especially if the partner is also older. One study showed that success rates may be lower when the man is over 51 compared to younger men.     Third: Can the effect of age be overcome?   Fortunately, modern assisted reproductive technologies can reduce the impact of some age-related factors in men, such as: - Intracytoplasmic sperm injection (ICSI), which allows for the injection of a single sperm into the egg. - Sperm DNA fragmentation tests to improve the selection of healthy sperm. - Lifestyle improvements, such as quitting smoking, maintaining a healthy weight, and avoiding exposure to toxins. - Use of antioxidants - Treatment of varicocele, if present - Use of advanced techniques to select the best sperm for in vitro fertilization - Sperm retrieval from the testicle in cases of high DNA fragmentation   Although men can father children at an older age, advancing age can lead to a decline in sperm quality and an increase in sperm DNA fragmentation, which can affect the chances of pregnancy and the success rates of IVF, especially if the woman is also older. Therefore, it is advisable to carefully assess the male reproductive factors when experiencing delayed pregnancy and not focus solely on the woman's age. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/unveiling-the-male-factor:-how-aging-and-sperm-defects-influence-ivf-success Mon, 08 Mar 2021 05:25:19 AM Procedures a Patient Should Follow After In-vitro Fertilization-IVF   IVF is one of the most important techniques used to treat infertility. Its success rate depends not only on the medical procedure itself but also on the patient's adherence to instructions after embryo transfer. The days following embryo transfer are a critical period as it is the waiting period for the results.   1- Relative Rest Rest is recommended during the first 24 hours after embryo transfer, but there is no scientific evidence to support the need for prolonged bed rest. The patient can engage in light daily activities while avoiding strenuous activity.   2. Medication Adherence The doctor will usually prescribe medications to support the uterine lining, such as progesterone. It is crucial to adhere to the prescribed dosage and timing and not to discontinue them without consulting your doctor.   3. Avoid Strenuous Physical Activity It is advisable to avoid lifting heavy weights or engaging in strenuous exercise during the first few days after embryo transfer.   4. Healthy Nutrition It is recommended to eat a balanced diet rich in protein, vegetables, and fruits, drink plenty of water, and reduce caffeine intake.   5. Stress Reduction Stress and anxiety can affect the patient's comfort during this stage. Therefore, relaxation and light activities such as leisurely walks or reading are recommended.   6- Taking a Pregnancy Test at the Right Time The success of the procedure is confirmed by a blood test for the pregnancy hormone (hCG) approximately 14 days after embryo transfer.   Common Mistakes After IVF:   1- Over-Resting Some patients believe that staying in bed all the time increases the chances of success, but studies indicate that light movement does not negatively affect embryo implantation.   2- Stopping Medications at the First Sign of Slight Bleeding Slight bleeding or brown discharge may occur after embryo transfer, which can be normal. A common mistake is stopping medication without consulting a doctor.   3- Taking a Pregnancy Test Too Early Some patients take a home pregnancy test a few days after the procedure, which may give an inaccurate result and cause unnecessary anxiety.   4. Excessive anxiety and monitoring every symptom: Analyzing every minor sensation, such as cramps or bloating, can increase anxiety. Many of these symptoms are caused by hormonal medications and are not necessarily indicative of the success or failure of the procedure.   5. Rapid return to strenuous physical activity: Performing strenuous housework or intense exercise immediately after embryo transfer can cause discomfort for the patient. Therefore, it is preferable to gradually increase physical activity. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/procedures-a-patient-should-follow-after-in-vitro-fertilization-ivf Mon, 08 Mar 2021 05:25:19 AM IVF After 40: Success and Challenges with Late Marriage   Late marriage and postponing childbearing have become increasingly common in recent years for social, professional, or personal reasons. As women age, some couples may face difficulty conceiving naturally, making assisted reproductive technologies like in-vitro fertilization (IVF) an important option for achieving pregnancy.   The Impact of Age on Fertility A woman's fertility gradually declines with age, and this decline becomes more pronounced after the age of 40. This is due to several reasons, the most important of which are: - A decrease in the number of eggs in the ovaries - A decline in egg quality with an increased likelihood of chromosomal abnormalities - A decrease in the ovaries' response to fertility drugs All these factors can reduce the chances of natural conception and affect the success rates of in-vitro fertilization (IVF) procedures.   IVF After 40 Despite the challenges, pregnancy is still possible after 40 using assisted reproductive technologies. Success rates depend on several factors, most importantly: - The woman's exact age - Ovarian reserve and number of follicles - Sperm quality - The presence of other conditions such as endometriosis or uterine problems. Generally, IVF success rates gradually decrease after age 40 compared to younger ages, but many cases still achieve successful pregnancies, especially when there is a good ovarian reserve. The Importance of Pre-Treatment Assessment Before starting treatment, a comprehensive assessment is recommended, including:  - Ultrasound examination of follicle count - Assessment of the uterus and its lining - Semen analysis - Laboratory tests   This assessment helps the doctor determine the appropriate treatment plan and explain the realistic chances of success to the couple.   The role of preimplantation genetic testing (PGT): As the mother's age increases, the likelihood of chromosomal abnormalities in embryos rises. Therefore, chromosomal testing of embryos before transfer to the uterus is sometimes recommended, which helps to: - Select chromosomally healthy embryos - Reduce the risk of miscarriage - Increase the chances of a successful pregnancy.   Important tips to increase your chances of success: - Don't delay seeing your doctor if you experience difficulty conceiving. - Maintain a healthy weight and a balanced lifestyle. - Avoid smoking. - Follow your doctor's instructions throughout your treatment.   Although fertility declines with age, advancements in assisted reproductive technologies have made pregnancy possible for many women over 40. Early assessment and an appropriate treatment plan play a crucial role in improving your chances of success. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/ivf-after-40:-success-and-challenges-with-late-marriage Mon, 08 Mar 2021 05:25:19 AM What symptoms can a patient expect during an IVF program?   The IVF program involves multiple procedures that rely heavily on medications and hormonal injections to stimulate the ovaries, retrieve eggs, and sometimes support early pregnancy. It is normal for the patient to experience a range of physical and psychological symptoms during this period due to the effect of hormones on the body.   Common symptoms during ovarian stimulation During this phase, hormonal injections such as FSH, LH, or gonadotropins are used to stimulate egg growth: - Abdominal bloating or a feeling of fullness: due to enlarged ovaries - Breast tenderness or pain: due to increased estrogen levels - Mood swings or emotional instability: common due to stress and anxiety - Bloating or gas: possible due to increased fluid retention and some medications - Flu-like symptoms or fatigue: sometimes a result of hormonal changes or daily injections.   • Symptoms after egg retrieval After the ovulation induction injection and egg retrieval: - Mild to moderate lower abdominal pain: normal due to the laparoscopy or ovarian stimulation - Bruising at the injection site, especially if subcutaneous needles were used - Light bleeding or spotting (normal after egg retrieval) - Mild fatigue or dizziness (due to the anesthesia or the procedure itself)     • Symptoms after embryo transfer Usually, after embryo transfer, pregnancy-supporting medications such as progesterone are used, so the patient may experience: - Mild abdominal contractions - Bloating or gas - Breast changes - Mood swings, as anxiety and tension are associated with waiting for the pregnancy test   • Rare complications to be aware of: - Ovarian hyperstimulation syndrome (OHSS): This includes severe abdominal bloating, rapid weight gain, shortness of breath, and severe nausea and vomiting. If these symptoms occur, contact your doctor immediately. - Heavy bleeding or severe pain after egg retrieval (requires urgent medical evaluation). - Allergic reactions to the injection (rare, including skin rash or severe itching).   • Tips to relieve symptoms: - Apply warm compresses to your abdomen to relieve contractions. - Drink plenty of fluids and avoid salty foods to reduce bloating. - Rest when feeling tired. - Contact your doctor regularly if you experience any unusual or severe symptoms. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/what-symptoms-can-a-patient-expect-during-an-ivf-program Mon, 08 Mar 2021 05:25:19 AM Common myths VS facts about IVF   Invitro fertilization is a method of assisted reproduction that has many indications and has evolved throughout the years. Such a novel technology has been controversial leading to many false information spreading which led to misleading of people.   Myth 1: IVF guarantees pregnancy It only improves chances of pregnancy in certain cases Success depends on many factors such as age and parameters of semen analysis The biggest determinant of success is the lady’s age, younger women are more likely to get pregnant by IVF   Myth 2: IVF always results in twins or triplets It increases the rate of multiple gestations but doesn’t guarantee it The medical community prefers singleton pregnancies because multi-fetal pregnancies have higher rates of complications   Myth 3: IVF results in abnormal babies Most IVF babies develop normally IVF babies are as healthy as naturally conceived babies Chromosomal abnormalities are usually linked to advanced maternal age   Myth 4: IVF is only for female factor infertility IVF is needed in many male-factor dependent infertility cases Many techniques are used like intracytoplasmic sperm injection to treat cases of severe male infertility   Myth 5: IVF is only for older women Usually, advanced maternal age is more linked with problems with conception Many young ladies need IVF for different indications   Myth 6: IVF is always the first treatment option Simpler options must be tried and explored before IVF   Myth 7: IVF causes cancers Studies have shown that hormonal stimulation doesn’t increase risk of breast/ovarian cancer or any other type   Myth 8: IVF is painful Egg retrieval is done under sedation Some parts of the procedure might lead to feeling of discomfort (like transvaginal ultrasound)   Myth 9: stress is the main reason IVF fails Biological factors are more important It is important to manage stress for the mental health of the lady   Myth 10: IVF always leads to complications IVF pregnancies are the same as natural pregnancies They have slightly increased risk of preeclampsia They have higher risk of twin pregnancies   If you are thinking about IVF then you should consider getting the information from a trusted scientific source because myths like these will affect your decision which might not be in your best interest. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/common-myths-vs-facts-about-ivf Mon, 08 Mar 2021 05:25:19 AM Understanding embryo transfer in IVF: fresh VS frozen   Embryo transfer refers to the step of invitro fertilization where the fertilized embryos are placed inside the uterus. Embryo transfer is an art and a delicate procedure, if not done with experienced hands it might lead to IVF failure. Studies have shown that 25% of embryos transferred inside the uterus are subsequently found inside the vagina (wrong position), that’s why gynecologists consider embryo transfer the most critical point of IVF.   What are the factors that affect embryo implantation? Timing Uterine receptivity Embryo quality   Fresh embryo transfer: The transfer is done in the same cycle as egg retrieval It is done 3-5 days after fertilization The advantage is that it doesn’t require embryo freezing or thawing The disadvantages are: ** it is done during a time where the body hormones are not induced naturally which might affect uterine lining **higher risk of ovarian hyperstimulation Fresh embryo transfer is preferred when the ovarian response is good and there are no risk factors of ovarian hyperstimulation   Frozen embryo transfer: The embryos are cryopreserved after fertilization and transferred during another cycle The advantage is that the uterus is more naturally prepared by natural hormones in subsequent cycles and lower risk of ovarian hyperstimulation The disadvantages are that it leads to longer treatment periods and embryo freezing and thawing might affect embryo survival rates It is preferred when there is high risk of ovarian hyperstimulation and when endometrial lining is found to be thin during the fresh cycle.   Are pregnancy rates higher with embryo freezing? Some studies showed that because when transferring frozen embryos, the uterine environment is more natural hormonally, but this doesn’t apply to all women as some ladies have higher pregnancy rates with fresh embryo transfer. Each case has to be individualized and studied thoroughly to decide what’s best for it.   Frozen embryo transfer leads to lower rate of: Preterm birth Low birth weight Because the uterine environment is more naturally prepared   So, to sum up, how do we decide if we should do fresh embryo transfer or frozen embryo transfer? By studying the following factors: Maternal age Ovarian reserve Endometrial thickness and quality Number and quality of embryos Risk of ovarian hyperstimulation syndrome Doctor assessment of the case Patient preference Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/understanding-embryo-transfer-in-ivf:-fresh-vs-frozen Mon, 08 Mar 2021 05:25:19 AM Coping with IVF failure   Invitro fertilization is an emotional experience with psychological and social impact. The procedure itself is complex and drains patients emotionally and financially. Pregnancy is not guaranteed in IVF and this might impose further stress on both patients and doctors. Common causes of IVF failure: Advanced maternal age leading to poor egg quality Bad embryo quality Poor uterine lining Hormonal dysfunction Patients should understand that when IVF fails its nobody’s fault.   Expected emotional reactions to IVF failure: Sadness Grief Guilt Self-blame Anxiety Feeling of isolation It is important not to suppress these emotions.   Coping strategies: Take your time to grief Ask for support Take good care of yourself: **get good sleep **eat healthy food **exercise **practice meditation **practice your favorite hobbies **apply relaxation techniques Sit with your healthcare provider to review your case and understand the possible causes of failure Planning the next step with your healthcare provider   The following is a checklist for you to follow in cases of IVF failure: Step yes no Give yourself permission to feel sad     Take a break from fertility conversations     Talk openly with your partner     Connect with supportive friends and family                                        Join a fertility support group     Look for professional counselling     Maintain healthy sleep     Maintain healthy diet     Engage in exercise     Practice meditation     Practice hobbies and joyful activities     Review IVF cycle with your doctor     Discuss adjustments of future IVF cycles     Consider complimentary therapies like acupuncture       Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist   https://www.layyous.com/en/assisted-reproduction/coping-with-ivf-failure Mon, 08 Mar 2021 05:25:19 AM Instructions to follow before egg retrieval   1- Fasting before the procedure: - Fast for 6-8 hours before the procedure. - The purpose of fasting is to reduce the risk of acid reflux, which can lead to choking.   2- Medication adherence: - Take the stimulation or maintenance medications as prescribed. - Administer the final maturation injection (trigger shot) precisely at the scheduled time. - Failure to administer the trigger shot at the exact time may affect egg quality.   3- Avoid certain medications: - Pain relievers that thin the blood, such as ibuprofen. - Blood thinners, such as anticoagulant injections or aspirin tablets. - Avoid taking any new medication without consulting your doctor.   4- Personal Hygiene: - Shower on the morning of the procedure. - Avoid applying creams, makeup, or nail polish. - Wear comfortable cotton clothing.   5- Abstinence from Sexual Intercourse: - Avoid sexual intercourse for 3 days prior to the procedure. - The duration of abstinence affects the quality of semen sample provided by the husband for egg fertilization.   6- Accompanying Person: - Because the procedure is performed under anesthesia, you must have someone with you to assist you in getting home. - Driving is prohibited for 24 hours after the procedure.   7- Bladder Emptying: - It is best to empty your bladder immediately before the procedure to prevent bladder injury and to ensure the ovaries are clearly visible on the ultrasound during egg retrieval.   8- Psychological Comfort: - Try to be relaxed. - Get enough rest and sleep.   The egg retrieval procedure takes between 15-30 minutes.   The procedure is a daily case procedure, meaning the woman is kept under observation in the recovery area for two hours after the egg retrieval to recover from the anesthesia. After that, she can go home.   It is common for the woman to experience mild cramps in the abdomen after the procedure, or slight bloating and abdominal distention.   The two most important factors for the success of the egg retrieval procedure are: - Taking the trigger shot at the exact time. - Fasting before the procedure. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/instructions-to-follow-before-egg-retrieval Mon, 08 Mar 2021 05:25:19 AM Embryo grading: what do the scores mean?   Embryo grading is a way for embryologists to assess the quality of embryos. Embryo grading is done by examining the embryos under the microscope. By determining embryo grades, the embryologist determines which embryos are better for higher rates of implantation and IVF success rate.   Day 3 grading: Cleavage stage Embryos are evaluated on day 2-3 after fertilization The embryologist evaluates: number of cells, cell symmetry and fragmentation On day 3 the number of cells should be 6-8 Even cells are better Less fragmentation is better Grades are as follows: ** grade A: excellent embryos with even cells and minimal fragmentation ** grade B: slight unevenness, slight fragmentation. These embryos are good **grade C: fair embryos with more fragmentation ** grade D: poor quality   Days 5 grading: Blastocyst stage We look at expansion, the more expanded the better We look at inner cell mas which becomes the baby, the more tightly packed cells the better We look at cells that become the placenta, many healthy cells mean better outcomes   We have to understand that better grading doesn’t guarantee success. Lower-grade embryos can result in pregnancy.   Why do doctors prefer day 5 transfer? The selection of embryos is better Implantation rate is high The grading system is more accurate   Does embryologists experience affect embryo grading? Yes, embryo grading is subjective and two embryologists might grade the same embryo differently.   What is the role of time-lapse imaging? These are new incubators which track embryo development They assess two things: division timing and patterns They help in embryo selection and decrease interpersonal differences   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/embryo-grading:-what-do-the-scores-mean Mon, 08 Mar 2021 05:25:19 AM Preparing for an IVF cycle   Being prepared for an IVF cycle is important as patients should be familiar with what to expect throughout the cycle. First of all, ladies should understand the basics of IVF and the milestones. In a simple way, IVF involves the fertilization of the egg outside the human body the returning the embryos inside the uterine cavity. Basic stages of IVF are: Ovarian stimulation Egg retrieval Egg fertilization Embryo transfer Pregnancy test   First step: consult with a doctor specialized in IVF: It should be a fertility specialist The consultation should be done by both partners   Second step: doing blood tests: Complete blood count to treat anemia that might decrease IVF success rate Blood sugar levels, as diabetes is linked to pregnancy failure, congenital anomalies and recurrent pregnancy loss Thyroid function tests: ** the fetus depends on maternal thyroid hormones in the first 12 weeks of pregnancy **thyroid dysfunction is linked to pregnancy failure and recurrent miscarriage Prolactin level: high levels might affect egg quality and subsequent fertilization Vitamin deficiency screening: vitamin supplementation improves fertility and egg/sperm quality Other blood tests are done based on individual cases and patients’ previous medical history or symptoms such as: thrombophilia screen, liver function test, kidney function test…etc. Viral screening (Hepatitis, HIV, Syphilis)   Third step: ultrasound examination of maternal pelvis: To check on the uterus looking for any possible anomalies that need possible surgical correction (adhesions or septum) To examine the ovarian volume and antral follicular count (estimation of ovarian volume and possible needed dose of stimulation medications)   Fourth step: speculum examination to check for any cervical pathology and taking a pap smear   Fifth step: thorough medical and surgical history should be taken, and any chronic diseases should be controlled.   Sixth step: learning about medications used in IVF: LH hormone FSH hormone Progesterone Possible side effects   Seventh step: lifestyle adjustment: Stop smoking Limit alcohol intake Maintain normal BMI Eat healthy food Vitamin supplements   Eighth step: emotional preparation: Set realistic expectations Join support groups Communicate with your partner Communicate with a trusted family member/friend   Ninth step: prepare yourself financially: Understand the costs of different procedures and medications Check possible insurance coverage for some parts of the treatment journey Keep a budget for unexpected additional costs   Tenth step: logistical planning: Arrange time off work for appointments Plan transportation and accommodation if coming from another country   Remember that, each IVF cycle is a step toward your goal.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/preparing-for-an-ivf-cycle Mon, 08 Mar 2021 05:25:19 AM Egg quality 101: what every woman should know   Egg quality is how healthy and genetically normal an egg is. A high-quality egg: Has correct number of chromosomes High potential to be fertilized Able to divide and form healthy embryo   An egg is deemed to have poor quality if: Fail to fertilize Stop developing at an early stage Result in miscarriage Result in genetic/chromosomal conditions   Egg quality is important because it has a pivotal role in: ** success of fertilization ** development of embryo ** higher rate of implantation ** healthier pregnancy outcomes   What is the biggest factor that affect egg quality? Age, increasing age leads to higher proportion of eggs with chromosomal issues   Is there a test for egg quality? Unfortunately, no. There is no direct test for egg quality before attempting to fertilize it, but quality can be indirectly assessed as follows: Embryo development Genetic testing of embryos Previous fertility or IVF outcomes   Signs of poor egg quality include: Recurrent IVF failure Recurrent miscarriage Poor embryo development in the lab Advanced maternal age   Is there a way to improve egg quality? Some habits help in supporting egg healthy, but they don’t guarantee high egg quality: Healthy diet Healthy weight Get good sleep Decrease stress level Stop smoking Avoid alcohol Take supplements like folic acid and vitamin D   What to do if egg quality is significantly reduced? Egg donation can be considered in certain countries, but it is illegal in many countries and some societies consider it unethical. Also, some religions prohibit it. Religion and traditions should always be respected. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/egg-quality-101:-what-every-woman-should-know Mon, 08 Mar 2021 05:25:19 AM Common Mistakes That Can Reduce the Chances of Pregnancy After IVF   IVF is one of the most advanced infertility treatment techniques. However, its success depends not only on the quality of the embryos or the doctor's skill, but also on daily habits and behaviors that the patient may engage in without realizing their impact. Here are some of the most prominent mistakes that can weaken the chances of embryo implantation and a continued pregnancy: 1. Not Adhering to Medications and Hormones Medications such as progesterone are essential for supporting the uterine lining. Mistake: Forgetting doses or not adhering to the prescribed schedule. Impact: Weakened uterine lining preparation, leading to implantation failure. 2. Psychological Stress and Anxiety Chronic stress leads to hormonal imbalances, such as cortisol. Mistake: Excessive worry and constant thinking about the outcome of the procedure. Effect: May negatively impact embryo implantation through hormonal and immune mechanisms. 3. Excessive Movement or Complete Rest (Both are Wrong) Mistake: Strenuous physical activity or complete bed rest. Effect: Strenuous movement may cause uterine contractions, while inactivity may affect blood circulation. 4. Smoking (even passive smoking) Mistake: Smoking or exposure to secondhand smoke. Effect: Reduces blood flow to the uterus and affects embryo quality.   5. High Caffeine Consumption Mistake: Drinking more than 2-3 cups of coffee daily. Effect: May reduce the chances of implantation and increase the risk of early miscarriage. 6. Sexual Intercourse After Embryo Transfer Mistake: Engaging in sexual intercourse without consulting a doctor. Effect: May stimulate uterine contractions at a sensitive time. 7. Unbalanced Diet Mistake: Excessive consumption of sugars and fast food, and a deficiency in protein and vitamins. Effect: Poor quality of the uterine lining and hormonal balance. Best: A diet rich in protein, iron, and omega-3 fatty acids. 8. Lack of sleep Mistake: Sleeping less than 7 hours a day. Effect: Hormonal imbalance that can affect pregnancy implantation. 9. Using medications without consultation Mistake: Taking painkillers or herbal remedies without consulting a doctor. Effect: Some medications may affect embryo implantation. 10. Ignoring important symptoms Mistake: Ignoring symptoms such as bleeding, severe pain, and excessive bloating. Effect: May lead to delayed detection of complications such as ovarian hyperstimulation syndrome (OHSS). 11. Obesity or extreme thinness Mistake: Failure to control weight before and after the procedure. 12. Rushing to take a pregnancy test Mistake: Taking the test too early. Effect: Psychological stress due to inaccurate results.   The success of IVF depends not only on the medical procedure but also on a comprehensive lifestyle. Avoiding simple mistakes can make a significant difference in the chances of pregnancy.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/common-mistakes-that-can-reduce-the-chances-of-pregnancy-after-ivf Mon, 08 Mar 2021 05:25:19 AM The Role of Modern Fertility Units in Improving IVF Results   IVF techniques have witnessed significant advancements in recent years, and modern fertility units now play a crucial role in increasing success rates. The more advanced the technology and the more experienced the medical staff at the fertility unit, the greater the chances of obtaining healthy embryos and achieving a successful pregnancy. What are modern IVF units? These are specialized laboratories where eggs are retrieved, fertilized with sperm, and embryo development is monitored before transferring them to the uterus. Modern units are characterized by advanced, precise equipment and sophisticated monitoring systems to provide an optimal environment for the embryos. Examples of modern technologies used in IVF units: - Smart incubators for embryos that mimic the uterine environment - Intracytoplasmic sperm injection (ICSI) - Chromosomal preimplantation genetic testing (PGT) - Embryo and egg freezing What role does the laboratory environment play in the success of IVF? - Air purification systems - Temperature and humidity control  - Precision instruments for monitoring embryo quality and growth  - Minimizing vibrations and contamination within the laboratory. Embryos are very sensitive to even slight changes in the laboratory environment. Is technology alone enough? Of course not. The success of IVF depends on several other factors, such as: - The wife's age - Egg quality - Sperm quality - The cause of delayed pregnancy - The experience of the doctor and medical team - Lifestyle - The woman's nutrition The readiness of fertility units is assessed by an integrated team and specialized regulatory bodies such as: - Ministry of Health - Fertility and infertility specialists - Embryologists - Infection control team - Companies specializing in calibration and maintenance of medical equipment - International accreditation bodies What are the key points assessed to determine the readiness of an IVF unit? - The efficiency and qualifications of the medical team. - The quality of the laboratory and equipment. - The success rates of procedures. - Embryo and egg preservation systems. - The accuracy of safety and sterilization procedures. - Sample documentation and prevention of medical errors. Dr. Najeeb is committed to working in IVF units equipped with modern technology, staffed with highly qualified personnel, adhering to the highest quality standards, and employing the best protocols with the highest success rates in the Middle East. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist   https://www.layyous.com/en/assisted-reproduction/the-role-of-modern-fertility-units-in-improving-ivf-results Mon, 08 Mar 2021 05:25:19 AM Advances in sperm preparation techniques for intrauterine insemination   intrauterine insemination is one of the most commonly used fertility treatments. intrauterine insemination has the following advantages: -    Less invasive -    Affordable -    Simple Proper sperm preparation aids in higher success rates. The modern sperm preparation techniques aim at the following: -    Select the healthiest sperm -    Select the most motile sperm -    Minimizing sperm damage -    Improving fertilization potential -    Reduce oxidative stress -    Enhance pregnancy rates What are the traditional methods of sperm preparation? -    Sperm washing -    Swim-up techniques -    Density gradient centrifugation What is the importance of processing raw semen before the process? -    Removing debris, dead sperms, white blood cells and bacteria -    Concentrate motile sperms -    Reduce prostaglandins that cause uterine contractions -    Improve sperm movement -    Improve sperm function -    Select sperm with better DNA integrity New advances in sperm preparation: 1-    Microfluidic sperm selection 2-    Magnetic-activated cell sorting 3-    AI and automated sperm analysis Microfluidic sperm selection: -    Mimic the natural environment of female reproductive tract -    Highly motile sperms move through microscopic channels -    No centrifugation -    Advantages: ** reduced DNA fragmentation **Lower oxidative stress **Better sperm motility and morphology More natural sperm selection -    This method reduces mechanical sperm damage Magnetic-activated cell sorting: -    Uses magnetic particles to remove damaged sperms -    Help enrich the sample with healthier sperms -    It improves DNA integrity and embryo quality AI and automated sperm analysis: -    Advanced software that assesses sperm motility, morphology and motility. -    Helps in faster sperm selection and reduce laboratory variability. These new advances improve IUI outcomes and improve overall reproductive outcomes. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/advances-in-sperm-preparation-techniques-for-intrauterine-insemination Mon, 08 Mar 2021 05:25:19 AM The Role of Lifestyle and Antioxidants in Improving Egg Quality Before IVF and ICSI   Egg quality is considered one of the most important factors affecting the success of IVF and ICSI treatments. Success does not depend only on the number of retrieved eggs, but also on their genetic competence and their ability to fertilize, divide properly, and develop into healthy embryos. Although a woman’s age remains the most significant factor influencing egg quality, a healthy lifestyle, proper nutrition, and certain antioxidants may help support ovarian function and reduce oxidative stress, which can negatively affect egg quality. First: What Does “Egg Quality” Mean? Egg quality refers to: The integrity of the genetic material inside the egg The egg’s ability to be fertilized Its ability to develop into a healthy embryo Reducing the likelihood of embryo arrest or early miscarriage As women age, or in the presence of factors such as smoking, obesity, stress, and poor sleep, oxidative stress inside the ovaries increases, which may negatively impact egg quality. Second: When Should Lifestyle Changes Begin Before ICSI? It is preferable to start at least: 3 months before egg retrieval This is because the egg maturation cycle inside the ovary takes approximately 90 days, meaning healthy lifestyle changes require time before their effects are reflected in egg quality. Third: Key Lifestyle Factors for Improving Egg Quality 1. Good Sleep Sleep is one of the most overlooked factors despite its major role in hormonal balance. It is recommended to: Sleep 7–9 hours daily Maintain a regular nighttime sleep schedule Reduce late nights and physical exhaustion Poor sleep may affect: Melatonin hormone levels Hormonal balance Ovulation quality 2. Healthy Nutrition A diet rich in antioxidants may help protect eggs from oxidative damage. It is recommended to consume more: Leafy green vegetables Colorful fruits Nuts Healthy proteins Omega-3-rich fish Whole grains It is also preferable to reduce: Excessive sugars Processed foods Trans fats Fast food 3. Maintaining a Healthy Weight Both obesity and being significantly underweight may affect: Ovulation Ovarian response to stimulation medications Egg quality Even losing 5–10% of body weight in some women may improve treatment response. 4. Moderate Exercise Moderate physical activity may help: Improve blood circulation Reduce inflammation Improve insulin sensitivity Reduce stress Recommended activities include: Walking Swimming Yoga Regular light exercise It is preferable to avoid: Excessively intense workouts Overtraining and extreme physical stress 5. Reducing Psychological Stress Chronic stress may negatively affect: Hormones Sleep quality Inflammation within the body Helpful practices may include: Meditation Breathing exercises Yoga Emotional support Reducing daily stressors 6. Quitting Smoking and Alcohol Smoking is one of the most harmful factors affecting egg quality, as it increases: Oxidative stress Genetic damage Diminished ovarian reserve Nicotine and certain toxins may also accelerate ovarian aging. Fourth: Antioxidants and Their Role in Improving Egg Quality Oxidative stress can damage cells and eggs, which is where antioxidants may help by reducing this damage. Common Antioxidants Used Before IVF/ICSI 1. Coenzyme Q10 (CoQ10) One of the most commonly used supplements to support egg quality. It may help: Support energy production within the egg Improve mitochondrial function Reduce oxidative stress It is frequently used especially in: Women over 35 years old Poor embryo quality Diminished ovarian reserve 2. Melatonin A hormone associated with sleep that also has antioxidant properties. It may help: Reduce oxidative damage within ovarian follicles Support egg quality Improve sleep 3. Omega-3 May help with: Reducing inflammation Supporting hormonal balance Improving cellular health 4. Vitamin D Vitamin D deficiency is common among women and may be associated with reduced fertility in some cases. 5. Myo-Inositol Particularly beneficial for women with PCOS (Polycystic Ovary Syndrome). It may help: Improve insulin sensitivity Regulate ovulation Improve egg quality 6. Other Antioxidants Sometimes Used Including: Vitamin C Vitamin E Selenium Zinc NAC (N-Acetylcysteine) However, their use varies depending on the individual case and physician assessment. Fifth: Are Supplements Alone Enough? No. Even the best supplements cannot compensate for: Smoking Poor sleep Obesity Chronic stress Poor nutrition The best results usually come from combining: Lifestyle modifications Healthy nutrition Good sleep Appropriate supplements when needed Sixth: Important Points Before Using Any Supplement Some supplements may: Interact with fertility medications Not be suitable for all patients Require specific dosages Therefore, it is always recommended to: Consult a fertility specialist Avoid taking random doses Evaluate vitamin levels and deficiencies first .  *Conclusion*  Improving egg quality before IVF or ICSI depends on a combination of: A healthy lifestyle Good sleep Balanced nutrition Stress reduction Smoking cessation Using suitable antioxidants when appropriate Although there is no magical method that guarantees treatment success, preparing the body before egg retrieval may help improve the environment in which eggs develop and increase the chances of obtaining higher-quality embryos.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/the-role-of-lifestyle-and-antioxidants-in-improving-egg-quality-before-ivf-and-icsi Mon, 08 Mar 2021 05:25:19 AM Mistakes That May Affect IVF Success   Can Pregnancy Succeed from the First IVF Attempt? And What Should You Do to Increase the Chances of Success After Embryo Transfer? IVF and ICSI procedures are among the most advanced and effective modern treatments for infertility and delayed pregnancy. Thanks to major advances in reproductive medicine, success rates have improved significantly over recent years. Although embryo quality and the treatment protocol are extremely important, the most delicate stage is the period following embryo transfer, when the embryo begins the process of implantation into the uterine lining. During these critical days, certain unhealthy habits or failure to follow medical instructions may negatively affect implantation and pregnancy success. One of the most common questions couples ask is: Can pregnancy happen from the first IVF attempt? The scientific answer is: Yes. Many couples achieve successful pregnancy from the very first IVF cycle, especially when the right medical and biological factors are present. --- Common Mistakes That May Reduce IVF Success Rates 1. Not Following the Prescribed Medications Correctly Supportive medications, especially progesterone, play a major role in maintaining the uterine lining after embryo transfer. Missing doses or changing medication timing without medical advice may reduce implantation chances. Medical Advice: - Follow medication schedules strictly - Use reminders or alarms for medications - Never stop medications without consulting your doctor --- 2. Severe Stress and Emotional Anxiety Mental and emotional stress can indirectly affect hormones and blood circulation. Excessive anxiety may increase stress hormones such as cortisol and adrenaline, potentially affecting blood flow to the uterus. Medical Advice: - Avoid overthinking and symptom monitoring - Practice relaxation and deep breathing - Maintain good sleep and emotional support --- 3. Excessive Bed Rest Many women believe complete bed rest improves implantation, but modern studies do not support prolonged immobility. Lack of movement may reduce circulation and increase the risk of bloating or blood clots. Recommended: - Gentle daily movement at home - Light walking - Avoid only strenuous activities --- 4. Heavy Physical Activity and Lifting Weights Heavy household chores or lifting objects may increase pressure on the abdominal and pelvic muscles. It is better to avoid: - Heavy lifting - Exhausting housework - Frequent or rapid stair climbing - Intense exercise --- 5. Sexual Intercourse After Embryo Transfer In many cases, doctors recommend avoiding intercourse during the first period after embryo transfer until the pregnancy result is confirmed, to reduce uterine contractions and irritation. The recommended duration varies according to each case and physician instructions. --- 6. Exposure to High Temperatures Excessive body heat may not be ideal during the first days after embryo transfer. Therefore, it is advised to avoid: - Saunas and hot tubs - Very hot showers - Overheating the body --- 7. Unhealthy Diet and Poor Hydration Nutrition affects digestion, circulation, and overall body energy. Severe constipation and straining may create unnecessary pelvic pressure. Recommended: - Drink 2–3 liters of water daily - Eat vegetables, fruits, and fiber-rich foods - Reduce fast food and heavy fatty meals - Maintain balanced protein intake and healthy nutrition --- 8. Smoking, Alcohol, and Excessive Caffeine Smoking negatively affects egg quality, uterine lining, and embryo blood supply. Excessive caffeine and stimulants are also not recommended during this stage. Recommendations: - Completely stop smoking - Reduce caffeine intake - Avoid substances affecting circulation or hormones --- Can IVF Succeed from the First Attempt? Yes, successful pregnancy from the first IVF cycle is absolutely possible. However, success rates depend on several important medical factors. --- Main Factors Affecting IVF Success 1. Female Age Age is one of the most important factors because egg quality gradually declines over time. - Under 35 years: highest success rates - Between 35–40 years: success rates gradually decrease - Over 40 years: chances decrease but pregnancy is still possible --- 2. Embryo Quality Higher-quality embryos with excellent cell division have better implantation and pregnancy potential. Day-5 embryos (Blastocysts) generally have higher implantation rates compared to Day-3 embryos. --- 3. Endometrial (Uterine Lining) Readiness A healthy uterine lining is essential for successful implantation. Ideally, it should: - Have a thickness of approximately 8–12 mm - Have good blood supply - Be free from adhesions, polyps, or abnormalities --- 4. Cause of Infertility Success rates also depend on the underlying infertility cause, such as: - Male factor infertility - Blocked fallopian tubes - Polycystic ovary syndrome (PCOS) - Endometriosis - Immunological or genetic conditions Some cases may require specialized protocols or multiple attempts. --- When Should Pregnancy Testing Be Done After IVF? A quantitative Beta hCG pregnancy test is usually performed approximately 10–14 days after embryo transfer, depending on embryo age and physician recommendations. Testing too early may lead to inaccurate results and unnecessary stress. --- Does Failure of the First Attempt Mean Future Failure? Absolutely not. Failure to achieve pregnancy from the first IVF cycle does not mean treatment failure or loss of hope. In fact, the first cycle provides valuable information regarding: - Ovarian response to medications - Egg and embryo quality - Uterine lining condition - The best treatment protocol for future cycles Many successful pregnancies occur during the second or third IVF attempt. --- Golden Tips to Improve IVF Success Rates ✔ Follow the treatment plan exactly ✔ Maintain healthy nutrition and hydration ✔ Prioritize sleep and emotional wellbeing ✔ Avoid smoking and stress ✔ Stay gently active without overexertion ✔ Continue regular follow-up with your doctor ✔ Stay hopeful, patient, and positive --- Final Message The IVF journey can be emotionally challenging, but it is also a journey filled with hope. Following medical instructions carefully, maintaining physical and emotional wellbeing, and choosing the right medical care can significantly improve the chances of successful implantation and pregnancy. At Dr. Najeeb Layyous Clinic, we support you step by step using the latest fertility treatments and assisted reproductive technologies to give you the best possible chance of achieving your dream of parenthood. Contact Us: 📞 +96265656575 Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/assisted-reproduction/mistakes-that-may-affect-ivf-success Mon, 08 Mar 2021 05:25:19 AM Piezo-ICSI: Advanced Microinjection Technology for Higher Fertilization Rates and Improved Oocyte Survival *1. Definition and Mechanism of Action*   Piezo-ICSI is an advanced micromanipulation technique developed in Japan for oocytes with fragile membranes. The system employs a piezoelectric actuator PMM4G that converts electrical signals into precise high-frequency mechanical pulses. These pulses advance a flat-tipped micropipette with 6μm outer diameter through the zona pellucida and oolemma with minimal deformation. *Fundamental difference compared to Conventional ICSI:*   1. *Oolemma rupture mechanism*: Conventional ICSI requires aspiration of ooplasm into the pipette to mechanically rupture the membrane. Piezo-ICSI achieves membrane breakage via localized piezoelectric pulses without aspiration.   2. *Pipette design*: Conventional ICSI uses a sharpened spiking needle with cutting action. Piezo-ICSI uses a flat blunt pipette with micro-vibration drilling.   3. *Mechanical deformation*: Conventional needle causes significant oocyte deformation and spindle displacement, while Piezo-ICSI maintains oocyte sphericity. *2. Clinical Results Derived from Studies*   The studies included 69 patients undergoing microinjection, 947 mature oocytes, and 137 women in a sibling oocyte design. *1. Fertilization Rates and Oocyte Integrity* **Measured Parameter**    **Conventional ICSI**    **Piezo-ICSI**    **Statistical Significance** Two-pronuclei fertilization rate 2PN    65.8% ± 2.3% and 70.1%    80.5% ± 2.4% and 75.4%    P < 0.0001 and P = 0.008 Oocyte degeneration rate    8.6% ± 1.2% and 6.4%    4.4% ± 1.3% and 0.0%    P = 0.019 and P = 0.0446 Abnormal fertilization 1PN + 3PN    7.4% ± 1.1%    2.9% ± 1.1%    P = 0.003 Oocyte survival post-injection    94.3%    95.2%    Not significant *2. Embryo Development and Quality* **Study Group**    **Blastocyst Formation Day 5-6**    **High-Grade Blastocysts Grade A+B**    **Mean Usable Embryos per Cycle** All age groups    54.9% vs 50.2%    33.3% vs 27.5%, P = 0.019    3.8 ± 0.2 vs 3.1 ± 0.2, P = 0.038 Women >35 years    52.4% vs 39.6%, P = 0.016    Significant improvement    Increase of one usable embryo per cycle Women ≤35 years    58.3% vs 61.7%    No significant difference    No significant difference *3. Pregnancy and Live Birth Rates*   - No statistically significant difference in clinical pregnancy rate per fresh transfer: 57.1% Piezo-ICSI vs 60.0% conventional ICSI, attributed to underpowered studies.   - Blastocyst grade correlates directly with implantation: Grade A 77%, Grade B 44%, Grade C 20%.   - The primary clinical advantage of Piezo-ICSI lies in increased availability of high-grade embryos for cryopreservation, thereby enhancing cumulative pregnancy rates across multiple transfers. *3. Patient Groups with Maximum Benefit*   Based on subgroup analysis of the three studies:   1. *Women aged 35 years and above*: Recorded the greatest improvement in fertilization rate with P = 0.008 and blastocyst development with P = 0.016. In the ≥38 years subgroup, degeneration decreased to 0.0% vs 6.4% with conventional ICSI.   2. *Poor ovarian responders*: Patients with prior cycles showing fertilization below 50% or embryo utilization below 20% with conventional ICSI.   3. *Low oocyte yield*: When ≤6 mature oocytes are retrieved, reducing degeneration from 12.1% to 6.3% critically impacts final outcome.   4. *Repeated fertilization failure*: Fragile oocytes unresponsive to sharp needle cutting respond more effectively to micro-vibration drilling. In women aged 35 years and below, no significant differences were observed between techniques due to inherent oocyte robustness. *4. Biological Explanation for Reduced Oocyte Damage*   1. *Elimination of ooplasm aspiration*: Aspiration in conventional ICSI displaces the meiotic spindle and stresses intracellular structures. Piezo-ICSI bypasses this step through pulse-mediated membrane rupture.   2. *Minimization of mechanical deformation*: The cutting and twisting action of sharp needles deforms the membrane and increases calcium permeability, whereas micro-vibration drilling penetrates while preserving spherical geometry.   3. *Reduction of membrane breach area*: The flat tip creates a precise micro-opening compared to the irregular tear from sharp needles, decreasing structural damage. *5. Technical Considerations and Current Limitations*   1. *Equipment*: Requires Piezo PMM4G system and ultrathin PINU06-20FT pipettes, plus specialized embryologist training.   2. *Live birth per transfer*: No proven significant difference in randomized trials to date. Primary benefit remains increased embryo inventory.   3. *Long-term data*: Ongoing collection of cumulative pregnancy rate data across multiple treatment cycles.   4. *Availability*: Not yet adopted in all IVF centers and currently offered through special access programs in select countries. *6. Conclusion*   Piezo-ICSI represents a mechanically less invasive microinjection method. Clinical studies demonstrate its superiority in increasing fertilization rates, reducing oocyte loss, and generating more high-grade embryos. Its clinical advantage is most evident in women over 35 years, poor responders, and patients with limited oocyte numbers. Conversely, outcomes converge with conventional ICSI in younger women with robust and abundant oocytes. Consultation with the treating physician is advised regarding availability and suitability for the individual case. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist   https://www.layyous.com/en/assisted-reproduction/piezo-icsi:-advanced-microinjection-technology-for-higher-fertilization-rates-and-improved-oocyte-survival Mon, 08 Mar 2021 05:25:19 AM Infertility | Inability to conceive | Infertility Guide | Reproduction Guide | Guide to Getting Pregnant Definition of Infertility   The term Infertility applies to a couple who are not able to achieve conception in spite of regular unprotected intercourse. Fertile women have a period of infertility during their menstrual cycle because their fertility period is limited to few days before ovulation and few days after , other than this time they are infertile for the rest of the month . Types of Infertility   A- Primary infertility: failure to achieve conception after one year of regular unprotected intercourse.   B- Secondary infertility:failure to achieve conception after 6 m of regular unprotected intercourse, if the couples previously had children. So if the couple can’t achieve pregnancy for the first time after one year they should visit their gynecologist and after six months if they had children before. However women who are over 35 years old should visit their gynecologist if they failed to conceive after 6 months of regular unprotected sexual intercourse, as they have not much time to play with.   Also if the women got married to a new partner then they are regarded as a new couple with Primary Infertility, because the infertility is referred to the couple not to the individual.   About 85 % of couples will conceive naturally within one year if they have regular unprotected sex. However, the chance of becoming pregnant is much lower for older women. 20 % will conceive within one month. 70% will conceive within 6 month. 85 % will conceive within one year. 90 % will conceive within 18 month. 95 % will conceive within 2 year. As the women get older, she become less fertile, so for women aged 35 years 94 % well get pregnancy after trying for 3 years. The male’s age effect on fertility is unclear. Male factor represent 30% of infertility, female factor 50% (25% due to ovulation problem, 25 % due to tubal and other factors), 20% of infertility are unexplained without an identifiable causes. https://www.layyous.com/en/infertility Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/infertility Mon, 08 Mar 2021 05:25:19 AM Fertilization - Fertility Potential   Definition of fertilization It is the union of the male sperm with the female egg. Every month, with each monthly cycle, there are a number of eggs that become ready for maturation, usually one matures, released after maturity and becomes ready for fertilization. The egg becomes mature in a fluid-filled sac in the ovary, called a Follicle. In the middle of the menstrual cycle ovulation occurs when the follicle ruptures and the egg is released. Then this egg will be attracted in the first part of the fallopian tube, called the Fimbria and move along its path towards the uterus.   Sperm Travels to the Egg Sperm reaches the nucleus of the Egg   The egg remains valid for fertilization for 12-24 hours, if the sperm enters the cervical canal and traverses through the uterine cavity to reach the fallopian tube at the time of fertilization (which we referred to earlier at mid-menstrual cycle), as it meets the egg, the sperm secretes a certain enzyme that smashes the outer crust of the egg so that it can penetrate into the nucleus of the egg and in this moment of docking , a cover is produced by the fertilized egg that does not allow the passage of any other sperm. The fertilized egg, which is called a (Zygote), then begins to divide, and continues to pass through the fallopian tube until it reaches the uterus. This takes around 7 days. This fertilized egg remains in the middle of the uterus for about two days before it sticks to the lining of the uterus and grows. This process is called Implantation.     Formation of the Zygote Fertilization and Implantation of the Embryo   Factors affecting Fertilization: 1 - Age: This affects both men and women, explaining the reason of the recurrence of abortions when the woman becomes older. Also the disruption of hormonal action and the emergence of some of the variables in the uterus such as fibroids, increased age, and overall fertility declines significantly in women after the age of 38. The effect of age is usually less with men.   2 - Frequency of the intercourse: Couples who have intercourse 3 times a week have the possibility of a pregnancy 3 times tgreater to those who have intercourse once a week.   3 - The environment and daily habits: With progress, some effects, such as factories that pollute the atmosphere, smoking, excessive or severe exercise which affects the secretion of hormones, (Gonadotropins FSH & LH) for both sexes, all have proven to have an impact on fertility.   - How to define the fertile couple, and the couples who are unable to have children?   For any couple who are in their twenties, and engaged in a natural sexual life, have a 25% chance to have pregnancy each cycle. Nine out of every ten couples will be able to become pregnant on an annual basis. A: It should be taken into account that whenever the couple are older in age, especially the wife, we have to accelerate doing the necessary tests, especially if there are symptoms that indicate fertility problems, such as irregular cycles or the appearance of hair in unusual areas in the woman's body , history of pelvic surgeries that may have led to adhesions, or an obvious problem with men such as Undescended Testicles, and so on.   B: Investigations usually start by checking the semen analysis for the man, and it might need to be repeated more than one time, post coital test, making sure of ovulation by several methods, determined by the physician, hysterosalpingogram. And if nothing is determined by those primary investigations the physician may resort to more complicated and effective ways, such as the Laparoscopy process which is diagnostic and therapeutic at the same time, in most cases.   C – The husband and wife must always attend together and consistently receive treatment from one specialist. Concerned couples may decide to see more than one doctor in the short term. This hinders the treatment and does not work at all.   4 - Last but not least, the woman and man should accept the situation, in other words, many men feel embarrassed psychologically and socially when they are asked to do semen analysis thinking that it reduces their manhood. Women think that this reduces their femininity. The health and cultural awareness should be available to allow the physician conducting the necessary tests, to give proper treatment and to reach the best results.   Dr Najeeb Layyous Obstétricien consultant, gynécologue et spécialiste de l'infertilité F.R.C.O.G https://www.layyous.com/en/infertility/fertilization-fertility-potential-how-to-become-fertile Mon, 08 Mar 2021 05:25:19 AM Causes of Infertility in Women   Definition of infertility: Inability to conceive despite trying and having regular intercourse for one year. Infertility is one of the widespread problems facing couples. And the causes could be due to female factors or male factors. Female factors: It has been proven by multiple researchers that the ability for women to conceive decreases with increasing age.   1- Vaginal Causes of Infertility in Women Blockage of the vagina which will interfere with the entrance of the male organ such as imperforate hymen, or extremely narrow vagina, or painful infections in the vagina.   2- Cervical Causes of Infertility in Women Previous cone biopsy or laser conization. This might cause a decreased amount of mucous. This will affect sperm movement. Presence of anti-sperm antibodies. Closed cervix (very rare condition).   3- Uterine Causes of Infertility in Women a. Congenital anomalies: Most of them precipitate from abortions, but some of them affect fertility and can be corrected surgically, such as a septate or divided uterus, which can be removed by hysteroscopy. Anomalies such as bicornuate uterus, rudimentary horn and T-shaped uterus. These anomalies usually are associated with unilateral or bilateral fallopian tube anomalies so they will also increase the risk for ectopic pregnancy and recurrent pregnancy loss in addition to infertility. b. Asherman Syndrome:In this syndrome intra uterine adhesions form either after repeated curettage, severe endometritis, or due to scars from previous uterine surgery. Women with this syndrome usually complain of decreased amount of blood loss during menstruation. It can be diagnosed easily using hysterosalpingogram. And hysteroscopic resection of these adhesions can be done but it may need multiple sessions, in addition to giving steroids with estrogen for three weeks after surgery to avoid recurrence. Asherman Syndrome c. Fibroids:Fibroids are a benign uterine tumor that might cause irregularities in the intrauterine cavity.Adenomyosis They usually do not cause infertility unless it affects the intrauterine cavity in an obvious way, but if no other reason for infertility can be found, it is better to do myomectomy (excision of the fibroid ) and restore the intrauterine cavity. Myomectomy can be done either by hysteroscopic resection or by laparatomy (abdominal incision is done to access the abdominal cavity then removal of the fibroid is done). d. Fibrosis:This may happen after endometritis and can be diagnosed using HSG, hysteroscopy can help in treatment. e. Endometrial polyp:Its presence mimics IUCD, polyps can be diagnosed by HSG, ultrasound or hysteroscopy then polypectomy (removing the polyp) can be done easily. f. Adenomyosis:Symptoms include secondary dysmenorrhea, some hormonal treatments could be helpful e.g. GNRH analogues, or Danazol, the decision for this treatment should be taken by the treating physician.   4- Tubal factors causing Infertility in Women: a. Chronic pelvic infections: This problem will cause tubal congestion. If the cross section reaches more than 3cm, tubal obstruction results in impeding of the oocyte transfer, chronic pelvic infections may also result in pelvic adhesions that will affect tubal movement. Slowing it so inappropriate time for oocyte transfer interferes with fertilization. Pelvic inflammatory disease will result in tubal occlusion or pelvic adhesions that cause inability for the fimbrial ends to catch the oocyte from the ovary or as mentioned before abnormal movement of the tubes and oocyte transfer. Causes for PID include infections with E.coli, or Gonococcus infection (STD) PID affects ovarian function and tubal movement. And it may be severe enough to destruct the tubes requiring surgical resection. - b. Destruction of the fimbrial ends :Disabling its function in catching oocytes into the tubes, PID or endometriosis can cause this. - c. Adhesions: Caused by tubal surgery done for ectopic pregnancy, pelvic surgery done to the tubes or due to appendicitis. - d. Short tubes(less than 4cm). - e Tubal Tumorsaffecting it's function.   5- Ovarian dysfunction: - A. Polycystic ovarian disease: 20% of females have what is called polycystic ovary which involves having follicles consisting of more than the normal condition.Ovarian Drilling In this case the woman has normal fertility but if it is associated with some of the following conditions, it is called polycystic ovarian syndrome and it is pathological. Please press on the link to read more about Polycystic ovarian disease. What about the possibility of doing IVF for these women? IVF was first done for women who have tubal occlusion or male abnormal semen analysis. But the decision, whether women with PCOD will need IVF, should be individualized as said earlier. -For hirsuitism treatment for women, seeking pregnancy is different from those who are not. Most of the time, treatment of hormonal imbalance is the best thing. -Regarding recurrent abortions in PCO patients, it occurs due to a slightly increased LH level, so it’s better to give medications to manage its level before starting induction of ovulation. Also some researchers have shown that ovarian diathermy lowers LH level and consequently lower the incidence of recurrent miscarriages. B- Failure of the ovary to perform its normal function: 1- Ovarian failure : A- Congenital causes. 1- Genetic and chromosomal causes. - Ovarian agenesis. - Hereditary causes for accelerated loss of ovarian reserve. - Familial premature ovarian failure. - Chromosomal abnormalities (47XXX). 2- Congenital enzymatic dysfunction. - 17-α Hydroxylase Deficiency. - Galactosemia. B- Exposure to certain factors: - Large amount of radiation exposure. - Chemotherapeutic agents as in cancer treatment. - Viruses such as mumps. - Heavy smoking. C- Autoimmune causes: Presence of ovarian antibodies. D- Lack of (or dysfunction) of LH, FSH ovarian receptors. E- Idiopathic causes. F- Surgical oopherectomy. 2- Physiological ovarian failure. Such as corpus luteum insufficiency or luteal unruptured follicle. C- Pituitary failure: 1- Secondary disorder of Gonadotrophin Regulation. High prolactine level either due to pituitary adenoma, idiopathic hypothyroidism or as a side effect to medication, which affects follicular maturation. - Suprapituitary Tumors,. - Pituitary Tumors, trauma such as in RTA, radiation exposure to the pituitary. - Idiopathic causes. 2- LH and FSH gonadotrophin Deficiency due to: - Pituitary tumors. - Destructive pituitary lesion. - Pituitary ablation. D- Hypothalamic failure.Which could be as a result of: Rapid and sudden increase or decrease in body weight. Severe psychological and neurological stress strenuous exercises. Radiation exposure. Medications that cause hypothalamic failure. Tumors. Unknown causes. E- Endocrinopathy Such as *Adrenal gland dysfunction which lead to hyperandrogenic state. *Thyroid gland problems. Hypothyrodism causes hyperprolactinemia and hyperthyroidism affects hormones necessary for follicular maturation, pancreatic problems such as diabetes.   6- Endometriosis: Which is the presence of endometrial tissues outside endometrial cavity it affects pregnancy either by forming chocolate cyst (or endometrioma) or by causing adhesions. Please press on the link to read more about Endometriosis Diagnosis is usually done by laparoscopy and treatment includes laparoscopic adhesiolysis, cauterization of endometriotic spots, salpingostomy and reanastomosis of fallopian tube problems. Success rate of tubal dilatation is around 35%, and if it was cornular obstruction (the area where the tube is connected to the uterus) success rate is around 55-60% success rate and can reach 80% in cases of tubal reconstruction. Cornular Dilatation is done by passing a special tube through the cervix to the tube. In cases of ovarian cysts (hemorrhagic cyst) surgical intervention is needed. Treatment of chronic PID causing adhesions, is similar to treatment of endometriosis, that is adhesiolysis and tubal reconstruction.   7- Unexplained Infertility: Inability to conceive after two years of marriage despite having regular intercourse, multiple researches have been done with multiple theories attempting to explain it. - Presence of certain amounts of fatty acids in the sperm - Cervical leucocytosis. - Psychological causes. It is said that stress and strenuous exercise, and unstable changes in weather may cause oligospermia but there is lack of strong evidence for this. But, psychological causes might affects premature ejaculation or erectile dysfunction. The best psychological support for the male is from his wife regarding psychological causes. In women, it affects sexual function and ovulatory failure. In our society, most females, after marriage, will find problems in proper sexual intercourse that is related to the way that most of them are raised, and psychotherapy is helpful in these cases. - Some hypotheses say that stress and worries may cause significant changes in internal hormones such as decreased cervical secretions or muscular spasm, including those lining fallopian tubes causing its obstruction, or muscles lining the vagina causing dyspareunia. Stress also has its effects on the hypothalamus and ovarian function. So we advise each couple seeking pregnancy to try, as much as possible, to alleviate stress and worries as much as possible and have trust in god and trust their treating physician. - Genetic causes. - Endometrial Immunity. - Lack of some vitamins and ferritine level. It should be said that these causes are rare and not that familiar, researchers are doing their best to identify and treat these causes.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/causes-of-infertility-in-women-female-factor-in-infertility Mon, 08 Mar 2021 05:25:19 AM Causes of male infertility   1-Causes that are related to the glands controlling testicular function: Delayed puberty. LH, and FSH deficiency. Congenital hypo-gonadotrophic hypogonadism (deficiency of pituitary gland hormones) e.g.: Kallman’s syndrome which is associated with abnormal sense of smelling. Other causes that may result in destruction of pituitary and hypothalamic glands are trauma irradiation tumors medications surgery. Hyperprolactinemia due to pituitary adenoma or a side effect(s) of some medications. Measurement of these hormones (LH, FSH, prolactine, and testosterone) will help in the diagnosis, for example: Primary testicular failure is associated with low testosterone level, and high LH, FSH. This syndrome is associated with either low sperm count (oligospermia) or completes absence of sperms (azoospermia). Retrograde ejaculation, if there is an obstruction in ejaculatory ducts, or germinal cell failure in these situations there will be normal levels of testosterone, LH and FSH. Dans le manque de récepteur LH : In this case, though hormonal levels are normal, but they are ineffective. If all of these hormones are low, it might be associated with other hormonal deficiencies, such as low growth hormone, low corticotrophin, low TSH.   Depending on these levels the treating physician, might determine the cause.   2-Testicular Disorders Idiopathic causes for testicular problems. Congenital causes. Chromosomal causes such as, klinefelter’s Syndrome (47XXY). Undescended testis or (cryptochidism) that may cause harm to testicular tissue. Congenital absence of both testes. Testicular varicocele : This is usually diagnosed through a physical examination, and using ultrasound, in this case tortuous veins around the epididymis, this might affect sperm production, and quality, but varicocele effect is still under debate, and there is controversy among researchers, and doctors as to whether it has a major effect or not. Major trauma to the testes. Severe testicular infection. Testicular tumors. Hazardous chemical or physical exposure. Medications such as cyclosporine, allopurinol, colchicines, sulfasalazine, spiranolactone. Drugs such as marijuana and alcohol especially if there is an addiction, will affect sperm quality, and slow its motility. Some chemicals used in factories like nematocid DBCP, lead, and mercury affects sperm production. Chemotherapy that is used in the treatment of cancer patients. All the above mentioned points affect sperm production or even might cause spermatogenesis arrest. Smoking. It is well known that smoking has effects on sperm production, motility, and morphology some researchers found that smokers who have varicocele have less ability for sperm production five times less as compared to nonsmokers. Heat has a major role in sperm production, so men should avoid wearing tight underwear for long periods, as it may cause low or reduced sperm count. Jobs that require sitting for long times, may affect sperm count. Chronic medical illnesses, such as chronic renal failure, or chronic liver failure. Immunological disorders: It may cause sperm antibodies that will kill the sperm. 3-Disorders related to epididymis, seminal vesicles, and prostate: Congenital causes: Vas aplasia, malformation of caudal corpus epididymis. Congenital obstruction of seminal vesicles. Congenital obstruction associated with bronchial dilatation of the lungs. Severe infections may cause epididymal obstruction: Some of the Microorganisms that may also cause infections are staph, gonorrhea tuberculosis, trachoma, anaerobes and Chlamydia. Vasectomy: A procedure done for male contraception in this procedure a cut in seminal ducts is done which will cause male infertility. 4-Coital Defects Inappropriate time for intercourse (not at time of ovulation). Erectile dysfunction: It could be due to psychological, neurological or vascular disorders or as a side effect for some medication. Using certain ointments or creams at the time of intercourse, some of which may kill the sperm. Hypospadias: This means abnormal position of urethral meatus. Congenital Penile Defects. Retrograde ejaculation: In these patients the semen flows to the bladder at the time of ejaculation instead of out through external opening this happens when there is a problem in bladder neck due to: A-Congenital causes: Stenosis of the external urethra. Stenosis of the external valve due to hypertonic muscles. Congenital anomaly of the internal valve. Congenital stenosis of bladder neck. B-Acquired cause: Neurological injury due to spinal cord injury. Pelvic fractue. Pelvic surgery. Diabetes. Prostate surgery. Bladder surgery. Urethral dilatation. C-Unknown causes.   5-Abnormal semen: Disorder of the sperm and its ability to fertilize. Immotile cilia syndrome. Necrospermia (dead sperm). Periaxonemal abnormalities. Increase viscosity of the semen above the normal levels. Some factors that may suppress the sperm such as deficiency of certain enzyme, which is important in sperm motility (protein- carboxyl methylase PCM). Zinc deficiency. Decrease the amount of the substances needed for sperm motility or decrease their use by the sperm (Adenosine triphosphate A.T.P). Sperm membrane malformation. Disorders in calcium metabolism. Lack of the substances in the semen that are needed for sperm motility such as bicarbonate or abnormal levels of prostaglandins.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/causes-of-infertility-in-men-male-factors-in-infertility Mon, 08 Mar 2021 05:25:19 AM Diagnosis Of Infertility In Women   Diagnosis of female infertility Diagnostic Procedures 1-Hormonal levels: Importance of Hormonal tests FSH, LH, testosterone and prolactine, the level of these hormones can be measured; the importance of measuring these hormones should be decided depending on the case of each patient for example testing progesterone level after ovulation to assess corpus Luteum function. 2- Vaginal Cytology:- It is an old procedure in which a swab is taken from the vagina, and tested to get an idea about ovarian function, but it is not done any more and there is more advanced tests for ovarian function. 3-Testing Changes in the Cervix: Cervical mucus has certain natural physiological changes that change during each cycle; this mucous is considered as a barrier against bacterial entrance to the uterus. During the first half of the cycle, cervical mucus is scanty, and thick, five days prior to ovulation it become watery and profuse, in order for the sperm to be able to pass through these secretions at the time of intercourse. Any change in these secretions, may impede or prevent sperm passage and consequently affect fertilization.   Hormonal changes during cycle each month plays a major role in these cervical changes (quality and amount), just before ovulation cervical mucus becomes watery and stretchable just like raw egg whites, 24 hour post ovulation, cervical mucus secretion stops, then it returns to be thick, white-yellow in color all through the second half of the cycle. 4-Microbiological, laboratory and blood tests: For example :-Liver function test. Blood sugar level. Urine analysis. Other tests for contagious microorganisms.   5-Ultrasound examinations: It is used to visualize internal organs including uterus, ovary, testes, prostate, liver, kidneys, and gallbladder……….etc, ultrasound is better than x-ray examination because it is not harmful for body tissues, and it can be used for men and women. There are two types of ultrasound in the diagnosis of female infertility:   A-Trans abdominal ultrasound: In this type, the probe is used over different areas of the abdomen depending on the aim from the examination, in this case, mainly the uterus and both ovaries. B-Trans-vaginal ultrasound: It gives more obvious and clear image for the ovaries, so it is better for accurate measurement such as: measuring follicular size after ovulation induction by medications, diagnosis of PCOS and to check for ovulation, pelvic organs in general, endometrium, uterine wall (myometrium), and fibroids (benign uterine tumor) all these are diagnosed easier by vaginal ultrasound.   How often should ultrasound be done to check for ovulation?   Usually a primary examination at the second or third day period to check on the uterus ovary and diagnose PCOS, the second examination is done at day 13 of period to check follicular size and ovarian function whether during normal cycle or after induction of ovulation, usually if the woman is not taking any ovarian stimulant, the average follicular size is 12-14 mm, and it increases by 1-2 mm/day, if ovulation happened there are certain signs the treating physician can notice, on ultrasound. The size of the mature follicle suitable for fertilization depends on the type of treatment used for ovarian stimulation, usually the mature follicle is suitable for fertilization, but sometimes it might be obvious on ultrasound that it is mature but it is not suitable for fertilization, so the physician may need serial follow up with ultrasound because follicular growth may stop, or continue to grow without ovulation, in this case he will need to give HCG hormone to induce ovulation, if the follicle continues to grow, ovarian cyst (LUF) will develop, it is not a serious condition, it doesn’t need treatment and will resolve spontaneously.   Ovarian Follicles as seen by Trans-vaginal ultrasound Other conditions that may be diagnosed by ultrasound: Small immature ovary in a mature woman (hypogonadotrophic hypogonadism). Infantile uterus (small size uterus). Check endometrial thickness in different menstrual stages. Multi cystic ovaries: a condition similar to PCO, but the follicles on ultrasound are less in number and larger in size. Women with anorexia nervosa in the healing process. Diagnose uterine fibroids or ovarian masses. Diagnose early pregnancy. Congenital anomalies in the fetus. Diagnose multiple pregnancies (presence of two or more embryos). Check on fetal presentation (if the head is down in the lower part of uterus), placental location, and sex of the baby. Diagnose ectopic pregnancy. Dating of pregnancy, estimation of fetal weight, check on the amount of liquor. Color Doppler ultrasound: It is a modern device and its use in infertility diagnosis is still under research. It measures the blood flow in blood vessels, so it can measure the blood path between the ovaries and uterus.   Color Doppler ultrasound Can this method affect the follicle or harm it? The answer is till now no proven harm for the follicles.   6-Hysterosalpingogram.(H.S.G) In this method, colored material (dye) is introduced through a tube inserted in the cervix, then serial multiple x-ray pictures are taken to visualize the passage of the dye on the screen, if there is a blockage in the fallopian tube, there will be no passage of dye, it should be mentioned that the amount, and duration of dye injection does not cause harm.   Hysterosalpingogram.(H.S.G) This procedure does not cause annoying symptoms except some lower abdominal discomfort; it takes only a few minutes and doesn’t need hospital admission.   This procedure is helpful in the diagnosis of:   Intrauterine lesions (fibroid, polyps). Tubal blockage or dilatation (hydrosalpinx). Uterine anomalies. Intrauterine adhesions (Asherman’s syndrome). H.S.G Showing patent tubes Tubal blockage and dilatation (hydrosalpinx). 7-Hysterosalpingo Contrast Sonography (HY-CO-SY) :- Since fallopian tubes can’t be visualized using ultrasound especially assessing their patency, this technique was developed, and it has many advantages. It is complementary to ultrasound examination which is becoming more widely spread and accepted in modern medicine. It avoids the patient's exposure to x-ray examination as in HSG. No need to use iodinated contrast media which might cause allergic reactions. Comparing HY-CO-SY to other techniques it is minimally invasive and it is not painful. No need for general anesthesia. It is an office procedure and doesn’t need hospitalization. It has quick and accurate results. It can give detailed information regarding structural and functional situations of the organ examined, if there are any anomalies.   For example, while examining the endometrial cavity, it can differentiate between submucosal fibroid and endometrial polyp.   This procedure can be done by either abdominal or transvaginal ultrasound.   First: Cleaning of the vulva (genital area), the woman is asked to bend her knees, and open them a little bit while she is lying flat on her back, the cervix is held using forceps, a catheter is inserted through the cervix, a special colored material called Echovist..200 is inserted through this catheter, it takes only 10-15 minute, and doesn’t need anesthesia as said before, at the end of the catheter there is a balloon that will be inflated in order to fix the catheter inside the uterus, before vaginal ultrasound is introduced inside the vagina, then the flow of the colored material is followed passing through the uterus, and both fallopian tubes on the screen, if there is obstruction in the tube the patient will feel some discomfort or mild pain, and she is asked to report that immediately to the doctor.   The treating physician needs from 2-3 ml to visualize the uterus and identify abnormalities such as uterine septum or myoma (fibroid). To visualize the tubes, another 1-2 ml of the colored material is added to the total amount. At the end of the examination the balloon is deflated before removing the ultrasound probe, so that the doctor would be able to visualize any lesion that was hidden by the balloon. Very mild lower abdominal pain (dysmenorrheal like pain) might be felt, not more than one hour after the test, and it is easily managed by simple analgesia. Hysterosalpingo Contrast Sonography This procedure is: Quick. Easily done. No major side effects. The patient is comfortable while performing the procedure. Some abnormal conditions that may be noticed: Reflection zone in the endometrium mostly due to previous caesarean section. Intrauterine adhesions like Asherman’s syndrome. Polyps. Fibroids Uterine anomalies like arcuate uterus, bicornuate uterus, Uterus duplex. Tubal occlusions. If it is bilateral, the uterus will become swollen on ultrasound screen and mild pain may be felt, if it is unilateral, there will be no swelling of the uterus and the blocked tube and the site of the blockage will be obvious on the screen. Adhesions or tumors will cause more time for the dye to pass; with no enough experience it will cause misdiagnosis. 8- Diagnostic laparoscopy   9- Diagnostic hysteroscopy 10- Falloposcopy:-   Either during laparoscopy or transcervical with or without hysteroscopy. 11-P.C.T (post coital test): Cervical mucus becomes watery at the time of ovulation, stretchable, transparent and in profuse amount, in order to allow the sperm to pass and fertilization be done, in this test cervical sample is taken 6-10 hours post coitus and examined under the microscope to assess functional ability of the sperm and cervical mucus elasticity.   At the time of ovulation, cervical mucus becomes watery, stretchable, transparent and in profuse amount, in order to allow the sperm to Cervical Causes of Infertility in Womenpass and fertilization be done, in this test cervical sample is taken 6-10 hours post coitus and examined under the microscope to assess functional ability of the sperm and cervical mucus elasticity.   Mucous secreting cells in the cervix are under the effect of estrogen which is produced in large amounts around the time of ovulation, at this time, 98% of the mucous is water resulting in increased elasticity, it also contains some materials at the time of ovulation due to increased amount of salts and water that interact with the protein in cervical mucus, which is indirect evidence for increased in estrogen level, all the above mentioned changes help to maintain the sperms for 24-48 hours post ovulation, progesterone level increase causing the mucous to lose its elasticity and decrease the maintenance of sperms, in this test if we could see 15-20 sperm it is considered a good result, if the count is less than five, it indicates a weak potential for fertility.   Post coital test is an easy test; in addition, seminal fluid analysis will help to give more clear idea about the best way for infertility treatment.   It was noticed that the amount of cervical mucus can compensate some shortage in semen amount.   Post coital test is an easy test as said before, but it is not that reliable, sometimes it can give false negative results such as in the presence of antibodies in the cervix, or if there is severe infection in cervical mucus this will affect the sperms and give bad result in P.C.T though the seminal fluid analysis is good.   Post coital test showing active motile sperm Assessment in P.C.T Post coital test includes:   1 - Elastity of the mucous since sperm cannot pass through if it is very thick.   2 - Presence of antibodies: Uterine cervix has the highest ability to produce antibodies followed by endometrium, fallopian tube and green fluid which gives local immunity, so the presence of sperm will cause sperm antibodies and consequently antibodies in the serum.   Uterine cervix is covered with plasma cells and it also contains the proteins required for antibodies formation. These contents differ in their amount, in different times of each menstrual cycle. It becomes less around the time of ovulation. Sperm Antibodies 3 - Determine if sperms are able to reach the cervix or not.   4 - Presence of vaginal or intrauterine infections, or if there is bacterial, fungal or other pathological microorganisms.   12-Endometrial Biopsy:   It is done at day 21-23 of cycle. First, dilation of uterine cervix then curetting of the endometrium, then it is sent for histopathology, if ovulation happens, serum progesterone level will be within certain range that correlates with histopathology result. If ovulation did not happen, there will be low progesterone serum level and different histopathological results.   Although some medical centers still use this method, to check for ovulation and assess fertility but with scientific and technical advances in the medical field, and with the presence of vaginal ultrasound, which can help in this issue, this test has become less and less important as it was before.   13 -Basal Body Temperature Chart (B.B.T):- It depends on measuring body temperature daily, once, early in the morning, starting from the first day period and document this temperature on a chart daily, till the time of the next period. If there was ovulation, a small increase in temperature (0.5-1.25c) will be noticed at the second half of period, which is caused by increased level of progesterone and it stays higher, till the first day of the next cycle or one day before it returns to its lower level. If pregnancy happens, it stays higher. If there is no ovulation, the temperature stays the same all through the cycle.   This method is inaccurate for many reasons. Body temperature readings might be wrong or taken incorrectly. The woman might have a high temperature due to infection or any other disease or there may be irregular patterns of increased and decreased temperature (step wise rise). In addition, the woman may have irregularities in her hormones though ovulation happens. In this case, changes in body temperature will not be ideal as in day 12-14 from cycle.   Other reasons for inaccuracy are different body reactions to hormonal changes i.e. high level of progesterone with ovulation but it does not cause increase in temperature.   Due to all the above mentioned causes, and recent advances, this method is not used frequently.   14-Immunological tests: Anti sperm antibodies either in serum or cervical mucus. Ovarian antibodies in cases of premature ovarian failure. Other antibodies like anti-phospholipid antibody which plays an important role in the ability to conceive after embryo transfer. 15-Genetic and chromosomal tests:   Such as in the cases of:   1-Premature ovarian failure.   2-Primary amenorrhea (menstruation cycles never starting).   3-Recurrent abortions.   16-Psychological tests:   Due to its major effect on fertility. See stress and infertility   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/diagnosis-of-infertility-in-women-diagnosis-of-female-infertility Mon, 08 Mar 2021 05:25:19 AM Diagnosis of Infertility in Men | Diagnosis of male infertility Diagnosis of Infertility In Men A-Medical history: Taking detailed medical history from both couples, they should be asked if there is any medical illness such as: Diabetes, high fever, taking certain medications for long times, mumps, any previous genital disease, any previous surgical intervention especially concerning the female pelvis and genitourinary system for the male, delay in pregnancy, previous miscarriages, previous marriages and if they had pregnancy in these marriages, frequency of intercourse, age of puberty, previous history of exposure to chemotherapy, irradiation or very high temperature. In addition to many other questions that may help to diagnose the causes for infertility. B-Physical examination: General examination is done at the beginning (head, neck, chest, abdomen, upper and lower limbs), then concentrate more on the examination of genital area. C-Diagnostic procedures and tests: 1-Seminal fluid analysis It should be emphasized here that one abnormal test is not enough to judge that there is abnormality in the semen. Most of the time, it should be repeated 2-3 times because many factors (such as his medical condition) affects the semen. The following instructions should be followed before doing SFA: Abstinence for 3-5 days. Avoid taking hot shower before giving the sample. Wash your hands with soap, then by water. Washing the genital area several times. Make sure to close the collecting tube carefully, and not to lose any amount from the sample given. The time between giving the sample and bringing it to the lab shouldn’t exceed one hour, it should be kept in the palm of hand or in close contact to the body to maintain its temperature around 37c. 2-Evaluation of the ability of sperms to fertilize: Seminal fluid analysis doesn’t evaluate functional ability of the sperm so many tests were developed: a-Testing the ability of the sperm to move inside the female body. -Post coital test (it will be explained later). -In-vitro mucous penetration test (ability of sperm to pass through cervical mucus). -Sperm survival tests (the ability of the sperm to move at some point of time within a certain perimeter). b-Acrosome reaction:This is done by using certain dye for the sperms to identify the presence of acrosome and its functional ability. c-Hyposmotic swelling test: This test identity the percentage of sperms with healthy membrane, and its ability. d-Ability of the sperm to inject the oocyte: -Hamster ovum penetration test. -Hemizona assay. -In-vitro fertilization of human oocyte. 3-Immunity tests: The presence of antis perms antibodies through blood tests or semen plasma or the sperms. 4-Microbiological tests: It is done when there is genital tract infection or if there is high level of white blood cells in the semen. 5-Hormonal tests: FSH, LH, Prolactine and testosterone, all these hormones can be measured by blood tests 6- Examination of the Testes: Testicular Biopsy It is done if there is azoospermia (no sperms in the semen) to assess the ability of the testis to produce sperm in order to decide the way of treatment. If there is obstruction in the seminal ducts, surgical intervention is done or the biopsy is done to use the sperms in ICSI ICSI (Intracytoplasmic sperm injection) procedures. Testicular Sperm Aspiration (TESA) -Vasography, if there is suspicion of seminal ducts obstruction. -Test to diagnose varicocele (dilated tortuous veins around the testis). Testicular ultrasound -Doppler blood flow analysis. -Thermograph. 7-Tests for disorders in ejaculation or in intercourse: For example, urine analysis after ejaculation to check if there is retrograde ejaculation. -Electric ejaculator. 8-Genetic and chromosomal tests: -If there is suspicion of klinefelter’s syndrome or cystic fibrosis. It is not necessary to do all the previous tests; the treating physician will decide which one is important for each individual case. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/diagnosis-of-infertility-in-men-diagnosis-of-male-infertility Mon, 08 Mar 2021 05:25:19 AM Treatment of infertility | Treatment of female infertility | Treatment of Male infertility After diagnosis for the cause of infertility; either due to male or female factor, treatment would be according to the diagnosis. Treatment of female infertility: A- Medical Treatment of female infertility: It depends on the diagnosis, some women may need hormonal therapy; others need other treatments such as endometriosis. Most of the cases will need hormonal therapy by giving different kinds of hormones to stimulate the ovary in order to enhance follicular growth (controlled ovarian stimulation either oral pills, injections or both such as FSH, tamoxifen, clomiphene citrate, GNRH analogues, antagonist, HMG), these medications help also in controlling the time of ovulation so that the possibility of fertilization at the proper time will be higher. At First, one of the previous medications would be given in certain amount, and duration decided by the treating physician, follicular tracing and follow up is done either by using ultrasound, hormonal level or both, when the number and the size of follicles are appropriate, HCG hormone will be given by intramuscular injection with timing of intercourse, it should be mentioned here that, these medications don't increase the incidence of congenital fetal anomalies or recurrent abortions, but the incidence of multiple gestation (more than one fetus) would be higher Women who need induction of ovulation more are: -Women with hormonal disturbances. -Women with Polycystic Ovary Disease (PCOs). B-Surgical treatment for female infertility: For example, treatment of fallopian tube blockage either by trying to treat the blockage, or by using in vitro fertilization (it would be explained later), also in cases of endometriosis, surgical intervention might be needed in addition to medical treatment, or the need for surgical intervention if there is fibroids impeding pregnancy: -If there is part of the tube that is blocked it can be removed and reanastomosis of the remaining parts done, if the blockage is at the distal part of the tube, the tube would become swollen which is called hydrosalpinx, a surgery known as salpingostomy can be done. -If the blockage is at the area where the tube is attached to the uterus and the blockage is extended to the uterus, the whole blocked area is removed followed by reanastomosis to the close open area; this surgery is called (tubal reimplantation). -Reopening the blocked tube can be done using a special catheter inserted through the cervix and uterus to reach the blocked area of the tube and reopen it, this procedure is called (transcervical selective salpingograph) which is diagnostic and therapeutic approach to cases of proximal tubal injection failure. The catheter used is a rubber catheter with a guide wire that helps in insertion, then the guide wire is removed, and the catheter is inserted through the ostium transcervical selective salpingograph(the area where the tube is attached to the uterus) when it reaches the obstructed area, the catheter is moved in certain way to bypass the obstruction, then the colored dye is injected to make sure that there is no blockage, and the tube is patent. This procedure has good results with minimal side effects in very short time with a success rate of 75.3%. -If fibroids are thought to be the only cause for infertility, surgical removal of these fibroids can be done by laparatomy (abdominal incision) or by laparoscopy. -Uterine septum, intrauterine adhesions and intrauterine fibroid are removed by hysteroscopy. -Ovarian drilling is done for women with Polycystic Ovary Disease PCO. -The success for any previous surgery will depend on the proper diagnosis and the skill of the surgeon. C-Other causes of female infertility such as Sperm antibodies inside female body, increase thickness of cervical mucus and other different causes that are less frequent causes are treated accordingly. D-Intrauterine insemination (IUI) Treatment of male infertility: Find the cause and treat it. 1-Instructions to increase sperm number and improve its quality: A-Changing lifestyle: Quit smoking. Avoid excess alcohol intake. Avoid exposure to sources of high temperature. Avoid wearing tight underwear’s. B-Changing environment: Avoid exposure to some chemical substances such as, working in industries. Stop medications that affect sperms. 2-Treatment that increase sperms production and its function: A-Medical treatment: 1-Hormonal treatment: To increase sperm production such as, Tamoxifene, Clomiphene, Androgens, Bromocriptine, GNRH and gonadotrophins. GNRH and Gonadotrophins give excellent results in cases of hypogonadotrophic hypogonadism. 2-Other treatments: Zinc, Phosphodiesterase inhibitors like, Pentoxifylline, and Kallikren are used to try to improve sperm motility, the response is limited and it differs from one male to another. Antibiotics to treat chronic genital tract infections. Other treatments like, vitamins didn’t show promising results. B-Surgical treatment for male infertility: Surgery done to treat varicocele. Varicocele alone is not by itself a reason for surgical intervention. Many fertile men have varicocele, and the success rate for varicocele surgery to improve sperms quality is still controversial, some studies showed promising results others did not. 3-Repairing the path of sperm to Oocyte: Reconnecting spermatic cord (vasovasostomy). The earlier the diagnosis is made and surgical intervention performed, the better are the results because the delay may result in anti sperm antibody production. Fixing epididymal obstruction (vasoepididymostomy), either the obstruction is congenital or due to infection. Using synthetic vesicle to collect semen in cases of absent spermatic cord. Aspiration of sperms from epididymus (MESA) or from testis (TESE or PESA) and using it in ICSI procedures (it will be mentioned later). 4-Treating Erectile Dysfunction if it was the cause for infertility: A-Medical treatment for erectile dysfunction: Injecting the penis with certain substances such as, prostaglandins. Medical treatment for hyperprolactinemia (high prolactine hormone level) such as bromocriptine. Androgen in cases with low testosterone level. Treating medical conditions affecting erection such as diabetes, thyroid problems, epilepsy. B-Surgical treatment for erectile dysfunction: Surgery done to the arteries supplying the penis to increase the amount of blood reaching the penis in cases of diseases affecting arteries such as, diabetes or smoking. Using certain devices to induce erection (like vacuum devices). Inserting plastic penis inside the penis. Electric ejaculator that will stimulate the nerves responsible for ejaculation via localized small electric current, to obtain semen that will be used in IUI, IVF or ICSI. C-Psychological therapy for erectile dysfunction: When it is the cause. 5-Treatment of ejaculatory problems: A-Premature ejaculation. B-Treatment of failure of ejaculation according to the cause, or by electric ejaculator. C-Retrograde ejaculation is treated according to its cause: Medical treatment such as, using Alpha-Sympathomimetic Agents. Using sperms present in urine for ICSI procedure after preparing it in the lab. Electric ejaculator. Surgical correction for the valve dysfunction to prevents retrograde ejaculation. 6-IUI (intrauterine insemination). Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/treatment-of-infertility-treatment-of-female-infertility-treatment-of-male-infertility Mon, 08 Mar 2021 05:25:19 AM Advice For Couples To Improve Chances of Pregnancy, Men And Women Guide to Preparing for IVF   We are committed to helping each couple optimize their chances for pregnancy in each cycle of treatment. It is well understood that treatment of infertility can be both costly and stressful emotionally. Trying to decrease or ease the stresses associated with treatment of infertility before starting ovarian stimulation has been shown to improve the chances of getting pregnant. Additionally, studies have shown that certain environmental exposures and lifestyle habits may affect fertility. To improve the chances for pregnancy, we recommend the following.   Instructions for the Male Partner To Increase Chances of Pregnancy: Heat is damaging to sperm. The temperature of the testes should be 2c less than the body temperature. Wash the testicles in cold water 2-3 times daily. Loose fitting pants and boxer shorts may be beneficial if you work or exercise in a warm environment, or if you sit for prolonged periods. Avoid nylon or wool underwear and use cotton underwear. Avoid drinking more than one alcoholic beverage /day. increase alcohol consumption decreases male fertility .it also affects the sexual performance of the man . ( through affecting androgen level ). Smoking decreases male fertility and may lower the number of egg's capability to be fertilized. Smokers should try to quit smoking. if possible. If it is not, try at least to reduce the number of cigarettes smoked. Decrease frequency of intercourse for long periods results in increasing the number of old sperms in the semen. Consequently, decreasing the number of sperms capable of fertilization. We advise having intercourse every three days at least. When a man is affected by a disease, however, simple such as tonsillitis, it could result in lowering his sperm count, consequently, his sperm's ability to fertilize. Semen tests should be repeated in such cases. Infections affecting the genitals can decrease count of the sperms, for example, Epididymitis or the Vas deferens could cause its blockage. Testicular infection ( orchitis ) results in the same outcome. If you have even mild symptoms, consult your doctor. Some medicines affect the production of sperms and reduce the sperm count. Consult your doctor if you are taking any medication . Avoidance of chemicals produced by factories and decrease exposure to them. Chemotherapy and Radiotherapy affect's sperm production. Consult your doctor. If you are using any medicine or herbs, please inform your doctor as it may interact with what the doctor prescribed for you   Instructions for the Female Partner To Increase Chances of Pregnancy: Smoking decreases your chance of pregnancy and increases the incidence of pregnancy complications such as miscarriage and preterm labor, particularly in females over 35 years, we advice to stop smoking before your IVF treatment. Smoking should be stopped during pregnancy. Avoid using alcohol before and during your IVF program. You should stop alcohol consumption completely during pregnancy. If you are overweight, try dieting also exercise regularly as it helps improve the circulation this increasing your chances of pregnancy. If you have very low weight, this may lead to have irregular periods or amenorrhea. Try to increase your weight to normal standards . Avoid drinking large amount of coffee daily as it lowers rates of pregnancy. It is recommended not to have more than three cups daily. If you are taking any medication, please inform your doctor. Some medicine might affect ovulation.   Instructions for the Couple To Increase Chances of Pregnancy Some drugs may be harmful for male or female fertility, especially those not prescribed by doctors, tell your doctor to evaluate these drugs. Several studies have shown that couples who have good emotional support have a higher pregnancy rate than couples who do not have this type of emotional support, Either from other infertile couples, friends, family members, or the Doctor. IVF can be very stressful. Keep stress stress as low as possible before and during starting IVF program. Try to have a healthy lifestyle. Take a multivitamin-mineral supplement. Avoid exposing skin to potentially toxic chemicals or breathing toxic fumes. e.g pesticides, paints, organic solvent's varnishes, glues, and heavy metals. Excessive application of perfume should also be avoided. Regular intercourse ( every 3 days at least ) renewed the semen and result in better quality sperms. having intercourse of pregnancy daily especially when the male is suffering from oligoasthenospermia .   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/how-to-increase-fertility-for-men-and-women-for-natural-conception-and-ivf-increase-ivf-success-rates Mon, 08 Mar 2021 05:25:19 AM Smoking and infertility | Smoking and fertility | Stopping Smoking increases Your Fertility   Smoking has been increasing world-wide and amongst all age groups, studies have proven that smoking has a significant impact on fertility for both men and women. When we say effects of smoking, this also includes vaping, shisha and marijuana First, we will be talking about the effects of smoking on female fertility: ** smoking significantly affects the number and quality of eggs ** smoking increases DNA fragmentation and decreases fertilization rates ** smoking decreases the quality of embryos and leads to recurrent miscarriages ** smoking harms the endometrium and impairs embryo implantation ** smoking leads to early menopause, Smoker ladies who start smoking at early age (before 18 years old) are three times more prone to menopause before they reach 40 years old ** nicotine and other chemicals interfere with the production of estrogen which leads to irregular menstrual cycles, it was proved by multiple researches those toxic substances in cigarettes such as nicotine or anabasine affects estrogen synthesis, its production or its efficacy ** smoking leads to pregnancy complications such as preterm birth and placental disease ** smoking affects fallopian tubes function by affecting cilial motility of its lining, so less ability to transfer the oocyte leading to increased rates of ectopic pregnancy ** It should be mentioned also that there is a strong relation between smoking and the risk of pelvic inflammatory disease at least 70% more than non-smokers. ** Toxic substances in cigarettes may affect the sperms due to the vaginal and cervical secretions. Studies have shown that smokers take twice as long to get pregnant compared to non-smokers. How does female smoking affect fertility treatments and IVF? ** lowers number of oocytes retrieved and increases chromosomal abnormalities in oocytes ** bad embryo quality ** decrease implantation rates Success rate of IVF for smokers are lower (at least by half) compared to non-smokers smoking with all its toxic components causes an increase in FSH level which will fail the IVF or increase the risk of failure. According to a study done by Dr. Jonathan Nelli on mice, he found that toxic substances in cigarettes especially polycyclic aromatic hydrocarbons can kill oocyte at early stages of division. Due to the fact that the stages of follicular maturation are the same in humans, it is a direct proof of smoking effect on ovarian tissue. Even female fetuses for smoker mothers are born with less ovarian reserve and are more prone for early menopause and premature ovarian failure. In addition to that, smoking has side effects on fetuses as follow: Low birth weight Small for gestational age Still birth Sudden neonatal death More incidences of respiratory problems Effects of smoking on male fertility: ** increased DNA fragmentation decreasing the ability of the sperm to fertilize the egg ** poor sperm quality ** impairs sperm motility and speed ** increases the number of sperms with abnormal morphology, Sperm abnormalities are much increased especially head of the sperms. ** decreases the number of sperms (concentration), Smokers have lower sperm count by at least 13-17 %, It was found that if sperm count is more than 80 million, the chances of having a fetus with medical problem decrease by 1% compared to 6 % if sperm count was less than 80 million, the incidence of abortions with low sperm count is 12 % as compared to 6% in high sperm count. ** Smokers have increased number of white blood cells and red blood cells which make a picture similar to infection of the genital area. This has a major role in motility and transfer of Seminiferous tubules. ** smoking destroys the blood vessels hence affecting the blood flow to the penis leading to erectile dysfunction and impaired sexual performance ** smoking interferes with the production of testosterone mainly lowering its levels which reduces libido and affects the process of sperm formation **some birth defects happen when fertilization occurs with damaged sperms Men who smoke lead to the formation of bad-quality embryos with poorer pregnancy outcomes and recurrent miscarriages How does male smoking affect IVF treatment success? It is noted that IVF success is much lower when the male partner is a smoker Does second hand smoking affects fertility? Yes, it does in both men and women How long does it take for female fertility to improve after stopping smoking? ** the function of ovaries takes 3 months ** the balance of hormones takes 3 months ** better pregnancy outcomes after 12 months How long does it take for male fertility to improve after stopping smoking? ** number of sperms takes 3 months (because the cycle of sperm production is 72 days) **motility of sperms takes 2-3 months ** hormonal effects take 2-3 months ** DNA damage needs 3-6 months Studies have shown that there are some vitamins that help improving fertility faster after quitting smoking: Vitamin C Vitamin E Omega 3 Vitamin A Are there any natural methods to help accelerate recovery of the body from smoking? Yes, Good hydration Aerobic exercise Diet rich in antioxidants like: fruits, vegetables, nuts and leafy greens  So, if you are a smoker, quit smoking please! If it was not for your own good, do it for the coming generations, and it is a major thing for medical institutions especially infertility center to make serious campaigns to help people quit smoking. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/smoking-and-infertility-smoking-and-fertility-stopping-smoking-increases-your-fertility Mon, 08 Mar 2021 05:25:19 AM Varicocele Effect on Infertility and its Management   The Varicocele is the widening and dilatation of the veins around the spermatic cord inside the scrotum, usually on left side. It affects around 15-20% of the masculine general population, most of them are fertile with normal semen analyzer and affect 20 to 40% of infertile men.   Symptoms of varicocele Asymptomatic. Dull discomfort. Heaviness in scrotum that increase while sitting and standing and worsen over the day and it can only be relieved by lying on the back. Feeling a lump or swelling in the scrotum.   The pathophysiology of varicocele and its effect on fertility The dilation of the veins draining the blood from testicles due to abnormality in the venous valves, most commonly the left side. The blood flow in those dilated vessels cause extra heat on the testicles, which may affect sperms production and quality. The intratesticular pressure and reduces the blood flow that may lead to Hypoxia and reflux of toxic metabolites from adrenal gland. This may damage the DNA in the sperm head due to oxidative stress. New studies are now showing that varicocele repair improves semen fluid analysis parameters (count and motility), but few studies showed improvement of pregnancy rate.   However, those results were confirmed both for fertile and infertile men having Varicocele, so it is difficult to link between it and fertility status.   The improvement of semen fluid analysis parameters is usually seen during the first 3-6 months of surgery. The decision of intervention is based on specific criteria, in which the physician should assure the following; 1- Pain and discomfort Or 2- Infertility more than 2 years with all the following Normal female partner Abnormal semen analysis Palpable varicocele by clinical examination   Or 3- Adolescents with progressive failure of testis formation   Varicocele is diagnosed by physical examination by an obstetrics and gynecology specialist, expert in male infertility or by a urologist. It is described as a “bag of warms”. Varicocele found only during scrotal ultrasound examination is not an indication for intervention. Scrotal ultrasound is used to rule out causes of varicocele and other causes of pain and discomfort. Daily habits and lifestyle such as smoking predispose patients to more severe damage from a varicocele.   Grades of varicocele Grade 1 It is not felt by the patient himself. Found by doctor’s exam during Valsalva maneuver. Grade 2 It is not felt by patient but found by the doctor’s clinical examination. Grade 3 It is visible.   Treatment of varicocele Pain can be managed by pain killers such as NSAID and tight underwear. As mentioned before in some conditions varicocele may need surgery In which the blood will stop flowing in the swollen veins and this leads to a decrease in the heat affecting the testicles.   Types of surgical interventions   Open surgery: Usually it is outpatient operation, under general or local anesthesia through a small incision in the groin. Microsurgery: microscope can be used. Laparoscopic surgery; this require general anesthesia. Percutaneous embolization this can be done under local anesthesia.   Complications   Infection Hemorrhage Blood clots. Hydrocele (collection of fluids in the scrotum). Testicular atrophy.   (Scrotum is the sac holding the testicles).   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/varicocele-effect-on-infertility-and-its-management Mon, 08 Mar 2021 05:25:19 AM Natural supplements For Infertility, Foods That Improve Fertility   One of the most frequent questions we encounter in the clinic concerns foods that improve fertility. An unlimited number of pharmaceutical companies spend millions trying to produce the perfect drug, and infertility clinics do their best to try to treat couples suffering from infertility with manufactured hormones and drugs. Research has shown that fertility depends on lifestyle, dietary factors, habits, and exposure to toxins, and in many cases, making simple changes can resolve problems such as infertility. How do foods improve fertility? ** They support hormones ** They improve egg and sperm quality ** They reduce oxidative stress in the body What foods improve fertility in women? Leafy green vegetables Avocado Berries: Red raspberry leaves help in multiple ways; they build up the lining, increasing the chances of implantation of the fertilized egg, and they relax the uterus and soothe cramps. Nuts Eggs Fish What foods improve male fertility? Seafood Tomatoes Garlic and onions Walnuts Honey Citrus fruits Leafy green vegetables Are there any general lifestyle tips to support fertility? **Drink 2 to 3 liters of water daily **Reduce processed foods and soft drinks **Reduce carbohydrates and sweets **Avoid trans fats **Maintain a healthy weight **Exercise in moderation **Avoid smoking, alcohol, and drugs Example of a breakfast that boosts fertility in couples: Two boiled eggs Sliced ​​avocado Whole-wheat bread A glass of fresh orange juice Oatmeal with milk and a spoonful of honey Yogurt Example of a fertility-boosting lunch for couples: Grilled chicken/Grilled salmon/Tuna/Lean beef Sweet potato/Whole wheat pasta Steamed broccoli/Slice of whole wheat toast Vegetable soup/Stewed vegetables Example of a fertility-boosting dinner for couples: Tuna/chicken salad Lentil soup and a slice of whole meal toast Avocado salad A boiled egg and an orange Are there any benefits to licorice? It has an estrogen-like effect and helps regulate the menstrual cycle.   It supports the immune system and prepares the body for pregnancy. Note: Licorice may increase blood pressure and lower potassium levels, so it should be avoided by people with high blood pressure, kidney disease, heart disease, or those who have had a stroke. What is the role of complete nutritional supplements in boosting fertility? Calcula, spirulina, and seaweed are natural and bioavailable sources that increase fertility. What about Omega-3? Salmon, halibut, eel, and fish in general, as well as nuts and seeds, are major sources of important oils that support fertility. Shilagit: It is a substance from India found in the rocky areas of the Himalayas. It is a substance known in India as one of the strongest remedies and is useful for men and women trying to conceive. What is a fertility blend? It contains chasteberry (an herb believed to improve ovulation and regulate hormones), larginine (an amino acid that improves blood flow to the reproductive organs), green tea, and some vitamins and minerals. You should check with your doctor because some of these herbs, especially chasteberry, should not be taken during pregnancy and breastfeeding. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/natural-fertility-boosters-herbal-supplements-for-infertility-foods-that-improve-fertility Mon, 08 Mar 2021 05:25:19 AM Pelvic Adhesions And Infertility   Pelvic adhesions are fibrotic tissues or scars that develop in the pelvic cavity between the uterus, ovaries tubes, bowels and the bladder. Also, they can be found inside the tubes and the uterus. These adhesions can block or distort the tubes. The formation and reformation of peritoneal adhesions is a common problem which causes a range of clinical symptoms in women including infertility. Pelvic adhesions are responsible for 15% to 20 % of all infertility causes. Tubal infertility accounts for 30% to 40% of the etiologic factors in female infertility   Incidence of Post-Operative Adhesions It has been recognized that pelvic adhesions occur in 55% to 100% of women following a laparotomy. Until anesthesia and the development of antiseptic surgery had made laparotomy a practical, relatively safe and routine procedure, towards the last quarter of the 19th century, intra-abdominal adhesions appear to have been of little interest to clinicians.   Increased awareness of peritoneal adhesions has encouraged the use of surgical techniques such as microsurgery and laparoscopy, designed to decrease peritoneal trauma.   Before laparoscopic surgery was introduced, microsurgical techniques had been developed, which introduced new concepts into operative surgery, giving respect for the delicate reproductive structures not found during old-fashioned laparotomy.   The main purpose of these procedures was to decrease the incidence of tubal and ovarian adhesions, by careful tissue handling, avoiding surface drying and giving meticulous attention to haemostasis.   Endoscopic surgery embraces the principles of microsurgery in that the large gas bubble formed by the pneumoperitoneum ensures adequate exposure and on holding the laparoscope close to the tissues, gives good magnification. In modern reproductive surgery, microsurgery means surgery of small structures that need magnification by glasses, microscope, or optic lenses such as those used during operative laparoscopy.   Pathophysiology of Adhesion Development The peritoneum is composed of multiple layers. The first layer is the mesothelium which is the inner layer; the second layer is a layer of connective tissue, and a basement membrane. When the peritoneum is injured (which is inevitable during surgery), there is an inflammatory response where histamine and other inflammatory mediators are released from leukocytes and the mast cells. Dilatation of capillaries occurs and permeability increases. This lead to accumulation of white blood cells. Fibrinous exudate is thus formed at the site of injury. Lymphokines prostaglandins, bradykinin, serotonin, transforming growth factor and other chemotactic agents are present within the exudates material. Now, fibrinolysis will clear the exudates. So, plasminogen must be converted to plasmin by tissue plasminogen activator (t-PA). There is a constant balance in the system between tissue plasminogen activator and plasminogen activator inhibitors but, surgical trauma may have an inherent ability to decrease tissue plasminogen activity while increasing plasminogen activator inhibitors. If the plasmin does not break the fibrin, the fibrinous exudate is converted into an organized adhesion and fibers of collagen are deposited. Then, blood vessels begin to form and lead to organization of the adhesion.   This process occurs over a one to seven day period of time. Usually the adhesions are complete within seven days. Then, Qualitative changes continue over the next months where the adhesions become more dense and vascularised.   Types of adhesions: Filmy adhesions: very thin and can be easily broken apart with gentle pressure Thick adhesions: often vascular and need energy to be removed like electrical or laser energy Band adhesions: string like bands between two or more structures Flat adhesions: result when two structures are stuck together Filmy adhesions: very thin and can be easily broken apart with gentle pressure   Tubal blockage versus adhesions: It is important to distinguish between tubes that are blocked from those that are open but affected by adhesions. Blocked tubes occur when there is actual obstruction within the tube. A blocked tube can be diagnosed by hysterosalpingography. But adhesions can only be diagnosed with surgery to look inside the abdomen   Incriminated risk factors in the formation of pelvic adhesions Intra abdominal infection Tissue hypoxia or ischemia. May result from excessive tissue handling, suturing, crushing, ligating, cauterizing or peritoneum stripping Tissue drying. Presence of reactive foreign body. The common foreign bodies that may be introduced into the field during surgery include: sutures talc powder from surgical gloves, Lint from drapes, gowns, masks or laparotomy pads. Presence of intraperitoneal blood. Dissection of prior adhesions.   Causes of pelvic adhesions and tubal lesions There are 3 main causes of pelvic adhesions and tubal lesions: Pelvic infections Surgical traumas Endometriosis 1. Pelvic infections (PID) They are asymptomatic in 15% of cases. They are ascending or proximal (appendicitis). Chlamydia is responsible for 50% of cases. It causes adhesions and creates proximal or distal obstructions (phymosis, hydrosalpinx), and the lesions affect the mucous layers. Tuberculosis (genital) should not be forgotten. 2. Surgical traumas The most traumatizing operations are: ovarian cystectomies, myomectomies, Ectopic pregnancy, Bowel surgery, and appendectomies. The last one appears to carry a risk of pelvic adhesions similar to that seen following gynaecological surgery. Reconstructive Tubal Surgery: The repair of blocked fallopian tubes is a delicate procedure that often includes the removal of existing adhesions. Unfortunately, the surgery itself can also lead to the formation of new adhesions and infertility. 3. Endometriosis The frequency of it being blamed for causing adhesions varies amongst authors (up to 40% in some series). Endometriotic nodules occur on the left tube, the ovary peritoneum and on the pelvic side wall. Mechanisms resulting in Infertility The fallopian tube is a muscular organ that retrieves the egg from the ovary and transfers it toward the sperm. If the mobility of the tube is restricted by adhesions or if infection has stripped the cilia from the tubal lining, the tube cannot perform its function. Adhesions can block the passage of the ovum (egg) from the ovaries into the fallopian tubes. Adhesions around the fallopian tubes can interfere with sperm transport to the ovum through functional alterations, a reduction of the mobility of the tube. The disappearance of ciliation can also interfere with sperm transport to the ovum. Dysfunction of ovulation and immunitary phenomena as is the case in endometriosis Falloposcopy (Tuboscopy) Falloposcopy is a transvaginal micro endoscopic technique to explore the human Fallopian tube from the uterotubal ostium to the fimbrial end. Which may be used therapeutically for removal of debris and for cutting down filmy intraluminal adhesions? Salpingoscopy Salpingoscopy allows the ampullary mucosa to be visually inspected during either laparotomy or laparoscopy. The use of salpingoscopy may modify the management of patients with tubal infertility, since accurate evaluation of the endosalpinx allows us to identify the patients with a normal tubal mucosa:   76% to 80% of cases of periadnexal adhesions and 35% to 42% of cases of hydrosalpinx will benefit the most from tubal reconstructive surgery. In these patients, an intrauterine pregnancy rate equal to or higher than 70% may be expected following salpingo-ovariolysis and 60% following salpingostomy (Brosens, 1996; Marana et al., 1997).   Salpingoscopy should be carried out in all diagnostic laparoscopies and particularly in patients with tubal factors, to help in making the choice between surgical treatment and ART.   However, problems with availability of equipment (2.8 mm rigid salpingoscope that allows a detailed vision of the tubal ampullary mucosa) limits the use of this method in routine clinical practice.   Selection of candidates for surgery Once diagnostic procedures have been performed and a therapeutic approach has been defined, patients must be fully informed of the results with each technique, possible complications and real expectations in terms of time for pregnancy to occur. Therapeutic alternatives should be mentioned so as to allow an informed decision by the couple:-   Surgery versus Assisted Reproductive Techniques For many decades, surgical adhesiolysis was the only realistic option for an infertile patient with pelvic adhesions. After the birth of the first "test tube" baby, a revolution in assisted reproductive techniques (ART) took place.   These techniques include:   -(IVF-ET) In vitro fertilization , embryo transfer   - Gamete intrafallopian transfer (GIFT) and Zygote intrafallopian transfer (ZIFT).   -Intracytoplasmic sperm injection (ICSI).   -PESA, MESA, TESA, TESE, etc.   Due to the wider availability of assisted reproductive technologies, the number of women with mechanical infertility, treated by tubal reconstructive surgery, has decreased, with most couples being referred to IVF–embryo transfer.   The increasing success of IVF has changed the way we evaluate and treat the infertile couple.   In the early 1980’s when pregnancy rates per cycle of IVF were less than 10%, surgery played a major role in the treatment of the infertile female.   However, the success of IVF has increased dramatically over the years, so by 1990, pregnancies occurred in one of every six cycles and by 1999, in nearly one of every three cycles. As the success of IVF has increased, the role of surgery has decreased.   Reported pregnancy rates after surgical treatment of pelvic adhesions vary from 25% to 75%. The 37% (average) rate of normal pregnancy reported after surgical treatment of moderate disease is comparable to the clinical pregnancy rate of 30% to 55% per IVF-ET.   My own comparative results Laparoscopic adhesiolysis PR% (two years follow-up):   - Mild : 65%   - Moderate: 35%   - Severe : 22%   ART Pregnancy rate (clinical pregnancy rate per fresh Embryo Transfer):   - Patients aged 35 years and less 65.2%   - Overall PR 50.6%   However, if you take 6 cycles cumulative pregnancy rate of IVF, versus 6 postoperative adhesiolysis pregnancy rate, IVF certainly comes out far better. While it is tempting to relegate infertility surgery and the infertility surgeon to history of gynaecology, such a move would clearly be wrong. Surgery is still necessary and indicated in several clinical situations.   An example of relatively simple, effective surgery is the laparoscopic excision of delicate, avascular adhesions encasing the ovary or the distal end of an otherwise normal fallopian tube. Recent series of salpingolysis or salpingoovariolysis report success rates up to 70%. Even when there are severe peritubal or fimbrial adhesions, cumulative pregnancy rates after laparoscopic fimbrioplasty are higher (51.4%) than those typically achieved through a single cycle of IVF in most programs and at less cost.   The decision whether to perform tubal surgery or IVF depends on several factors:-   Before choosing between surgery and ART, one must consider the following: Tubal mucous layer (intra-tubal adhesions and folds): The degree of tubal mucosa damage is the most important prognostic factor in tubal surgery. Tubal wall: thickness The patient's age. Previous reproductive surgery??. Condition of the tubes Severity of adhesions (type and size) extensive and dense adhesions have a poor prognosis of surgery Coexistent infertility factors, for example: poor semen, suspected cervical or immunological causes. Experience of the surgeon. The success rate of IVF. The financial constraints. And last, but not least, the couple’s wishes.   The role of laparoscopic Surgery in an in vitro fertilization program:   Even in cases when IVF is the right choice, laparoscopic surgery has an important role to play.   It is the duty of the surgeon to make sure that the ovaries are accessible for oocyte pickup by the transvaginal route, by performing adhesiolysis in cases where the ovaries are inaccessible vaginally. The techniques of tubal translaparoscopic transfer of gametes or embryos (gamete intrafallopian transfer (GIFT), tubal embryo transfer (TET), zygote intrafallopian transfer (ZIFT), etc.) are nearly obsolete. Methods of transvaginal ambulatory embryo transfer, which give comparable results, are definitely less invasive.   The surgeon must also remove any tube with hydrosalpinx, as it lowers the success rates in IVF. Salpingectomy performed for hydrosalpinx, prior to IVF, improves pregnancy rate, implantation, and live birth rates.   Adjuvants for adhesion reduction.   Methods that decrease adhesions:   - Inhibiting the coagulation cascade and promoting fibrinolysis.   - decrease inflammatory response   - Using barriers for separation of surfaces at high risk for adhesion formation.   1. Fibrinolytic agents (fibrinolysis , plasminogen activators stimulation)   Fibrinolysin, Streptokinase, Urokinase, Hyaluronidase, Chymotrypsin, Trypsin, Pepsin   Plasminogen activators   2. Anticoagulants (prevention of clot and fibrin formation)   Heparin, Citrates, Oxalates   3. Anti-inflammatory Agents (reduce vascular permeability, decrease histamine release and, lysozomes stabilisation)   Corticosteroids, Nonsteroidal anti-inflammatory agents, Anti-histamines, Progesterone Calcium channel blockers, Colchicine   4. Antibiotics (prevent infection)   Tetracycline, Cephalosporin   5. Mechanical Separation (surface separation and hydro flotation)   - Intra-abdominal Instillates:   Dextran, Mineral oil, Silicone, Vaseline, Crystalloid solutions, Carboxymethylcellulose   Hyaluronic acid, Chelated hyaluronic acid, Poloxamer, Icodextrin 4% - Barriers:   Endogenous tissues:   Omental grafts, peritoneal grafts, Bladder strips, fetal membranes   Exogenous materials:   Fibrin glue ,Polytetrafluoroethylene ,Oxidized cellulose ,Oxidized regenerated cellulose Gelatin ,Rubber sheets ,Metal foils ,Plastic hoods   The most popular strategy used for adhesion reduction is the use of crystalloid solutions to irrigate (Hydroflotation) during surgery (open or laparoscopic) and instillation into the peritoneal cavity at the end of surgery in sufficient volume (300-500 ml) to allow for 'flotation' of the abdominal and pelvic organs. Physiological crystalloid solutions – saline, Ringer's lactated solution and Hartman's solution are frequently used. Their attraction may lie in their simplicity of use, availability and are relative inexpensive.   However, these crystalloids are rapidly absorbed. These solutions are absorbed from the peritoneal cavity at the rate of 30 - 60 ml per hour, so that 10 -12 hours after surgery, little, if any, crystalloid structure would be left in the pelvis.   Peritoneal healing may take as long as 5 - 7 days, thereby meaning that there is an extended period of time during which fibrin outpouring from the damaged surfaces can interconnect with adjacent structures in the peritoneal cavity, leading to adhesion formation. Therefore, post surgical instillates with prolonged peritoneal residence time should theoretically be more successful at preventing adhesions.   A more vicious gel preparation has been developed: Intergel solution ( ionically cross-linked 0.5% ferric hyaluronic acid), (Gynecare, USA), which has an increased residence time in the peritoneal cavity.   Another Preparation: Icodextrin 4% (Adept) (Shire pharmaceuticals, UK) is colourless, non-viscous and iso-osmolar with an intraperitoneal residence time of at least 4 days.   The significance of good surgical technique   Adhesions are most likely to form following tissue ischemia caused by surgical knots and the opposition of damaged peritoneal surfaces.   Recent studies have shown that it is not necessary to suture the peritoneum to help it heal after surgery. Indeed, it is better to leave the peritoneum unsutured. It will heal satisfactorily with fewer adhesions (suturing causes inflammation and foreign body reaction to suture material and may lead to tissue ischemia)   It is essential to use gentle techniques when operating on the ovary and copious irrigation to prevent tissue drying.   It is also important to be careful about haemostasis since the presence of blood in the peritoneal cavity increases the likelihood of postoperative adhesions.   It is also important to be careful about haemostasis since the presence of blood in the peritoneal cavity increases the likelihood of postoperative adhesions.   Excessive use of electro surgery can cause substantial tissue necrosis.   The bad effects of bad surgical technique cannot be avoided by any liquid barrier.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/pelvic-adhesions-pelvic-adhesions-and-infertility Mon, 08 Mar 2021 05:25:19 AM Stress and Infertility, Interaction between stress and fertility And Stress reduction strategies   Infertility is a common and worrisome problem faced by many couples nowadays. Infertility is the inability to conceive in spite of regular normal sexual intercourse for more than one year. Infertility could be present without any cause identified in the female or the male (functional infertility), or organic meaning an identifiable cause is present.   Stress has an important role in infertility through the physical and psychological changes that are associated with it leading to a vicious endless circle.   Any condition that a person considers as threatening or harmful is known as Stress. Stress affects pituitary gland hormones and ovaries (hypothalamic- pituitary- gonadal axis / HPG axis) through affecting brain/ hypothalamic function leading to altered ovulatory function and delayed follicle maturation.   Stress leads to sleep on deprivation (Insomnia) causing changes in the daily rhythm of many hormones connected to reproduction. Stress elevates prolactin level and cortisol and interferes with the regulation of LH thereby affecting ovulation.   The interaction between stress hormones (cortisol, melatonin and endogenous opioids) and the hypothalamic pituitary adrenal axis (HPA) hormones (GnRH, prolactin, LH, FSH) will affect the fertility.   It has been found that similar neurotransmitters and nuclei within the hypothalamus control both stress and reproduction.   Through neuronal transmitters, stress leads to spasm of the fallopian tubes and the uterus interfering with the implantation of the fertilized ovum.   Stress affects the immune system and implantation. Activated T-cells in peripheral blood are associated with reduced implantation rate in IVF cycles. Infertile couples have greater susceptibility to depression and anxiety.   Anxiety is either trait or state: Trait anxiety is the tendency to respond to stressful situations with elevated exaggerated responses. State anxiety is the anxiety related to a specific cause, mainly the procedures and drugs used to treat infertility. Females with functional infertility have a greater tendency towards anger repression and anxiety, while females with organic infertility have a tendency towards depression. It was found that women trying to achieve pregnancy have stress levels similar to those having cancer or HIV and heart disease.   Infertile couples have to deal with many stressors related to the IVF program, mainly: Their infertility The daily injections and blood samples that may be inconvenient. The perception of low success rates Waiting for the results The financial pressures   Stress factors related to low cumulative pregnancy rates in IVF cycles:   Previous pregnancy history. Trait anxiety and hostile mood state. Full time employment. Factors affecting ART outcome include:   Patient’s age Infertility category (male factor/ female factor/ combined factor or idiopathic infertility) Infertility duration Response to ovarian stimulation, stimulation protocol used and number of ova retrieved and embryos transferred. An individuals’ ability to deal with stress is conditioned by past experience and current social status.   Life style factors could influence the woman’s ability to cope with infertility treatment. Women with previous pregnancy history have a higher cumulative probability of pregnancy. Those with a full-time employment have a lower pregnancy probability for the first five treatment cycles.   Such women have the stress of difficulty arranging leave from work, the financial burden, added time pressure, the worry and embarrassment over work colleagues’ knowledge of her personal issues and the added discomfort of stimulatory drugs.   Women who are hostile have a lower success rate for all treatment cycles. Hostile mood is associated with decreased pregnancy probability after successive treatment cycles, and it could be that these females are less responsive to treatment or that the treatment itself is compromised by the hostile attitude. Anxious women have less chance to get pregnant during the later treatment cycles. They fail achieving pregnancy through ART because they are less able to cope with stressors of treatment; this is observed only in the initial treatment cycles but later cycles showed increased pregnancy rates. This could be explained by the fact that such females deal with their anxiety by defense mechanisms like repression and denial developing a different psycho endocrine stress response which positively affects treatment outcome. Female reproductive tract has catecholamine receptors thus catecholamine in stress affects fertility by interfering with the transport of gametes through the tubes and by altering uterine blood flow.   In addition to depression, high active coping and high expression of emotion, being anxious with high cortisol levels prior to oocyte retrieval and embryo transfer lead to a lower pregnancy rate. Treatment of chronic /trait stress anxiety is much more important than treatment of procedural/state anxiety related to fertility treatment.   Stress affects semen quality and sperm motility by the loss of glutathione and free sulfhydryl content of seminal plasma or through the inhibition of conversion of androstendione to testosterone in Leydig cells on account of higher adrenocorticotrophic hormone and cortisol levels.   Why stress should be treated before fertility treatment:   Infertility causes stress in the infertile couple. Infertility treatments cause stress in the couple involved. Stress could be a cause on infertility (either primary or secondary) . Helpful advices for male and female fertility patients:   Reduction of feelings of helplessness through coping with infertility. Changes in sexual behavior. Modifications of negative cognitions as to infertility Overcoming deficiencies in knowledge about infertility. Improving marital communication skills. Relation between stress and fertility could be through:   Stressful event Psychological factors (coping, habituation) Stress Autonomic system Behavioral activation Para ventricular nucleus CRH Sympathetic system Adrenal medulla Adrenaline Metabolic cardiovascular activation ACTH Adrenal cortex Cortisol Hypothalamic pituitary adrenal activation Para ventricular nucleus Vasopressin B-endorphin GnRH Pulse LH, FSH Ovary Oestraodiol/ progesterone Hypothalamic pituitary gonadotrophic inhibition. Stress reduction strategies:   Regular physical exercises to release physical and emotional tension. Avoid excessive intake of caffeine and other stimulants. Learn stress reduction techniques like yoga, massage therapy. Get emotional support. Psychotherapy Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/stress-and-infertility-how-does-stress-affect-fertility Mon, 08 Mar 2021 05:25:19 AM Polycystic Ovarian Syndrome Symptoms, Causes, Diagnosis and Treatment | PCOS   PCOS is a disease that affects the ovaries, disrupting the normal ovulation process due to a hormonal imbalance. It is sometimes accompanied by several symptoms that appear together in the patient, in which case it is called polycystic ovary syndrome. These symptoms include menstrual irregularities and weight gain, appearance of coarse hair in different areas of a woman's body are symptoms, and sometimes the disease is asymptomatic and may be discovered incidentally during a routine examination.   Prevalence and incidence of polycystic ovary syndrome (PCOS): It is a very common gynecological condition, and the incidence varies from country to country, and the overall infection rate ranges from 5-10%, and this rate is increasing without knowing the reasons   Causes of polycystic ovary syndrome (PCOS):  The true causes of the disease are unknown. It is believed that there is a genetic component to the disease, and it is believed that the gene is of the dominant type. Its appearance in women is associated with male-pattern baldness in women, and the genetic inheritance of the disease has not yet been discovered. The age group most affected by this condition is adolescence, a time marked by rapid weight gain and hormonal changes.   Some studies suggest a link between insulin receptor function and certain medications, such as some epilepsy treatments, can cause these symptoms in users. Symptoms of Polycystic Ovary Syndrome (PCOS):  As previously mentioned, the symptoms of this condition vary greatly and can sometimes be discovered incidentally during a routine examination. Diagnosis is based on an ultrasound image of the ovaries, which reveals the presence of 10-12 follicles measuring 8-10 mm distributed around the periphery of the ovary. Other symptoms include: 1- Menstrual cycle disturbances, which come in the form of amenorrhea or infrequent periods. The amenorrhea may be primary or secondary depending on the severity of the disease.   2- Weakness and disturbance in the ovulation process, which leads to delayed pregnancy and cases of primary or secondary infertility. 3- Weight gain, with the patient's BMI > 30 kg. The weight gain is usually concentrated in the trunk and limbs, and this occurs due to an imbalance in the body's lipid levels, including leptin.   4- The appearance of coarse hair in various areas of the woman's body, including the chin, upper lip area, lower abdomen, and chest. This occurs as a result of an imbalance in male hormones. 5- Increased risk of acne and oily skin.   6- Recurrent miscarriages due to elevated LH hormone levels.   7- Polycystic ovary syndrome (PCOS) may be associated with high blood pressure and diabetes.   8- It can also lead to depression or other psychological problems     Causes of these symptoms: The hormonal changes that occur in polycystic ovary syndrome (PCOS) are not fully understood, but the most important factor is elevated insulin levels in more than 50% of cases. This hormone is secreted by the pancreas, and its primary function is to bind to the cell membrane It then carries glucose molecules from the blood into the cells, where they are used to produce energy and carry out metabolic processes. However, in polycystic ovary syndrome (PCOS), these molecules are unable to perform this function despite their normal adhesion to the cell wall, which in turn signals the pancreas to The hormone is secreted to compensate for the decreased effectiveness, thus increasing hormone levels.   This effect on the ovaries can be summarized in two main points: 1- A disruption in the ovaries' response to hormonal signals from the brain responsible for egg production, leading to premature cessation of egg development and their retention in the ovaries as small, adjacent cysts.   Increased secretion of male hormones from the ovaries, as well as increased sensitivity of body cells to these hormones.   Diagnosis of Polycystic Ovary Syndrome (PCOS): Diagnosing the disease is not difficult nowadays and depends on three factors:   First: A physical examination of the patient and observation of the symptoms mentioned previously. Second: Some laboratory tests include: 1- Elevated LH hormone levels 2- Elevated insulin levels despite normal blood sugar levels. This is due to ineffective insulin receptors, leading to increased insulin secretion. 3- Elevated testosterone levels. 4- Elevated prolactin levels 5- Elevated estradiol and estrone levels. 6-- Decreased levels of sex hormone receptors.   7- Sometimes the disease is accompanied by thyroid hormone and prolactin hormone imbalances.   Third: The best way to diagnose the condition is by performing an abdominal or vaginal ultrasound. The vaginal ultrasound is preferred due to its accuracy, reaching 100%, while the abdominal ultrasound has a 30% error rate. The visual finding is the appearance of 10-12 small cysts ,More than 8-10 mm in size, distributed in a ring-like pattern resembling a string of pearls, there is also an enlargement of the ovary, increasing its size by one and a half to three times its normal size, and an increased concentration of ovarian tissue is observed in the center.   Treatment of polycystic ovary syndrome (PCOS): Treatment for PCOS focuses on managing its symptoms, as there is no cure for the disease. First: Menstrual cycle irregularities: This can be treated by using birth control pills or progesterone pills regularly, along with metformin pills at a dosage appropriate to the patient's weight, and continuing to take them until the body's hormones are regulated. Secondly: The appearance of coarse hair: This is achieved by taking anti-androgen pills, but these treatments require a period of 6-8 months for changes in hair thickness to occur. Therefore, it is recommended to use other methods of hair removal until these treatments begin to work, such as laser hair removal and the use of various hair removal products Third: Weight gain,There is a very strong link between weight gain and the disease, and both lead to each other, as weight gain can be associated with a hormonal imbalance, which in turn leads to polycystic ovary syndrome (PCOS), and vice versa. It is highly recommended to use dietary programs and exercise to reduce weight in order to balance this hormonal imbalance. The benefits of weight loss include: - Reduced insulin resistance - Reduced risk of heart disease - Reduced risk of uterine cancer - More regular menstrual cycles - Increased chances of pregnancy - Reduced acne and excess hair growth - Improved mood.   Fourth: Infertility: Infertility treatment is divided into two types:   1- Drug therapy 2- Surgical treatment   -Drug therapy for polycystic ovary syndrome (PCOS):  Drug treatments are also divided into two categories: The first type is Metformin pills, which help regulate the body’s hormones and increase the ovaries’ response to stimulating treatments. This treatment also helps prevent an excessive response when using ovulation-stimulating injections or pills. It is also recommended to use these pills during the first months of pregnancy to reduce the rate of miscarriage during this period. The second treatment is to give the patient ovulation-inducing hormones, either in the form of Clomid pills or FSH/LH hormone injections, with careful monitoring of the ovaries and identification of ovulation days. When ovulation occurs, the chance of pregnancy is about 40%. Surgical treatment for polycystic ovary syndrome (PCOS): The old surgical method for ovarian surgery involved the surgical removal of part of the ovaries. This required opening the patient's abdomen, which could result in adhesions that, in turn, led to infertility. This procedure is no longer used today.   Long-term complications of polycystic ovary syndrome (PCOS): 1. Diabetes. 2. Uterine cancer. 3. High blood pressure. 4. Certain cardiovascular diseases. 5. Lipid disorders and excess fat in the body. What can be done to reduce long-term health risks?   - Adopt a healthy lifestyle (a balanced diet, regular exercise, and weight loss).  - Get regular medical checkups to avoid the risk of developing conditions such as diabetes, high blood pressure, and endometriosis.   The New Revolution in Women's Health 2026-May Goodbye PCOS... Hello PMOS After more than 90 years, science has finally agreed that the term "Polycystic Ovarian Syndrome" was misleading. In May 2026, by decision of 56 international medical organizations and published in The Lancet, the name was officially changed to: Polyendocrine Metabolic Ovarian Syndrome (PMOS). Why this change now? Because the old focus on "cysts" was wrong; what appears on ultrasound are not true cysts but rather "follicles" that have stopped growing. More importantly, PMOS is not just an ovarian disease, but a comprehensive "systemic" disorder that affects ovulation, the reproductive system, insulin, metabolism, skin, and even mental health. The Four Dimensions of PMOS: What Does the Patient Experience? The condition must be assessed from four integrated perspectives: Reproductive dimension: Impaired egg maturation leads to delayed pregnancy and menstrual irregularities. Metabolic dimension: 70% of patients have insulin resistance, increasing the risk of diabetes fourfold. Endocrine dimension: Elevated male hormones (androgens) cause hirsutism and acne. Psychological dimension: Our deep understanding that PMOS increases anxiety and depression necessitates compassionate and supportive care. How do we diagnose PMOS? Modern diagnosis does not require the presence of all symptoms. Instead, we rely on precise criteria that include: Menstrual irregularities: (fewer than 8 periods per year). Signs of hyperandrogenism: such as resistant cystic acne or unwanted hair growth. Ultrasound: Using the latest technology to precisely visualize the follicular units (12-25 follicles). Treatment Roadmap: An Individualized, Goal-Based Approach We believe that every patient is unique, so we design a treatment plan based on your health goals and age: Lifestyle Modification (Cornerstone): We begin with a personalized lifestyle program. Science has proven that losing just 5-10% of body weight restores ovulation in 80% of patients, a more powerful effect than any medication in improving insulin sensitivity. Cycle Regulation and Endometrial Protection: We use combined oral contraceptives or cyclical progesterone to ensure endometrial regulation and prevent future hyperplasia. Ovulation Stimulation for Those Wishing to Conceive: We use ovulation-inducing medications at carefully calculated doses to suit each individual case. Insulin Resistance Treatment: We use the Metformin protocol (1500-2000 mg daily) to improve metabolism, reduce the risk of diabetes, and decrease the rate of early miscarriage. Beauty and Skin Solutions: We address hirsutism and acne with anti-androgen medications that block receptors, giving you the skin you deserve. Our vision: Protecting your future health. Changing PCOS name to PMOS confirms the validity of our long-standing protocol, which focuses on "long-term follow-up." We are committed to a follow-up protocol that includes: Regular glucose and lipid tolerance testing to protect your heart and regulate your metabolism. Endometrial ultrasound assessment if you have been amenorrhea for more than 3 months. Ongoing psychological support, because we believe that psychological well-being is key to hormonal balance. PMOS is not just a new name; it's a promise to provide deeper, more comprehensive medical care. We are here to transform this hormonal challenge into a journey of success and restored confidence.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/polycystic-ovarian-syndrome-symptoms-causes-diagnosis-and-treatment-pcos Mon, 08 Mar 2021 05:25:19 AM Polycystic Ovary Syndrome - PCO Patients FAQ Polycystic ovary includes many symptoms associated with hormonal imbalance in the body, so it is not one disease; it is multiple symptoms associated with each other. - What is the prevalence of Polycystic Ovary Syndrome?   The prevalence of PCO in the world is 5-10%, and it is a major cause of infertility.   - What are the most important symptoms of Polycystic Ovary Syndrome?   Any of these symptoms can occur in this syndrome:   - No periods or scanty periods. - Ovulatory disorders. - High testosterone level which leads to increase growth of hair over chin, chest and thighs. - Infertility due to disorders in ovulation. - The ovary on ultrasound has a larger size than normal ovary with multiple small follicles on its edge like a pearl necklace. - Over weight. - Insulin resistance which leads to increase insulin level although there is normal level of blood glucose. - Lipid profile disorder. - Elevated blood pressure. - Acne and oily skin. - What is the cause of Polycystic Ovary Syndrome?   The main cause is still unknown, but there are many studies refer it to a genetic cause because it is clustered in the same families - Other studies showed that there is a role for insulin receptors effectiveness. - There is also a role for antiepileptic drugs in unmasking the symptoms of this disease. - Is there a definitive treatment for Polycystic Ovary Syndrome?   No, not yet, all treatments available only decrease the symptoms, but don’t cure it.   - Is there a specific laboratory investigation should be done to diagnose Polycystic Ovary Syndrome?   No, no specific test, because there is no specific cause.   - How the diagnosis is made?   It depends on the clinical examination, and ultrasound examination beside blood test.   - How is the diagnosis made by vaginal ultrasound?   The ovaries look like a necklace of pearls with 8-10 follicles in each ovary, and the ovary is larger than normal ovary.   - What is the laboratory test that should be done routinely?   - Random blood sugar. - Lipid profile. - Thyroid stimulation hormone. These tests should be done once a year at least. - Does every PCOS woman have infertility?   It depends on the severity of the disease, so if it causes disordered ovulation it will lead to infertility.   - Is it possible to have regular menses without ovulation?   Yes, but the ovulation depends on the period between two consecutive cycles.   - Does the body temperature predict the time of ovulation in PCOS patients?   It depends on the severity of the disease.   - Does clomid have a role in PCOS cases?   Yes, it may have a role in inducing ovulation, but only 40% will get pregnant, and it can be used for 3-4 cycles.   - Does PCOS affect the quality of the oocyte?   Yes, this may be due to high insulin level, or due to delayed ovulation.   - What is the role of cortisone treatment in addition to induction of ovulation?   Cortisone has a role in lowering androgenic hormones serum level which are increased in those patients, and by that induces ovulation, but its use should be after consulting your doctor, because it may affect insulin level.   - Is it necessary to use progesterone in PCOS patients?   Usually PCOS patients have low level of progesterone so they need to take them either orally or per vagina in order to support the endometrium.   - May we use oral hypoglycemic drugs with ovulation induction drugs?   Yes, you can, even sometimes you may be given oral hypoglycemic drugs 3-16 months before using induction of ovulation drugs, and this depends on insulin serum level.   - Does PCOS carry a risk of ovarian hyper-stimulation syndrome?   Yes, and this occurs due to the presence of multiple small follicles, and the use of induction of ovulation is to induce growth of certain follicles without inducing those small ones, and the use of metformin will reduce the risk of ovarian hyper-stimulation.   - Is it necessary to take baby aspirin during induction of ovulation in PCOS patients?   This decision is left for your doctor, but there is some studies that confirm that using baby aspirin will reduce pregnancy complications.   - Is there a relationship between PCOS and endometriosis?   It is unknown, but if both diseases coincide with each other; there may be a genetic cause.   - What is the surgical treatment for PCOS?   There are two types of surgery: 1- Partial oopherectomy, which is an old method done through an abdominal incision, it may lead to adhesions, and by that may lead to infertility. 2- Laparoscopic ovarian drilling, which is done using a laparoscope, and the success rate 50-70%, but it may be only 25%, according to the surgeon skill. - What is hyper-prolactinemia, and what is its treatment?   It is the increase of prolactin level in blood, which may lead to production of milk from the breast or irregularity of menses, it is rarely due to pituitary tumors, which is diagnosed by doing pituitary magnetic resonance ionization, if it is positive you may be advised to underwent resection of the tumor, but if MRI is negative there is a medical therapy.   - Does the risk of abortion increase in cases of PCOS?   The incidence of abortion is increased up to 45% in PCOS patients for unknown reason, but there are some opinions that this is related to high LH level, others say that it may be due to high level of insulin which affects embryo implantation, and fetal development.   - Does metformin reduce the risk of abortion?   Yes, especially if it is used during the first 3 months in patients with recurrent abortion.   - Does PCOS patient have a risk of developing diabetes mellitus later in life?   Yes, there is a higher risk for developing diabetes.   - Is there a hope for permanent cure for PCOS once pregnancy occurs?   No, definitive cure for Polycystic Ovary Syndrome, but there may be hormonal changes which leads to regularity of the cycle.   - What are the drugs used for treatment of PCOS?   1- Oral contraceptive pills used to regulate the cycle. 2- Anti-androgenic drugs. 3- Acne treatment drugs. - What are the ways used to induce menstruation?   Oral contraceptive pills could be used, but some patient refuse these drugs, so they may use oral progesterone.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/pco-patients-faq-answers-to-frequently-asked-questions-about-polycystic-ovary-syndrome Mon, 08 Mar 2021 05:25:19 AM Infertility Frequently Asked Questions - Answers to Questions about Infertility and its Treatment   1 - Q: Does temperature affect the fertility of men such as in the use of very hot water in the shower?   Answer: The temperature can effect a man's fertility, but more so in a bath over a shower. It can affect sperm production, decreasing the quantity and quality. To restore a man's ability to produce sperm to normal levels, it needs at least three months to bring sperm counts back to better quantity and quality. Always keep genitals away from heat sources, and in general, it is important to keep testicular temperature 1 to 2 degrees Celsius lower than normal body temperature.   2 - Q: Does wearing tight clothes affect men's fertility?   Answer: No, but if those clothes elevate testicular temperature, it will affect it. It is better to wear loose fitting clothes as much as possible.   3 - Q: Does masturbation affect fertilization?   Answer: No, unless obtained at the time of ovulation. If copulation is being planned to fertilize the wife's eggs, masturbation is not recommended until fertilization has been accomplished and a pregnancy has been the result. And certainly, if the husband already suffers from low sperm count or bad quality, masturbation is not recommended.   4 - Q: If the man has sexually transmitted infections does it affect fertility?   Answer: It may indirectly affect the potential for a pregnancy. For example, in the case of epididymitis can lead to an obstruction so the sperm will not be able to exit. In general, these diseases may not affect fertility, unless the disease reaches the testicles.   5 - Q: Can the use of creams or medicines during intercourse affect fertility?   Answer: Most of these materials have an unpleasant effect on sperm. Preferably use only when absolutely necessary   6 - Q: How often should I have intercourse?   Answer: Plan intercourse every other day as sperm can remain alive for 38 hours inside a woman's body and the egg should be fertilized within 48-72 hours.     7 - Q: Does the use of certain drugs affect fertility?   Answer: There are toxic substances that affect sperm, called Gonadotoxins which includes alcohol, marijuana and smoking.   8 - Q: Most men complain about different results on their semen analysis from time to time and from one lab to another?   Answer: Semen quality can vary from day to day, and week to week or month to month. It may also vary from lab to lab depending on the techniques used in examination. This does not mean that varying semen analyses, with many problems discovered cannot be rejuvenated by your physician. It is better to order at least three tests in the same way. They collect semen every time in special lab using identical methods. If the same defect is found in these three results of analysis, we must then look toward management.   9 - Q: Is there a problem when there is a burning sensation during urination, after ejaculation?   Answer: No, the sensation is created by friction, which happens in the Urethra (tube inside penis), during intercourse or masturbation. When it comes in contact with your urine, this can cause a burning sensation   10 - Q: Some men wonder why they see Clumps accumulating in their semen, when ejaculating?   Answer: Semen is a material that comes from the testicles, prostate and seminal vesicle. When there is an ejaculation of semen, which is jelly-like, it quickly becomes liquid within 5-30 minutes and during this transformational process into a liquid, it may show clumps, and this is normal.   11 - Q: The couple may wonder about the position that they must take during sexual intercourse, and if it affects pregnancy?   Answer: There are no specific positions that increase the incidence of pregnancy, as long as semen enters the vagina. It is normal for some semen to flow out of the vagina, after intercourse. This does not necessarily affect the ability to conceive. It is preferable not to go to the bathroom too frequently to urinate after intercourse. It is best to empty your bladder / urinate, before intercourse.   12 - Q: As long as only one sperm is needed for fertilization, why must there be a large number of sperm needed to ensure fertilization?   Answer: Most of the sperm will die on the way and a large amount will flow out of the vagina or remains in a section of the cervix so only about 1/1000 enter and penetrates the cervix. Most of them die within the uterus and only about 200 remain to potentially penetrate and fertilize the egg. Many of the remaining sperm will penetrate the outer shell of the egg, but only one can fertilize it. 13 - Q: How long does the sperm stay alive inside a woman's body?   Answer: There is no sure answer. Where sperm survives about 2-4 hours in the vagina, with some being found alive after nearly 16 hours of sexual intercourse. Once sperm enters the cervix, uterus or uterine tubes it's time of survival is fixed. The average is 3-4 days, with rare recorded cases where sperm has remained alive for as much as 7 days.   14- Q: How many sperm are needed for conception to occur?   Answer: No one knows exactly, but we should take into account that abnormal sperm with decreased count and / or motility will lower the incidence of pregnancy.   15 - Q: How does the fertilized egg attach to the endometrium?   The answer: This happens when the fertilized egg reaches the Blastocyst stage. The implantation process occurs about 7 days after fertilization.   16 - Q: Is it possible that women can conceive at any time during the menstrual cycle?   Answer: No. Pregnancy should occur soon after ovulation, which is usually the middle of the menstrual cycle. However, ovulation can occur at different times and not necessarily mid-cycle.   17 - Q: What are the most fertile days in the menstrual cycle?   Answer: In the regular cycle (28 days), Days 12-13-14-15-16 are the most fertile. If we take into account the fact that the sperm has the ability to continue fertilization for 48 hours after ejaculation, and egg fertilization remains possible for 25 to 48 hours after ovulation, conception may occur on Days 9 to up to 15 of the menstrual cycle.   18 - Q: Is it possible to determine the sex of the baby while having natural intercourse?   Answer: Since the sperm contains chromosome X and Y, as mentioned previously, it depends on the sperm. Each of chromosomes has a certain quality, as it is known scientifically. The Y chromosome is more powerful and faster sperm than that which carries the X chromosome. However, the Y chromosome has a shorter life span than the sperm that carries the X chromosome, which moves slower, but lives for days longer than the sperm that contain the Y chromosome. From this, we can conclude that the period of intercourse may help to choose the sex of the baby. So, if intercourse is 3-5 days before ovulation, (which is usually in Day 13 or14 of the menstrual cycle), the fetus will most likely be female, but if intercourse occurs at time of ovulation, the fetus will most likely will be male.   19 - Q: Is orgasm during intercourse necessary to conceive?   Answer: No.   20 - Q: Is it possible to get pregnant if intercourse occurs at time of ovulation?   Answer: No, because the likelihood of pregnancy for normal couples is 15-20%.   21 - Q: Is the concern of genital hygiene an important issue for males and females?   Answer: Yes, psychologically it may create an aversion between the husband and his wife. If they do not take this aspect into account, it can affect the relationship and sexual intercourse. The male must wash his genitals and the female should wash as well for the following reasons: -   A – The urethra is so nearby, the vagina secretes vaginal discharge and when urine passes, if drops accumulate, and are not cleaned, it can lead to inflammation.   B - External female genitals secrete sweat heavily.   C – Heavy vaginal secretion may lead to skin infection.   22 - Q: What are the changes that occur in a woman's body when she becomes pregnant?   Answer: Many changes occur, organic, physical and psychological. These are temporary and will gradually disappear after birth, such as the enlarged breast size , the emergence of nipple-Sadr, 40% increase in body fluid, increases the work the heart must do and accelerated heart rate, some changes in skin color face and abdomen and weight gain, especially in the second half of pregnancy to mention a few.   23 - Q: How long does a pregnancy take, in normal circumstances?   Answer: On average, a 25 year old woman practicing unprotected sexual intercourse, on a regular basis, there is a possibility 20 -25% to become pregnant each month. This means that most of the couples, in this case, can create a successful pregnancy, during the first year of marriage.   24 - Q: Is there a difference in age between the women and men and their fertility?   Answer: Yes. Above the age of 35 years in females, the fertility rate decreases and if she gets pregnant, the rate of abortion increases. Even the risk of an abnormal baby increases with increased maternal age. The ability of fertilization in men may not be affected up to the age of 60 years or more. 25 - Q: Does a Retroverted Uterus affect a pregnancy and lead to infertility?   Answer: 80% of women have an Anteverted uterus and the remaining 20% have a Retroverted uterus. This is very unusual condition which does not affect or delay pregnancy, only if the uterus has no ability to move due to the presence of adhesions or a condition of Endometriosis.   There is a concern that if you tell the woman that her womb is retroverted, she may worry more than she needs to.   You must understand that normal uterus change direction due to the fullness of the bladder or the rectum. Often, it may remain at a right angle with the vagina. In the event that the uterus is tilted backward, moving the cervix up and forward, and the base back and down toward the rectum that most reasons for this are congenital, other reasons may be due to repeated pregnancy and childbirth, especially if the birth was hard and / or took a long time. This leads to weakness of connective tissue in the uterus. So, in response to a question that occurs to many, that the uterus has been in a natural position in the past, the woman has never been informed that the uterus is retroverted as a result of poor, loose connective tissue. But, if there are no problems, there is no need for medical intervention.   If the uterus is retroverted backward as a result of adhesions, this sometimes can lead to a delayed pregnancy. Adhesiolysis may be needed. 26 - Q: Does obesity lead to infertility?   Answer: Generally, there are many obese women who have good fertility and the ability to conceive. But in the event of difficulty in conceiving, we advise her to lose weight to ameliorate known issues of hormonal balance. In case of PCOS, the extra weight may make fertility more difficult. There are some patients who may not show symptoms unless there is a weight increase.   27 - Q: Is it true that taking the contraception pill delays pregnancy?   Answer: You may need longer time to conceive when taking these pills, but most ladies return to their ordinary cycle within 3 months after removing the pills from their regimen. If pregnancy is delayed, you must look for other causes, and not the pill itself. But, the menstrual cycle being interrupted by using the pill for a long time, is not true. We must draw attention to the fact that taking the contraceptive pill, helps about 50% improves cases of chronic pelvic inflammation, one of the reasons for a delay in pregnancy. This means that the pill, in this case, indirectly may help to improve the ability to conceive.   28 - Q: Can the use of IUDs, as a contraceptive for pregnancy, affect the next pregnancy?   Answer: If the IUD used has led to inflammation in the pelvic area, it may affect subsequent pregnancies a little, especially if these infections lead to adhesions in the fallopian tube, but it may not have a direct impact.   29 - Q: Is it possible for the oocyte to be fertilized in every cycle?   Answer: No. In the beginning stage of maturity, when the irregular and non-fertilized (no ovulation). Alternately, Menopause or Premenopause, may occur during the lifetime of fertility in women. There may be some courses in fertilizing and this is normal. Sometimes, the reason may be an organic disturbance of Hypothalamic pituitary ovarian axis or abnormal thyroid function. These cases need special care.   30 - Q: Is it true that if there is no menstrual cycle, there will be no ovulation?   Answer: Yes. If the endometrium does not develop, due to lack of hormones, there will be no cycle. This is what happens at a certain age and menopause occurs.   31 - Q: Does irregular cycle mean no ovulation?   Answer: In this case, either there will be no ovulation or ovulation will be reduced in an irregular cycle. For example, when speaking of the menstrual cycle of a woman that occurs every six weeks to every six months, this condition is called Oligomenorrhea. In this case, the possibility of pregnancy is reduced.   32 - Q: Is the absence of menstrual cycle mean that there is still a possibility of pregnancy (and what if there is no cycle at all)?   Answer: It depends on the case. Is it primary amenorrhea or secondary amenorrhea? Most of these cases need special care and treatment, unless it is due to an ovarian failure.   33 - Q: What does, “Premature Menopause,” or, “Premature Ovarian Failure,” mean?   Answer: This can happen if the menstrual cycle is interrupted, before 40 years old. There are several reasons for this and it can be diagnosed by a physician. This situation is usually associated with low estrogen and high FSH with menopause. Treatment is usually difficult because it is often due to obvious reasons, such as congenital diseases like Turner Syndrome and other causes. The probability of pregnancy in this case is very difficult. In rare cases of ovarian failure, some may return to normal temporarily. Remember, this is an age related condition.   34 - Q: Can severe weight loss lead to amenorrhea?   Answer: Yes, if the decreased weight is too much, it may affect the potential for ovulation. A possible issue for this may be Anorexia Nervosa.   35 - Q: Does excessive exercise lead to amenorrhea?   Answer: Yes. You must avoid regular, severe, strenuous exercises.   36 - Q: Is polycystic ovary syndrome a genetic disorder?   Answer: There are some scientific results that, if a woman is affected by this disease, it is possible for her daughter or sister to experience the same condition. However, this is not always the reason. The real reason is still under discussion and there are still some theories taught that may better clarify these reasons.   37 - Q: If I need treatment to become pregnant, does that mean that I would need to be treated every time?   Answer: No. In some cases, pregnancy occurs naturally, without the need for treatment. It depends on the reason why your pregnancy is delayed. The correct diagnosis and proper treatment is necessary.   38 - Q: How does endometriosis cause a delay in pregnancy and infertility?   Answer: This happens in cases of a severe degree where the disease can be divided into mild, moderate and severe. In severe cases, it may lead to adhesions in the fallopian tube, ovary, uterus, intestines, etc., according to the area where it is located. Adhesions may be so severe that the position of the ovary, fallopian tube or uterus may become adherent to other organs and this leads to interference with the passage of the egg from the ovary to the fallopian tube or the passage of the sperm.   39 - Q: Does pregnancy occur if the woman has only one patent fallopian tube?   Answer: Yes. It will if it’s healthy and patent or viable.   40 - Q: Is it possible to re-open the tubes after they have been blocked or tubal ligation has been performed?   Answer: Yes. It depends on the type of the procedure used in closing the tube. If it was by burning, Electro diathermy, the tube was severely harmed and the tissue is very difficult to re-open. The probability of success is very low. However, if clips were used, it may be easier.   41 - Q: If a man reaches maturity, does that mean he must have a good semen analysis, and vice versa?   Answer: No. You may experience external manifestations of masculinity and even the external genitalia look good but the analysis may have some abnormalities, and vice versa.   42 - Q: How many eggs does the female have at birth?   Answer: At birth, both ovaries contain around 2 million eggs, and the eggs remain in a dormant state until puberty. Only 400,000 of those follicles reach puberty. Even during periods of pregnancy and during each monthly cycle, around (20) follicles grow but only one reaches the stage of maturity and the rest vanish. There are factors that program the rate of egg development through the life of the woman, each inherited through their genes. Some are due to environmental factors such as exposure to radiation, certain drugs, smoking. And the age of menopause varies each individual.   43 - Q: What is the Follicle?   Answer: It is a fluid-filled sack that contains the egg.   44 - Q: How is the oocyte released from the follicle?   Answer: By the LH hormone, which is secreted from the pituitary gland and leads to the development of a hole in the membrane, leading to the egg being released, then it is picked up by the fallopian tubes.   45 - Q: What is the shape of the sperm?   Answer: Sperm consists of the head that contains the genetic material and the middle part called the neck that gives the energy needed for sperm movement, and the tail. The tail is designed to push the sperm inside the female genital tract. We would like to note here that the man starts producing sperm at puberty only, unlike a woman as she delivers her eggs from the ovaries after puberty but has them inside her at birth.   46 - Q: What is the amount of semen normally ejaculated?   Answer: Between 1-6 mm. When ejaculated, seminal fluid is viscous but soon turns into a liquid in the vagina. This takes about 20-30 minutes. It takes sperm about two minutes to penetrate the mucous substance in the cervix.   47 - Q: What is the amount of sperm required during intercourse to conceive?   Answer: About 100-300 million. The release of this enormous number of sperm, although only one is required to fertilize the egg. Most of these sperms die during their way in the female genital tract. Most of the seminal fluid pours out of the vagina, and about 1,000 sperm make it to the egg to be fertilized. Some of these may be able to penetrate the outer membrane of the egg. But, only one sperm is required for fertilization.   48 - Q: How long is the life span of sperm inside the female genital tract?   Answer: Although the answer is certainly difficult, sperm can be observed in the vagina about 16 hours after intercourse. Once the sperm penetrates the cervix, uterus and uterine tube they remain about 3-4 days.   49 - Q: Will abstinence from sex and masturbation improve sperm count?   Answer: Abstinence will increase the number of sperm but most of them will be dead or be of bad quality, and with time, their ability of fertilize will decrease.   50 - Q: Does disease affects the sperm count?   Answer: In the case of mild disease, even tonsillitis for example, may reduce sperm count. Due to this, we can not judge seminal ability on a single semen analysis. 51 - Q: Does smoking and alcohol intake have an effect on male fertility?   Answer: Smoking leads to a decrease in the number of sperm and interferes with sperm motility, but for the alcohol excessive drinking leads to a lack of sperm production, and that effects, indirectly, can lead to inefficient sexual activity.   52 - Q: Is it possible to menstruate if there is no ovulation?   Answer: The menstrual cycle is the blood from the lining of the uterus, ( endometrium ), under the influence of estrogen and progesterone in the blood. These hormones can be excreted from the ovary, even in the absence of mature eggs.   52 - Q: Is it possible to menstruate if there is no ovulation?   Answer: The menstrual cycle is the blood from the lining of the uterus, ( endometrium ), under the influence of estrogen and progesterone in the blood. These hormones can be excreted from the ovary, even in the absence of mature eggs.   53 - Q: What is the cause of the chemical pregnancy?   Answer: It has been scientifically found that many early miscarriages are caused by genetic abnormalities, (genetic and chromosomal), and this leads to a chemical pregnancy as well as problems in implantation embryos in the lining of the uterus which may also lead to a chemical pregnancy.   54 - Q: - What is the cause of nausea, bloating and weight gain, cramps in the abdomen, as well as congestion in the breasts before a pregnancy test? Is it possible that these are symptoms of pregnancy?   Answer: It is mainly due to the hormones given to the patient and rarely occurs before a missed cycle.   55 - Q: What is the period in which they can use clomid, then move to use injections for ovulation induction and then assisted reproduction procedure?   Answer: In most cases, pregnancy occurs within 4 - 5 cycles and if there is no pregnancy, other procedures are indicated.   56 - Q: How many trials of intrauterine insemination can we apply before moving to the IVF procedure?   Answer: We can apply it 3 times before ivf.   57 - Q: What are the chances of ovarian cancer after taking ovulation induction?   Answer: It has not been proven scientifically through research and studies that there is no relationship between the ovulation induction hormones and the incidence of ovarian cancer.   58 - Q: How long does an egg remain valid for fertilization? After how many days does implantation of a fertilized egg occur and how long does it take for pregnancy to be verified?   Answer: The egg remains valid for fertilization approximately 24 to 48 hours after ovulation occurs and it decreases with the increase of age. The fertilization occurs within 24 hours after ovulation. The implantation of the fertilized egg occurs 6 days after ovulation.   59 - Q: Does the length of the menstrual cycle affect reproduction?   Answer: As long as there is a regular menstrual cycle that means ovulation occurs. Some women have an interval between sessions about 40 days. This is normal but can reduce the number of fertilizable eggs.   60 - Q: When the couple are of different blood groups, does it affect their chances of pregnancy?   Answer: No.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/infertility-frequently-asked-questions-answers-to-questions-about-infertility-and-its-treatment Mon, 08 Mar 2021 05:25:19 AM Present and futuristic developments in fertility treatment   Nowadays fertility care is undergoing one of the most transformative periods in its history. These advancements are improving success rates and makes treatment more individualized. What is the importance of having these new advances: Make treatment less invasive Make treatment accessible This article explores the most recent significant developments reshaping the future of fertility treatment. Some advances of the present and future researches are: To obtain eggs from the woman’s ovaries and freeze them for future use.  taking part of the ovary containing immature eggs and freeze it, so that when the need arises maturing of the eggs is carried out in the laboratory.  Using new methods to freeze the eggs that improve their survival rate after thawing, such as ultra-rapid vitrification and artificial intelligence-assisted freezing protocols. These freezing processes could help the women who are at risk of losing their fertility as a result of exposure to radiation (during radiotherapy treatment) or chemotherapy. To make improvement of the culture media used for growing the embryos in the IVF laboratory to reach the blastocyst stage (five days after fertilization) where the best embryos are selected, one or two embryos transferred to the uterus, consequently chances of pregnancy and success rates are increased without the need for transferring many embryos with risks of multiple pregnancy. The advances in computer technology have enabled choosing the best sperms for doing intracytoplasmic sperm injection by a method called keiss method where the computer chooses the best sperms for use avoiding the human error factor thereby improving the success rates. The use of artificial intelligence in fertility treatments: ** many AI models are being used for diagnosis and treatment. ** some models are used to predict which embryos have the highest implantation potential. ** there are models to predict live-birth success ** some models are used as tools to detect sperm DNA fragmentation ** Time-Lapse embryo monitoring (continuous imaging) combined with AI for embryo grading.   The use of stem cell for ovarian support: Using pluripotent stem cells to create ovarian support that helps with egg maturation outside the ovary, leading to much lower hormone doses and shorter durations for stimulation   The use of stem cells to rejuvenate the ovaries to help women with weak ovaries. The use of stem cells to rejuvenate the endometrium to help women with thin lining. Stem cell research is still confined to laboratories but it is greatly promising where it could be taken from the boys before maturity then frozen to be reimplanted (could be used for those boys who are going to be subjected to chemotherapy). And it will be helpful for infertile men by triggering the stem cells to produce sperms. Uterine Receptivity Analysis (ERA): The use of advanced testing to determine the best day during which the endometrium is in its highest receptivity for embryos. Microbiome-Based Treatments: testing the microbiome of the vagina and uterus to ensure having appropriate environment for embryo implantation. In Vitro Gametogenesis (IVG): using non-germ cells (like cells from the skin) to produce eggs or sperms which helps men and women with severe infertility such as premature ovarian failure and azoospermia. 10- using splitting cells instead of sperms. This method is still under research. The idea is that the 46 chromosomes present in human cells, 2 of which are sex chromosomes. In the women two XX chromosomes and in the man, XY chromosomes. When the egg from the woman (containing 22 +X chromosome) fuses with the sperm from the man containing either 22 +X or 22 +Y chromosome fertilization occur, so it could be possible to use any cell from the man’s body, such as blood cell, for example, split it in the lab and each half could be used (which contain half the chromosome number) to inject inside the egg’s cytoplasm using intracytoplasmic sperm injection method, which will solve the infertility problem for men with no sperms in their seminal fluid or testicles. 11-Using techniques that correct genetic abnormalities (gene editing) in the embryos before transferring them into the uterine cavity. 12-Artificial Wombs (Ectogenesis): developing external environments that mimic the inutero atmosphere thus supporting the growth of the embryo outside the uterus and supporting it till term. where special plastic incubators are used to provide the suitable atmosphere for the growth and development of the fetus until maturity, the fetus takes what is needed whether for nourishment or oxygen and completely grown in the artificial uterus. This might be useful for prematurely delivered fetuses or for those women where pregnancy endangers the woman’s life or in those who congenitally the uterus is absent or women with uterine abnormalities. 13-Intra uterine culture of embryos This method is still under research where the gametes (eggs and sperms) are put in a special container made from a dissolvable material and then transferred inside the uterus for the material to dissolve in one week to release the embryo inside the uterus at the same time naturally needed to be in the uterus. The difficulty is in finding the proper material for the purpose without being rejected by the uterus. 14-Robotic assisted procedures: using robots to perform certain procedures and sometimes surgeries. There is a legal and ethical dimension to a number of technologies, and therefore some technologies may not be acceptable in some countries, but this does not negate the fact that they are useful in a number of cases. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/present-and-futuristic-developments-in-fertility-treatment Mon, 08 Mar 2021 05:25:19 AM Frequently Asked Questions   Q: I am a woman 22 years old, I am married from one year and six months, I got pregnant after one year from my wedding, and now I am in my 23rd week of my pregnancy. The problem is when I start to take my prenatal vitamins, I get constipation, and I am afraid that I harm the baby or the placenta when I push hard, and also I am afraid to get Piles - Hemorrhoids. So does the pushing hard harm the baby or the placenta? So please tell me what to do.   A: Pushing doesn’t harm the baby but causes hemorrhoids. I advice you to take Duphalac suspension as a laxative. Q: I had to have a partial hysterectomy. I had a C-Section about two years ago, and the doctors messed up my uterus pretty badly. I left the man I was with then. I plan to be married in July to somebody else. In a conversation about the impossibility of my having a baby; I was informed that there may be another way. You may not know anything about what I need to know or where I may need to go for an artificial uterus, but in a search on the net, I found your site. I thought I could get some answers. Also maybe some information on side effects of a partial hysterectomy too. If you can help me. It would be greatly appreciated   A: at the present time there is no solution. however, scientific research is working on solutions, uterine transplantation has already been done on animals and succeeds. But no studies yet have been done on humans. I'm sure it will be achieved in the future. As far as the uterus, the work is also going on but not yet practical .in subtotal hysterectomy, the uterine cervix is left so you have to have a routine check up with PAP smear .no periods usually and no pregnancy. Q: HI I am wondered if there is any way I can be pregnant with twin like any medicine, I can take it from home without going to doctor and when it is the best day after my period to get pregnant with my age 29, and I live in USA if you can give me any name for medicine, I can use it without any side effect to be pregnant with twin? A: You cannot take any medicine without going to the doctor because you should take injection if your purpose to have twins and follow up should do. Q: I am sure you get tons of Americans asking if you accept them as patients. If you dose take Americans how much do your sessions for IVF run? My husband and I were thinking about spending a summer in your country. A: The cost of IVF – ICSI procedure is 2535 $ plus the cost of Embryo Glue,which is 105 $ plus the cost of injections and medication, which differ from one women to another according to her age and state of her ovaries. You are welcome to come for treatment and while you are here you can enjoy touring around and having a nice holiday. Q: I want to introduce to you, my wife's medical history and the problems that we have in conceiving a baby. Our medical history starts in 2001 when we found out that my wife has Fibroids. We scheduled a Myomectomy in March of 2001 to remove the fibroids, so we can have a baby. All of them were removed with the exception of one that was attached to the uterus. The Surgeon removed as much as he could from that one. He did not remove all of it because he was afraid it would cause too much bleeding and that he might have to perform a hysterectomy. At the end of September 2001 my wife was pregnant. Everything was going well and the baby was doing well. Middle of October my wife started bleeding but did not lose the baby. We had several sonograms to check on the baby's health and to find out what was causing the bleeding. The Doctors couldn't find any reasons for the bleeding and they told us it could happen without anything being wrong. The only thing they could see from the sonograms that the remaining fibroid was growing. The Doctors did not think the Fibroid was the cause of the bleeding. The baby was ok, and everything was fine except the bleeding. We had 6 sonograms during the first 13 weeks of pregnancy and the fibroid had grown to 13 cm. After a routine check up the Doctor was not able to hear a baby's heartbeat. The following day we had another sonogram to confirm or not confirm the Doctor's findings. The sonogram had shown that the amniotic fluid was gone, and the baby was dead. We had a D&C to remove the baby. Q: We tried for a year to get pregnant again. With no success, We thought that the Fibroid was the problem. We went to a Doctor, who performs embolization of fibroids. After getting an MRI, the Doctor informed us the Fibroid was dead and there was no need for the procedure and that the fibroid had shrunk to about 8 cm. My wife went for her annual checkup and explained to the Doctor that she hadn't gotten pregnant after trying for a year. The Doctor schedule an HSG to check on her Fallopian tubes. The results of the test showed both of her tubes were blocked, and the Doctor could tell us the reason for the blockage. So after I visit your web page, I found a lot of information I need to know. My question to you is can my wife's tubes be unblocked with surgery? And can we have a baby without having IVF? If there is surgery for the blocked tubes what percentage is successful? Cause here in the US no Doctor will perform that type of surgery because there is IVF, and that's what they prefer to do. My wife and me are coming to Jordan for a visit in September/October and I would like to have an idea of what options we have. By the way, my wife is 34 years old. Thank you very much for your time and I hope to have a baby will be under your help. A: The success of surgery for the tubes depends on the degree of damage and the skills of the surgeon. I advise you to go for IVF and not the surgery because it’s more successful, and the tubal blockage may recur. I would like to examine her before giving you my opinion for the surgery. Back to the top   Q: 41 years old male, married since 1983, teacher, complain from infertility since marriage. He asked many doctors with no benefit...........Systemic enquiry: all are normal........ No history of previous mump or other operations or accidents except infective hepatitis of mild type with no sequel .No birth injury, infant or childhood previous medical illnesses apart from febrile convulsion for two attacks with no complication. FAMILY HISTORY: his father died since 1980 as a complication of diabetes mellitus. His brothers are suffering the same conditions .They are living in the same housing conditions (their ages 40 and the second 31).His uncle son with two other neighbors also suffer the same illness. He is not alcoholic, no tobacco, no any history of drugs .N0 siblings. PHYSICALLY: in good condition, with no abnormality seen. INVESTIGATIONS DONE: many seminal fluid analysis reveals: Volume ranging from 1-4 ml, Viscosity: high or normal. Color: white, milky or gray, PH: alkaline, Sperm concentration: 5ml Active: 10%-20%, sluggish: 10%, Immotile: 80%. Sperm morphology: normal: 60%, abnormal: 40%, no pus cells.   Cytogenesis report :( 1987) G-banding investigation of peripheral blood culture reveals {46, XY}   with no obvious chromosomal aberration.   U/S: both testes are normal in size &texture with moderate left side varicocele diagnosed as mild hydrocele. SERUM HORMONES: at 2/6/2001:S.FSH= 14.9 mule/ml   S.LH =13.0 mule/ml S.Prolactin =375 mule/ml   L H: 7.1 mule/ml FSH: 1.0 Prolactin: 6.0 TESTESTERON: 1.75 ml u/ml............ AT? /11/1985 Spermatozoal antibody report: Serum: positive titer 1:128. AT 11/7/1993 seminal plasma: positive titer 1:32. S. testosterone =42.6 mule/ml Drugs taken: 1. Clomid 2.Pregnyl inj. 3.Systanon inj. 4.Proveron 5.Prednisolone & other steroids 6. Multivitamins 7.Parlodel with no response. A: After 19 Years of marriage and trying different treatments, I think it is time For treatment by ICSI, That is Intracytoplasmic Injection. Back to the top   Q: I have been married for three years, I am 22 years old. In the first year I had difficulties for several months (about six months) to get pregnant. Finally, I was advised to take Clomid tablets which helped me and resulted in conceiving and normal pregnancy after 2 months. After few months of my first baby I decided to have another baby. I got pregnant easily without any medication but I had a miscarriage after 8 weeks. I waited few months more and get pregnant again but unfortunately I had miscarriage again after about 5 weeks. Now I would like to get pregnant again but I am quite worried that I may have same problem. Also, here in UK the GP, s do not send patient to see specialist unless the patient had miscarriage for three times, which I don't prefer to do after all suffering I had in my last two miscarriages. Could you please advice me what to do?. I have been advised by some people who have been through same experience before to use Progesterone injection or Duphaston tablets. Is it OK to use these tablets and are there any side effects (I do not suffer from any illnesses)?   A: Having miscarriages is distressing. The reason that in the UK the GP's do not send patients to see a specialist unless the patient has miscarriages for at least three times is that scientifically, about 60% of abortions are caused by chromosomal abnormalities and nothing can be done about them. Normal pregnancy follows and the pregnancy continues without treatment. Duphaston tablets are preferable to the injections but they are also of limited benefit, more of Placebo (psychological) benefit than medical. So out of the two take Duphaston   Q: I want to ask if you know if there is anything that can be done to stop women after the age of 40 getting brittle bones, e.g. vitamins, food etc? Also my mother has just had an operation on both her knees where a piece of metal replaced the bones that has rubbed against each other and disappeared, what I would like to know is is there anything she can't do to look after herself after the operation e.g. what to eat what kind of exercise to do, also what to try and avoid and also what type of vitamins to take? I have a sister who is 40 years old and has been married for over 7 years but unable to have children, she is married to someone who has been married before and he has children from his first wife so he is ok, but my sister has tried fertility treatment but it did not work, she saw the doctor and he said that her ovaries have shrunk, is there any advice you could give to her or anything that would be of help to her?   A: To stop getting brittle bones , women should start increase her calcium intake either from food by taking lot of milk enriched in calcium in addition to milk products or by taking calcium tablets plus vitamin D e.g. : Oscal-D daily . Also exercising is very important and the best exercise is walking . If the women are on the verge of menopause, hormonal replacement therapy should be started in addition to calcium, of course this is decided examination by her Gynecologist . Your sister case needs quick interference because she is 40 yrs old. I suggest doing serum FSH level on the 3rd day of cycle, and if it is within normal level she can start super ovulation of the ovaries and continue for IVF- ICSI program.   Q: My daughter is extremely sick with her second child. She is depressed, has no energy, nausea, vomiting, etc. Her doctor says this is all-normal and has only treated her with I.V. bags just to keep her hydrated. I know there has to be so much more that can be done or tried. Ginger teas, ginger ale, etc. has not helped. I need more information. In addition, this doctor claims that he will be able to tell the sex of the child at 12 weeks with 3D. Is this possible? I always thought and have been told you cannot really tell the sex of the child until the 5th month.   A: I advise your daughter to take Metoclopramid tablets or preferably rectal suppositories three times daily, which has been proven very effective all over the years. As far as the U/S. yes it's possible to know the sex of the fetus at 12 wks but preferably between 13-14 wks as the clitoris can sometimes be mistaken for penis at this age.   Back to the top   Q: I'm 24 years old married lady. This is my first pregnancy and I'm in the first week of my 6th month. My pregnancy is going fine but I'm suffering from a strong acidity in my throat. I feel that my throat is burning but there is no pain in my stomach. This acidity is very strong so that I can't sleep at night. When I have it, I drink cold milk which makes me feel better but it takes some time. This acidity started slightly since last month ( 5th month) but it has become stronger lately. Since that time I tried to avoid oily and spicy food as much as I could but still most food items cause this acidity like white or yellow cheese, labnah, eggs, etc....   and there are some questions I would like you to answer if possible:and there are some questions I would like you to answer if possible:   1) what are the reasons for this acidity? 2) I heard that pregnant ladies get it at the last stages of their pregnancy like 8 and 9 month? why did I get it that early and does it mean that their might be any problem? 3) does this acidity mean that my baby's hair is growing as most old ladies think? 4) what food items you advice me to eat as breakfast, lunch and dinner so i avoid having acidity? 5) does drinking cold milk or eating some pieces of almond makes me feel better when I have acidity? 6) what is a safe acidity medicine you advice me to take when acidity gets worse?   A: 1. Reflux osophagitis is common in pregnancy and sometimes it start early, and this is normal variation I advise to start Ranitidine 150mg twice daily before meal 2. No, the baby's hair is the cause. 3. As you said, avoid hot spicy and oily food. Lot of fresh vegetables and fruits. 4. If it relieves you, yes you can. Q: I am married and I have one daughter she is now 27 months thanks god she is healthy baby I never have any problem with her sorry I make the question very long but I am from Jordan and live in CA united state, I had last year at 02/14/04 miscarriage and another one at 05/23/04 and I was pregnant this year and the doctor give me progesterone 400 to keep the baby but they tray to see the hart beat they cant .now I am bleeding and I make ultrasound they say they cant see the hart beat and the sac the same size from the last week (from conception day 7.5 week) .   A: If the fetus is not viable, you have to do evacuation of the pregnancy and certain investigations should be done for you as you aborted 3 consecutive times. You can go to page habitual (recurrent abortion) in my website. Back to the top   Q: I want to ask you if smoking reduces my pregnancy.   A: yes, smoking can affect the fertility of both male and female so it should be decreased or stopped which is better. Q: concerning the gender selection service at your clinic In your estimations or close speculations: How many days does it require me and my husband to finalize the operation completely? How much would it nearly cost us? I live outside Jordan and need to have a good idea about this issue before visiting you in the near future. Thank you very much and best regards.   A: From the first day of cycle until the program finishes completely requires around 20 days You can read more information on the website Q: I have visited your site. and exactly the gender determination methods part. I saw the Chinese table for baby gender determination. and i checked other sites for this table when I knew my baby gender... there was a difference. your chart gave a boy and the other charts gave me girl.i checked three other tables and they all gave me the same result (GIRL) while yours gave me boy.   just wondering why is the difference???   A: There are many kinds of Chinese table and the one in my site is the most accurate rate one and it only raise the pregnant by 8-9 % Q: I would like to know whether the hernia affect my fertility or not? A: hernia has no affect on fertility Q: I have a query regarding important days for getting pregnant? Does only one day in a cycle guarantee pregnancy? Or are there four to five days to get pregnant in a cycle for a woman? A: Women with regular cycle. the days of ovulation will be between the 12th and 16th day of the cycle. but this is not accurate. by transvaginal ultrasound we can determine the exact date of ovulation.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/frequently-asked-questions Mon, 08 Mar 2021 05:25:19 AM Weird Factors That Could Affect Your Fertility   Deciding to bring a new member into your little family marks a huge leap in the relationship between you and your partner. You are both mentally, emotionally, financially and physically ready to embrace the responsibility of raising a child. You’re doing everything it takes to hear your doctor confirm the good news soon, right from keeping a tab on your fertile window to eating the “right foods” and popping nutritional supplements religiously as prescribed. Alas, despite all your attempts to conceive successfully, you fail each time. What you don’t realize, however, is that there could be a host of other lifestyle factors beyond your diet and consistent sexual intercourse that could also be impacting your fertility. Here are five weird factors that could affect your ability to get pregnant:   1. Using Smartphones/Tablets At Nighttime –A lot of us have the bad habit of scrolling through our phones and tablets late at night before sleeping. Apart from hindering your good night’s sleep the artificial light from these gadgets can also greatly impact your fertility! A research published in the Journal of Fertility and Sterility reports that excess exposure to artificial nighttime light causes a blockage in melatonin production. Melatonin, known as the "sleep hormone," is also produced by the reproductive tract to protect the eggs from free radical damage during ovulation. Less melatonin thus equals greater chances of infertility.   2. Poor Oral Health –Strange as it may sound, poor oral hygiene and health can also result in reduced fertility! An Australian professor at the annual meeting of the European Society of Human Reproduction and Embryology, Stockholm announced that the impact of gum diseases on fertility could be as bad as obesity. The mouth is the breeding ground for many bacteria. Regular flossing and brushing help get rid of the plaque that can turn into tartar without proper oral hygiene. Tartar and plaque cause the inflammation of gums that can even impact the tissue and bones and subsequently undermine immunity by causing the inflammatory agents to move into the bloodstream. This could be the cause of chronic conditions like diabetes, cardiovascular diseases, and infertility.   3. Use Of Some Cosmetic – How could something used to make you look and feel beautiful, possibly affect your fertility, right? Wrong! A lot of cosmetics (perfumes, shampoos, hairspray, nail polishes, etc.) these days contain synthetic chemicals called phthalates that apart from hampering male fertility can also lower female conception. A 2013 study by the European Society of Human Reproduction and Embryology found the evidence to prove so. The increased concentration of phthalates in women can double the chances of implantation failure after IVF as compared to those with low phthalates levels in their system, the study reported. In males, phthalates are known as endocrine disruptors, one of the many possible causes of fertility decline.   4. Childhood Diet – Ever thought the food you ate as a child could impact your ability to conceive today? Probably not, but turns out it’s true! A 2010 study by the University of Sheffield reported that men and women born in poor families had low rates of reproduction. Half the poor population born during years with low rye, and barley yields had no children during their entire lives. Those born during good harvest years reproduced at least once in their life. This study proves that food provided during prenatal or early postnatal phase can curb the reproductive system’s development.   5. The Use Of Lubes – Lubricants, often used by couples to enhance their sexual experience can also reduce their chances of conception. Studies report that many lubricant brands contain spermicidal agents that can reduce sperm motility by over half. To enjoy the lube experience but to prevent its negative impact, opt for natural lubricating agents like mustard oil that help sperms thrive.   Apart from taking these factors into consideration, ensure that you don’t disregard the essentials. Make a preconception visit with your doctor and share your entire medical history with him. Doing this will help mitigate the possible risks that can arise over the course of your preconception and pregnancy journey. Remember, your healthy choices today will go far in improving your fertility as well as ensuring a healthy pregnancy. 6-Food quality and pregnancy There are a lot of foods that can have a wide impact on the fertility rate and also have an effect on the health of the fetus. Therefore, eating a healthy diet is one of the best changes that you can make to improve your health and increase the chances of pregnancy. A diet has been devised that benefits the fertility of men and women that consists of the mainnutrients necessary for the balance of hormonal activity and the quality of eggs and sperms. This diet includes eating a lot of fruits and vegetables because they contain antioxidants, full-fat dairy and some types of fish such as salmon because it contains omega-3, as well as whole grains,Natural and high-fiber foods. It is also preferable to avoid some types of food that may impair fertility, such as soft drinks, because they contain a high percentage of sugar and caffeine that harm the process of producing eggs and sperms, as well as unsaturated fats found in fried foods, processed meats, and raw meat. 7-Men insomnia and fertility? it affects the quality of sperm, as studies have shown that staying up late after 10:30 pm affects the quality of sperms. The researchers explained this by: 1. Staying up late leads to an increase in the work of the immune system, which leads to itsfight against sperms 2. The husband & stay awake leads to adecrease in the chances of sexual intercourse between the spouses 8-Age and fertility Advance age reduces a woman’s chances of having children due to the decrease in the number of eggs and their efficiency with age, (as there will be a defect in the quality of the DNA and chromosomes of the eggs), so she becomes more vulnerable to infertility problems, especially after the age of 40. Also her pregnancy at an advanced age categorize her into high risk pregnancy .The reproductive ability of a woman differs from that of a man, as it can remain to a later age, unlike the woman.. With the advancing age of a man, the number and quality of sperms decrease due to anomalies in the sperm cells, and he may have other medical conditions that affect his reproductive ability, especially after the age of 55 years old.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/weird-factors-that-could-affect-your-fertility Mon, 08 Mar 2021 05:25:19 AM Sleep Correlation with Male Infertility   Effect of sleep on the sperm count, motility, and morphology.   Sleep is a natural state of rest for the mind and body, and it is essential for mental and physical health Proper and sufficient sleep is a fundamental component of healthy lifestyle. Multiple factors interfere with the proper amount of sleep each person needs and it varies by age, 7-8 hours per night usually is enough for most adults. In developed countries sleep disturbance and lack of enough sleep is becoming an increasingly common problem , and that is important not only for social reasons but also for other health disorders related to humans such as heart problems and possible impairment of male reproductive functions.   Studies have shown that lack of enough sleep might interfere with immune function by interfering with the levels of IgG, IgA and IgM.   The relationship between sleep duration and reduced sperm quality has been studied extensively, with much less studies on the relation to the production of anti-sperm antibodies.   Numerous studies have shown that men who slept poorly had lower sperm counts and higher percentage of abnormal sperms.   A comparison between selected group of males which were selected according to certain criteria with the evaluation of the effect of duration of sleep and bedtime on sperm count and quality was done with the establishment of good and regular sleep duration and ideal bedtime for six months before the starting of the study with the exclusion of any other psychological or physical disorders , it showed that sperm count and survival were significantly low in all short sleepers and most of long sleepers ( more than 9 hours of sleep each night for adult is considered long sleeping ) .   The relationship between sperm parameters and late bedtime are controversial and mostly it refers to its effect mostly on the quality and depth of sleep that will eventually affect on the sleep on subsequent nights. Studies have also shown that even men who woke many times in the night had a sperm count 25% lower than those who had no troubles with that, and they had smaller testicles (American Journal of Epidemiology). Positive anti-sperm antibodies was significantly higher in short sleepers as compared to others. Other than the effect of sleep on anti-sperm antibodies, it was found that sleep duration and quality has an effect on sex hormone production and nighttime testosterone rhythms. In conclusion, sleep disturbances should now be added to the line of lifestyle attributes associated with abnormal semen analysis in addition to other previous well-known factors such as smoking, environmental toxins, elevated body max index.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/sleep-correlation-with-male-infertility Mon, 08 Mar 2021 05:25:19 AM Male Hypogonadotropic hypogonadism   Hypogonadism is a condition in which the male testes produce little or no sex hormones.   Hypogonadotropic hypogonadism is a form of hypogonadism that is due to a problem with the pituitary gland or hypothalamus. It is caused by a lack of hormones that normally stimulate the testes. These hormones include gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH) and luteinizing hormone (LH).   Causes of hypogonadotropic hypogonadism   Kallmann syndrome. Abnormal development of the hypothalamus — the area of the brain that controls the secretion of pituitary hormones — can cause hypogonadism. This abnormality is also associated with impaired development of the ability to smell (anosmia) and red-green color blindness. Pituitary disorders.An abnormality in the pituitary gland can impair the release of hormones from the pituitary gland to the testicles, affecting normal testosterone production. A pituitary tumor or brain tumors located near the pituitary gland may cause testosterone. In addition, the treatment for a brain tumor, such as surgery or radiation therapy, may impair pituitary function and cause hypogonadism. Inflammatory disease. Certain inflammatory diseases, such as sarcoidosis, histiocytosis and tuberculosis, involve the hypothalamus and pituitary gland and can affect testosterone production, causing hypogonadism. HIV/AIDS. HIV/AIDS can cause low levels of testosterone by affecting the hypothalamus, the pituitary and the testes. Medications. The use of certain drugs, such as opiate some hormones, can affect testosterone production. Obesity. Being significantly overweight may be linked to hypogonadism. Normal aging. Older men generally have lower testosterone levels than younger men. As men age, there is a decrease in testosterone production. Concurrent illness. The reproductive system can shut down due to the physical stress of an illness or surgery, as well as emotional stress. This is a result of diminished signals from the hypothalamus and usually resolves with successful treatment of the underlying condition In adult males, hypogonadism alter masculine physical characteristics and impair normal reproductive function. Signs and symptoms may include:   Erectile dysfunction Infertility Decrease in body hair growth Decrease in muscle mass Enlargement in breast (gynecomastia) Loss of bone mass (osteoporosis) Hypogonadism can also cause mental and emotional changes. As testosterone decreases, some men may experience symptoms similar to those of menopause in women. These may include: Fatigue Decreased sex drive Difficulty concentrating Hot flashes TREATMENT   Testosterone therapy for males is used to improve genital development, develop secondary sexual Characteristics, allow for the growth and closure of the epiphyseal plate, and improving sexual Function. This therapy does not restore fertility, as gonadotropins are required for spermatogenesis If fertility is desired, pulsatile GnRH therapy or gonadotropin therapy is necessary. Gonadotropin therapy involves the use of human chorionic gonadotropin (hCG) and FSH. HCG Stimulates Leyding cells to produce testosterone. With the increased levels of testosterone, sexual activity, libido and overall wellbeing should improve. Administration of FSH is required to induce spermatogenesis by acting on Sertoli cells. FSH is required for maintaining the production of high numbers of good quality sperm. Gonadotropin therapy in HH men usually is able to generate enough sperm for fertility to occur BUT sperm count is still lower than normal. For hyperprolactinemia, dopamine agonists are used to improve GnRH secretion. These results in the inhibition of secretion of prolactin resulting in less direct and indirect inhibition of GnRH secretion. In up to 10-20% of cases, patients can exhibit sustained fertility and steroid production after therapy, resulting in hypogonadotropic hypogonadism reversal. The mechanism for this reversal is unknown, but there is believed to be some neuronal plasticity within GnRH releasing cells.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/male-hypogonadotropic-hypogonadism Mon, 08 Mar 2021 05:25:19 AM Genetic causes of male infertility Is infertility hereditary or are there other causes? Infertility is defined as the inability to have children after a full year of marital relationship, without the use of protection methods, and it is possible that infertility has genetic causes, and genetic causes of infertility are found in men more than women, but there may be other causes of infertility other than Genetic factors, and in many cases the diagnosis of infertility may be unjustified The main causes of infertility in men: 1- Occlusion of the vessels carrying sperm, or testicular and varicocele injuries. 2- Problems with erection and ejaculation. 3- Sperm abnormalities, and genetic problems. 4- Hormonal problems and genetic defects. Causes of Klinefelter syndrome A large percentage of families suffered from some genetic diseases, the most important of which is the genetic problem of infertility resulting from a defect in the chromosomes that carry the genetic characteristics of the person. The most common disease is a disease called "Klinefelter's syndrome" as a result of late childbearing, where the mother's and father's abilities to form normal gametes have been weakened due to their being affected by age, environment and the various diseases they have had over time. In most cases, people with Klinefelter syndrome have the ability to have children, but in a small percentage. In Klinefelter syndrome, a specific genetic defect occurs in men, where a man is supposed to have an X chromosome and a Y chromosome, but in this syndrome, a man has 2 X chromosomes and one Y chromosome, and there are many types of this increase in the X chromosome, as it is possible for a man to have a chromosome It is possible that this extra chromosome is just a coincidence that is found only in the male reproductive cells, and the birth of a male child at an old age is the most common reason for not having Kellefelter syndrome. This syndrome causes the testicles to develop abnormally, which leads to a low level of testosterone in the man, and a decrease in the number of sperm, which leads to infertility. Symptoms of Klinefelter syndrome Symptoms of this syndrome may appear in males since childhood, or symptoms may be delayed until puberty, and some may not know that they have this condition from the ground up, and the symptoms of this syndrome in newborn males are the failure of the testicles to fall into the scrotum, or the slowness in learning to sit Crawling, talking, or being overly calm, but these symptoms are not necessarily a sign of the syndrome. Dr. Najeeb Layyous F.R.C.O.G Consultant of Obstetrics and Gynecology and Infertility https://www.layyous.com/en/infertility/genetic-causes-of-male-infertility Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/gynaecology/ovarian-cysts-definition-types-signs-and-symptoms-causes-of-ovarian-cysts-complications-diagnoses-prevention-and-treatment-options Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/pregnancy/sex-selection-before-pregnancy-how-to-get-pregnant-with-a-boy-or-girl-gender-selection-choosing-the-sex-of-your-child Mon, 08 Mar 2021 05:25:19 AM Anemia and its relation to fertility Healthy food provides the body with vitamins and minerals necessary for the body's organs, including the reproductive system, and a deficiency in any of them, whether in the husband or wife, leads to delayed pregnancy. iron deficiency has been linked to infertility, miscarriage, low birth weight, and preterm labour  Even if you are iron insufficient and manage to become pregnant, the lack of oxygen delivery affects the baby’s development, prevents proper placental development, and increases the rates of miscarriage and preterm birth  Among the causes of iron deficiency:  - Malnutrition  - Malaria  - Blood diseases - Diseases of the immune system.  Symptoms of anemia: General fatigue and exhaustion; palpitations; Dizziness; Cold extremities and pale skin. Anemia and its relationship to pregnancy: Anemia leads to delayed pregnancy, especially if it is caused by iron deficiency. How is that? Where if the iron, which plays a role in the formation of hemoglobin, decreases, the number of red blood cells will decrease, which leads to a decrease in the amount of oxygen reaching the organs of the body such as the ovaries (because the body gives priority to the distribution of oxygen to vital organs such as the brain and the heart) and this leads to poor ovulation, i.e., failure to produce eggs and thus no pregnancy. Iron is also one of the most important minerals necessary for the formation of sperms. heme Vs. Non-Heme Heme iron is the more easily absorbed form of iron, and is typically found in animal sources. Non-heme iron is more difficult for your body to absorb, and comes from plant-based sources. Although heme iron is more absorbable, research to date shows more benefit of non-heme iron when it comes to improving ovulation to ensure you are absorbing as much iron as possible (whether heme or non-heme), it’s important to pair iron with nutrients that boost its absorption. For example, vitamin C, B12, and folate women who supplement with iron regularly decrease their risk of infertility by 40%1. Moreover, women who take more than 41 mg of iron per day decrease their risk of infertility by 62%1  range for ferritin, values ranging from approximately 20 – 200 ng per mL in women Avoid anemia by maintaining a healthy diet, such as eating vegetables and chicken which is rich in iron, lemon and tomatoes because they contain vitamin C (which helps iron absorption), and reduce coffee and tea intake. Blood type and its effect on female fertility There are four main blood types: O, A, B and AB. Your genetic makeup and proteins on the surface of your red blood cells determine your blood type What is the least fertile blood group? Studies have shown that women with O blood type are at a greater risk of depleting healthy eggs faster than others and therefore find it difficult to conceive. Why? Because the quality and number of eggs in women with blood group O is lower - according to studies - than women with other blood types (especially blood type A), as the hormone FSH (ovulation stimulator) is higher for them than their counterparts, which indicates a decline in the ovarian reserve . Immune Response: they have found that type O people have an imbalanced immune reaction that could affect implantation, especially in IVF treatments. This could account for poorer IVF outcomes in women with type O blood. A woman's balance of eggs is her fertility balance. And the O blood type indicates a decrease in its balance compared to other blood groups. This leads to a change in the thinking of women when they start to establish a family based on the blood type. regardless of your blood type, a healthy diet and lifestyle is critical for fertility, conception, and pregnancy. We may  never be able to control every possible factor related to our fertility. However, we can take charge of the foods we eat and how we live, and that can make all the difference   https://www.layyous.com/en/infertility/anemia-and-its-relation-to-fertility-blood-type-and-its-effect-on-female-fertility Mon, 08 Mar 2021 05:25:19 AM Premature ovarian Insufficiency (failure) What is meant by premature ovarian Insufficiency (failure)? It is the decline and loss of ovarian reserve before the age of 40 What are the causes of premature ovarian Insufficiency? ** Genetic factors that lead to accelerated consumption of ovarian reserve, which leads to its expiration before the expected time ** Chromosomal disorders such as Turner syndrome ** Surgical procedures (removal of part of the ovary or removal of the entire ovary) ** Chemotherapy or radiation treatments ** Smoking What are the complications resulting from premature ovarian Insufficiency? Loss of the female hormone secreted by the ovary, which results in: **Lack of sexual desire **Vaginal dryness **Urinary incontinence **Recurrent female infections **Hot flashes **Osteoporosis **High blood lipids **Increased incidence of cardiovascular diseases Can premature ovarian Insufficiency be avoided? This depends on the cause: ** If it is due to genetic/chromosomal factors, it cannot be avoided. ** If it is due to surgical procedures, it is possible to try as much as possible during ovarian surgeries to preserve as much of its cortex as possible. ** In cases of chemotherapy/radiation therapy, it is possible to freeze part of the ovarian cortex and replant it after the end of the treatment period, and we may resort to freezing eggs to preserve reproductive capacity. ** Stop smoking and shisha. How is early ovarian Insufficiency treated? This depends on the cause, the woman's reproductive desire, and the symptoms she complains of: ** Hormone replacement therapy (hormonal pills containing the female hormone) to avoid complications resulting from a deficiency of this hormone ** Freezing eggs/ovarian cortex in certain cases to preserve reproductive capacity **Some people in some countries may resort to donating eggs for the purpose of reproduction **Ovarian plasma, but its results are not guaranteed and do not exceed 1 percent **Stem cell technology, which is still under study and has not been proven effective in humans Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/premature-ovarian-insufficiency-failure Mon, 08 Mar 2021 05:25:19 AM How to get pregnant with twins One of the frequently asked questions is how to get pregnant with twins, and in this article we will discuss this topic a little. It is worth noting first that getting pregnant with twins is not easy and that it requires more close monitoring during pregnancy due to the difficulties that accompany it. What is meant by twin pregnancy? Carrying more than one fetus inside the womb during pregnancy Is there a genetic factor for twin pregnancy? Yes, as some families are characterized by multiple ovulations during the menstrual cycle (i.e. the release of more than one egg in the menstrual cycle), which results in pregnancy with more than one fetus What are the possible complications of twin pregnancy? ** Premature birth ** The need for a cesarean section ** The rate of malformations is higher in twin pregnancies ** Gestational diabetes ** High blood pressure in pregnancy and preeclampsia ** Postpartum bleeding ** Anemia during pregnancy Are there medical ways to get pregnant with twins? Yes, using assisted reproductive techniques that include the use of ovarian stimulation injections/pills Is it possible to get pregnant with twins through intrauterine insemination? Yes, as ovarian stimulation medications are used, which leads to the release of more than one egg from the ovary, but pregnancy with twins is not guaranteed using this method Is it possible to get pregnant with twins through in vitro fertilization (IVF)? Yes, as more than one embryo is returned to the uterus, which increases the rate of pregnancy with twins, but it does not guarantee it Is there a 100% guaranteed way to get pregnant with twins? No, but using ovarian stimulation drugs increases the chance of getting pregnant with twins What are ovarian stimulation drugs? **Pills that work at the level of hormone receptors such as Clomid and Letrozole **Hormonal injections containing pituitary hormones LH/FSH Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/how-to-get-pregnant-with-twins Mon, 08 Mar 2021 05:25:19 AM Ovarian reserve Ovarian reserve is the number of eggs present in the ovary, which reflects the woman's reproductive capacity. Is ovarian reserve renewable? No, a female is born with a certain number of eggs, and when she reaches puberty (menstruation), a number of these eggs are consumed every month until the reserve is completely finished around the age of 50, so the woman enters menopause and loses her reproductive capacity completely Is there a way to increase the ovarian reserve? No, there is no medical treatment to increase the number of eggs in the ovary Does the rate of ovarian reserve decline vary from one woman to another? Yes, and therefore reaching menopause varies between women What are the factors that control the rate of ovarian reserve decline? ** Genetic factors ** Smoking ** Ovarian surgeries that reduce ovarian reserve ** Some treatments such as radiation/chemotherapy for cancer patients ** Some chromosomal disorders such as Turner syndrome Do vitamins help increase ovarian reserve? No, but they improve the quality of existing eggs Can stem cell technology be used to increase ovarian reserve? It is still under study and has not been officially applied to humans What tests are performed to assess ovarian reserve? ** Ovarian reserve blood test AMH ** Evaluation of the number of eggs visible on ultrasound ** Evaluation of ovarian size on ultrasound ** FSH hormone test on the second or third day of the cycle Can birth control pills be used to stabilize the ovarian reserve and slow its decline? No, although birth control pills prevent ovulation, they do not maintain the ovarian reserve as a certain number of eggs are lost from the ovary each month whether ovulation occurs or not. What is the solution for a woman who wants to have children and lost her ovarian reserve at an early age? Egg donation, but this is prohibited in many countries for religious or legal reasons What are the consequences of losing the ovarian reserve for a woman? Loss of the female hormone (estrogen) which leads to symptoms of menopause, in addition to the loss of reproductive ability Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/ovarian-reserve Mon, 08 Mar 2021 05:25:19 AM The Impact of Infertility on the Relationship Between Spouses   Infertility significantly impacts the relationship between spouses, and the extent of the impact is related to their personalities, how they handle stress, and the strength of their psychological and social bond.   What are the psychological effects of infertility on couples? - Depression - Loneliness - Guilt, especially if one partner is the cause of the infertility - Frustration - Constant anxiety and fear of the relationship ending - Sexual frigidity and loss of spontaneity   Does infertility destroy a marital relationship? Not necessarily. It may bring a couple closer together if they view the problem as a shared experience that strengthens their bond.   What advice can be given to couples suffering from infertility to strengthen their relationship and prevent its deterioration? - Regular conversation between the couple - Seeking the help of a psychological counselor, such as a marital relations specialist - The couple should avoid blaming each other - Encourage them to focus on their emotional and sexual relationship - Encourage them to be flexible in their thinking and to be open to multiple options for starting a family   What is the role of the family in mitigating the psychological effects of infertility on the couple? Family members of both spouses should avoid pointing fingers at either of them and should try to provide psychological support to help preserve their relationship.   Are there support groups for couples struggling with infertility? Yes, there are support groups. These groups consist of other couples struggling with the same issue, who share their experiences with a specialized psychosocial counselor.   Does stress affect fertility? Constant stress leads to elevated cortisol levels, negatively impacting sexual performance and fertility for both partners. It can also lead to miscarriages and premature births if pregnancy occurs. Therefore, we advise couples to find ways to reduce stress levels, given their negative effects on fertility, to prevent the situation from worsening. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/the-impact-of-infertility-on-the-relationship-between-spouses Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/gynaecology/sclerosing-therapy-for-endometriomas Mon, 08 Mar 2021 05:25:19 AM The Impact of Obesity on Fertility   What is the definition of obesity? According to the World Health Organization, obesity is defined as having a body mass index (BMI) over 30. It is well known that obesity is increasing globally due to changing dietary habits and decreased physical activity among most people. Therefore, obesity negatively affects fertility in both women and men. How does obesity affect fertility in women? ** Increased body fat leads to higher estrogen levels, causing hormonal imbalances. ** Increased insulin resistance negatively impacts ovarian function. ** Affects the concentration of hormones secreted by the pituitary gland. ** Affects egg quality and maturation. ** Causes ovulation disruption. ** Disrupts endometrial receptors, affecting embryo implantation. ** Increases the risk of miscarriage. How does obesity affect male fertility? ** It reduces testosterone levels. ** It affects sperm production, decreasing sperm count and negatively impacting sperm motility and morphology. ** It increases harmful oxidative stress in the body, leading to DNA damage in sperm. ** It can cause erectile dysfunction and decreased libido What is the ideal body mass index (BMI) for fertility? 18.5 to 24 What tips can help with weight loss? ** A healthy, balanced diet ** Focus on fruits and vegetables ** Reduce consumption of processed foods, fats, and sugars ** Get enough sleep ** Exercise regularly ** Use an insulin-sensitizing medication if you have insulin resistance Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/the-impact-of-obesity-on-fertility Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/gynaecology/having-daughters:-when-females-excel-in-the-balance-of-giving Mon, 08 Mar 2021 05:25:19 AM Unexplained infertility (a clinical challenge in reproductive medicine)   Unexplained infertility is defined as the failure to conceive after 12 months of regular, unprotected intercourse, or after 6 months in women over 35 years of age. Despite significant advancements in diagnostic methods, approximately 10-20% of cases remain classified as unexplained infertility, where routine tests for both partners appear normal. This diagnosis presents a clinical and psychological challenge due to the absence of a clear underlying cause toward which treatment can be directed.   Diagnostic Assessment: Unexplained infertility is diagnosed after completing basic investigations, which include: 1- Evaluation of ovulation through ultrasound monitoring of follicles.   2- Semen analysis according to World Health Organization standards.   3- Assessment of the patency of the fallopian tubes.   4- Evaluation of the uterine cavity by ultrasound or hysteroscopy, if needed. When these elements are normal, the diagnosis is based on exclusion.   Possible Pathological Mechanisms:   Despite the absence of a clear defect, studies point to several subtle mechanisms that may explain the condition, including: - Subtle disturbances in egg quality.   - Subtle sperm dysfunction (DNA fragmentation).   - Disruptions in the interaction between egg and sperm.   - Impregnation.   - Subtle immunological abnormalities. Some recent research published in journals suggests that a percentage of these cases may be reclassified later with the development of genetic and functional testing techniques.   Treatment Plan: Management depends on the woman's age and the duration of delayed pregnancy:   1- Expectant Management.   Suitable for women under 35 years of age with a short period of delayed pregnancy.   2- Ovulation Induction with Intrauterine Insemination (IUI).   This is the first-line option in most cases, especially within 3-6 treatment cycles.   3- Intracytoplasmic Sperm Injection (ICSI). It is recommended in cases where IUI has failed, the wife is over 38 years old, and there has been more than 3 years of infertility.   Data shows that pregnancy rates in this group are often good when IVF is used, suggesting a minor uterine dysfunction that can be overcome through laboratory testing.   Psychological aspects: Studies indicate that women with unexplained infertility experience higher levels of anxiety compared to those with a clear organic cause, due to the lack of a direct explanation. Therefore, psychological support is an important part of the treatment plan. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist   https://www.layyous.com/en/infertility/unexplained-infertility-a-clinical-challenge-in-reproductive-medicine Mon, 08 Mar 2021 05:25:19 AM Fertile window tracking   Fertile window tracking helps identifying the days in the menstrual cycle during which pregnancy is most likely.   What is the fertile window? 5 days before ovulation and the day of ovulation.   The sperm can live inside the female reproductive system for up to 5 days, the egg survives for up to 48 hours after ovulation. That is why the fertile window is 6 days.   When does ovulation occur? 14 days before the expected menstrual cycle day. In a 28-days menstrual cycle it occurs on day 14. In a 30-days menstrual cycle it occurs on day 16. In a 26-day cycle it occurs on day 12.   The ways to identify fertile period: Calendar method: The cycle should be tracked for 3 months Estimate ovulation time based on average cycle length This method can’t be used in irregular cycles (the cycle has to be regular for at least 3 months) Basal body temperature: Temperature slightly rises on the day of ovulation (up to 0.5 degrees Celsius) The temperature is taken daily before getting out of bed It detects ovulation after it happens, not before   Cervical mucus: At the time of ovulation cervical mucus is clear, slippery and stretchy in order to facilitate the movement of sperms   Ovulation predictor kits: Detect LH surge in urine If it was positive then ovulation will most likely happen within 36 hours Used to time intercourse   Artificial intelligence-based applications   Ultrasound tracking by a gynecologist starting on day 9 of the menstrual cycle and every few days   Factors that affect ovulation: Polycystic ovary syndrome Thyroid disease Stress Significant weight loss/gain Breastfeeding Perimenopause These lower the chances of overall pregnancy   Percentage of pregnancy using fertile window tracking: Depends on timing, age and overall fertility health for both couples Women under 35: 25 % per cycle Women between 35-37 years: 20% per cycle Women between 38-40 years: 10% per cycle Women over 40 years old: less than 5%   Cumulative pregnancy rates: 70% within 6 months 85% within 12 months 90% within 24 months These percentages are for healthy young couples with no fertility problems. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/fertile-window-tracking Mon, 08 Mar 2021 05:25:19 AM Things we do daily that may be delaying pregnancy without us realizing it.   Fertility is a complex process influenced by hormonal, environmental, and behavioral factors. While many focus on illnesses or obvious medical causes, there are common daily practices that may negatively affect the chances of getting pregnant without us realizing it. These habits include: 1- Excessive caffeine consumption: Consuming high amounts of caffeine (more than 300 mg daily) may be linked to lower fertility rates and delayed pregnancy. It is believed that caffeine affects blood flow to the uterus and hormonal balance.   2. Smoking (even passive smoking) Smoking directly affects egg quality and accelerates the depletion of ovarian reserve. It also increases the risk of miscarriage and ectopic pregnancy.   3. Lack of sleep or sleep disturbances Irregular sleep affects the secretion of hormones such as melatonin and ovulation hormones. Women who suffer from sleep disturbances may experience menstrual irregularities.   4. Unbalanced weight Both extreme thinness and obesity can lead to ovulation disturbances. Excess fat affects estrogen levels, while severe weight loss can stop ovulation altogether.   5. Excessive Exercise While exercise is beneficial, strenuous and excessive exercise can inhibit ovulation, especially in women with low weight.   6. Exposure to Everyday Chemicals Such as pesticides and cosmetics containing hormones. These substances can act as endocrine disruptors and affect fertility.   7. Chronic Stress Psychological stress can affect the hypothalamic-pituitary-ovarian axis, leading to ovulation disturbances or delays.   8. Unhealthy Diet Fast food, trans fats, and deficiencies in vitamins such as folic acid, iron, and vitamin D are all factors associated with reduced fertility.   9. Excessive use of vaginal douches: Frequent use can alter the natural environment of the vagina and affect sperm motility, potentially reducing the chances of fertilization.   10. Prolonged sitting and lack of movement: A sedentary lifestyle can affect blood circulation and hormonal balance. It is also linked to weight gain and insulin resistance.   11. Unsupervised use of certain medications: Such as excessive use of anti-inflammatories, some antidepressants, or hormonal medications. These can affect ovulation or the uterine lining.   Many simple daily habits can have a cumulative effect on fertility. Awareness of these factors and lifestyle modifications can significantly improve the chances of pregnancy without the need for complex medical interventions.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/things-we-do-daily-that-may-be-delaying-pregnancy-without-us-realizing-it. Mon, 08 Mar 2021 05:25:19 AM Fertility preservation in cancer patients Cancer treatments such as chemotherapy, radiotherapy and surgeries can affect fertility in both men and women. All cancer patients should be counselled regarding preservation of fertility before starting any treatment in order to have the ability to have children in the future. The effects of cancer on fertility depends on the following: -    Type of cancer -    Age of patient -    Type of cancer treatment -    Dose of treatment -    Duration of therapy -    Location of cancer 1-    Fertility preservation for women include: -    Egg freezing -    Embryo freezing -    Ovarian tissue freezing -    Ovarian suppression ** egg freezing: -    The most commonly used method -    Ovaries are stimulated with hormones after which eggs are collected and frozen for future use -    Used for married and unmarried women -    Its disadvantage is that hormonal treatment might not be suitable in certain cancers and the ovarian stimulation takes time which might delay initiation of cancer therapy ** embryo freezing: -    Higher success rate -    Used for married women ** ovarian tissue freezing: -    Ovarian cortex removed surgically, frozen and reimplanted after finishing cancer treatment -    It doesn’t need hormonal stimulation which might be helpful in certain cancers ** ovarian suppression: -    Suppression of ovaries might help protect its function during chemotherapy -    Reduces ovarian damage -    Doesn’t guarantee fertility preservation -    Should be used with other more reliable methods 2-    Fertility preservation for men: -    Sperm freezing -    Testicular tissue freezing ** sperm freezing: -    Requires puberty (sperm production) -    Non invasive -    High success rate ** testicular tissue freezing: -    Used for prepubertal boys -    Still experimental  -    Invasive and requires local/general anesthetic All cancer patients of all age groups should be referred to fertility specialists before initiation of treatment to improve chances of future parenthood. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/fertility-preservation-in-cancer-patients Mon, 08 Mar 2021 05:25:19 AM Autoimmune disease and infertility Autoimmune disease occurs when the body’s immune system mistakenly attacks its own healthy tissues. This might affect fertility in both men and women. How does autoimmune disease affect fertility? -    In a healthy pregnancy the body must accept the embryo and support its growth. -    In autoimmune disease abnormal immune response may interfere with ovulation, implantation, embryo development or pregnancy maintenance. Some autoimmune conditions may: -    Affect ovarian function -    Affect egg quality -    Increase inflammation in the reproductive organs -    Interfere with embryo implantation -    Raise risk of recurrent miscarriage -    Affect hormonal balance -    Affect menstrual cycles Thyroid autoimmune disorders: -    Hashimoto thyroiditis and graves’ disease Systemic lupus erythematosus: Affects fertility through: -    Inflammation -    Medication -    Complications related to pregnancy Antiphospholipid syndrome: Leads to: -    Recurrent pregnancy loss -    Implantation failure -    Abnormal blood clotting Rheumatoid arthritis: -    Chronic inflammation -    Some harmful medications Endometriosis: -    Has autoimmune component -    Leads to chronic inflammation which affect fertility IVF challenges related to autoimmune disease: -    Inflammation related problems with implantation When to suspect autoimmune disease as a cause of pregnancy complication/infertility: -    Recurrent miscarriage -    Unexplained infertility -    Associated systemic manifestations Evaluation of autoimmune disease include: -    Thyroid function tests -    Autoimmune antibody screen -    Hormonal tests -    Ultrasound examinations -    Thrombophilia screen Medications to be given when autoimmunity is suspected to be the cause of infertility: Immune modulating medications such as: -    Prednisolone  -    Progesterone supplements -    Vitamins and antioxidants -    Intralipid -    Aspirin and anticoagulants Many patients with autoimmune disease conceive and deliver healthy babies with proper medical care. Care should be multidisciplinary. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/infertility/autoimmune-disease-and-infertility Mon, 08 Mar 2021 05:25:19 AM Pregnancy Guide   Definition of Pregnancy: The pregnancy is the fertilization and development of one or more off spring known as an embryo or fetus and it’s the period from conception till birth. The egg is fertilized by a sperm then implanted in the in the lining of the uterus to develop to placenta and embryo, and later to fetus.   Development of the Embryo Normal pregnancy last 38 to 42 weeks beginning from the first day of the women last menstrual period and it’s divided to 3 stages and each stage last for 3 months. 1st trimester: It carries the highest risk of miscarriage (natural death of embryo or fetus). 2nd trimester: The development of fetus can be more easily monitored. 3rd trimester: It approximates the point of viability, or the ability of fetus to survive with or without medical help outside the uterus. Symptoms of Pregnancy: A- 1st trimester (1 - 12 weeks) : Development of the Placenta Fetal Development clip no 1 Missed period The most common symptom of pregnancy, although some women bleed in the beginning but typically the bleeding will be shorter or lighter than a normal period. Implantation bleeding: One of the earliest symptoms of pregnancy. The embryo implants itself in to uterine wall about 6 to 12 days after conception and may cause spotting and cramping. Swollen / tender breasts: Shown in the first 2 weeks after conception as the mammary glands prepare for eventual breast feeding, nipples begin to enlarge, veins over surface of breast become more prominent and skin around your nipples may get darker. Nausea and vomiting: Common symptom usually shows up between the second and the eighth weeks after conception and it’s commonly known as morning sickness but it can happen any time of day or night and it is caused by hormonal changes especially the increased level of progesterone. Fatigue / Tiredness: Common symptom start as early as the first week after conception due to hormonal changes. Back aches: It can occur early in pregnancy and it’s common to experience a dull backache through pregnancy. Headaches: It can occur early in pregnancy and it’s common due to the sudden rise of hormones. Frequent urination: It’s common around the sixth and eighth weeks after conception and there may be a creamy white discharge from the vagina. B- 2nd trimester (13 - 28 weeks) : Fetal Development clip no 2 Enlarged uterus easy to feel Skin may become darker Some may have flushing Baby’s movement will be felt in most women by week 22 Increase of Appetite Nipples become bigger and dark Nausea and vomiting fade away and women feels better C- 3rd trimester (29 - 40 weeks) : Some may have nipple discharge Low back aches Braxton hick's contraction may become stronger Stretch marks may appear on abdomen, breast Dark lines may appear from navel to pupil hair The baby’s head drops down low in pelvis at about the week 36 and this relieve pressure on upper abdomen and lungs. Fetal Development clip no 3 Weight gain: Healthy weight gain is between 25-35 pounds and pregnant women need an additional 300 calories/day. In the first 3 months, women will gain 3 to 5 pounds. After the first 3 months, women gain 1-2 pounds a week until baby is born. On average, the birth weight of a healthy full term baby is 7.5 lb. (3.4 kgs). The weight of placenta and fluid together is 3.5 lb. The remaining weight that women gains during pregnancy is water retention and fat stores. The breast gain about 2 lb. and increase blood volume cause 4/6 weight gain. Other problem that may be annoying Fetal Circulation Constipation. Hemorrhoid. Sensitive gums. Dry eyes. Ankle swelling. Varicose veins. Those symptoms usually disappear after delivery. Chloasma (mask of pregnancy) Blotches of pale brush skin on forehead, cheeks, and nose, they usually disappear after pregnancy or may become permanent. Some symptoms that could be dangerous: Abdominal pain Fluid leakage from vagina (rupture amniotic sac). No fetal movement for 24 hours Continuous headache Persistent vomiting Blared vision during last 3 month Sudden swelling of hands, face or eyelid during the last 3 months https://www.layyous.com/en/pregnancy Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/pregnancy Mon, 08 Mar 2021 05:25:19 AM Pregnancy Month by Month - What to expect during the months of pregnancy     1 month pregnant (Weeks 1-4) First Month Pregnant: Your belly will be the same size as pre-pregnancy, but you may experience some fatigue, breast engorgement and frequent urination, which will fade in time. Do not worry. This is a natural process.   2 months pregnant (Weeks 5-8)     Second Month Pregnant: The fetus head is growing more rapidly than the other parts as the brain has a crucial role in regulating the function of all the vital organs. Consult your doctor before taking any drugs.   3 months pregnant (Weeks 9-13) Third Month Pregnant: Your abdomen and breasts are growing larger. Baby is in a “floating” position, weighs about an ounce (about 28g.) and is 3inches (8cm) long. The arms, legs and head are barely distinguishable.     4 months pregnant (Weeks 14-17) Fourth Month Pregnant: Maternity clothes may be required by now. Baby is now about 6 inches (about 15cm.) long, and weighs 1/4 lb. (about 114g.). You may feel the first movements.   5 months pregnant (Weeks 18-21) Fifth Month Pregnant: The skin on your abdomen stretches considerably. The Doctor can hear Baby’s heartbeat with a stethoscope, and Baby's movements are more easily felt. Length is about 10 inches (about 25cm.) long, and weight is about ½ lb. (about 227g.) now.   6 months pregnant (Weeks 22-26) Sixth Month Pregnant: As your abdomen continues to enlarge, Baby’s movements become more vigorous. The skin is red, wrinkled and covered with soft down, and hair has begun to grow on the head. Length is now about 12 inches (30cm.) long, weighing 1 ½ lbs. (about 680g.).   7 months pregnant (Weeks 27-30) Seventh Month Pregnant: Baby’s eyes are open. If born at this time, Baby has some chance of survival. Weight is about 2 ½ lbs. (about 1 kilo 130g.) and about 15 inches (about 38cm.) in length.   8 months pregnant (Weeks 31-35) Eighth Month Pregnant: Baby’s movements are more forceful and may be seen from outside. Weight has increased to about 4 lbs. (about 1 kilo 812g.), and length to about 16 ½ inches (about 42cm.). The skin is not as wrinkled, and Baby is in the position in which birth will occur (normally, head down).   9 months pregnant (Weeks 36-40) Ninth Month Pregnant: Baby settles lower into the abdomen, ready for birth. Most of the fuzzy down on the body has disappeared, and the head may be covered with hair. Weight is at least 6 or 7 lbs. (2.7 to 3.2 kilos), and is about 20 inches (50cm.) or more in length. https://www.layyous.com/en/pregnancy/pregnancy-month-by-month Mon, 08 Mar 2021 05:25:19 AM Advice for Pregnant Women - Tips For Pregnant Women   How to organize your life during pregnancy? Rest During Pregnancy: Any pregnant female should sleep daily for 8 consecutive hours. She should also have a nap @ midday. Avoid squatting and putting pressure on the abdomen as this can lead to back and abdominal pain. Avoid sitting and standing improperly and holding heavy materials. Bending your knees is essential while you are holding things   Appropriate Clothes for Pregnant Women: It is best to wear attractive and comfortable clothes. Multiparas tend to have a larger waist than primigravida. At around 5 months, the lower abdomen will begin to enlarge and clothing will feel too small to you. When you buy new pregnancy clothes, it should be easy to keep clean and feel comfortable. Be aware that your body weight will increase as pregnancy advances. Comfortable clothing is important but make choices that make you feel good about yourself. You may gain 10-20 kg during pregnancy and the upper part of your body will be 10 cm larger than before. By the last month, your abdominal circumference will be around 1meter more or less, depending on your normal body structure. Wide sleeves can be helpful so that you can extend your arms easily. Cotton made clothes are preferred as they absorb humidity and provide good ventilation. You may choose polyester made clothes as they cover your mummy bump easily. Your underwear should be made of cotton. You should wear low heel shoes, be sure that they are not slippery as high heel shoes may cause back pain and legs cramps. Soon, you will also have difficulty seeing where to put your feet as your tummy will get in the way. The higher the shoe heel, the greater the chance of losing your balance. You do not want to fall when you are pregnant. It can injury your baby. In worst cases, it can lead to losing your baby. Exercises during pregnancy : You can walk and do your daily home duties but avoid lifting or pushing heavy objects, or doing aggressive exercises. Be gentle with yourself. You can learn to do the appropriate pregnancy and post-partum exercises. We have approved exercises available here on our Site.   Diet during pregnancy: You do not need to eat for two. Instead, you need a healthy, balanced diet which contains all the necessary vitamins. Avoid fatty, spicy food, decrease the consumption of tea, cocoa, and coffee. Concentrate on eating diary product such as eggs, cheese, meat, birds, and fish. Also, eat vegetables, especially leafy, green ones and fruits. If you are overweight you need to decrease consumption of rice, potatoes, and sweets. You need to eat 6 small meals per day, which is better than 3 meals/day. Gestational Diabetes Sex during pregnancy: You can have intercourse during pregnancy. However, if you have a history of abortion or preterm labour or have abdominal pain intercourse should be avoided. In the last 4 months of pregnancy, you need to avoid intercourse as it will induce uterine contractions, rupture of membranes, vaginal infection or vaginal bleeding. Also, intercourse may increase pressure in the uterus which may increase fetal heart rate. So, try to avoid positions that cause pressure on the abdomen that can effect your fetus. Skin Care during pregnancy: You may notice some skin changes as striae over your belly, breast, thighs, buttock, and freckles over your face. You may notice darkening over the nose or eyebrows. You may prevent these by eating a high protein diet and taking vitamins, especially vitamin B2, vitamin C, as in vegetables, mussels, Oysters, beans, apples, oranges, lemons, etc… The fullness of the face may cause wrinkles in the skin, so try to massage your face with a small amount of moisturizing cream. As your skin becomes more sensitive during pregnancy, do not change your skin care product. Try to use bright color lipstick and make up to make you feel good about yourself. Some obstetricians advise that you massage your belly with olive oil to alleviate stretch marks and wrinkles. Breast care during Pregnancy: Use a high quality bra that elevates your breast properly without being too tight or uncomfortable. Clean your nipples with warm water. Avoid soap. Massage them using olive oil, starting from the 5th month of pregnancy. You may also use cocoa butter or lanolin. You can use breast suction before cleaning and doing breast massage, 6 weeks prior to delivery. You can also do a massage to open your milk canal by compressing the areola between your index and thumb to ejaculate milk, to avoid breast engorgement and post-partum pyrexia which occurs after delivery. Gums and Teeth Care during Pregnancy: Clean your teeth after each meal and before going to bed. Consult your dentist if you have a problem with your teeth.   Changes and Complications during Pregnancy: Beast changes during Pregnancy: Your breast will be soft during early pregnancy, then they will enlarge. The areola will be darker and have protruding glands which will make the nipple protrude more, anteriorly. Once the milk canal forms, colostrum starts to form and will be ejaculated when you do breast massage. After 4 months of pregnancy, you will need a larger bra. Cleaning your breasts and massaging the nipples prevents nipple cracks, makes them tighter. Back pain during Pregnancy: As pregnancy advances, and belly continues to enlarge, it will press on your back. You will need to bend your back in order to balance the enlarged uterus. Many women complain of back pain during pregnancy, but it will decrease when lying down and resting. But, if you do not feel relief, this may be due to compression on a nerve, or due to disc prolapse. If this occurs, you need to consult your doctor. Constipation during Pregnancy During pregnancy, bowel motility decreases due to muscle relaxation, but this will lead to anal fissure, or possibly, rectal prolapse hemorrhoids. To maintain bowel motility, you need to eat fruits and vegetables and drink lots of water.   Numbness in the hands and feet during Pregnancy: Although numbness increases during pregnancy, its cause is still unknown. But, some say that it may be due to bending the back, not only in the lower back but also in the neck and upper back. It may also be due to hormonal changes. Because of all of this, the upper limb nerves are pulled upward and this will cause numbness and cramps. After delivery, all of these will disappear. But if they persist you should consult your doctor. Nausea during pregnancy: The cause is unknown, but it may be due to hormonal changes, especially progesterone. You need to avoid fried food, fatty food or anything that could make you nauseous. Try lying in bed for a short while after you wake up. Eat small, frequent meals. You may need to take some medications to decrease these symptoms. They should normally decrease on their own after the 10th week of pregnancy and disappear totally after the 14th week of pregnancy. Normal vaginal delivery video | Caesarean section video Carpel tunnel syndrome during pregnancy: In this syndrome, you may suffer from wrist pain and numbness, which are due to the increase in tunnel pressure as a result of joint swelling. This will compress the nerves that pass through the tunnel, especially the median nerve, and this will lead to hand numbness. It is worst in the morning and before moving your wrist. It disappears after delivery. So, when you move your wrist it will make the joint more elastic. Treatment will be with an analgesic ointment, or a diuretic, in order to decrease joint swelling and pressure on the joint. Also, this symptom may be due to vitamin B12 deficiency. Treatment will be by B12 injections. Joint pain during pregnancy: During pregnancy, some physiological changes occur in the woman’s body causing loosening of the cartilage in addition to an increase of fluid in the joints. This can cause an increase in the range of movement, which may lead to joint pain. As the pregnancy advances, the uterus is heavier. The curvature of the back increases, and the pelvic joints loosen. All of these lead to pressure on the muscles and tendons, which lead to back pain. Pregnant women need 28gm of calcium for bone formation, 25gm in the last trimester. If there is a decrease in calcium level in your blood, this will lead to loosening of the joints and more bone and joint pain. This will occur with the lactating woman, who has a deficiency of calcium in her diet. Heart burn during Pregnancy: This affects 1/3 – 1/2 of all pregnant women due to gastric juice regurgitation, upward, to the esophagus. This is due to gastroesophagial sphincter relaxation, working as a valve, due to the increase of pressure inside the abdomen, or due to herniation of the esophagus above the diaphragm. This will disappear spontaneously after delivery. To treat heart burn, you should avoid bending forward and squatting. You should put a pillow under your back so that the upper part of your body is above the level of your lower abdomen, while sleeping. Avoid eating large meals. Instead, eat smaller, more frequent meals. Avoid spicy food. You can also use antacid medications. Anemia during Pregnancy: Anemia is diagnosed during pregnancy if hemoglobin drops below 10mg/dl. This effects 15% of all pregnant women. As pregnancy advances hemoglobin level, red blood cell count will drop further, due to deficiency in iron intake as compared to iron consumption. This occurs due to the increase in metabolic rate in the mother and fetus. Types of anemia, aplastic anemia, megaloblastic anemia, Iron deficiency anemia which is the most common type of anemia. Anemia will affect the growth of the fetus and can cause intrapartum complications. It is necessary to monitor hemoglobin level in the 1st trimester of pregnancy in order to give the mother the appropriate dose of ferrous supplements or transfuse her with blood, in severe cases. Spontaneous Miscarriage: Spontaneous Miscarriage is defined as fetal loss before 20 weeks of gestation (before fetal viability) or fetal loss of less than 500mg fetus. Its incidence is 10-15% of pregnant women. Its cause is a bad quality oocyte or sperm, so that the embryo can’t continue pregnancy. Some maternal diseases may cause spontaneous Abortion: Maternal diabetes, maternal hypothyroidism, cervical incompetence, psychological and physiological stress. Recurrent abortion is defined as, if the woman aborts more than 3 consecutive times. Around 20-30% of women who aborted once previously, will abort their current pregnancy. But, if the woman has had recurrent abortions, this percentage may increase to 30-50%. The cause for this is anatomic or physiological problems in the mother. Around 70% of abortions occur in the 1st trimester of pregnancy. The danger of recurrent abortion is when the pregnancy advances, so you may need cervical cerclage to prevent abortion during 14-16 weeks (4 months). Frequency of Urination during Pregnancy: You may experience an increase in frequency in urination in the 1st trimester of pregnancy. This occurs due to physiological pregnancy changes. Also, the enlarged uterus compresses on the bladder. This leads to increased urination and will continue for 4 months, then disappear, once the uterus is out of the pelvis and into the abdominal cavity. Then it recurs again once the head of the baby compresses on the bladder, in the last month. The frequency of urination increases, but there should not be any pain during urination. If you complain of pain, consult your doctor as it may be due to a urinary tract infection. Vaginal discharge during pregnancy: Vaginal discharge may increase during pregnancy due to increased cervical mucus secretion. Sometimes, the increase in vaginal discharge may be due to candidal infection or trichmonas which occurs in 20-30% of pregnant women. Its discharge has thick, yellowish color and smelly. To treat this infection, you may use metronidazole. If there is candidal infections, (which affect 20% of pregnant women), it will cause whitish vaginal discharge. If symptoms are mild, no treatment is needed, but if severe, you may use mycostatin. Vaginal bleeding during Pregnancy: 1- Bleeding in the 1st half of pregnancy: If you see any sign of bleeding, you should consult your doctor. There are many causes like cervical infection, and ectropion, or you may get pregnant on top of IUCD ectopic pregnancy, molar pregnancy. If bleeding is minimal, you can rest at home. Avoid intercourse for two weeks until bleeding stops. If bleeding is severe and leads to anemia, it is necessary to induce abortion. In cases of spontaneous abortion, you may complain of vaginal bleeding associated with regular uterine contraction. Also, this may occur with ectopic pregnancy. If uterine contractions continue to 6 hours, or cervix dilates or rupture of membranes occur, then you cannot keep your fetus. 2- Bleeding in the 2nd half of pregnancy: It may occur due to vaginal friability, or cancerous changes of the cervix, placental abruption or low lying placenta. In these cases, you may need emergency intervention in order to save your life, and your baby’s life. You may experience passage of a bloody show, which may indicate labour may start any time. What about rubella? This disease is not dangerous if you are not pregnant. But, if a pregnant female is infected with rubella during her pregnancy, this will increase the risk of congenital abnormalities: In the 1st month of pregnancy 50%. In the 2nd month 25%. In the 3rd month 15%. Congenital abnormalities include: congenital cataract, glaucoma, visual problem, hearing problem growth retardation. The most important thing is to diagnose the disease and consult your doctor. Immunity and vaccination during pregnancy: Vaccinations depend on the vaccine or the immunity the patient has received before. The pregnant female could receive diphtheria, tetanus vaccine if she did not receive them in the last 10 years. Avoid polio vaccine unless it is endemic in the area, and ensure that the inactivated vaccine is used. Avoid mumps and rubella vaccine during pregnancy. Vaccine for typhoid fever should be given only if she is travelling to an endemic area, as the danger of the disease is more than the danger of the vaccine. Also, cholera vaccine should not be given unless you are travelling to an endemic area, or you have contacted an infected person. Rabies vaccine could be given as a protocol. Hepatitis vaccine can be given during pregnancy if she wants to travel to an endemic area, or have been in contact with an infected person. Preterm labour: It is defined when a baby is born after 20 weeks, but before 36 weeks of pregnancy, or if the weight of the baby is less than 2500gm once delivered: At 20 weeks baby’s weight reachs 300 gm. At 24 weeks baby’s weight reachs 700 gm. At 28 weeks baby’s weight reachs 1000 gm. At 31 weeks baby’s weight reachs 1700 gm. At 35 weeks baby’s weight reachs 2500 gm. At 40 weeks baby’s weight reachs 3200 gm. Factors that may cause preterm labour are: Rupture of membrane. Cervical incompetence. Polyhydramnios. Abruptioplacenta. Pneumonia, pyelonephritis of the mother. Preterm babies need to be put in an incubator for a while. Fetal movement: You may feel your fetus' first movement between 20-22 weeks of pregnancy, and it is called quickening. Some pregnant women cannot feel quickening until the 6th month of pregnancy. Some may confuse quickening with bowel movement or muscle cramps. Fetal movement may be an indicator of the health of the baby, but also a healthy baby will not move continuously, all through the day. You may induce fetal movement by tapping gently over your abdomen. If there is no fetal movement, this may be a pseudo pregnancy, an hydatiform mole, or may signify an intrauterine fetal death. If fetal movement has decreased, you should do a, “non stress test,” which measures the fetal heart beat. If there is a decrease in fetal movement, this may indicate a threat to the baby’s life. Give this problem special care. What are the medications that may harm the baby? Some medication may pass the placenta to the fetus. Before taking any medication, it should be approved by the FDA: Medications that are absolutely harmful to the baby: Alcohol, Antibiotics (Chloramphenicol, Chloroquine, Nitrofurantione, Novobiosin, Quinine, Streptomycin sulfa drug, and Tetracycline), anticancer drugs, testosterone, antithyroid drugs, cadmium, mercury, lead, oral contraceptive pills, nicotine, and warfarin. Medications that are deadly dangerous: Nitrous oxide, some Oral hypoglycemic agent, Chlorobromide, Tolbutamide, Tranquilizers, Reserpine, Vitamin A. Medications that may be harmful: Caffeine, valium, insulin, librium, meclizine, mebrobamit.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/advice-for-pregnant-women-tips-for-pregnant-women Mon, 08 Mar 2021 05:25:19 AM Heartburn during pregnancy   Definition of Heartburn Painful and burning sensation in the esophagus, just below the breast bone, most of the time associated with regurgitation of gastric acid (GERD) gastro esophageal reflux. The pain starts in the chest and may radiate to neck, throat and jaw. According to medical experts, heartburn is one of the symptoms of GERD or gastro esophageal reflux disease. If this is not properly treated, it can lead to serious disease like cancer. In addition, it can create lesions or ulcers in the esophagus due to the acid reflux. Statistics have shown that almost 80% of Americans will experience recurring acid reflux even after several treatments, remedies, and procedures.   Symptoms of Heartburn during Pregnancy: - Burning feeling. - Sense of pressure in chest. - Burping. - Sour taste in the mouth. - Chronic cough. - Sore throat. Prevention and Management of Heartburn in Pregnancy: - Life style management. - Food and drink. Life style change to help relief Heartburn: - Avoid tight clothes, tight belts. - Avoid stressful life. - Lose some weight. - Chewing gum can increase the saliva production which neutralizes the acid. - Drink a lot of water after exercise. - Trace what activities make you heart burns and avoid them. - Wait at least 2-3 hours after your meal before sleeping. - Wait at least 2 hours after your meal before exercise. - Avoid smoking because it relaxes the esophageal sphincter and lead to reflux. - Try to raise the pillow and the head of the bed. - Bend with your knees, not your waist Changing your meals to help in relieving Heartburn during Pregnancy: - Limit acidic food like grape fruit, oranges, tomatoes, vinegar. - Limit or even stop eating pepper, chilies and spicy foods. - Avoid greasy food. - Reflux is avoided by decreasing the consummation of chocolate, mint, citrus, tomatoes, pepper, vinegar, mustard, alcohol, caffeine and carbonated drinks. - Reduce the size of the meal - Eat slowly. - Avoid snacks at bed time. - Chamomile tea can prevent heart burn. - Peppermint tea can prevent heart burn, but at the same time can relax the esophagus sphincter and lead to reflux. - Baking soda and water can help but, should be used wisely. Mix of ½ tipper glass of water, but should avoided in pregnancy. - Ginger can help you. - Celery consummation is good for the pregnancy. - Raw almond are very good. - Pickle juice can help you. - Pineapple can help you - Yoghurts consummation is good for the pregnancy. - Milk can temporary buffer and the secretion of the acid, so it is not that great for heart burn. Conclusion: All of the above mentioned food and drinks can benefit some but not everyone, so it is better to trace what triger the heart burn and avoid it.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/heartburn-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Selecting the Sex of the Baby - Sex selection Before Pregnancy - How to get pregnant with a boy or girl - Gender Selection - Choosing the Sex of Your Child   Over decades, the parents were fascinated in determining the sex of their baby according to biological and inherited beliefs, which depend on the human needs. Sometimes a medical situation where there is a disease linked to either the male or female genes. Since the eighties the researches are done in order to determine the gender of the baby, which is determined by the type of chromosome in that particular sperm (X-Chromosome) or (Y-Chromosome). At the same time the oocyte only contains X-Chromosome so when fertilization occurs between an x-sperm and an oocyte, the embryo will be a female (xx), while if a Y sperm meets the oocyte then the embryo will be a male (xy). Greeks were convinced that the (y) sperm is located in the right testis and the x-sperm in the left testis, so Greek men tied their left testis to prevent female’s embryos, but the Indian man held his left testis tightly during intercourse for the same reason. At the same period of time, French men underwent left orchiectomy in order to prevent female embryos production entirely. There were some beliefs that when a fat man marries a thin woman they would produce only females and vice versa. There were also some who believed that if they eat spices, meats or salted fish and testis of animals they were to produce male babies, while others thought that if they had the intercourse during the conjugal day they were to produce male, while during individual days they would produce females. Here are some methods that can be used to increase the chance of having a male baby.   Following certain Diet to Select the Sex of the Baby Rajan S. Joshi researches proved that the female diet affects the gender of the baby and this occurs due to its effect on the sperm receptors in the oocyte wall and via these receptors the sperm penetrates this wall and fertilization occurs. The balance between sodium and potassium versus calcium and magnesium affects these receptors, which change the wall of the oocyte to favor the attraction of either a male or female sperm. When there is a high sodium and potassium intake, and a low calcium and magnesium in the female’s diet, the oocyte wall will change to attract the (y-sperm) and exclude the (x-sperm) and at the end will produce a male baby. And vice versa, when there is more calcium and magnesium in the blood and a low sodium and potassium that will attract the (x-sperm), and exclude the (y-sperm) and at the end produce a female baby. In order to follow this method, the female should follow a special diet for at least 2 months. How to get pregnant with a girl How to get pregnant with a boy Calcium Magnesium Potassium Sodium -Milk and diary products (cheese, labneh). -bread made from white grain without salts and yeast. -grains like: almond hazelnut, sun flower seeds. -salmon, sardeen, oysters. -vegetables especially lettuce, parsley, coriander, mallow, okra, carrot, garlic, spinach. -chickpeas, halva. -butter without salt. -bran bread.-almond, kazoo, peanuts, peanut butter without salt. -soy beans potato in small amount. -dairy products. Cornflakes, pretzels. -Fruits like banana, apricot, grape fruit, watermelon, nectarines, Orange juice, pears, cherry. -dried fruit. -vegetables like green beans, cornflower, corn, peas, potato, sweet potato, tomatoes. -chicken without its skin especially breast part, turkey. -dried grains like lentis, white beans. -sugar, jelly, popcorn. -margarine. -jam. -rice. -white bread. -meat, fish. -soups. -coffee. -salt -all fruit expect banana, peach, cherry, apricot, cooked tomatoes. -honey, coffee, fish, 125 gm/day. -avoid fried meals, popcorn, sweets, chocolate -you allowed to eat only 2 eggs/week. -avoid brown bread.   Timing intercourse to Select the Sex of the Baby:   This method depends on the molecular Weight of the sperm; researchers found that the y-sperm has a low molecular weight, so it is faster in movement but lives shorter.   On the other hand, the x-sperm has a heavier weight then slower motion, but lives longer.   So, we can calculate the time of ovulation and determine the time of intercourse according to the desired sex. If intercourse occurs 12 hours prior to ovulation, a baby boy is favored but if it occurs several days before ovulation, it will favor a girl.   If you want a better result, you should combine this method with the diet described before, and also you should calculate the time of ovulation precisely, because it differs from one patient to another and from one month to the other in the same person.   Vaginal douches to Select the Sex of the Baby:   An acidic media in the vagina favors the x-sperm, while alkaline media favors the y-sperm. This increases the success rate of having a male baby by 5%, and it is done using vaginal douches that can be bought from the pharmacy.   ‘How can the female follow the diet and maintain timing intercourse with the help of vaginal douches under medical supervision?’   The patient should follow the described diet for at least two months before stimulating the ovary, and before that we should complete these investigations:   1- Sodium and potassium level for those who desire a baby boy. 2- Blood calcium and magnesium level for those who desire a baby girl.   So, if the women want to achieve a pregnancy of a baby boy, she should have intercourse after ovulation immediately, and this is combined with alkaline vaginal douche ½ an hour prior to intercourse. But if she wants a baby girl, then intercourse should occur 24 hours prior to ovulation and this is combined with acidic vaginal douche ½ an hour prior to intercourse.   XY sperm separation and Intrauterine Insemination (IUI) for Sex selection:   This is done after inducing the female’s ovary by medication to increase the number of follicles in order to increase the chances of pregnancy, then the semen is inseminated into the uterus after treatment and separation of the sample is done in the laboratory.   This method is not 100% accurate, so you can be pregnant with the undesired sex.   To increase the chances of pregnancy with the desired sex, the female should receive the appropriate diet; consider timing of ovulation, in addition to the IUI. There are many ways to separate the sperm, some methods depend on the molecular weight of the sperm others on electronic activity, others by passing the sperm through albumin. But all these method are inaccurate.   Cytometry /sperm separation flow for Sex selection:   This method of sperm separation depends on the DNA content of the sperm and it is called Cytometry sperm separation flow. It depends on the fact that x-sperm contains 2.8% more DNA than the y-sperm, and accordingly using flow cytometer instruments, they can separate the x-sperm from the y-sperm, to confirm the separation they use FISH method, which gives the y-sperm the green color and the x-sperm the pink-red color. With this method, they can separate y-sperm with 73% accuracy, x- sperm in 88% accuracy. Usually the semen contains 50% y-sperm and 50% x-sperm, but there are some exceptions. This sample is used for IUI or IVF or ICSI with a success rate reaching 90%. This method is only done in certain centers of the world. Preimplantantion genetic diagnosis for Sex selection:   This method is 99%-100% accurate and before continuing with this method there is several points to consider:   1- The wife’s age. 2- How many children they have and their gender. 3- Medical health of the wife, and the ways of delivery. 4- If the couples can cope with a pregnancy of the undesired sex   This method includes the following steps:   First: Ovulation induction using injections: During this time, the follicle size is measured till it reaches the appropriated size. Second: Pick up of the follicle via the vagina under general anesthesia, and then insemination of the oocyte by the sperm is done under the microscope. (Some people might ask if it’s possible to separate the y-sperm from the x-sperm before doing insemination, in order to increase the number of the desired sex embryos, but researchers found no difference in the result.) Third: Embryos are transferred to the uterus after 3 days in the incubator when they reach the 6-8 cells stage. A cell from each embryo will be taken later on and a chromosomal analysis is conducted to determine the sex of the embryos.     Fourth: The normal embryos having the desired sex are transferred to the uterus, sometimes we can’t transfer any embryos if they were abnormal or of the undesired sex.   Finally: The patient should receive some medication and wait 2 weeks before she does the pregnancy test, this methods success rate is almost 100%, without any risk on the fetus regarding dysmorphology, but it is associated with lower pregnancy rate than other methods of IVF without determining the sex of the baby.   Chinese calendar for Sex selection:   This calendar is one of the first methods used to determine the sex of the baby. It dates back to 700 years ago. Astronomers correlate the age of the fetus and mother age with water, earth, wood, fire, metal. This doesn't depend on any scientific bases, but this method made the chance of having a baby boy 60% (its usually 51%). i.e. there is 9% difference that we can’t ignore. We attached this table below, Age Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 18 G B G B B B B B B B B B 19 B G B G G B B B B B G G 20 G B G B B B B B B G B B 21 B G G G G G G G G G G G 22 G B B G B G G B G G G G 23 B B G B B G B G B B B G 24 B G B B G B B G G G G B 25 G B B G G B G B B B B B 26 B G B G B G B G G G G G 27 G B G B G G B B B B G B 28 B G B G G G B B B B G G 29 G B G G B B B B B G G G 30 B G G G G G G G G G B B 31 B G B G G G G G G G G B 32 B G G G G G G G G G G B 33 G B G B G G G B G G G G 34 B G B G G G G G G G B B 35 B B G B G G G B G G G B 36 G B B G B G G G B B B B 37 B G B B G B G B G B G B 38 G B G B B G B G B G B G 39 B G B B B G G B G B G B 40 G B G B G B B G B G B G 41 B G B G B G B B G B G B 42 G B G B G B G B B G B G 43 B G B G B G B G B B B B 44 B B G B B B G B G B G G 45 G B B G G G B G B G B B Across- month when the child was conceived   On a vertical- age of mother when she will give birth to the child   The success rate of each method is as the following:   Natural intercourse without following any method 51% baby boy, 49% baby girl Method Followed % baby boy Diet + timing intercourse + alkaline douche 70% Intrauterine insemination + diet + Chinese calendar 80% Alkaline vaginal douche 56% Diet + alkaline vaginal douche 65% Chinese calendar 60% IUI only 55% PGD 99 % Natural intercourse without following any method 51%   In some countries, sex selection via PGD is forbidden by the law. Unless it is linked to a disease connected to the sex of the baby.   Some question you may ask:   1- Is sex selection by any previously mentioned method affect the health of the baby? No. 2- Is any method associated with dysmorphology or abortion? No. 3- Is there a grantee for these methods? We can’t grantee these methods except what is previously mentioned success rate. 4- What is the privacy in doing these methods? We grantee 100% privacy. 5- When the mother can know the gender of the baby? At the 12-13 weeks of pregnancy through 4 dimension ultrasound. Chromosomal Sex Determination Video   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/sex-selection-before-pregnancy-how-to-get-pregnant-with-a-boy-or-girl-gender-selection-choosing-the-sex-of-your-child Mon, 08 Mar 2021 05:25:19 AM Gestational Diabetes (Diabetes During Pregnancy)   Definition of Diabetes During Pregnancy: Gestational diabetes is a type of diabetes that starts during pregnancy. When the pregnant woman has diabetes, her body is not able to consume the sugar (glucose) in her blood as well as it should. So the level of glucose in the blood becomes above normal. Gestational diabetes occurs in 4% of pregnant women. It is usually diagnosed in the fifth or sixth month of pregnancy (Between the 24th and 28th weeks). Gestational diabetes occurs because your body is unable to produce enough insulin, the hormone responsible for controlling blood sugar levels.   Generally, Females are cured from gestational diabetes after delivery.     Causes of gestational diabetes: Almost all women have some degree of impaired glucose intolerance during pregnancy due to the hormonal changes that occur during pregnancy. In this case, the level of glucose in the blood may be higher than normal, but not high enough to cause diabetes. During the last phase of the pregnancy (the third trimester), these hormonal changes place pregnant women at risk for gestational diabetes. During pregnancy, increased levels of certain hormones made in the placenta (the organ that connects the baby by the umbilical cord to the uterus) help shifting nutrients from the mother to the growing fetus. The placenta produces hormones to prevent developing low blood sugar. They stop the actions of insulin. Over the course of the pregnancy, these hormones produce impaired glucose intolerance, which increase the level of glucose in the blood. In order to decrease this level, the body makes more insulin to shuttle glucose into cells. Usually the mother's pancreas can produce more insulin (about three times the normal amount) to overcome the effect of the pregnancy hormones on glucose levels. When the pancreas cannot produce enough insulin to do it, the glucose levels will raise and cause gestational diabetes. Risk factors for Diabetes During Pregnancy: being overweight prior to becoming pregnant. Having glucose in the urine. Impaired glucose tolerance or impaired fasting glucose (blood-glucose glucose levels are high, but not high enough to be diabetic.) Family history of diabetes. (If the parents or siblings have diabetes) Previously giving birth to a baby over 9 pounds. Previously giving birth to a stillborn baby. Having gestational diabetes with a previous pregnancy. Increased Amniotic fluid Volume (A condition called polyhydramnios)  The family origin is Chinese, South Asian, African Caribbean, or Middle Eastern.   Many women may develop gestational diabetes without having any risk factors. Symptoms of Diabetes During Pregnancy: Usually, there are no symptoms, but the following may be occurred: Increased thirst Increased urination Weight loss in spite of increased appetite Fatigue Nausea and vomiting Frequent infections, including those of the bladder vagina and skin Blurred vision Note. Although these symptoms are also common later in pregnancy anyway.   Diagnosis of Diabetes During Pregnancy: High-risk females should be screened for gestational diabetes as early as possible during their pregnancies. All other women will be screened between the 24th and 28th week of pregnancy. To screen for gestational diabetes, the pregnant female should take a test known as “Oral Glucose Tolerance Test”. It involves quickly drinking a sweetened liquid, containing 50 g of glucose. The body will absorb the glucose rapidly, causing elevation of blood glucose within 30 to 60 min. One hour after drinking the solution, a blood sample will be taken from the arm to be tested and measures the processing of the glucose in the body. Any level of blood glucose greater than or equal to 140 mg/dl is recognized as abnormal. In that case, another test will be given after fasting for eight hours. High-risk female with a normal screening test result, need to undergo another screening test at weeks 24 and 42 for confirmation of the diagnosis. If the woman has a history of gestational diabetes in a previous pregnancy, she will be given a kit containing blood glucose monitoring devices at the beginning of the pregnancy. If the readings are normal, a gestational diabetes test will be performed between weeks 24 and 28 of pregnancy.   Treatment of Diabetes During Pregnancy: Monitoring is carried out by a team consisting of an obstetrician-gynecologist, an endocrinologist, and a neonatal specialist.   The aims of treatments are to maintain the blood-glucose level within the normal limits during the pregnancy, and ensure the well-being of the fetus. 1- Close monitoring of the mother and fetus should continue throughout the pregnancy. Fetal monitoring to assess the fetal size and well-being may include ultrasound exams and non-stress tests, a very simple and painless test,for both mother and fetus. An electronic fetal monitor (a machine that hears and displays the baby's heartbeat) is placed on the abdomen. When the fetus moves, His heart rate normally increases 15 to 20 beats above its regular rate. Self-monitoring of blood-glucose level allows the women to participate in her care. Monitoring glucose levels in the blood four times per day (before breakfast and two hours after meals, monitoring blood glucose before all meals may also become necessary) the range included: before breakfast: plasma < 105 mg/dl, two hours after meals: plasma < 130 mg/dl 2- Following specific dietary guidelines as instructed by the dietician. The pregnant will be asked to distribute the calories evenly throughout the day. Following these eating tips: Eat three small meals and two or three snacks at the regular time's every day. Try not to skip meals or snacks. Carbohydrates should be 40% - 45% of the total calories with breakfast and the bedtime snack should contain 15 – 30 grams of carbohydrates. If the mother complains of nausea and vomiting, she should eat 1-2 servings of crackers, cereal or pretzels before getting out of bed. Eat small, frequent meals throughout the day and avoid fatty, fried and greasy foods. If she takes insulin and has morning sickness, make sure how to treat hypoglycemia. Choose food high in fiber such as whole-grain breads cereals, pasta, rice, fruits and vegetables. All pregnant women should eat 20 – 35 grams of fiber a day. Fat should be less than 40% of calories with less than 10% consumed being from saturated fats. The pregnant woman should make sure that she is getting enough vitamins and minerals in her daily diet. Drink at least 8 cups or 64 ounces of liquids per day. 3- Regular exercise during pregnancy can improve the posture and decrease some common discomforts such as backache and fatigue. Being fitted during pregnancy is important, mild to moderate exercise at least three times a week. However, every pregnant woman should consult with her doctor before beginning an exercise program. Since both insulin and exercise lower blood glucose, the mother should follow additional exercise to avoid a low blood-glucose reaction: Always carry any kind of sugar with her when exercising such as glucose tablets or hard candy. Eat one serving of fruit or the equivalent of 15 g of carbohydrate for most activities lasting 30 min. If the pregnant woman exercises two hours or more after a meal, you should eat a snack before exercise 4- Monitoring weight gain: The recommend amount of weight gained during pregnancy depends on the pre-pregnancy weight. Typically, gain weight more during the second and third trimester and recommended intakes of calories should increase at that time. 5- If you gain the proper amount of weight during pregnancy by eating a healthy, balanced diet, then it is a good sign that the baby is getting all the nutriments he or she needs and is growing at a healthy rate. 6- It is not necessary to "eat for two" during pregnancy. It's true that pregnant woman needs extra calories from nutrient-rich food to help her baby grow, but she generally needs to consume 200 to 300 more calories than she did before she became pregnant to meet the needs of her growing baby. She must ask the doctor how much weight she should gain during pregnancy. A female of average weight before pregnancy can expect to gain 25 to 35 pounds during pregnancy. She may need to gain more or less weight, depending on what her doctor recommends. 7- In general, the pregnant woman should gain about 24 pounds during first three months of pregnancy and 1 pound a week for the remainder of the pregnancy. The weight will be distributed as follows: Baby 8 pounds Placenta 2-3 pounds Amniotic fluid 2-3 pounds Breast tissue 2-3 pounds Blood supply 4 pounds Fat stores for delivery and breast-feeding 5-9 pounds Uterus increase 2-5 pounds 8- Medical Treatment: Based on the mother's blood glucose monitoring results, the doctor will tell her if she needs to take insulin in the form of injections during pregnancy. Insulin is a hormone which controls blood glucose. If insulin is prescribed for her, she may be taught to perform the insulin injection procedure. As the pregnancy progresses, the placenta will make more pregnancy hormones and larger doses of insulin may be needed to control the mother's blood glucose. The doctor will adjust her insulin dosage based on her blood-glucose level. When using insulin, a "low blood-glucose reaction," or hypoglycemia, can occur if the mother does not eat enough food, skip a meal, do not eat at the right time of day, or if she exercises more than usual. Symptoms of hypoglycemia include: Confusion Dizziness feeling shaky Head aches Sudden hunger sweating Weakness Hypoglycemia is a serious problem that needs to be treated right away. If the pregnant woman thinks that she has a low blood-glucose reaction, she should check her blood glucose. If the blood glucose is less than 60 mg/dl, eat food containing sugar, such as 1/2 cup of orange or apple juice, 1 cup of skim milk, 4-6 pieces of a hard candy (not sugar – free), 1/2 cup regular soft drink; or 1 tbsp of honey, brown sugar or corn syrup. 15 min after eating one of the food listed above, check your blood sugar again. If it is less than 60 mg/db, eat another one of the food choices above. If it is more than 45 min until the next meal, eat a bread and protein source to prevent another reaction. Record all low blood-glucose reactions in the logbook, including the date, time of day the reaction occurred and how she treated it. Complications of Diabetes During Pregnancy: Diabetes in pregnancy affects the developing baby throughout the pregnancy: 1- In early pregnancy, maternal diabetes can result in: Birth defects affect major organs such as the brain and heart. Increased rate of miscarriage. 2- During the 2nd and 3rd trimester: Maternal diabetes can lead to over – nutrition and excess growth of the baby. Having a large baby increases risks during labor and delivery. Large babies often require caesarean deliveries, and if he or she is delivered vaginally, they are at increased risk trauma to their shoulder. 3- After Birth: The baby may have low blood sugar (hypoglycemia) after birth. This is because the baby's pancreas makes extra insulin in response to the mother's high blood-sugar level. Shortly after birth, the baby may continue to make extra insulin even though high level of blood sugar is no longer present. After the pregnancy, the newborn blood-sugar level is measured regularly. Sometimes babies should be given an early feed of a sugar (glucose) solution through a drip (fed directly into a vein) to correct low blood sugar. It is more likely that the newborn baby will develop jaundice (yellowing of the skin and whites of the eyes). This is not serious and usually disappears slowly over a few weeks, without the need for medical intervention. There may be an increased risk of the baby developing type II diabetes or being overweight later in life. There is an increase risk that the baby will be born with congenital problems, such as a heart defect. Sometimes infants can be born with respiratory distress syndrome, in which the baby has problems in breathing because his or her lungs do not mature normally. This usually clears up with time. There is also a slightly higher chance of stillbirth or death as a newborn, but if it is detected and the glucose level was managed. Death is rare. This increases the rate of admission to NICU.   4- Effects on the mother Gestational diabetes is not an immediate threat to the woman's health. Most of those in whom blood sugar levels stay within the normal range, deliver their babies without complications. However, in some cases, it may lead to high blood pressure. Women who got gestational diabetes are more likely to develop gestational diabetes in next pregnancy, and developing type II diabetes later in his or her life. In almost every case, gestational diabetes disappears on its own after delivery, in which the blood-glucose level returns to normal about six weeks after childbirth. To be sure, the doctor may check the mother's blood sugar levels a few times after the birth, and some doctors recommend an oral glucose tolerance test 6-8 weeks after delivery to checks for diabetes. Women who have had gestational diabetes have a 60% increased risk of developing type II diabetes later in life. However, they can reduce the risk of developing type II diabetes by maintaining an ideal body weight, following a healthy diet and exercising When and how does a woman with gestational diabetes give birth?   **Delivery can occur before the 41st week of pregnancy if blood sugar levels are stable. **We may need to deliver the baby between the 37th and 39th weeks if blood sugar levels are not stable. **Delivery may be vaginal or cesarean, depending on the individual case. Blood sugar readings should be monitored during Delivery to prevent severe hypoglycemia in the fetus after birth.   How should a baby be cared for after birth? ** Regularly monitor the newborn's blood sugar levels. ** Breastfeeding is safe and should occur every 2-3 hours to prevent hypoglycemia in the newborn.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/gestational-diabetes-diabetes-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Cerebral Palsy: Causes, Classification and Treatment   Definition of Cerebral Palsy: The Cerebral Palsy is a group of disorders or abnormality in movement, posture or coordination, caused by injury and damage to the motor control centers of the developing brain and can occur during pregnancy, childbirth or after birth up to approximately age of three. According to the degree of the damage and the affected areas, some people are severely disabled while others have minor disruption. Around 2000 babies from all social backgrounds and ethnic groups are diagnosed every year. Cerebral Palsy may cause abnormal brain development for some people and can lead to results such as intellectual disabilities, blurred vision, seizures and many others serious problems.   Causes of Cerebral Palsy: Cerebral Palsy (CP) was identified in 1860 by William Little, an English Surgeon, who referred the cause of the disorder mainly to the possibility of Asphyxia during Birth. In 1897, Sigmund Freud, a Neurologist proved the contrary. He stated that Birth difficulties are only symptoms caused by other effects on the fetal development. The researches, conducted during 1980 by the National Institute of Neurological Disorders (NINDS), submitted that few cases of CP are caused by the lack of Oxygen during Birth. Most people think that CP is caused by difficulties during Labor and Birth, but its actually only less than 10% of CP that is due to Birth Asphyxia. As mentioned before, CP is a condition caused by injury and damage to the motor control centers of the developing brain, and can occur during pregnancy, childbirth or after birth up to about the age of three. Actually, Antenatal Factors causing CP are found in 80% of the affected, including genetic problems… malformations of brain and maternal infections such as rubella or toxoplasmosis. Premature delivery is an important cause for CP, around 40-50% of all children who develop CP were born prematurely. Premature infants are vulnerable due to the incomplete development of their organs, increasing the risk of Hypoxic injury of the Brain. Low birth weight is a risk factor for CP, and premature infants usually have low birth weights < 2 kgs. Multiple Birth infants (Twins, Triplets…) are more likely to be born early or have a low weight at birth than single birth infants. Maternal infections, even infections that are not easily detected, may triple the risk of the child developing CP. Infections cause the release of Cytokines, produced as part of inflammatory response. These chemicals are toxic to the brain.   In brief, CP is a result of the below: Antenatal or Prepartum causes of cerebral palsy: Random mutations in genes controlling brain development. Maternal infections ( toxoplasmosis, chicken pox, German measles….) Infant's infections. Fetal stroke (compromise in blood supply). Exposure to radiation Multiple gestations Breech birth Intrapartum (during labor) causes of cerebral palsy: Premature delivery Birth trauma or asphyxia After birth causes of cerebral palsy hyperbilirubinemia (jaundice). Meningitis. Lead poisoning. Shaken baby syndrome Choking on foreign objects such as toys, food, drowning or poisoning Unfortunately, in many cases doctors can’t give the parents a clear reason why the brain has been injured or failed to develop as it should, and there may be multiple or complex causes. Signs and Symptoms of cerebral palsy: The signs and Symptoms of CP are various and begin to appear directly after Birth. They might affect one limb or one side of the body, as well as the whole body. All types of CP are characterized by irregular muscle tone, reflexes, abnormal motor development and coordination. Variation in muscle tone either too stiff or too floppy Stiffness of the muscles and Hyperreflexia (spasticity) Stiff muscles with normal reflexes ( rigidity) Lack of muscle coordination (ataxia) Tremors or involuntary movements Slow and writhing movements (Athetosis) Preferring to use one side of the body more than the other such as eating with only one hand or dragging a leg while crawling Delays in reaching motor skills milestones, such as sitting up alone or crawling Difficulty in walking, such as walking on toes, scissors like gait with knees or wide gate Excessive drooling or difficulty swallowing, sucking, eating Difficulty with drinking or eating Delays in speech development or speaking Difficulty with precise motions Since the brain damage or injury is not progressive, the symptoms don’t usually worsen with age.   Classification of Cerebral Palsy: A- Spastic : The most common type, occurring in 80% of all cases Characterized by hypertonic muscles Easy to manage by the person affected The spasticity will cause pain and stress from tightness leading to very early onset of arthritis and tendonitis Usually caused by damage of upper motor neuron, corticospinal tract or motor cortex B- Ataxic : Caused by damage of the cerebellum Less common than spastic (10% of cases) Characterized by hypotonic and tremor Motor skills such as typing, writing, or using scissors for cutting might be affected Balance might be affected as well C- Athetoid or Dyskinetic CP: mixed type characterized by both Hypotonia and Hypertonia combined with involuntary motions Trouble holding the body in an upright steady position like sitting or walking, It will take a lot of work and concentration to reach a certain spot using the hands (like scratching the nose or holding a pen The damage of brain in this type of CP is usually pyramidal, extra pyramidal tract or basal ganglia High level of Bilirubin in the blood of new-born babies is an important cause of this type of CP Treatment of Cerebral Palsy: There is no cure for Cerebral Palsy, but treatments and therapies may reduce its impact by providing new ways for communication. The treatment is a lifelong multidimensional process. Children with CP do best when they get special help from an early age. In fact, the brain changes a lot at early ages, the ability to assess the extent of cerebral palsy at first is difficult, but most of the experts advice that babies should be assessed at age 9 to 12 months. The brain up to age of eight years is not concrete in its development, it reorganizes and reroutes many signal paths that may have been affected. The earlier it is treated, the more successful it will be.   The treatments will include:   A- Medical Treatment of Cerebral Palsy It mainly aims to lessen the spasticity of muscles and treat pain. The selection of medication depends on whether the problem affects only certain muscles (isolated) or the whole body (generalized) -Isolated spasticity: Local injection of Botox directly into the muscle (nerve or both) but might cause severe weakness as side effect. -Generalized spasticity: Oral medications such as diazepam, Tizanidine, Baclofen which can be pumped directly to the spinal cord with a tube; the pump is surgically implanted under the skin of the abdomen.   B- Physical Therapy Treatment of cerebral palsy: - Muscle training and exercises can help strength, flexibility, balance motor development and mobility of the muscles.   C- Occupational Therapy Treatment of Cerebral Palsy:- It promotes the child’s independent participation in daily activities and routines at home/school.   D- Speech Therapy Treatment of Cerebral Palsy:- IIt improves the ability to speak clearly or to communicate easily using communication devices.   E- Surgical Treatment of Cerebral Palsy: - It helps loosen the tight muscles release fixed joints. The insertion of Baclofen pump (Baclofen is a muscle relaxant) during the stage while a patient is a young adult, sends bits of baclofen alleviating continuous muscle flexion Straightening abnormal twists of the leg bones, the surgery is called Derotation Osteotomy in which the bone is broken (cut) and then set in the correct alignment. Choosing the muscles mostly affected in their movement and cutting their nerve supply and spasms, procedure called Rhizotomy.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/cerebral-palsy-causes-classification-and-treatment Mon, 08 Mar 2021 05:25:19 AM Cord blood   In 1970, the researchers discovered that umbilical cord blood could supply the same kinds of blood forming (hematopoietic) stem cells as a bone marrow donor. From that time, umbilical cord blood began to be collected and stored   What is cord blood, why it is useful, how it is used ? It's the blood remaining in the umbilical cord and placenta after birth. It contains stem cells used for children and young adult transplants.   What are stem cells? The Stem Cells are capable of developing into the three types of mature blood cells present in our blood (red, white, and platelets) and have a potential to rise to other undefined cell types in our body. However, Stem cells can be used to treat other conditions such as blood and metabolic disease   Why is cord blood useful? Cord Blood is used in the treatment of blood disorders like leukemia, sickle-cell anemia cell anemia, some immune system disorders, and some metabolic disorders like hurler syndrome. Researches showed that blood cord can be used to cure diseases such as Alzheimer's , Parkinson’s and to treat diseases affecting the brain, heart and spine. More than 6000 cord blood transplants between relatives and non-relatives have been done successfully. Stem cells found in cord blood can be used as an alternative to bone marrow transplants to treat blood disease. Stem cells transplants are performed only on child or young adult due to insufficient quantity of stem cells to complete adult transplant. Stem cells from cord blood are naïve so the donors of cord blood stem cells do not need to be the perfect match to create successful transplant. Some researchers are concerned that an affected baby who receives his or her own stem cells may repeat the disease. Cord blood transplant v/s Bone Marrow transplant Less complications in cord blood transplants. Easier to match the stem cell. Cord blood can be frozen and stored for years. Disadvantages of cord blood transplant Insufficient Stem cells quantity from one cord to transplant. The stem cells may contain the same abnormalities that caused the child illness. Procedure of cord blood transplant: After delivery, umbilical cord is clamped on both sides and cut. The blood is collected before the delivery of placenta. Once done, a tube is inserted into the umbilical and the Stem Cells are then separated and stored by cryogenically   What is cord blood banking?   Types of cord blood banks: a. Public cord blood banks: The cord blood is collected from volunteers and then stored in a public bank to be used by anyone, anywhere without any charge. It's an alternative for volunteer bone marrow donor.   b. Private cord blood banks: There is a fee for collection and long-term storage of the stem cells to be used only from a member of the family of the donor. The chance to be used by the same child is rare. The chance to be used by the same child is rare. Cord blood collection may not be advisable if: The baby is premature. If you are delivered by emergency c/s. You or the father has been tested positive as a transmissible infection.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/cord-blood-umbilical-cord-blood-collection Mon, 08 Mar 2021 05:25:19 AM Ectopic Pregnancy: Clinical features, causes, prevention and treatment options   Definition of Ectopic Pregnancy The Ectopic Pregnancy is the implantation of the fertilized egg outside the Uterus where the placenta and fetus are developed. The most common organ of the Ectopic Pregnancy is the fallopian tube, commonly known as tubal pregnancy and represent 95% of cases. Ectopic pregnancy can also rarely occur in the ovary, in the abdomen "abdominal pregnancy" or in the cervix located in in the lower portion of uterus referred to as cervical pregnancy. Ectopic pregnancy occurs in 1-2% of the pregnancies. Ectopic pregnancy is an important cause of maternal mortality in the first trimester.   Symptoms of ectopic pregnancy The symptoms of Ectopic Pregnancy are similar to those that happen in normal early pregnancy like… headache, nausea, vomiting and breast tenderness. Other symptoms may as well occur, such as: Lower abdominal pain, sometimes may be localized to one iliac fossa. Pain is present in 95% of cases Delayed period or irregular menses occur in 75% of cases. Light vaginal bleeding usually just spotting. The vaginal bleeding or brownish discharge is due to shedding of the decidua or "decidual cast" when the pregnancy fails. Causes of Ectopic Pregnancy 50% of women with Ectopic Pregnancies have a medical history of Salpingitis or PID. Thus making PID "pelvic inflammatory disease" one of the important causes. Mostly caused by infection of some organisms as gonorrhoea and tuberculosis (TB), Chlamydia, and other infections, such as appendicitis which increase the incidence of ectopic pregnancy. The ciliated epithelium in the fallopian tube transport the fertilized ovum to the uterus but it can be damaged inflammation increasing the risk of ectopic pregnancy. Previous tubal surgery like tubal sterilization increases the risk of ectopic pregnancy and may reach up to 60%. Also congenital tubal abnormalities, endometriosis and tubal scarring caused by ruptured appendix or by previous pelvic surgery can cause ectopic pregnancy. Contraceptive methods: like using progesterone, oral contraceptives and progesterone bearing IUD . The contraceptive method is effective in preventing pregnancy but in case of pregnancy, the risk of Ectopic Pregnancy is high. The components of Progesterone affect peristaltic movement of tubes and slow down the transport of fertilized egg and results in implantation in the tube. Risk factors for Ectopic Pregnancy Maternal age between 35-40 Previous ectopic pregnancy increase the risk of recurrence by 10-15% Smoking Previous salpingitis resulting in tubal damage. History of infertility Previous pelvic surgery, including sterilization Races other than white IUD (intra–uterine contraceptive device) users Exposure to diethylstilboestrol in utero Complications of Ectopic Pregnancy Rupture ectopic pregnancy with resulting hemorrhage leading to shock. This is the most common complication Infertility: occurs in 10-15% of women with history of ectopic pregnancy. Prevention of Ectopic Pregnancy Ectopic pregnancy cannot be prevented but there are important points that should be considered to decrease the incidence of (PID) which as previously mentioned increases the incidence of ectopic pregnancy. Avoiding multiple sexual partners Using condom during intercourse when one of the partners is infected with (STD) Early diagnosis and adequate treatment for (STD) Early diagnosis and treatment for (PID) Diagnosis of Ectopic Pregnancy Vaginal examination: It may reveal uterine adenexal tenderness. Blood test: to check the level of pregnancy hormone (HCG). If the hormone level is not correlated to the normal levels of that stage of pregnancy, it may be ectopic and should be done every 3 days. Ultrasound: by using transvaginal ultrasound, the physician can detect embryo in the fallopian tube. But in most cases, the embryo dies early in the process and is too small to be detected by the sonographer. By transvaginal ultrasound, we can detect blood clots as well as tissue that remain from the embryo. Such diagnostic strategies have greatly reduced the use of laparoscopy, but this diagnostic surgical procedure is likely to remain the final diagnostic test if interpretation of the test results is uncertain. If the pregnancy test or the level of hormone is above 1000 iu/l, with the absence of intrauterine gestational sac it is more likely that we are facing an ectopic pregnancy. Culdocentesis (historical) this test less commonly performed is used to look for internal bleeding, not useful in detecting an early ectopic pregnancy. Intact tubal pregnancy Treatment of Ectopic Pregnancy Conservative management of Ectopic Pregnancy By monitoring ectopic pregnancy, if its size is small and cannot be detected by vaginal u/s and level of HCG very low. The pregnancy though ectopic can resolve spontaneously with "spontaneous miscarriage through fallopian tube" without any medical or surgical intervention. Medical treatment of Ectopic Pregnancy The success rate of medical treatment is 80-90%. In the absence of infertility history, the subsequent conception rate is 80% and the recurrent ectopic pregnancy rate is 11% This method is safer than surgical treatment. It is used when the embryo is still small and HCG level is not high by using drug (methotrexate) I.M injection and the dose according to BMI and body weight. The drug affects the embryo through blood stream as well as the growth of placental cell. Overtime, The tiny embryo is reabsorbed into your body. The patient needs blood testing for HCG level to make sure that the pregnancy has been terminated. The use of metrotrexate may have the following side effects: Abdominal pain or cramps Nausea And vomiting Diarrhea   Note: During treatment, alcohol should be avoided as well as multivitamins containing folic acid. Some oral intakes can interfere with action of methotrexate. You can take paracetamol only as analgesia. Preferable to use contraceptives pills for 3-6 months after medical treatment with methotrexate. Surgical treatment of Ectopic Pregnancy   Laparoscopic Removal of Ectopic Pregnancy The most common surgical treatment used in stable patients in non-emergency cases. Less invasive and requires minimal hospitalization. After this operation patient need one week to recuperate. Numerous advantages are gained from laproscopic treatment of tubal pregnancy: less time required for surgery, hospital stay at lower costs, with earlier return to activity and improved cosmetic result. Surgical Laparotomy to Remove Ectopic Pregnancy Used when the embryo is too large or when ruptures have already occurred with severe internal bleeding and patient is in shock. After the operation, the patient needs six weeks to recuperate. Surgical methods include removal of product of conception, and the tube may be preserved or may need to be removed depending on the situation.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/ectopic-pregnancy Mon, 08 Mar 2021 05:25:19 AM Contraception - Different Birth Control, Family - planning methods   There are many types of contraception widely used now a days for the purposes of family planning. Every method has its advantages and suits special cases and doesn’t necessarily suits others, and the choice of contraception depends on different needs of the patients like the period of contraception, and also your doctor should decide which method suits your needs more. No method of contraception is completely effective, and failure rates for most reversible methods are strongly influenced by compliance.   Types of contraception:- Mechanical contraception Hormonal contraception Surgical contraception Mechanical method of contraception:- * IUD: It is a device that is designed to be inserted into the uterine cavity. It is available in different shapes and sizes. It could be composed of copper, polyethylene, or sometimes with a hormone component that controls the heavy bleeding in addition to its contraceptive effects (MIRENA IUD). * Rhythm method for contraception: This method can be used for patients with regular cycles only. This is done depending on the exact knowledge of ovulation day and avoiding intercourse during the days before and after ovulation; for example, in a regular period that occurs every 28 days, the exact day of ovulation should be day 14, so intercourse should be avoided four to five days before and after this days. Many methods were found to detect ovulation days; Increase in body temperature by about o.5 C. Change in type of cervical mucous You can easily find ovulation kits these days for ovulation day detection by measuring LH surge. Diaphragm and cup for contraception:- These devices are made of plastic, and take different shapes and sizes and act as a barrier preventing the seminal fluid from entering the cervix. They are placed vaginally before intercourse and are sometimes coated with a spermicidal gel to increase their efficacy. The size should be adjusted by the doctor. Suppositories for contraception:- Spermicidal preparations applied vaginally before intercourse. Male and female condoms:- Male condoms: Devices made of latex lubricated with spermicidal agents designed to cover the erect penis and capable of destroying sperms. Usually incorporated into an inner base, which itself may impair sperm activity, e.g. nonoxynol-9,0. These are available as creams, jellies, foaming tablets, pessaries, and aerosols. Condoms are safe and effective, unless they are perforated during use. Female condom:- Polyurethane sheath with its open end attached to a flexible polyurethane ring. Spermicidal agents may be used with it. It is not a very popular method. Hormonal contraception:- 1- Contraceptive pills The most commonly used contraceptive method worldwide, especially India, China, and South Africa. Ovulation arrest will be induced by the hormones in these pills, thus preventing pregnancy. There are many types of oral contraceptive pills differing in the concentration and type of estrogen and progesterone used. Combined oral contraceptive pills (COC): This type contains estrogen, usually ethinyl estradiol and progesterone. The dose of estrogen varies from 20-50 mg; the low- dose pills, 30-35 mg, are much safer since the cardiovascular risks of the pills are mainly due to estrogen. Combined pills are available as monophasic preparation in which every pill in the packet contains the same dose of steroid and biphasic and triphasic preparation in which the dose of both steroids changes, once or twice during the cycle because this regimen mimics the normal cycle and produces better cycle control. Mode of action of oral contraceptive pills:- The principal mode of action is inhibition of ovulation. Estrogens inhibit pituitary FSH, thus suppressing the development of ovarian follicle while progesterone inhibits the surge of the luteinizing hormone (LH). Advantages of using combined contraceptive pills as contraceptive method :- It regulates menstrual cycles. Bleeding amount gets less Duration of the cycle gets shorter Decreases premenstrual symptoms and dysmenorrhea chances of having benign breast lumps, functional ovarian cyst, endometriosis, acne vulgaris, and possibly pelvic inflammatory disease will be increased. There is substantial evidence that COC protects against ovarian and endometrial cancer. Disadvantages and side effects of oral contraceptive pills:- * Weight gain * Fluid retention * Nausea and vomiting * Cloasma * Mood changes * Breast enlargement and mastalgia * Loss of libido * Tendency to hypercoagulability, risk of DVT (deep-vein thrombosis) and hypertension, and also the risk of myocardial infarction, especially if associated with smoking. Contraindications to using oral contraceptive pills Absolute contraindication to oral contraceptive pills:- Ischemic heart disease Valvular heart disease Arterial thrombosis Venous thrombosis CVA (cerebrovascular accidents) Vascular malformation in the brain Pulmonary hypertension Hyperlipidemia Migraine Active liver disease or tumor Gall stones Porphyria Oestrogen dependent neoplasm Trophoblastic disease Undiagnosed genital tract bleeding Relative contraindication to oral contraceptive pills:- History of arterial and venous disease in the family. Smoking, advanced age, obesity, diabetes mellitus, and migraine are additional risk factors to taking COC. Hyperprolactinaemia, since oestrogen, stimulates the lactotrophes, increasing prolactin secretion. Progestogen- only pills :- This was introduced to avoid the side effects of estrogen. It prevents pregnancy by inhibiting ovulation, changes cervical mucus reducing sperm permeability and transport. It also has an effect on the endometrium that compromises implantation. Indications to Progestogen- only pills:- It is commonly prescribed for women in whom oestrogen is absolutely or relatively contraindicated. Contraindications to Progestogen- only pills:- Absolute Contraindications:- Known or suspected pregnancy because it leads to masculinization of the genitalia of the female fetus. Undiagnosed irregular uterine bleeding Recent history of serious cardiovascular disease. Relative Contraindications:- Severe obesity Breast cancer Molar pregnancy Severe hypertension History of recurrent ovarian cyst Chronic liver conditions Side effects to Progestogen- only pills:- Irregular bleeding, headache, nausea, bloating, breast tenderness, and mood changes. 2. Injectable progestogen:- Long-acting injections of Norethisterone-enanthate (NET-EN) and medroxy progesterone acetate (MPA) is given as intramuscular injection of 150 mg/ 12 weeks. It prevents ovulation. Side effects to Injectable progestogen:- Inappropriate for women wishing short-term contraception because it may take one year to return to normal fertility after cessation of treatment. Weight gain and reduction in bone mineral density (BMD) Prolonged amenorrhea and irregular cycles. Spotting. 3-Progestogen only implants:- Norplant is a long-acting hormonal method of contraception consisting of six flexible capsules releasing a low dose of levenorgestrel 30-35 mg/ 24 hours for 18 months. First local anesthesia is given then. The capsules are inserted subdermally in the inner aspect of the upper arm. Insertion and removal are minor surgical procedures, which require specialized training. It lasts for five years and fertility returns rapidly after removal. Side effects to such a regimen are menstrual disturbances with a very low failure rate. Recently, a new hormonal therapy has been used for males to suppress sperm production. The technique consists of implanting rods that contain the hormones testosterone and progestin into the arm of the man under local anesthesia. They last long and are very effective and easily removed after 12 weeks after insertion. Testosterone acts by turning off the signal from the pituitary gland that stimulates the testis to produce sperms, and progestin acts directly on the testis to decrease sperm production.   Surgical contraception   1. Female sterilization Surgical female sterilization is done by blocking both fallopian tubes by three ways: Laparotomy minilaparatomy laparoscopy Laparotomy: Bilateral salpingectomy or hysterectomy may be preferable when there is a coexistent pathology while the other two ways are preferred because they are more effective and safe. Methods of tubal occlusions:- *Tubal ligation by sutures, whether absorbable or non-absorbable, the ends left free or buried in the broad ligament or uterine cornue. *Using bipolar diathermy for electrocauterisation allows only the tissue held between the jaws of the forceps to be cauterized. *Falope ring: a specially designed applicator is used to place a ring of silicone or rubber over a loop of the tube. This destroys two to three cm of the tube. *Clips: A variety of clips are available: Hulka-clemens clip (stainless steel and polycarbonal and filshie clip) (titanium lined with silicon rubber). In this method, a smaller length of the tube is destroyed as compared to the ring. *Laser: using CO2 laser divides the tube very cleanly but may allow a high incidence of recanalization. *A number of chemical agents have been tested for their ability to occlude the Fallopian tube when installed into the tube either directly or transcervically via the uterus, e.g. 252 mg quinacrine pellet inserted through IUD inserter passed through the cervix. Inflammation and fibrosis will result and can occlude the tubes. However, the safety of using quinacrine in sterilization has not yet been determined, so the surgical method is safer. 2-Male sterilization:- Vasectomy:-surgical occlusion of the vas deferens to prevent the passage of sperm. Methods:- Clips Diathermy injection of sclerosing agents percutaneously or occlusive substances (such as silicone used in China). The success of the procedure is verified by the absence of sperms from two consecutive samples of ejaculate collected at least four weeks apart. Using other contraception must be continued until confirmation of two negative semen results has been achieved, and this is achieved after 16-18 weeks of performing the vasectomy. Points discussed before using any contraceptive method: *Use of COC for curing menstrual symptoms. *Size of the family and possible desire for future pregnancy. *Maternal disease threatening her life. *Sexual life pattern. *Maternal age and risk of side effects. *Reversibility of the method used. *Educational state of couples. *Cost. *Choosing which partner to sterilize. Reversal of sterilization This is required if the sterilization was done at a young age or immediately postpartum or after a therapeutic abortion. A change of partner is the commonest reason for requesting reversal. Reversal of female sterilization involves laparotomy, but may fail. Microsurgical techniques are associated with around 70% success and carry a high risk of ectopic pregnancy. Ovulation should be confirmed and semen analysis done before reversal is undertaken. Reversal of vasectomy is technically feasible in many cases with patency rate 90%, but pregnancy rate reaches only 70%, and may be due to antisperm antibodies. Emergency contraception If you have had unprotected sex (without contraception) or think your method might have failed there are two emergency methods you can use. The emergency hormonal pill – must be taken up to three days (72 hours) after sex. The earlier it is taken after sex the more effective it will be. If you want to use IUD, it must be inserted up to five days after sex, or up to five days after the earliest time you could have released an egg (ovulation).   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/contraception-different-birth-controls Mon, 08 Mar 2021 05:25:19 AM Piles - Hemorrhoids in Pregnancy   Normally there are numerous blood supplies with arteries and veins to the anal and rectal area which has important role in regulating bowel motion, and controlling stool incontinence through protecting anal sphincter from being exposed to high pressure, (15 % of anal closure pressure at rest is contributed by these blood vessels). There are some blood vessels in that area called sinusoids; they differ from arteries and veins, in that they don’t have muscles tissue in their walls. This set of blood vessels with the connective tissue and smooth muscle are called hemorrhoid plexus. Under normal circumstances, these plexuses are not palpable. If there’s an increase in the pressure in anal area or intra-abdominal this would cause them to dilate and become tortuous and eventually be palpable. It is a common problem, it is estimated that half of the population by the age of 50 years, may have one of the symptoms caused by hemorrhoids.   Causes of Piles - Hemorrhoids: The conditions that may lead to increase pressure and dilatation of these vessels (hemorrhoids) include the following: Pregnancy: enlarging uterus causes increase pressure on these veins. Straining caused by chronic constipation. Straining during bowel movement. Prolonged sitting on the toilet. Obesity. Liver cirrhosis liver failure or chronic liver disease. Aging as the supporting connective tissue weaken with age. Lack of exercise. Nutritional factors (low-fiber diet). Increase intra-abdominal pressure caused by ascetic, intra-abdominal mass, prolonged straining or pregnancy. Genetic factor. Rare factor is related to absence of valves in hemorrhoid veins. Prostate hypertrophy in male patient makes them more prone to Piles - Hemorrhoids. Anal intercourse. Types of Piles - Hemorrhoids: There are two types of hemorrhoids according to their anatomical position Internal Piles: Hemorrhoids which are located in the lower rectum above the dentate line they lack pain receptors. External Piles: Hemorrhoids located under the skin around the anus covered by endoderm and skin which are sensitive to pain and temperature. Internal Piles - Hemorrhoids are subdivided into four grades according to the degree of prolapse: Grade 1: No prolapse just prominent dilated and tortuous blood vessels. Grade 2: They become prolapsed with bearing down but spontaneously become reduced. Grade 3: Prolapsed only with bearing down but you need to do manual reduction to be reduced. Grade 4: In this grade Piles - Hemorrhoids become irreducible. Symptoms of Piles - Hemorrhoids: Hemorrhoid symptoms usually depend on their location. The most common sign and symptom of hemorrhoids is painless bleeding either fresh after having bowel movement or streak of blood on toilet paper. Painless bleeding, usually bright red rectal bleeding. Rectal pain: For internal hemorrhoid, as mention before they have pain receptors but if they swell and prolapse they might get strangulated with anal sphincter muscle or if their blood supply is cut off. For external Piles - Hemorrhoids they become painful if thrombosis pain will usually resolve in 2-3 days but the swelling may take few weeks. Peri anal mass: Feeling of a lump at anus which is either a prolapsed internal hemorrhoid or a skin tag from thrombosis or dilated skin over external Piles - Hemorrhoids. Anal itching and irritation when a hemorrhoid protrudes it can collect small amount of mucous and microscopic stool particles that may cause irritation. Mucous discharge. Fecal incontinence Diagnosis of Piles - Hemorrhoids: Diagnosis is usually done by history and simple physical examination visual examination of the anus and surrounding area may diagnose external or prolapsed hemorrhoids. A rectal exam may be performed with rectal examination. The doctor might need to insert a gloved lubricated finger into the rectum trying to feel for masses. He might also use small lighted scope to look inside the anal canal or distal rectum (endoscopy) which is performed as an office procedure that doesn’t need sedation depending on past medical history, medications and stability of the patient treatment may follow with further testing. Things you should pay attention to Rectal bleeding is never normal although most of the time is due to hemorrhoids but other serious conditions might be the cause. If rectal bleeding is associated with marked changes in bowel habit. If passing black tarry stool. If there is associated abdominal pain hemorrhoids doesn’t cause pain in the abdomen. If there is family history of colorectal cancer. If the patient age is above 50 year old. If there is significant blood loss causing anemia. If the patient is taking anticoagulation. Differential Diagnosis of Piles - Hemorrhoids: Rectal polyp. Anal fissure. Fistulae. Abscesses. Rectal varices. Colorectal cancer. Inflammatory bowel diseases. Diverticular disease. Angiodysplasia. Anal warts might be mixed with skin tags resulting from external hemorrhoids. Rectal proplase. Management of Piles - Hemorrhoids: The most important is preventive and conservative management if conservative management failed or complications happened .then surgical intervention should be done. Conservative Management of Hemorrhoids: Add more fiber to daily diet; food containing fiber such as (lettuce, fiber con, Metamucil) will avoid having constipation which intern will lessen the pressure on the rectum and anus. Increase fluid intake at least 8 cups of water. Stool softeners it may help but if hemorrhoids are present liquid stool may cause inflammation and infection of the anus. The above three points help in decreasing the pressure on hemorrhoid ,decrease bleeding inflammation and reduce the irritation from small bits of stool that are trapped around the blood vessels. Exercise is helpful in relieving constipation and decreasing pressure even brisk walking 20-30 minutes a day can help stimulate bowel function. Individuals should be encouraged to have a bowel movement as soon as possible after the urge arises, if it pass, stool can become constipated and straining with a bowel movement may occur . Warm baths, for the buttock and hips can relive itching irritation and spasms of sphincter muscles, 15-20 minutes sitz bath after each bowel movement and two times a day in addition is recommended. Try to avoid sitting for long period of time or may benefit from sitting on air or rubber dount available in most pharmacies. Medication for Piles - Hemorrhoids: Over the counter medication such as topical creams containing local anesthetic to sooth pain. Creams and suppositories containing hydrocortisone are also effective but they shouldn’t be used for more than a week at time because they can cause the skin atrophy. Surgical treatment of Piles - Hemorrhoids: Coagulation by either infrared, laser or bipolar which depend on using heat causing small bleeding eventually hemorrhoid hardens and shrivel; this method has few side effects but high recurrence rate. Sclera therapy: Injecting a chemical solution into the hemorrhoid tissue to shrink it, it has little or no pains but not that effective. Rubber band ligation: the most common used procedure in the united states in which small elastic band is placed around the base of a hemorrhoid to shrink and the surrounding tissue to scare as it heals holding the hemorrhoid in place. It takes 2-4 procedures done 6-8 weeks a part to completely eliminate the hemorrhoid. Complication are rare, it include mild pain or tightness, bleeding and infection. Hemorrhoidectomy : A surgical procedure done under local or general anesthesia where the whole hemorrhoid is removed. Staples: It is the newest surgical technique in which the abnormally lax and expanded hemorrhoidal supporting tissue that has allowed the hemorrhoid to prolapse is removed it is less painful than traditional hemorrhoidectomy and patients usually return earlier to work. Regardless of the surgery sitz baths and dietary suggestion for increase roughage are recommended.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/piles-haemorrhoids-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM Causes of Recurrent Miscarriage - Recurrent Abortion   Causes of Recurrent Miscarriage (Abortion): - 1-Parental chromosome abnormalities causing Recurrent Miscarriage (Abortion): identified in between 3-5% of couples with Recurrent Miscarriage. The most common cause is balanced or reciprocal translocation twice as many females compared with males are identified as carrying structural chromosome abnormality, this is most likely due to structural abnormalities with males associated with infertility.  2-Fetal aneuploidy: - Trisomy or Monosomy is the most common identified chromosome abnormality in human miscarriage; about 30% of miscarriages are trisomy and increase with maternal age.  3- Endocrinopathy causing Recurrent Miscarriage (Abortion): - Luteal phase defect which has women with recurrent miscarriage, the diagnoses of luteal phase defect based on luteal phase progesterone level and endometrial biopsy patient with PCOS associated with higher rate of pregnancy loss. Hormonal responses of the endometrial to be receptive to the embryo.  4- Antiphospholipid syndrome: - it’s the most important treatable cause of recurrent miscarriage. In the first trimester of the pregnancy, the majority of miscarriages accrue, after fetal heart which ascribed to thrombosis of the uteroplacental vasculature using of Aspirin alone as prophylactic agent increase live birth to 40% , when adding heparin with aspirin the rate will increase to 60%.  5-Thrombophilic defects  6- Immune dysfunction which causes of Recurrent Miscarriage ( Abortion ):- (NK) Natural killer cells: The Lymphocytes, part of immune system present in peripheral blood, have more killing ability than uterine natural killing (NK) cells. Embryo has to be receptive to implantation. This needs continuous interaction between embryo and uterus mainly by cytokines which secreted by the immune cells of the uterus. If immune cells don’t respond to the signal from embryo adhesion and implantation will not occur. 7- Structural uterine abnormalities causes of Recurrent Miscarriage ( Abortion ): - The prevalence of uterine abnormalities among women with Recurrent Miscarriage range from (1.8-37.6) %  8- Uterine environment that inhibits embryos from implantation, classified as anatomic, hormonal and immunological: Endometrial polyps: Benign outgrowths of the endometrium in the uterine cavity. Sub mucous fibroids: Benign tumors which protrude from the uterine wall into the uterine cavity. Uterine Synechia: Due to scarring or adhesion in the uterine cavity. 9- Infectious agents causing Recurrent Miscarriage (Abortion)  10- Environmental: - tobacco, alcohol, radiation chemotherapy  11- Psychological causes of Recurrent Miscarriage (Abortion).  12- Idiopathic (Unknown): - 40% of recurrent pregnancy loss   Frequently asked questions:   Why does early miscarriage occur? In most cases, no specific cause can be identified, but the most common cause is believed to be a chromosomal abnormality in the fetus.   Is two miscarriages considered recurrent miscarriage? No.   What does recurrent miscarriage indicate? It indicates a problem with the mother, whether it's blood clots, a uterine problem, or a genetic issue causing a chromosomal abnormality in the fetus. How can I maintain a pregnancy after recurrent miscarriages? Continuous follow-up with your doctor before trying to conceive is essential to determine the cause and avoid future occurrences.   Does recurrent miscarriage affect the uterus? Yes, especially if it was followed by a dilation and curettage (D&C). What are the risks of recurrent miscarriage for the mother? • Weak or damaged uterus, which may delay pregnancy. • Reproductive tract infections and pelvic inflammatory disease. • Psychological problems that may persist for up to 6 months, such as anxiety and depression. In which month is the risk of miscarriage lowest? By the 12th week of pregnancy, the risk of miscarriage decreases to 5%. Can artificial insemination help treat miscarriage? Yes, if there is a genetic problem, coordination with an embryology lab is possible to avoid any chromosomal issues. Can the husband be the cause of recurrent miscarriage? Yes, if there is a chromosomal abnormality. Is it a hereditary disease? No. What factors increase the chances of miscarriage? Age over 30 Uncontrolled health conditions such as diabetes Maternal obesity When is a dilation and curettage (D&C) procedure necessary? - Heavy, persistent bleeding - Signs of infection - If medications are ineffective Is intercourse safe during pregnancy? It's best to avoid it during the first 3 months, especially in cases of recurrent miscarriage. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/causes-of-recurrent-miscarriage Mon, 08 Mar 2021 05:25:19 AM Constipation During Pregnancy   Constipation is the difficulty of deification, and it’s due to irregular bowel movement that result in small amount of hard, and compact stool, and this is different from person to another and from family to another. Roughly speaking constipation can be defined as. An irregular and infrequent evacuation. Difficulty in evacuation. Feeling of incomplete evacuation. Causes of constipation during pregnancy: 40% of pregnant women suffer from constipation, and it’s often due to: Increased level of progesterone hormone that leads to relaxation of smooth muscles of the intestine. Abdominal distention due to pregnant uterus that leads to increased pressure on intestine thus leads to constipation. Other causes of constipation: Unknown causes. Social reasons as: Not eating enough amounts of vegetables and fruits. Life style. Over weight or excessive thinness. Discomfort and inconvenience of draining area (bathroom and toilet). Some medications as: Anti depressants. Drug used to treat psychological disorders and epilepsy. Diuretics. Colon cancer. Diabetes. Hyper calcemia. Intestinal inflammation and irritable bowel syndrome. Tips to avoid constipation: Increase consumption of: Food that sufficiently rich in fiber. Vegetables and fruits. Whole grains. Drink advantage of natural juices, and water. Exercise muscle and sports activities during pregnancy. Laxatives are used in some cases. Prevention of constipation: Adoption of a new healthy life style. Maintaining exercise during pregnancy. Its imperative to defecate when the urge to evacuate arises (don’t ignore that feeling). Consequences of constipation: First: Hemorrhoids that result in: Anal itching. Swelling and pain of anal area. Rectal (anal) bleeding. Second: An accumulation of dried feces in rectum that result in: Swelling of rectum. Insensitivity at rectal area. An inability to control bowel movements. Anal prolapse.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/constipation-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Libido in Pregnancy, best sexual practices and positions during pregnancy   Is having sex during pregnancy safe? Dose the desire, sensation and pleasure fluctuate during pregnancy? What are the most positions for sex during pregnancy? What are the symptoms that require medical attention? In which cases, sex should be avoided during pregnancy? Can making love during pregnancy triggers abortion? What are the best practices to prevent sexual transmitted diseases during pregnancy? Is having sex during pregnancy safe? Sexual relationship plays a very important role in couple life, either before pregnancy or after child birth, generally this sexual relationship is safe for the pregnant and the baby, as the baby is protected by the amniotic fluid, the uterus and the abdominal wall.   Dose the desire, sensation and pleasure fluctuate during pregnancy? Some women experience a decrease in sexual desire, others an increase in sex drive and desire. Some have one advantage sexuality, while other women have little interest in sex during pregnancy. Indeed, the cause of this variation is mainly due to the profound hormonal changes. During the first half, some women suffer from fatigue and nausea with pain in the breast, and the increased need to use the bathroom is felt that significantly reduce sexual desire. However the libido and the sensations are more voluptuous for other women during their pregnancies, because of an increase in vaginal secretions and hyper-vascularization of the genital area thus creating a sexual fulfillment. But throughout pregnancy, and with the increased size of pregnant abdomen it becomes more difficult for both partners to adopt adequate and comfortable position.   Best positions for sex during pregnancy: In fact, any position that ensures the comfort of the women can be adapted, here are some suggestions: The position of Andromache: the man on his back, the woman sits on him just to be more comfortable with less pressure on her abdomen. The position of spoons: woman and man are lying on the side. What are the symptoms that require medical attention? It is quite natural to feel some contractions during and after sex, but if the problem persists for a few minutes, the doctor’s advice becomes mandatory. In case of bleeding during intercourse. Sex during pregnancy should be avoided in following cases: In cases of placenta previa. Pain of preterm delivery. In case of vaginal bleeding. Abdominal pain. Laxity of the cervix. Dilatation of the cervix. Passage of amniotic fluid. A sexually transmitted infection such as: herpes. On medical advice. Can having sex during pregnancy hurt the baby or lead to abortion? In most cases, early miscarriages during the first trimester of pregnancy are mainly caused by chromosomal abnormalities, and it has nothing to do with sex during pregnancy. In addition, the baby is too far from the vaginal area, and is protected, and hardly be hurt.   Prevention of sexually transmitted diseases in pregnancy: It is strongly recommended to stop all sexual contact if the partner has multiple sexual relations during the entire period of pregnancy or at least use a condom.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/sex-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Anemia in pregnancy   Anemia is a condition in which the healthy red blood cells that carry oxygen to the tissue are insufficient to carry out normal activities and is diagnosed when Hb is less than 11g/dl. During pregnancy, the blood volume is increased by 20-30%, and that will cause a mild anemia due to the dilution of blood and this will lead to a decrease in blood Hb down to 11.5g/dl which is considered to be normal during pregnancy. Therefore, the anemia during pregnancy is diagnosed when the Hb is less than 10.5g/dl and after delivery it's diagnosed when the Hb is less than 10 g/dl. Causes of anemia during pregnancy: Physiological anemia: This is caused by the increase in blood volume that will cause dilution of blood due to the decrease in the concentration of red blood cells, and this is normal during pregnancy.   Iron deficiency anemia: It’s the most common cause of anemia during pregnancy. And it is caused if the woman does not have adequate iron stores before she becomes pregnant. The fetus uses her red blood cells to grow and develop.   Vitamin B12 deficiency: Vitamin B12 is important for red blood cell formation and its deficiency will lead to anemia. this is common in vegans (those who don’t eat animal product). To prevent this, adding foods to your diet such as milk, meat, egg, and poultry can prevent vitamin B12 deficiency.   Folic acid deficiency: Folic acid works with iron to help in the growth of cells, and usually is associated with iron deficiency anemia because both iron and folic acid are found in the same types of foods.   Thalassemia: Thalassemia is an autosomal recessive disorder that is caused by missing, or variant genes, that are important in Hb synthesis. This will cause weakening and destruction of red blood cells. Women who are thalassemia carriers may be asymptomatic before pregnancy and may become symptomatic during pregnancy. In these cases, the father should be examined and they should be advised to consider genetic counselling as they may need some prenatal testing to make sure that the baby will not be affected. Chorionic villous sampling that is done usually at 11 weeks, includes removing a tiny piece of placenta for evaluation, and amniocentesis is another method that is done at around 16 weeks of pregnancy by taking some of the fluid from around the baby for evaluation.   Sickle cell anemia: Sickle Cell Anemia is an inherited blood disorder that is characterized by defective hemoglobin that becomes stiff and sticky when they lose oxygen These cells tend to cluster and this will cause blockage of blood vessels and this is what causes pain and the complications of sickle cell anemia. Normally the hemoglobin life span is 120 days while the sickle cell's life span is only 15 days, and they are under risk of being destroyed in the spleen. Risks of sickle cell anemia on pregnant women include: Infections (including urinary tract and lungs) Gall bladder stones Heart failure Risks of sickle cell anemia on fetus: Miscarriage Preterm labor Intrauterine growth restriction Low birth weight Stillbirth Less common causes of anemia in pregnancy Leukemia Hemolytic anemia GI bleeding Symptoms of Anemia: Fatigue Shortness of breath Pale skin, lips, nails, palm of hands. tachycardia Investigations needed to diagnose anemia during pregnancy: Hemoglobin Ferritin ( if it was between 10-50 mcg/l it needs to be followed up and if it was less than 10 mcg/l then it needs treatment). Mean cell volume (MCV), if it is less than 86 this verifies a diagnose of iron deficiency anemia. Hemoglobin electrophoresis Treatment of anemia in pregnancy: This depends on the type of anemia and it includes; Identification of the type of anemia and treat the underlying cause Dietary advice Iron, folic acid and vitamin B12 supplements Complications of anemia in pregnancy: The mortality rate is 3-5 times higher in pregnant women that have anemia than those women who don’t have anemia, and the incidence of still birth is 6 times higher.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/anemia-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM Pregnancy Exercises - Exercises During Pregnancy   In the last weeks of pregnancy some pregnant women feel dizzy when they lie on their back, and that is because of the uterus which compresses on a major blood vessel, inferior vena (IVC) which transports blood from the lower limbs to the heart, all this will cause hypotension, so don't lie on the back and always lie on the side and do the mentioned exercise. You may feel that your knees and pelvis are more lose. You may have muscle cramps but this will disappear later on. Benefit of exercises during pregnancy: They are useful for your circulation and help to protect you from varicose veins. Decrease labour pain and make the uterus contract in the puerperium. they increase the contractions and by that help to push the head downward. Squating help the pregnant female to get rid of constipation, and your baby will be in the proper lie, and they will help in labour. If you can't do it while you are in labour; you can do it while you are pregnant. These exercises may help you to get rid of back pain and will strengthen your muscles. They will prepare your pelvis for the passage of the baby. Normal vaginal delivery video | Caesarean section video Appropriate Position and exercises during pregnancy and before delivery:   A ­ To keep good body shape: This will make you feel comfortable during pregnancy and after delivery, because they will prevent back pain, and will keep your fingers, toes and joint straight and relaxed. 1-Standing position: Lift your head and hold it as if somebody is pulling it upward. Keep your back straight because bended shoulders give you an ugly look. Hold your abdomen while you are trying to pull your abdomen upward and inward, and try to elevate your pelvic bone upward. Bend your knee a little bit. Try to do these exercises in front of a mirror, so that you can see yourself, because bad position will weaken your abdominal muscles, and cause you back pain, so try to shift your weight from one foot to another, or from the toes to the ankles, this will decrease back pain, also avoid high heels because they increase back pain, and try to wear comfortable shoes. 2-Sitting position: While you are at home: You may spend a lot of time sitting on a chair or on the floor. If you are on a chair: Pull your buttock anteriorly, and support your back on the back of the chair. In case you are working on the disk: Pull your buttock backward, till the back of the chair and keep your back straight. If you are sitting on the floor: lying your legs while you are bending your feet towards your body as shown in the picture. 3-Lying down position: As pregnancy progress, your baby will get bigger, your big belly is more annoying, and you may not find a comfortable position. You may feel comfortable, if you lie on your side because this will improve your blood circulation. But if you are lying on your back this will prevent blood from reaching your lower limbs and your baby, and that is because of the pressure made by your uterus on the major blood vessels, so you need to put a pillows in between your legs or under them. 4-How to lift yourself up from the floor: First, use your arms to push against the floor and sit down, then bend your knees and slowly elevate yourself using your knee as a support one after the other. 5-How you pick things up from the floor: Open your legs as far as possible to support your weight, then bend your knees slowly while keeping your back straight, then after picking up things elevate yourself same as before, and for better result, hold something to support you while standing.   B - Exercises before delivery: These exercises is important to strengthen the muscles that have a role during labour, even if you were an active person and exercise daily, this may not be effective to strengthen the abdominal and pelvic muscles which will affect labour. Try not to do heavy duty or exercises, because you will be exhausted. Benefits of exercise before labour: Decrease the stress on the muscles associated with joints and… pregnancy. Decrease back pain. To maintain maternal health and weight. To protect the good condition of pelvic muscles, joints… which become lose during pregnancy because of its hormone. To maintain the effectivity of the abdominal and pelvic muscles. To supply the lower limbs with blood. To decrease daily stresses. To strengthen the abdominal muscles which will support the enlarged uterus. To keep self respect and confidence of the mother, these exercises help the mother to recover rapidly after delivery, and decrease post partum complication. Before you start to does any exercise consult your doctor regarding any problem face you and do not do exercise once you feel tired and exhausted. At the beginning try to exercise 1-2 times daily then increase it to 5 times then up to 10 times, if you feel pain in your muscle or joint decrease the number, exercise in a room with good ventilation and wear comfortable clothes. Swinging of the pelvis pregnancy exercises: 1-Swining of the pelvis while you are lying: Purpose: To maintain the shape of your body. To strengthen the abdominal muscle. To avoid treatment of back pain, this is due to weakness of muscles and their tendons. How to do it: Lie on your back while bending your knees. Take a deep breath while you are bending your abdominal muscles and pelvis while keeping your feet on the floor. Exhale slowly and relax your muscles. Repeat these exercise. 2-Swinging of pelvis while you are on your knees and hands: Purpose: As mentioned previously. How to do it: Support your body and knees while you are putting your hands on the floor, let your arms perpendicular with the shoulders, knees and pelvis, don't relax your back. Hold your abdominal muscles and elevate your back. Lifting your legs straight pregnancy exercises: Purpose: Strengthen your abdominal and legs muscles. To increase the elasticity of the lower back. To increase blood supply to the lower limbs. How to do it: Lie on your back. Bend one knee and elevate the other straightly around 30-45o. Put it down slowly. Change with the other leg. 4-Special pregnancy exercises: Purpose: To strengthen back muscles, and abdominal muscles. How to do it: Lie on the floor with your knees bended. Elevate your hips as shown in the figure. Then return it back and relax. 5-Semisitting pregnancy exercises: Purpose: To strengthen the abdominal muscles. How to do it: lie on your back while bending your knees.. Stetch your arms straightly and upward. Push your head and shoulder anteriorly as shower in the figure. Then return your head and shoulder backward to the ground, rarely parts of abdominal muscles may tear later in pregnancy, so to avoid these complications you need to perform the previously mentioned exercises to strengthen the abdominal wall muscles early in pregnancy. If you notice that your muscles are separate hold your abdomen between your arms. 6-Stretching your muscles pregnancy exercises: Purpose: To strengthen your inner thigh muscles. How to do it: Stretch your limbs apposing each other while you are pulling your feet toward your body. Put your palms on your knees as shown in the figure. Try to push your knees downward to reach the floor. 7-Stretching your calf pregnancy exercises: Purpose: To avoid calf cramps   Method (1): Stand behind a chair stretch your calves and that is by bending your toes upward as in the figure.   Method (2): Sit on the floor or bed and stretch your calves and that is by pulling your toes towards your body, you can do it by yourself, or somebody helps you by holding your feet and pushing your toes towards you, doing this will prevent or decrease muscle cramps.   8-Rotation of your shoulder pregnancy exercises: Purpose: To keep the shape of your body. To increase blood supply to the arms and decrease numbness in the hands and arms. How to do it: You may stand or sit. Do circular movements for the shoulder anteriorly and posteriorly. 9-Stretching your arms pregnancy exercises: Purpose: To decrease GI upset or shortness of breath and this by expanding your chest. To keep the shape of your shoulders and back. How to do it: You may sit or stand. Stretch your arms above your head then stretch one arm above the other. Repeat this exercise alternatively for each arm. 10-Pelvic exercise pregnancy exercises: Purpose: The perineum is composed from multiple layers which support the pelvis. The inner muscles support the urinary bladder, uterus and rectum. The outer layer support the urethra and the cervix, and works as a sphincter for the anus, and by strengthening the pelvic muscles, they may support the enlarged uterus more. To decrease the chances of tearing these muscles and avoid hemorrhoid formation, to control urination post delivery without suffering from incontinence, you need to perform these exercises. How to do it: It is called kegel exercises. Imagine how you feel once you need to stop urination while you are voiding. To contract your anal muscles imagine, that this area is in the basement and imagine that it want to get up through the elevator to the 1st, 2nd and 3th floor as you contract these muscles. Now try to relax these muscles as if we are returning back down the 1st floor. Then repeat these contractions and relaxations again. Pelvic muscles are not strong enough as the arm and thigh muscles so don't overdo these exercises epically after delivery, you may repeat these exercise 20-30 times, you may do these anytime and anywhere and nobody will notice that you are doing these exercises.   Repeat these exercises in order to have a healthy baby, and a grateful labour.   Normal vaginal delivery video | Caesarean section video Other pregnancy exercises you can do Beginning of the exercise: Lie on your back, bend your knees and make the distance between your feet 30cm, your heels are attached to the floor. Support your head and shoulders on pillows; put your arms beside your body on the floor. This exercise is allowed only till the 4th month of pregnancy, after that it is better to avoid performing exercises while you are lying on your back because the enlarged uterus may compress your blood vessels. Contract the perineal muscles as far as you can till you reach 10 seconds there relax them slowly, after the 4th month you should do these exercises while you are sitting or standing repeat this exercise at least 25times/day. Exhale your breath while you are pushing by the uppermost part of your back on the floor, take a deep breath and relax your spine, repeat it 3-4 times you may do it while you are standing and pushing your back against a wall (this could be done after the 4th month of pregnancy). Lie on your left side while your shoulders, buttock and knees straight, put your right hand on the floor anterior to your chest, put your left hand under your head, relax, take a deep breath then exhale it while you are elevating your right leg slowly as far as you can while keeping it stretched, repeat it 10 times on each side. Put your hands and knees on the floor while your back are relaxed straight, keep your head straight with your neck an spine then bend your back up ward like: the hump, and let your head fall down, relax your back slowly and elevate your head back, repeat it 3-4 times, this exercise is good all through pregnancy even during delivery to help to decrease the pressure over the spine. Squatting is so comfortable and try to stretch your arms over your shoulders then upward, and try to stretch each arm alternatively as it you want to reach the ceil above you, repeat it 10 times on each side. This helps you to relax your neck. Squat while your eyes are closed, take a deep breath, turn your head in to half a circle slowly exhale your breath, relax and let your head bend forward, repeat it 4-5 times with turning your head to the opposite side, repeat this exercise 3-4 times daily. Consult your doctor before doing any of these exercises or if any symptoms occur to you due to these exercises.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/pregnancy-exercises Mon, 08 Mar 2021 05:25:19 AM All You Need To Know About Pregnancy After 35   There is a growing trend among women over the past couple of years to put off getting pregnant to their 30’s and 40’s. It could be your drive to excel on the professional front or your will to cherish quality years alone with your partner before a baby enters your lives. You sure have valid reasons to delay pregnancy until both, you and your beau are mentally, emotionally and financially ready to embrace such a huge responsibility. However, when everyone right from your doctor to your mother tells you how hard conceiving after 30’s is, you are burdened with many apprehensions and fears. You worry thinking whether your bundle of joy will ever be able to see the light of the day! Though getting pregnant after 35 does have a fair share of risks, with proper care and a healthy lifestyle, it is surely not impossible. Here is all that you need to know about pregnancy after 35:   The Risks Increased Chances of Delivery Complications – Women who get pregnant after the age of 35 are at a greater risk of experiencing complications during their delivery such as miscarriage and stillbirth which are due to chromosomal abnormalities. Chromosomal abnormalities can also heighten the risk of Down syndrome and multiples. In addition, women who conceive late are more likely to deliver babies prematurely with a low birth weight. This can pose serious health complications for the baby in future. Due to increased susceptibility to conditions like placenta previa, a lot of women pregnant over 35 also have to opt for a C­section. Delay In Conception – A lot of couples in their 30’s and 40’s often complain about a delay in being able to conceive despite all their efforts. This is mainly because the numbers of eggs decrease as women reach their 30's. They also deteriorate in quality. It is not just the female fertility that declines with age. According to a review conducted by The University of Otago, male sperm quality starts to decline between the age of 35­40, thereby increasing the risk of infertility, obstetric complications, and miscarriage. It may also put the baby at the risk of autism, Down syndrome, epilepsy, and schizophrenia. Higher Risk Of Developing Blood Pressure And Diabetes – Another risk associated with pregnancy after 35 is developing health conditions like high blood pressure and gestational diabetes. Gestational diabetes is a type of diabetes in which your body fails to produce enough insulin to absorb the sugar into the bloodstream. This leads to elevated sugar levels which if left uncontrolled can increase the risk of miscarriage, pre­ term birth, and C­section delivery. You may even become susceptible to developing high blood pressure and preeclampsia for the first time during pregnancy. These conditions can hinder fetal growth, lead to preterm labor, as well as a c­section.   The Suggestions A Wholesome Diet – Though we have grown up learning lessons on how a health diet is a prerequisite to a healthy body, we don’t pay heed to what we eat. There are days when all we eat is a sandwich, and then there are days when we gorge on a calorie­laden buffet spread. It is extremely important to follow a strict dietary schedule maintain overall good health. When you are trying to conceive, especially, your diet must comprise of a healthy mix of all food groups that provide the body with essential nutrients. Foods rich in iron (lean meats, green leafy vegetables, nuts, etc.) increase the baby’s birth weight. Iron also reduces the risk of ovulatory infertility and iron deficiency in the unborn fetus. Calcium rich foods like milk, cheese, and leafy greens improve the alkalinity of the reproductive tract, thus increasing sperm activity. Folic acid is another important nutrient that your body needs so as to reduce the risk of neural tube defects in the unborn fetus. Foods such as broccoli, citrus fruits, beans, and avocados have high folic acid content. Other nutrients that are important for you are vitamin D, vitamin E, zinc and vitamin C. You must also consult your doctor and take a prenatal vitamin daily. An Active Lifestyle – Given that the modern day jobs are highly sedentary, chances are that you might hardly be getting any physical activity. Not only does lack of exercise give rise to health problems like obesity, hypertension, and diabetes, but it can also affect your fertility. Make sure to get at least an hour of moderate­intensity physical exercise like walking, swimming, yoga and stretches in a day. In addition to enhancing your fertility, exercising also improves muscle strength, mood, and reduces pregnancy­ related discomforts like nausea and back pain. Also, remember that women who maintain a healthy weight during pregnancy face fewer complications as compared to those who are overweight. Regular Doctor Visits – You must speak to your doctor extensively about your health problems, lifestyle habits, and any other factors that can come in the way of your successful conception and delivery. Once you are pregnant, make sure to visit your doctor regularly for constant monitoring of your health, as well as your baby’s development. Take your doctor’s advice on your dietary choices, exercise regimen, and other factors that could impact your pregnancy. Don’t ignore any signs and symptoms that you are experiencing. An early detection of a problem is much better and more controllable. Avoidance Of Substance Abuse – Though alcohol, tobacco and other types of drugs pose some serious dangers, couples trying to conceive must avoid it all the more. Women smokers increase their risk of infertility and age­related egg depletion. High alcohol consumption during pregnancy can increase the chances of miscarriage. Make sure to steer clear of all illicit drugs that are not just detrimental to your heath, but your baby’s too!   Regardless of why you and your partner postponed your decision of having a baby, make sure that now you make healthy choices to ensure successful conception and good health of both, you, and your baby!   Written by: Aradhana Pandey Author Bio Aradhana is from India. She is a veteran writer on topics concerning parenting, child nutrition, wellness, health and lifestyle. As a regular contributor to popular sites like Huffington Post, Natural news, Elephant journal, Thehealthsite, Naturally Savvy, Curejoy, Aradhana writes to inspire and motivate people to adopt healthy habits and live a stress-free lifestyle.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/pregnancy-after-35 Mon, 08 Mar 2021 05:25:19 AM Pregnancy Video clips https://www.layyous.com/en/pregnancy/pregnancy-video-clips Mon, 08 Mar 2021 05:25:19 AM 7 Most Common Toxins During Pregnancy that Affect your Child’s Health and How To Avoid Them   Constant exposure to the polluted environment puts our health at risk as it increases instances of asthma, different kinds of cancer, reproductive dysfunction, birth defects and many more. The risks increase when you are pregnant since your unborn child is more vulnerable. The effects of toxins feel compelling since they can not only be lasting but also adverse. Major causes of brain and neural defects among children have been traced back to a mother’s exposure to toxins during pregnancy. Here are some toxins you should be wary of and avoid: Tobacco Smoke: Cigarette smoking is not only injurious to your health, it also has a lasting effect on your unborn child. Usually, a smoker’s body is tuned to the cigarette that may act as a trigger to some bodily functions. However, lead, cyanide, nicotine and carbon monoxide among a plethora of other harmful chemicals that are present in tobacco clog your blood vessels. It also affects the umbilical cord that is your baby’s only source of oxygen. Nicotine deposits reduce the circumference of your blood vessels that implies reduced oxygen transport. Also, your red blood cells begin to replace oxygen molecules with carbon monoxide molecules during their transport, thereby completely cutting off supply. Reduced oxygen to the fetus is the major reason for stillbirth, stunted growth, and other birth defects. How To Avoid: You might be a light smoker and assume that a few cigarettes a day as opposed to a whole pack are a healthier choice. You are wrong. You should not smoke while trying to conceive or even during your pregnancy. If you have been smoking for a long time, it is going to be a difficult habit to give up, but you have to find a way to quit. Mercury: Some fish contain a high concentration of mercury like tuna, king mackerel, shark, swordfish, shellfish and tilefish. It enters our food chain from contaminated water. Fishes in mercurycontaminated water absorb the mercury through their gills. Bigger predatory fish contain more mercury concentration as can be understood from their place in the food chain. The mercury passes on into the human body when these predatory fishes are consumed. Doctors ask women to avoid mercurycontaining fish during pregnancy since it can cause neurological damage to the growing baby. Recent research has also linked increased concentration of mercury to Attention Deficit Hyperactivity Disorder (ADHD) in kids. How To Avoid: You can have wild salmon and other river fish over tuna and mackerel. Also, you can have small fish that have reduced concentrations of mercury, if at all. Arsenic: Arsenic is a carcinogen that can be detrimental for your pregnancy. Arsenic is found in the environment in its organic as well as inorganic forms and predominantly affects skin, liver, kidney and lungs. Apple and grape juices, as well as rice and rice products, can contain organic and inorganic arsenic. More often than not arsenic contamination results from naturally occurring arsenic that gets diluted in the water that is used for irrigation. It can also be caused by arsenic contained in pesticides that seeps into the soil and is absorbed by the plants. Arsenic poisoning can lead to neural tube defects as well as death in acute cases. How to Avoid: East fresh fruits and avoid packaged fruit juices. Also, before eating a fruit, rinse it properly or soak it in dilute potassium permanganate solution and then wash it. For rice and other grains, make sure to wash them properly before cooking. If you want to exclude rice from your daily diet, doctors advise mothers to include a diet of whole grains as the replacement. Pesticides: To control pests and infections, most farmers resort to using pesticides. It is easier on their pockets, and is effective. However, it is harmful to us. Pesticides contain chemicals that are carcinogenic, and also adversely affect your pregnancy. You baby might be born prematurely, with stunted growth and reduced weight because of pesticide poisoning. The concentration of pesticides continues to increase as we move up the food chain. It implies that human beings incur maximum concentration of pesticides. Now you know why you must be careful of the food you eat! How To Avoid: Ideally, you can have organically grown food that uses manure and compost as fertilizers instead of chemical fertilizers. Also, organic crops avoid the use of any pesticide. Organic fruits like mangoes, pomegranates, apples and pineapples are also a healthy choice of preservative induced fruit juices. Don’t’ forget to rinse fruits and vegetables properly before consuming. You can also soak them in dilute potassium permanganate solution for some time, and wash them again before consumption. Lead: Lead has been used in paint and toys for a long time until it was banned. The presence of lead in your body can cause neurological damage in the fetus, stunted growth, reduced or delayed development as well as kidney damage. Lead is a heavy metal that does not disintegrate or is flushed from your body which is cause for concern. How To Avoid: Check the product content of the toy you pick up, as well as jewelry for lead. Keep sink and washbasins at home clean and leadfree. Also, check the content of paint before purchasing it. Avoid using hair colors that contain lead as an ingredient. Fluoride: Fluoride is beneficial since it prevents cavities, but its increased concentration is responsible for some health problems. It can lead your teeth enamel to corrode, pits in your teeth enamel, teeth discoloration as well as neurotoxicity. Fluoride is a naturally occurring chemical that is required by our bodies in moderation. Increased concentration of fluoride during your pregnancy can affect your baby’s brain development. It has also been linked to psychiatric disorders among children, as well as increase risks of other birth defects. How To Avoid: Avoid using any fluoridecontaining toothpaste and mouthwash. Also, be careful of the water you drink since fluoride is sometimes externally added to as a public health measure. Find out what is the level of fluoride in your drinking water and consider investing in a water purifier. Bisphenol A And Phthalates: Both bisphenol A (BPA) and phthalates are found in canned food, bottled formula, and plastic containers. They are endocrine disrupters that mimic natural hormones and vary their secretion. BPA and phthalates can lead to the increased secretion of estrogen thereby causing miscarriage. It can also lower the secretion of testosterone in men and affect sperm motility and fertility. How To Avoid: Do not microwave your food in plastic containers since they release BPA into your food. Also, avoid buying canned food or check if they are BPAfree. Avoid using personal care products that have ‘fragrance’ listed in the ingredients since more often than not, they contain phthalates. When you are more cautious, you can avoid exposure to some of the common toxins present in the environment. Reduced exposure to toxins is going to ensure you baby’s health as well as yours. So, increase your awareness of toxins to guarantee a healthy pregnancy. Written by: Aradhana Pandey Author Bio Aradhana is from India. She is a veteran writer on topics concerning parenting, child nutrition, wellness, health and lifestyle. As a regular contributor to popular sites like Huffington Post, Natural news, Elephant journal, Thehealthsite, Naturally Savvy, Curejoy and MomJunction.com, Aradhana writes to inspire and motivate people to adopt healthy habits and live a stress-free lifestyle.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/7-most-common-toxins-during-pregnancy-that-affect-your-childs-health-and-how-to-avoid-them Mon, 08 Mar 2021 05:25:19 AM Anterior Placenta During Pregnancy - Everything You Need to Know   The gift of a child is the most precious thing any parent can ask for. And, when you are blessed with a child, your happiness knows no bounds. You have been blessed, with the most beautiful opportunity to care, to nurture and to raise an individual who makes you proud. However, waiting to hold your baby in your arms can be an unbelievably long wait. And, over the course of nine months, there are going to many ups and downs; morning sickness, regular checkups, and ultrasounds will be part of daily life. And one clinical term that you may hear during this time is an 'anterior placenta.' While, the condition doesn't risk your unborn baby and isn't something to worry about, most women do. What Anterior placenta means is that the placenta inside your womb is positioned on the front wall instead of the back wall. And here are some things to help ascertain if you have an anterior placenta and what you can do:   Normal Position Of The Placenta: The placenta helps the fetus in your womb to latch on to you and maintain constant nutrition. After fertilization, the embryo moves out of the fallopian tube and implants itself into the uterine wall. The placenta develops wherever the embryo embeds itself and ideally has four positions – posterior, anterior, fundal, and lateral. Sometimes, it ends up being on the anterior end of the womb and is known as the anterior placenta. The position of the placenta does not otherwise affect your baby's nutrition or health.   The Symptoms of a Problem: While anterior placenta is no reason to worry, it can induce more pain than a regular pregnancy. Increased uterine contractions, vaginal bleeding, increased abdominal and back pain are typical symptoms of a potential placenta problem. You need to go for a check up in case you experience similar symptoms.   Is There Need For Delivery Variations: Cases of anterior placenta do not call for differences in delivery practices? However, if the anterior placenta has implanted downwards, towards your cervix instead of upwards, there is some cause for concern. The growing placenta can block your baby's passage during delivery, thereby making a c-section necessary. Also, an anterior placenta marked by lower position can sometimes make a c-section tricky since there are chances of excess bleeding. In such cases, your doctor will advise another ultrasound to ascertain where your placenta is and then figure how best to make the incision.   What Is Placenta Praevia: Sometimes, during the initial stages of pregnancy, the placenta can be positioned on the lower part of your uterus. The condition is called placenta praevia. During your pregnancy, the lower part of the uterus expands and eventually the placenta rest in a proper position.   What Is Placenta Accrete: If you have had a C-section earlier, the placenta from your current pregnancy may have started to grow on the site of your old scar. The condition can sometimes cause the placenta to grow into and through the uterine wall and is called placenta accreta. This is a rare condition.   So, if you have been worried about not having felt your baby kick or noticed its heart beat on your ultrasound, the anterior placenta may well be the reason. Remember; there is no need to panic as your baby is fine. Trust your doctor to make the best choice for your child's and your health. In the meanwhile, enjoy the beautiful glow from your pregnancy and the abundant pampering!   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/anterior-placenta-during-pregnancy-everything-you-need-to-know Mon, 08 Mar 2021 05:25:19 AM Why Oral Health Care Becomes All the More Important During Pregnancy?   A recent online research conducted across 12 countries has revealed some of the major misconceptions that people have when it comes to dental care.   For instance, many still believe it's important to brush their teeth immediately after every meal, or rinse their mouth out with water right after brushing.   However, according to FDI World Dental Federation - a person ideally should brush after 30 minutes of eating to avoid any weakening tooth enamel, and delay the rinsing of mouth to allow the fluoride to have longer preventative effects!   This lack of knowledge and bad oral health practices significantly increases the chances of oral disease, pain and discomfort, and being visually unappealing that ends up impacting a person’s self-confidence.   Oral health care is crucial to our overall well-being and better quality of life. It becomes all the more important during pregnancies since the female body undergoes several transient changes, including oral cavity.   A pregnant woman experiencing several psychological and hormonal changes tends to snack more and at odd times during this period, thereby increasing the risk for various oral diseases like - Gingivitis (inflammation or bleeding gums), Pyogenic Granulomas (tumors), Gingival Hyperplasia (enlargement of oral tissues), Dental Caries (decaying of tooth) or even a dry mouth.   Any untreated cavity or gum disease can adversely affect the health of an unborn child and may also lead to serious conditions like premature delivery, intrauterine growth restriction, low birth weight, gestational diabetes or preeclampsia.   As per stats, 80% women suffer from gingival inflammation during the first and second trimesters of pregnancy, while 77.4% of pregnant women with gestational diabetes had ‘Periodontitis’ (inflammatory disease that affects the soft and hard structures supporting the teeth).   This is because the higher concentrations of oestrogen and progesterone during pregnancy induce hyperaemia, oedema and bleeding in periodontal tissues that increases the risk of bacterial infections.   Unfortunately, a considerable amount of women enter pregnancy with unnoticeable or mild oral diseases.   While half of these women ignore the dental care despite being aware of their oral issues, many even fear that the numbing medications would hamper the development of their fetuses. As a result, they end up suffering more since the disease becomes more severe as the pregnancy advances.   Taking precautions at the early stages of pregnancy can minimize any further risk to you and your baby.   It’s very important to know that routine dental examinations, cleanings or treatment can easily be performed during normal pregnancy. So start by getting a dental checkup done as soon as possible.   Pay extra attention to red, swollen or bleeding gums and any loose or sensitive teeth. Check for pus in and around your gums, or any dark spots on your teeth. See if you experience any pain while chewing or if you have bad breath.   Sometimes, morning sickness or nausea during pregnancy may hinder dental hygiene. Women may find it extremely difficult to place anything in their mouth, leave alone brushing or flossing. Also, the rise in stomach acid due to esophageal reflux, vomiting or severe heartburns can also upset the gingival tissue - leading to dental erosion.   While these oral issues are treatable, maintaining oral hygiene at all times will drastically reduce the risk of experiencing the discomfort - associated with these diseases.   Eating a well-balanced and healthy diet; controlling plaque by proper brushing, flossing and using a mouth-wash twice every day; rinsing the mouth with water after vomiting or acidic burps; avoiding sugar or sugary fruit drinks as much as possible and a regular visit to your dentist - are just some of the basic preventative strategies.   Contributed by: Jenny Travens   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/oral-health-care-during-pregnancy-dr-n-layyous Mon, 08 Mar 2021 05:25:19 AM Post Pregnancy Diet   Every mother feels the need for a post pregnancy diet soon after giving birth.   However, it is not right to rush things until 6 weeks after the pregnancy. Give it time before getting into a diet routine. It is simple if you focus, eat right, and be disciplined throughout. There is a lot of conflicting advice on what you should have or shouldn’t while breastfeeding. So instead of trying too hard to understand every detail, remember that it’s the small things that contribute to the post pregnancy diet difference.   Your post pregnancy diet isn’t only about food but other aspects too. To maintain the body and continue to be healthy while losing weight, here are some ways that could benefit. A good plan to follow post pregnancy to shed the extra pounds would be:   Post Pregnancy Measures Exercise Everyday It is essential to have a routine of physical activity included in your daily lives. A walk in the park or an hour at the gym can both be fruitful ways of sweating out the unwanted toxins of the body. Start off small and try to make it better with every passing day. Exercise would also release a rush in the body, that is nothing short of an adrenaline rush.   Yoga or Pilates Yoga is an effective way to combat stress and make you feel comfortable at all times. It not only stresses on the well being of the mind but also gives equal results to the physical stature. Pilates can help in bringing back the body to its toned manner, while shedding weight as well as tightening the skin.   Do Not Skip Any Meal This is the biggest fad about losing weight - to skip meals. Do not ever skip a meal, instead have small portions of meals. Skipping meals confuses the stomach and disrupts the metabolism, causing it to become slower. Eat more number of meals in lesser quantities, as this helps in keeping the metabolism active throughout the day as well as reduce the intake of calories that go into your stomach. Breakfast, being the most important meal of the day cannot be skipped. If eaten regularly, it can help in avoiding being famished and gives energy to survive for the rest of the day.   Indulge In Fruits All Day Portable and nutritious, fruits are a great deal of energy to bank on. Citrus fruits are great for post-pregnancy as they require a great deal of Vitamin C for nourishment. Rather than fatty foods for energy during the day, try to eat as many fruits as possible. Also, try to mostly have fruits that do not increase the heat inside the body and citrus fruits are a big thumbs up in this category.   Increase the Intake Of Milk or Curd The intake of milk and curd needs to maximize post pregnancy for an increase in calcium in the body. This gives a good balance of nutrients to the mother. All diary products should be consumed such as yogurt, curd, milk etc.   Eat Almonds In Snack Period Almonds are a rich source of protein and calcium and enrich the health aspects of a nursing mother. Eating almonds as snacks even during pregnancy enhances the growth of the new born. Avoid deep fried snacks in between and instead opt for almonds. Be sure not to have too many almonds too, limit it to 5-8 per day.   Let Your Meals Flow With Green Vegetables It is no surprise that green vegetables are included here. Green vegetables are a great source of iron, as it helps the body to recuperate. Try to eat every seasonal green vegetable during its season and you will benefit from it. Sprouts are an ideal go-to food for intake on a daily basis.   Avoid Sweet Foods Like the well-learned say, ‘Sugar is white poison’. Try to keep your sugar intake to as minimum as possible. Sweets only satisfy hunger in a way to make you feel more hungry, and the contribution to healthy fats is insignificant. Post pregnancy, it is best to avoid extremely sweet, salty or spicy foods in order to let the body go through a smooth metabolism. So don’t rush into things; take it slow while keeping all the above tips in mind. Your post pregnancy diet will turn out to be better than you expect. Have you tried any other way that made you shed your post-pregnancy weight and regain your original nature in the healthiest manner? If yes, do let us know if it isn’t mentioned already. Keep following us for further updates that help you to stay fit and healthy all day long! Stay beautiful and healthy! Take care.   Author:Bhavya Rebala Author Bio: Bhavya Rebala is a content writer who is formerly into fashion, wellness and life style. She is a writer by day and a reader by night, always ready to share new things.In pass time writes for Fashionlady.in Twitter Handle: https://twitter.com/RebalaBhavya   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/post-pregnancy-diet Mon, 08 Mar 2021 05:25:19 AM Molar pregnancy   A molar pregnancy is an abnormal pregnancy that occurs during the fertilization. It resembles a cluster of grapes Molar pregnancies are categorized as partial moles or complete moles The word mole being used to denote simply a clump of growing tissue Incidence 1/100 to 1/1000 pregnancies and higher rates in Asia than the Western countries   Genetic review Complete moles have 46 chromosomes (diploidy) 85% are 46; XX and 15% are 46, XY, all of paternal origin. Most partial moles have 69 chromosomes (triploidy) 69, XXX; 69, XXY; or 69, XYY, including 23 of maternal origin and 46 of paternal origin   Signs and symptoms An early molar pregnancy may be clinically indistinguishable from a normal pregnancy. Molar pregnancies usually present with vaginal bleeding, abdominal pain, cramps of the lower abdomen The uterus is often large for gestational age. The ovaries may be enlarged with cysts that cause abdominal pain There may also be more vomiting than would be expected (hyperemesis). Sometimes there is an increase in blood pressure along with protein in the urine which may present as early preeclampsia Sometimes symptoms of hyperthyroidism are seen Causes and Risk Factors The cause of this condition is not completely understood. Risk factors may include Defects in the egg Abnormalities within the uterus, Nutritional deficiencies. Diets low in protein, folic acid, and carotene Women under 20 or over 40 years of age have a higher risk Patients with previous history of molar pregnancy Diagnosis Ultrasound examination is used in the diagnosis before evacuation   Partial mole is usually presented as a fetus with large placenta Complete mole presents with a picture of snowstorm or bunch of grapes Definitive diagnosis is made by histological examination of the products of conception Ultrasound findings Complete mole Enlarged uterus May be seen as an intrauterine mass with cystic spaces without any associated fetal parts "Snow storm" or "bunch of grapes," type appearance. Bilateral theca lutein cysts may also be seen on ultrasound Partial mole Usually presents as a fetus with large placenta Cystic spaces within the placenta which may not always be present Coexisting molar with a normal fetus Rarely in the twins’ pregnancy one can be complete mole and the other a normal fetus, usually does this pregnancy end up with preterm labor or preeclampsia. Investigations Urine analysis Thyroid function test BhCG usually highly elevated and is used in diagnosis and follow up Baseline creatinine, electrolytes that may be abnormal after severe vomiting Liver function test Full blood count and cross match Chest x ray Complications of molar Persistent mole or malignant complications are more common with a complete mole than with a partial mole. Degeneration into more invasive and malignant types of gestational trophoblastic disease can occur in about 10-20% of case Thyroid storm Bleeding during evacuation Preeclampsia and eclampsia   Treatment and prognosis Suction and curettage is the treatment of choice, ultrasound is better used during the operation to assure empty uterus Rarely, management of molar is by hysterectomy and it is used in women over 40 years of age. Patient is followed up with Serial beta-hCG levels until it goes back to normal. It is recommended that the women avoids pregnancy for 6 months to 1 year after normalization of BhCG   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/molar-pregnancy Mon, 08 Mar 2021 05:25:19 AM 5 Tasty breakfast recipes that will quash your pregnancy blues detectable cravings every day     Recipes by - https://www.tesco.sg/ Infographic by - https://superfoodsliving.com/   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/5-tasty-breakfast-recipes-that-will-quash-your-pregnancy-blues-detectable-cravings-every-day Mon, 08 Mar 2021 05:25:19 AM Preterm labor   What is preterm labor? Preterm labor is defined as regular contractions of the uterus that leads to change in the cervix that start before 37 weeks of pregnancy. Changes in the cervix include effacement and dilation.   What is preterm birth? When birth occurs between 20 weeks and 37 weeks of pregnancy.   What is premature rupture of membranes? Rupture of membranes (PROM) that occur at term before onset of delivery Preterm PROM if occur less than 37 weeks Prolonged preterm PROM before viability (at < 24 wk) The interval between PROM and onset of spontaneous labor (latent period) and delivery varies inversely with gestational age. At term, more than 90% of women with PROM labor starts within 24 hours At 32 to 34 wk, mean latency period around 4 days. Risk factors, which increase the incidence of preterm labor Infection Smoking or substance abuse during pregnancy History of PROM or preterm delivery in previous pregnancies Polyhydramnios: large volume of amniotic fluid Multiple gestation: being pregnant with two or more fetuses at one time Having had episodes of bleeding anytime during the pregnancy Amniocentesis Cervical incompetence: having a short or prematurely dilated cervix during pregnancy Mechanism of rupture of membranes Intrauterine infection is thought to be one cause of preterm premature rupture of the membranes (PPROM). A prospective study of the vaginal flora in pregnancy shows that the presence of these vaginal floras increases the risk of premature rupture of membranes: Trichomonas virginals Bacteroides sp Ureaplasma urealyticum What are the signs and symptoms of preterm labor? Change in character of vaginal discharge ( watery, mucus, or bloody ) Increase in amount of discharge Pelvic or lower abdominal pressure Constant low, dull backache Abdominal cramps, with or without diarrhea Regular or frequent contractions or uterine tightening Rupture of membranes and leakage of liquor   Diagnosis of premature rupture of membranes History : sudden gush of fluid or continued leakage of fluid Physical exam : check pooling of amniotic fluid Sterile speculum exam: The presence of amniotic fluid pooling in the posterior fornix of the vagina   Dilatation of cervix Nitrazine paper for PH to distinguish amniotic fluid from urine and vaginal secretions. Amniotic fluid is alkaline so color will turn dark blue, vaginal secretions have a pH of 4.5 to 6.0, and urine has a pH of ≤6.0 Using slides looking for ferning   Avoid digital exam unless presence of labor Endocervical samples may be considered for gonorrhea and chlamydia testing if clinically indicated. Group B streptococcus cultures are obtained. Ultrasound : amniotic fluid index Complication of premature rupture of membranes Chorioamnionitis: may occur it is a medical emergency. The mother will complain from fever, foul-smelling vaginal discharge, and abdominal pain. Abruption: premature separation of placenta Cord compression Preterm delivery & its complication Limbs deformity and lung hypoplasia Differential diagnosis of premature rupture of membranes Urinary incontinence. Normal vaginal secretions of pregnancy Increased sweat or moisture around the perineum Increased cervical discharge: this can happen when there is a genital tract infection Semen Douching Vesicovaginal fistula: an abnormal connection between the bladder and the vagina Loss of the mucus plug Management of preterm labor The main goal is to delay delivery as you can without doing risk to mother or fetus. Use tocolytic if no contraindications Corticosteroid Magnesium sulfate In utero transfer to tertiary center Management of premature rupture of membranes Corticosteroid: * Betamethasone 12 mg, 24 hours apart, in 2 doses. * Dexamethasone 6 mg, 12 hours apart, in 4 doses. Antibiotic: Antibiotic therapy has been shown to prolong pregnancy, but the effect on infant morbidity has been inconsistent. Delivery   Fetal age Management Term &late preterm 34-37 weeks Induction of labor Antibiotics  to prevent GBS transmission Preterm 24–33 weeks Expectant management Tocolytics Magnesium sulfate infusion for 24–48 hours as tocolytic and also has neuroprotection Corticosteroids before 34 weeks Antibiotics if needed to prevent GBS transmission Pre-viable < 24 weeks Discussion of expectant or induction of labor No latency antibiotics, corticosteroids, tocolysis, or MgSO4   Tocolytics Tocolytic are medications used to suppress uterine contractions. They also buy time for the administration of corticosteroid to accelerate fetal lung maturity or to allow in utero transfer, but takes one to two days to work. Mother and fetus may require monitoring.   Contraindication to tocolytics Gestational age more than 34 weeks gestation Fetus weighs less than 2500 grams or has intrauterine growth restriction Placental insufficiency Lethal congenital or chromosomal abnormalities Advanced cervical changes , dilatation is greater than 4 centimeters Chorioamnionitis Mother has cardiac disease , pre-eclampsia Fetal distress or fetal death   What is magnesium sulfate? Magnesium sulfate is a medication that may be given at gestational age less than 32 weeks, and are at risk of delivery within the next 24 hours. It has a neuroprotection, reduce the risk of cerebral palsy that is associated with early preterm birth.   What are corticosteroids? Betamethasone and dexamethasone are corticosteroids, that are given before birth to accelerate a preterm fetus's lung development, used when a mother is in preterm labor to prevent respiratory distress syndrome (RDS) and complications of premature birth after delivery. Antenatal steroids can decrease rates of: Breathing problems (respiratory distress syndrome) after birth. Bleeding in the brain (intraventricular hemorrhage). Intestinal infection (necrotizing enterocolitis). Death. Types of corticosteroids? If there is a possibility that you may have preterm delivery two types of Corticosteroids can be given to you to help your baby. Corticosteroids are given by an injection into the muscle. Betamethasone and dexamethasone enhance fetal lungs to produce surfactant, so babies are more able to breathe on their own, or with less treatment with surfactant, after birth. Dexamethasone is recommended over betamethasone based on its efficacy, safety, wide availability, and low cost. Betamethasone, on the other hand, is preferred over dexamethasone due to better prophylaxis against brain softening of premature fetus. Treatment consists of 12 mg of betamethasone 2 doses given 24 hours apart or 6 mg of dexamethasone 4 doses given 12 hours apart. At what stage of pregnancy should corticosteroids be given? A single course of corticosteroids offered to women between 24 and 34 weeks and 6 days of gestation who are at risk of preterm birth. In the case of elective caesarean section between 35 and 38 weeks and 6 days, corticosteroids are recommended, to reduce respiratory morbidity. If delivery does not occur within 7 days of treatment, the injections should not be repeated, as this May cause long-term effects on the growing child.   How long are they effective for? Corticosteroids are most effective if the last dose is given between 24 hours and 1 week before delivery. Corticosteroid can reduce neonatal death within the first 24 hours so can be given within this time.   Side Effects of Corticosteroid Corticosteroid can cause fluid retention and increased blood pressure. But these are short-term and less likely to occur at all during such a short period of treatment. Control of diabetes may be more difficult in pregnant women when corticosteroids are used. Your doctor may recommend a different insulin dose during this time.   Who should be given corticosteroids in pregnancy? Premature labor Premature rupture of membranes Intrauterine growth restriction antepartum hemorrhage Caution should be taken when giving corticosteroid therapy to women with systemic infection tuberculosis or sepsis.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/preterm-labor Mon, 08 Mar 2021 05:25:19 AM Vision changes during pregnancy   Visual acuity problems are common complaints in pregnancy. However, most cases are just related to physiology of pregnancy and do not need serious medical treatment and most symptoms will reverse within several months of delivery. Some cases suggest the presence of underlying diseases including preeclampsia, diabetes, or refractive eye disorders. Doctors should be able to distinguish between the pathologic and normal physiologic changes of visions during pregnancy to avoid unnecessary treatment. The visual acuity alterations during pregnancy, which can start in the first trimester, can be caused by changes in the thickness of cornea, it happens to as much as 15 percent of all pregnant women. Changes in hormones, metabolism, fluid retention, and blood circulation that occur during pregnancy can affect your eyes. If you think your vision has changed significantly, see an eye doctor (ophthalmologist) for the examination. What can you do about blurred vision? pregnancy-safe eye drops. Also known as “artificial tears,” are often safe. Rest. Don't shell out for a new prescription. Wait until after you have had your baby, when your vision should go back to normal. Don't over-correct. How else can pregnancy affect the eyes? Dryness and irritation During pregnancy and breast-feeding, the eyes may be irritated and drier. Visual disturbances from migraines One cause is a condition called migraine headache with aura, which some women experience for the first time during pregnancy , notice as a flashing lights or blind spots Eye disease Some women with an otherwise healthy pregnancy develop an eye disease; fluid builds up under the retina. Layers of the retina then detach and distort vision, creating blind spots and this is called central serous chorioretinopathy This condition due to stress hormones and usually develops in late pregnancy, vision usually returns to normal at the end of your pregnancy or within a few months after delivery. Changes to current eye conditions Pregnancy can improve or worsen eye conditions, with diabetes this condition often worsens during pregnancy. Glaucoma, sometimes improves during pregnancy, so the dose can be decreased.   Concern of vision changes during pregnancy? Some changes in vision can be symptoms of dangerous conditions, such as high blood pressure 25 % of women with severe preeclampsia and 50% of women with eclampsia develop visual symptoms; include blurred vision, blind spots, and inability to focus the eyes, double vision, and flashes of light.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/vision-changes-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM 7 Skin Care Tips to Follow During Pregnancy   Pregnancy marks an important phase in a woman's life when she experiences the rewarding feeling of birth giving. However, this also means that she has to undergo some temporary and permanent changes in her body, both physical and on the mental side. The skin is one such organ which experiences drastic variations during the entire cycle. Changes in metabolic, hormonal, and vascular patterns lead to notable differences in the skin. While the good effects are usually evident in pinkish or red streaks or a sudden glow, ill-effects can be disturbing. Skin issues like pigmentation, spots, acne, broken veins, melasma, dermatitis, and spider angiomas are common. Though most of these conditions aren’t severe but can well aggravate, leading to maternal and fetal complications. What’s important to note is that even the smallest of skin problems can add to pregnancy stress, so nothing should be left ignored. Skin care becomes even more important during this phase. Here are a few simple tips that help - Cleansing and toning is must - Cleanse your face with a gentle pH balanced cleanser at least twice a day. Continual hormonal changes encourage production of excessive sebum that can cause oil-buildup. This leads to clogged pores resulting in acne, cystic acne and spots. It’s a good idea to use a fragrance-free cleanser to avoid nausea. Toning your skin is also important to get an even skin tone. Apple cider vinegar works as a natural toner that is rich in natural enzymes and alpha hydroxy acids. Don’t forget to apply sunscreen when out in the sun - Sunscreen is the holy grail of skincare. Melasma or skin discoloration is usually caused by increased pigmentation which can result in dark splotchy spots to appear on face. These color changes are actually triggered by hormones that increase the production of melanin in the skin. This can be reduced by applying a good sunscreen with at least 30+ SPF whenever you are under direct sun exposure. Opt for a sunscreen that contains zinc oxide or titanium dioxide. It doesn’t penetrate the skin. Also, try covering up bare skin as much as possible to reduce damage from UV rays. Though sun exposure is great in terms of acquiring vitamin D but over-exposure can cause allergies and skin problems like Photodermatitis, Petechiae & others. Instead, resort to foods that are rich source of vitamin D. . Moisturize & hydrate - During pregnancy, skin becomes sensitive. It reacts differently for each woman. It generally has to do with the skin type one has. Skin hydration means restoring the water balance to skin cells. This helps to deal with dryness and heat. A good moisturizing lotion or cream will keep your skin supple and nourished as you advance into pregnancy. Dry and flaky skin can result in itchiness and broken complexion. Moisturize daily with a purifying facial oil to balance natural oils. To manage hypersensitivity, it’s essential to use an emollient while bathing. It will soothe and keep the skin soft. Opt for safer products - What you ingest orally or apply topically, has a direct impact on your health. The baby’s health is equally influenced. One should be cautious in picking beauty and skin products. Your skin type and physical condition can help you to decide what to use and what not. Ensure the ingredients aren’t harsh. The products should be away from harmful chemicals like Parabens, Triclosan and Phthalates. Organic skincare products are a little expensive but most appropriate to use during pregnancy. If budget is limited, one can rely on home remedies. Either ways, consult your doctor once. You can also make use of plant-based or herbal skin care products. They contain natural ingredients, making it a safe and effective remedy for skin ailments. Makeup with care - Women simply cannot live without a make-up! You can do a light makeup during pregnancy to cover up dark under eyes or pigmentation. Avoid cosmetics that contain retinol or salicylic acid. You can substitute it with willow bark which is a natural source of salicylic acid. Opt for a mineral based makeup, that sits on top of skin and hardly causes any irritation. Your makeup should be BPA, parabens and fragrance free. Plant-based ingredients like alfalfa and white tea helps in keeping the skin refreshed and firm. Mild workouts and daily exercise - Skin is affected by other factors too. In fact, a disciplined regimen matters more than sole reliance on body care products. A routine without exercising and yoga would make it all the more challenging to cope with pregnancy jitters. While intense exercise is not recommended during pregnancy, mild workouts can be extremely beneficial for holistic health and skin. A well maintained exercise routine also helps to confront weight issues post-delivery. One should consult with doctor to get right guidance on gentle sports and activities to indulge in. We know pregnancy causes the skin to stretch, resulting in stretch marks. A comprehensive skin care regime into pregnancy will prepare you to handle it easily. As much as it is important to take care of skin during pregnancy, post gestation brings in equal care and hardship. Relax & stay clutter-free - Relaxation is the key. Not just during pregnancy but even otherwise. Those 40 weeks can be really stressful at times. It’s important not to cave in. Add more of organic and probiotic foods in your diet to achieve a glowing skin. Timely eating and a balanced diet with appropriate mix of vitamins and minerals resonates with good health and ultimately flawless skin. Remember to take frequent breaks while completing your daily chores. Therapeutic massages and spa sessions are extremely relaxing and helps to loosen up. 7-9 hours of quality sleep is must. Let go of things that make you anxious or worried. Don’t spend time alone. Stay with friends and family. Avoid negative thoughts. These can be more harmful than chronic diseases.   Final Words - Pregnancy indeed requires you to be a little mindful of things. Be aware of the Do’s & Don’ts, especially if it’s your first experience. Skin issues during this time are usually transient. The skin returns to its original condition a few weeks after the baby is born. It is advised to avoid oral medication and over the counter treatments, unless prescribed by a qualified doctor. Skin care products included. Remember, none of the above tips is effective enough to reinstate that gleam and luster. These are elementary wellness practices that must be followed in concert, if you want to reap optimum salutary benefits. -Jenny Travens Jenny Travens is a creative blog writer who has many passions and interests. Health and wellness is one area where she likes to contribute as much as she can. She often writes for top blogs including Remedy and others. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/7-skin-care-tips-to-follow-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Systemic lupus erythematosus (SLE) In Pregnancy   Systemic lupus erythematosus (SLE) is a chronic inflammatory, autoimmune disease that can affect various organs of the body. Characterized by production of antibodies to components of cell nucleus.   Who’s affected: Young women, peak incidence age 15-40 years with female: male ratio 5:1 African Americans have higher lupus mortality risk compared to Hispanics and Caucasians Causes Of Systemic lupus erythematosus (SLE) Unknown Genetic factors Environmental factors, which may include: Sunlight (UV rays) Stress Viral or other type of infection Drugs There are drugs that cause Drug Induced Lupus Most common : Hydralazine, Procainamide, and Isoniazid Pathogenesis Of Systemic lupus erythematosus (SLE) central immunologic disturbance is autoantibody production Antinuclear antibodies (ANA) found in >95% : anti-SSA (anti-Ro) anti-dsDNA and anti-Sm specific to SLE anti-ssDNA Others: anti-histones (H1, H2A, H2B, H3),anti-U1RNP,anti-SS-B Organs involved 90% joints 80% skin, serous membranes, lungs 67% kidneys, heart 25% CNS, small vessels Risk factors of Systemic lupus erythematosus (SLE) Genetic predisposition (i.e. black race, 25-50% monozygotic twin concordance, 5% dizygotic twin concordance) Postmenopausal hormone replacement therapy increases the risk for developing SLE Smoking increases the risk for SLE and ex-smokers have an increased risk for SLE Diagnosis of Systemic lupus erythematosus (SLE) Diagnosis is clinical Any 4 or more of 11 criteria Malar rash, fixed erythema, flat or raised. Discoid lupus , erythematous raised patches with adherent keratotic scaling . Photosensitivity , skin rash resulting from unusual reaction to sunlight Painless oral or nasopharyngeal ulcers. Non-erosive arthritis , involving 2 or more peripheral joints Serositis , pleuritis or pericarditis Renal involvement include persistent proteinuria or cellular casts Seizures or psychosis without other organic cause Hematologic disorder Hemolytic anemia with reticulocytosis WBC < 4,000 at least 2 times Absolute lymphocyte count < 1,500/mm3 at least 2 times Platelet count < 100,000/mm3 without thrombocytopenic drugs Immunologic disorder Anti-DNA, in abnormal titer Anti-Smith antibody Positive finding of antiphospholipid antibodies based on Abnormal serum level of IgG or IgM anticardiolipin antibodies Positive lupus anticoagulant False positive serologic test for syphilis for at least 6 months Positive ANA of abnormal titer in absence of drugs associated with "drug-induced lupus" Treatment of Systemic lupus erythematosus (SLE) Prompt evaluation of unexplained fever Lifestyle measures Medications guided by specific symptoms Nonsteroidal anti-inflammatory drugs For constitutional symptoms, musculoskeletal symptoms and mild serositis Caution regarding renal toxicity Antimalarials For skin manifestations and for musculoskeletal symptoms unresponsive to NSAIDs Ophthalmologic monitoring recommended every 6-12 months Corticosteroids Topical steroids useful for skin manifestations Systemic steroids may be needed for severe symptoms in any organ system Immunosuppressive agents Used alone or with steroids Particularly effective for renal and CNS symptoms Low-dose methotrexate is effective for arthritis Omega-3 fatty acids may be effective for SLE Based on small randomized trial Omega-3 fatty acid group had significant reductions from baseline in disease activity measures Systemic lupus erythematosus (SLE) in Pregnancy There is no increase in infertility Outcome is best for mother and child when SLE has been controlled for at least 6 months prior to pregnancy Flares during pregnancy occur in 7-33% Pregnancy Complications with Systemic lupus erythematosus (SLE) Preeclampsia Fetal Loss: Women with persistent high titers of antiphospholipid antibodies are at increased risk Women with lupus nephritis have increased risk of fetal loss by 75% Preterm Delivery Low Birth Weight Infant :Infant less than 2500g Deep Vein Thrombosis/Pulmonary Embolism :Risk of DVT and PE increases dramatically with SLEInfant less than 2500g Neonatal Lupus Occurs in about 2% of babies born to mothers with anti-Ro/SSA and or anti-La/SSB antibodies Caused by passage of the antibodies across the placenta to the developing baby after about 20 weeks Signs of neonatal lupus includes skin manifestations red, raised rash on the scalp and around the eyes that resolves by 6-8 months Complete heart block and learning disabilities Risk of neonatal lupus in subsequent pregnancy is 17% Preparing for Pregnancy with Systemic lupus erythematosus (SLE) Discuss desire to have child with rheumatologist and Obstetrical doctor Follow-up with prenatal visits After 28 weeks, visits will be weekly to asses fetal condition (. Biophysical profile and NST) Women with lupus nephritis should delay pregnancy until their disease is inactive for at least 6 months Discuss medication effects Women with SLE may need anticoagulation Used in women with antiphospholipid syndrome Low dose aspirin is safe Increased rates of stillbirth has been shown with aspirin doses greater than 325 mg/day Medications during Pregnancy for Systemic lupus erythematosus (SLE) Drugs to avoid immunosuppressant therapy Mycophenolate mofetil Cyclophosphamide Methotrexate Biologic medications Etanerecpt, infliximab, anakinra Until more data is available, these meds should be avoided Drugs with small risk of harm Aspirin Prednisone/Glucocorticoids Azathioprine NSAIDs Drugs that are probably safe Antimalarials (Hydroxychloroquine) No evidence that antimalarials increases risk of miscarriages or birth defects at normal doses Delivery in cases of Systemic lupus erythematosus (SLE): Will need stress dose during active labor Breastfeeding in cases of Systemic lupus erythematosus (SLE): Is recommended even for women with SLE Birth control in cases of Systemic lupus erythematosus (SLE): IUD is effective OCP can be used but should be avoided in women with the following: Migraine headaches Raynaud Phenomenon Past history DVT Presence of antiphospholipid antibodies Kidney disease and active SLE   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/systemic-lupus-erythematosus-sle-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM 5 Ways To Cope Up With Back Pain During Pregnancy   Pregnancy is a time when you are carrying a life within you. Although it is one of the most important moments for a couple, it comes with certain implications. Due to the bulging of the abdominal area, you tend to carry a lot of weight on your midriff. This not only puts excess stress on the back but can also cause it to suffer from back pain. Over the time as the baby grows during your pregnancy, the pain can even go on to become more severe. Hence, dealing with back pain during pregnancy is a must for the woman. Read on to know the causes and ways to cope with back pain during your pregnancy effectively. Causes of the Back Pain The body of a pregnant woman goes through a gradual gaining of weight. This puts all the pressure on the spine. Besides, other significant reasons include hormonal changes, muscle separation near the pubic bone region and stress. These factors can collectively bring about instability in the back and worsen the pain. Given below are the ways to treat this problem efficaciously.   Light Exercises Although exercising during pregnancy may seem like a tough task, it is actually not, provided you indulge in light exercises. There is an ample number of exercises you can do to strengthen your back and increase resistance during pregnancy. These include walking, stationary cycling, child’s pose, gentle pelvic tilts, and swimming. Not only will these exercises keep your spine well-functioning but will also ensure the buildup of your core. Besides, these shall also facilitate the blood circulation in the affected area of the back. As per a study, doing these exercises will definitely help you in both avoiding the back pain and preventing it from aggravation. Make sure you have a word with your doctor or a physical therapist about the ways to maintain the health of the back effectively.   Right Posture The abdominal area grows bigger as the baby grows, thereby shifting the center of gravity forward. In order to avoid falling ahead, you may tend to bend your back backward to balance the body. This can lead to a severe strain on your back and can perpetuate muscle cramps over time. Thus, it is imperative for you to maintain a good posture throughout the day whenever you can. Key principles of an appropriate posture include the following Keep your shoulders relaxed. Try standing straight as much as possible. Keep a comfortable wide stance when you stand. When you sit, keep the back straight and support the back with a pillow behind the lower back. These tips will prevent you not only from catching back pain but will gradually make your back more resistant.   Hot and Cold Therapy In order to get an instant lower back pain relief, you must try applying cold packs. Take a cloth soaked in cold water or any other cold wrap and apply it on your back for a period of 20 minutes. This can be done around 4 times a day at regular intervals. Performing this simple procedure shall help you lower the inflammation in your back and mitigate the strains by bringing about a reduction in the nerve impulses. After having completed the cold therapy, it is now time to switch to the use of hot wraps. Give a gap of about two to three day between these for the maximum benefits. The heat works wonderfully for the back by inhibiting the pain and invigorating the flow of blood throughout the back. Just keep in mind not apply heat to the abdominal area and ensure yourself a strengthened back.   Adequate Sleep One thing you should not compromise on is sleep. No matter how busy you get or how many occasions you have to go for, sleeping for at least 6-7 hours a day is paramount for optimal health. According to a study, sleep allows you to rejuvenate and ensure the strength of your joints and the back simultaneously during the period of pregnancy. Hence, indulge in a sufficient amount of sleep on a daily basis to not only effectuate cell regeneration and relieve the accumulated stress from the body naturally but also to boost the immune system. Besides focusing on the ample amount of sleep, you should also be mindful of the posture you sleep in. Sleeping on your side with a pillow between the knees and keeping your spine straight while lying down shall go a long way in ensuring your back pain stays at bay.   Eat Pain-relieving Foods Make balanced diet a priority during the pregnancy to ensure the health both of your child and yourself. Besides, there are certain nourishing foods you can inculcate in your diet to keep away the pain from the lower back. Vegetables like kale, broccoli, spinach and spices like turmeric and cinnamon have anti-inflammatory properties and heal the pain internally. Apart from these, spring vegetables and foods such as sweet potatoes, beets, watermelons, and nuts also go a long way toward helping you cope up with the back pain. These foods are known to diminish the inflammation of the back and provide toughness to the spine to endure the weight gain during pregnancy. Thus, eat these foods regularly and observe a positive effect on your back in no time. If your back pain gets severe and lasts for more than a couple of weeks, consult your doctor immediately. However, if your back pain is at a preliminary stage or you tend to avoid it from happening in the future, do keep in mind these tips and imbibe them in your schedule.   This article was contributed by Sara O Brown   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/5-ways-to-cope-up-with-back-pain-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Pregnant women Nutrition   It is well known that the pregnant woman should pay attention to her health by following a balanced diet. We will mention the foods that we recommend to eat at each stage of pregnancy, as well as some tips and advices regarding foods to avoid during pregnancy. It is important that pregnant women follow a balanced diet during pregnancy as this keeps the mother in a healthy weight and in turn enhances the mother's chances of having a healthy child and reduces the risk of postpartum health problems. A balanced diet reduces the risk of anemia and a lack of essential vitamins for maternal and fetal health, which reduces the incidence of congenital malformations. The lack of folic acid available in dark green vegetables has a role in increasing the risk of neural tube malformations. Folic acid should be taken three months before pregnancy and continue after pregnancy. A balanced diet ensures that the fetus gets enough protein, which is the first element in building muscles, hair, nails, bones, brain tissue and blood. And do not forget that it is necessary for the pregnant mother to drink four cups of calcium-fortified milk daily because it has a key role to build bones and teeth. The following are important steps to follow regarding diet during the whole period of pregnancy:   Nutrition of pregnant women in the first trimester of pregnancy: The first months of pregnancy are accompanied by symptoms such as fatigue, anorexia and nausea and you can overcome those by the following: Divide your meals into 4-6 snacks. Drink plenty of liquids, especially water. Eat fresh fruits and vegetables. Eat foods that are easily digested and low in fat. Concentrate on fruits, vegetables, dairy products and milk. Nutrition of pregnant women from the fourth month till the end of pregnancy: During this period, pregnant women regain their appetite, so choose the right food necessary for the growth of the fetus and maintaining the health of the mother. The most important of these foods are meat, chicken, eggs and legumes because they contain protein and have a key role in the formation of the fetus and its muscles and focus on milk and dairy products rich in calcium to form the bones of the fetus and prevent the pregnant woman from osteoporosis. The pregnant mother is advised to focus on whole grain carbohydrates, whole wheat and fiber-rich oats that reduce the constipation during pregnancy.     Folic acid before and during pregnancy What folic acid s and how it helps prevent neural tube defects and other congenital malformations.  The need to take folic acid it for 3 months before pregnancy or as early as possible after a first positive pregnancy test, and for at least the first 12 weeks of pregnancy. a high-dose folic acid supplement is offered to anyone who is planning to become pregnant or is in the first 12 weeks of pregnancy if they have an increased risk of having a baby with a neural tube defect or other congenital malformation(personal or family history of a neural tube defect or other congenital malformation or maternal  diabetes or the mother has a hematological condition that requires folic acid supplementation, such as sickle cell anemia or thalassemia or the mother is taking medicines that can affect how folic acid is absorbed or metabolized (for example, people taking anti-epileptic medicines)). Vitamin D and other vitamin supplements during and after pregnancy: anyone who is pregnant or breastfeeding should take a vitamin D supplement.   during pregnancy pregnants should not take cod liver oil or any supplements containing vitamin A (retinol) pregnants are advised to have Healthy life style physical activity and weight management during pregnancy (intentional weight loss during pregnancy is not recommended because of potential adverse effects on the baby) Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/pregnant-women-nutrition Mon, 08 Mar 2021 05:25:19 AM Corona COVID-19 and Pregnancy   Novel coronavirus (SARS-COV-2) is a new strain of coronavirus causing COVID-19, first started spreading in Wuhan City, China in October 2019. The information we have here is a sum of few observational studies made on few pregnant women in the past few months in additional to experts’ opinions. Transmission in pregnancy COVID-19 can be readily isolated from respiratory secretions, feces and fomites. Pregnant women do not appear more likely to contract the infection than the general population. Pregnancy puts the body’s immune system and the response to viral infections down, also the physiological changes during pregnancy (e.g., diaphragm elevation, increased oxygen consumption, and edema of respiratory tract mucosa) makes them intolerant to hypoxia. That’s why in pregnancy the symptoms of this disease are more severe and pregnant women are more likely to be hospitalized. regarding vertical transmission (transmission from mother to baby during pregnancy or labor), case reports from China have showed no evidence of it. Experts think that the fetus is unlikely to be exposed during pregnancy. A study in china tested amniotic fluid, cord blood, neonatal throat swabs and breastmilk samples from COVID-19 infected mothers and all samples tested negative for the virus. The situation may change and we will continue to monitor outcomes.   Symptoms in pregnancy Most pregnant women diagnosed with COVID-19 had mild to moderate flu-like symptoms. The risks to the mother appear to increase in during the last trimester of pregnancy. Pregnant women with COVID-19 pneumonia showed clinical characteristics similar to that of nonpregnant adult patients with COVID -19 pneumonia. In a study in China on 15 pregnant women, the diagnosis for all with COVID-19 pneumonia, including three patients with underlying diseases, was mild pneumonia without acute respiratory distress syndrome in the whole course of the study, all had good recovery and did not need mechanical ventilation. None of them had a relapse or sudden aggravation of pneumonia symptoms due to childbirth or pregnancy. risk factors that increase the severity of the disease in pregnant women: -Age more than 35 -Body mass index more than 25 -Pre existing medical problems such as diabetes and hypertension -iow vitamin D level Imaging Chest CT showed Ground Glass Opacities, crazy paving pattern, and consolidations in the lower lobes of both lungs.   Fetal/Neonatal Effects No enough data suggesting increased risk of miscarriage, early pregnancy loss, intrauterine fetal infection, or congenital/teratogenic effects on fetus in relation to COVID-19. All COVID-19 infected mothers had healthy babies and with good Apgar scores. Swabs from the neonates were all negative. Delivery did not aggravate the severity of COVID-19 pneumonia.   Royal collage advice for pregnant women during this pandemic: If you are infected with COVID-19 you are still most likely to have no symptoms or a mild illness from which you will make a full recovery. If you develop more severe symptoms or your recovery is delayed, this may be a sign that you are developing a more significant chest infection that requires enhanced care, and our advice remains that if you feel your symptoms are worsening or if you are not getting better you should contact your maternity care team or call 111 straight away for further information and advice. You should pay particular attention to avoiding contact with people who are known to have COVID-19 or those who exhibit possible symptoms. If you have a routine scan or visit due in the coming days, please contact your maternity unit for advice and to agree a plan. You may still need to attend for a visit but the appointment may change due to staffing requirements. https://www.layyous.com/en/pregnancy/corona-virus-and-pregnancy Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/gynaecology/intra-uterine-contraceptive-devices-iud Mon, 08 Mar 2021 05:25:19 AM Placenta previa centralis suspected accreta without hysterectomy (uterine preservation) Placenta previa is known to be one of the challenges in obstetrics, as we have to balance between minimizing blood loss and uterine preservation for future fertility. Another challenge is that it sometimes comes with morbidly adherent placenta which represents a serious condition in terms of diagnosis and surgery. As referral center, we face many similar cases per month and today we are going to talk about one particular case that represents an achievement. A 36 years old lady, in her fifth pregnancy, medically free with previous 4 cesarean sections. Her first presentation to our clinic was at a gestational age of 34 weeks, known to have placenta previa suspected accreta, she was worried about risk of hysterectomy. She was advised to do MRI to confirm diagnosis of accreta, she attended to our clinic for a second opinion. Ultrasound examination revealed: fetus with transverse lie, back anterior, placenta previa centralis, no signs of morbidly adherent placenta by Ultrasound (no increased vascularity in placental bed and no placental vacuolations) She was asymptomatic (no abdominal pain and no vaginal bleeding) Cesarean-Section was booked at 37 weeks of gestation, dexamethazone was given. Laboratory investigations were sent for, HB:9.6, so decision was taken to admit patient one day pre-operation for blood transfusion and preparation for surgery. A day before surgery she was admitted, a total of 6 units Packed RBCs were prepared, she was given 2 units increasing her hemoglobin to 11.6 and 4 units were kept standby. On the day of surgery 4 units were in the OR before starting surgery, uterotonic drugs were prepared. Under general anesthesia, Low transverse abdominal incision was done, intraoperative ultrasound was done for placenta mapping, upper transverse uterine incision was done, baby delivered by breech extraction, placenta was delivered smoothly, 2 defects were detected in the lower uterine segment at the site of previous scars (dehiscence) and both were repaired after bladder mobilization. Estimated blood loss was 4 Liters and the patient received 4 units of Packed RBCs intaopiratively. Patient was discharged 2 days later, HB repeated before discharge 11.3 with complete uterine preservation. Intrauterine fetal death, presentation of thrombophilia It is well known that intrauterine fetal death has many reasons and well-established risk factors, some of these factors are modifiable (smoking, use of certain drugs, obesity), and others are non-modifiable (maternal age, chromosomal translocations), other causes can be dealt with by administration of certain medical treatments that are found to be effective based on clinical trials (like anticoagulation in cases of thrombophilia). Many cases of Intra Uterine Fetal Death remain unexplained and thus management in subsequent pregnancies will be empirical trying to address all possible sinister causes. Let’s talk about another interesting case, 22 years old primigravida presented to our clinic, she was diagnosed during her pregnancy with gestational hypertension (Blood Pressure controlled on methyldopa 250 mg three times daily) with no previous history of surgeries, gestational age upon presentation: 31 weeks, her pregnancy was uncomplicated with no previous hospital admissions. Level 2 Ultrasound examination was done at 20 weeks of gestation and showed growth on the lower limit of normal and bilateral choroid plexus cysts. Cell free fetal DNA testing was done during this pregnancy and also showed the fetus to be chromosomally normal. She presented complaining of decreased fetal movements of 2 weeks duration (in terms of frequency and intensity), her Blood Pressure readings at home ranged between (120/70-140/90). At our clinic her Blood Pressure reading was 180/110 (repeated multiple times, appropriate cuff size), she was symptomatic (complaining of headache). Ultrasound examination: revealed dead fetus, breech, measurements with 28-29 weeks, and no amniotic fluid. Vaginal examination: closed long thick posterior cervix. She was immediately admitted and blood tests/urine analysis were sent. Blood Pressure stabilization was started, she was given a total of 15 mg hydralazine and one-tab nifedipine 30 mg and her BP dropped to 155/93. Laboratory testing showed proteinuria +3, otherwise normal tests. She was given a loading dose of magnesium sulfate (4 g over 15 minutes) and immediately transferred to theatre for delivery via c-section (indication being severe pre-eclampsia and unfavorable cervix). Intraoperatively the fetus was found to be macerated, morphologically normal, thrombosis was noted throughout the umbilical cord and thrombosis was also noted in the placenta and placental bed. Post-operation she was kept on magnesium sulfate for eclampsia prophylaxis for 24 hours and her Blood Pressure was controlled using anti-hypertensive medications. Given the above-mentioned findings: the patient had thrombophilia and will be needing thrombophilia testing and anticoagulation in her subsequent pregnancies (aspirin and Low Molecular Weight Heparin) A rare case of Hydatid cyst in pregnancy A 26 year old PG presented at 5 weeks gestational age as antenatal visit ; on ultrasound intrauterine gestational sac seen with left ovary with around five enlarged follicles , Patient as a foreigner came at gestational age 35 weeks with MRI report of left adnexea with multiple small thin walled cysts largest 7 x6 cm , The fetus was oblique in lie so caesarean planned at 38 weeks Intraop there was a mass in the uterine wall around 7x 6 cm , after the baby was delivered the mass was excised as it was adherent to the bladder anteriorly , the left uterine wall laterally and the vagina caudally reaching the vaginal introitus . After that repair of the uterus , bladder and vagina was done through the pfennestiel incision , the pat is doing well and she was discharged on albendazole 400 mg 1x2 for 28 days https://www.layyous.com/en/pregnancy/interesting-cases Mon, 08 Mar 2021 05:25:19 AM Cats and pregnancy Cat breeding does not cause infertility, but infection with “toxoplasma.” Has many harmful effects. So what is toxoplasmosis? It is a parasitic infection that infects many animals such as cats, cows and cattle. Cats usually do not become infected with this parasite except in two cases: 1. Eating raw meat 2. exposure to feces of infected cats As soon as cats are infected with this parasite, it begins to multiply in their intestines, then the eggs come out in the feces and are transmitted to humans by cleaning their cats and not washing hands after that, so they eat with contaminated hands. Effect of toxoplasmosis on pregnancy This disease affects pregnancy if it is acquired during pregnancy, and its effects include: 1. miscarriages 2. Stillbirths 3. congenital anomalies Symptoms: 1. Flu-like 2. Lymph node enlargement 3. rash 4. blurred vision 5. Spasm and twitching of the limbs Ways to take care of cats to avoid infection: 1. Clean the litter box frequently and wash hands afterwards 2. Do not let cats out of the house 3. Do not give cats raw meat 4. Change the water daily Diagnosis of Toxoplasmosis: There are two types of analyses: 1. IgG analysis: indicates the presence of a previous infection, and this does not affect pregnancy and does not require treatment 2. IgM analysis: indicates the presence of a recent infection and should be treated. It is preferable that we do these tests before marriage to give the appropriate treatment before pregnancy.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/cats-and-pregnancy Mon, 08 Mar 2021 05:25:19 AM Pregnancy and Amniocentesis   There are many problems that might exist in the fetus, which appear in the fetus on ultrasound as a problem in the growth (the measurements are smaller) or structural abnormalities or fluid collection behind fetal neck. There are hereditary / genetic problems that do not give signs on ultrasound and are discovered after birth. The technique of examining the amniotic fluid (amniocentesis) enables us to diagnose many chromosomal/genetic problems in the fetus while it is inside the mother’s womb. Accordingly, the fetus can be treated, the pregnancy terminated, or preparation for postpartum care by providing an NICU bed and pediatric care that the fetus might need according to the case. The test can detect chromosomal abnormalities such as Down syndrome, cystic fibrosis, sickle cell anemia, Tay-Sachs disease, muscular dystrophy, and spina bifida. Drugs.com states that amniocentesis is often recommended for pregnant women over age 35, and for women who have an abnormal “triple screen” blood test during pregnancy. It is also possible to analyze Amniotic fluid to search for possible infections inside the uterus to give the necessary antibiotic treatment before a miscarriage or premature birth occurs. the fluid can also be examined to ensure the maturity of the fetal lung (in cases of premature birth). In cases of rhesus disease, the amniotic fluid is analyzed to estimate the presence of anemia in the fetus and to determine the need for a blood transfusion for the fetus inside the uterus. there are cases of high amniotic fluid pressure inside the uterus that requires withdrawal of the fluid to reduce the pressure (which improves the patient’s breathing and prevents premature birth).   Amniotic fluid examination is a diagnostic test that is performed during pregnancy to obtain a small sample of the amniotic fluid that surrounds the fetus, it is a simple procedure through which we can examine the genetic material (DNA) of the fetus between 15-20 weeks of pregnancy, as follows: ** Under sterile conditions, the abdomen is sterilized, a numbing material is inserted to minimize discomfort, a needle is inserted through the abdominal wall into the uterus under ultrasound guidance, and a sample of the fluid surrounding the fetus (20 ml) is withdrawn. The procedure is under control and direct vision with an ultrasound device, and then the sample is sent to the laboratory where the sample contains cells from the fetus with fetal DNA, and they are studied in search of chromosomal abnormalities or genetic defects, depending on the case, and in some cases to diagnose the presence of infections inside the uterus. The mother can return to her normal life immediately after the examination. Obtaining results may be within 24-48 hours, and it may take a longer period, depending on the technique used.   What are the contraindications for an examination? 1- The presence of a viral infection in the mother (hepatitis C, HIV) for fear of transmitting the infection to the fetus 2- The mother has a tendency to bleed (bleeding diathesis) or is actively bleeding 4- The presence of contractions in the uterus or signs of infection inside the uterus.   What are the possible complications? It is an invasive procedure and carries risks for both the mother and fetus 1- Premature birth 2- Placental abruption 3- Miscarriage (pregnancy loss), The risk of miscarriage is about 1 in 400 to 500 procedures. 4- The occurrence of infections inside the uterus 5- Increasing the proportion of antibodies in cases of rhesus disease 6- Twisting of the limbs of the fetus due to the withdrawal of an excessive amount of fluid Who should do the operation? A person who is properly trained and familiar with the technique and its complications. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/pregnancy-and-amniocentesis Mon, 08 Mar 2021 05:25:19 AM Consanguineous marriage Marriage is the basic for the formation of society, and a healthy marriage protects the family from genetic diseases, and this contributes to a happy and healthy family and giving birth to healthy children. Consanguineous marriage is a union between two individuals who are related as second cousins or closer. Consanguineous marriages are common globally and constitute an estimated 10.4% of all marriages worldwide. However, the prevalence of consanguineous marriages varies widely across countries and regions Consanguineous marriages take place between first cousins and can represent up to 50% of marriages within some communities. The practice of marrying within an extended family has deep cultural and even practical values. Consanguineous unions, particularly if the family is part of a small community or ethnic group, can perpetuate genetic disorders that are rare in the general population A study published on SpringerLink found that consanguineous marriage is associated with increased risk of congenital physical disabilities, as well as behavioral and mental health problems among consanguineous offspring. Furthermore, mental health problems have been highlighted as being prevalent among women involved in consanguineous marriages.   There are many grades of relatives:   • First cousin: He is the direct cousin of one of the parents • Second cousin: He is the son of the cousin of one of the parents • Third Cousin: He is the son of the first cousin of one of the parents or the son of the first cousin. The closer the degree of relationship the more DNA individuals share. Thus, increases the emergence of genetic diseases.   A genetic disease is defined as a disease that results in a change in the DNA sequence. Genetic diseases arise because the spouses carry more similar chromosomes between the sperm and the egg, which leads to chromosomal anomalies and deformities in the embryos   Dominant inheritance and recessive inheritance: Diseases that depend on dominant inheritance occur when there is a problem in one of the two copies of a particular gene, i.e. the father or the mother. Therefore, this is considered sufficient to cause the person to develop the disease. As for cases based on recessive inheritance, it occurs when the problem is found in the two copies of the gene exclusively,  that is, the mother and the father, therefore one mutation is not sufficient to cause the disease. The problem of recessive inheritance is that each of the parents has one copy of the mutated gene so the disease is not apparent to them, but when the two copies meet in the child then he gets the disease despite their parents being normal.   Diseases resulting from consanguineous marriage:   - Increases the percentage of diabetes, hypertension and heart diseases -Increased risk of infant death -Having a mental disability such as Alzheimer's and dementia. - disorders in the digestive system - Sickle cell anemia, which causes red blood cells to break down, leading to infarctions -Exposure to Mediterranean anemia, which leads to difficulty breathing - Exposure to polycystic kidney disease that leads to kidney failure and thus continuous dialysis. -Thalassemia -Infantile Cerebral Palsy -Congenital deafness -Cystic fibrosis -Spinal muscular atrophy -Tay-Sachs disease -Down's syndrome -Multiple sclerosis -Parkinson's disease -Spina bifida. Consanguineous marriage and its relation to pregnancy:   Increases the risk to: - miscarriages -maternal anemia - preeclampsia -Vaginal bleeding - premature birth -increase in the rate of caesarean sections.   Premarital examination: To find out the presence of some hereditary blood diseases and some infectious diseases, in order to give advice  about the possibility of transmission of these diseases to the children, and to give alternatives to the fiancés in order  to help them planning for a healthy family. The premarital medical examination program aims to: • Reduce the spread of some genetic blood diseases (thalassemia - sickle cell disease) and some  infectious diseases (hepatitis B / C). • Avoid the social and psychological problems of families with disabled children. • Reduce the financial burden resulting from the treatment. Therefore, it is advised to avoid consanguineous marriage, in order to avoid the emergence of genetic diseases in children, which may turn the family’s life into a hell of suffering. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/consanguineous-marriage Mon, 08 Mar 2021 05:25:19 AM External cephalic version ECV   Breech presentation occurs in 3-4 % of term deliveries,  It is more common in preterm and nulliparous women. And It is associated with uterine and congenital abnormalities. In many countries planned vaginal breech birth remains rare and attempts to prevent breech presentation remain important External cephalic version is a manual procedure that is used to turn a baby from a breech or side-lying position to a head-down position in the womb in order to enable vaginal delivery . During the procedure, the healthcare provider places their hands on the outside of the belly and attempts to rotate the baby. The baby's heart rate is monitored to check for any problems.   -The success rate of ECV is 50 % ,Success levels are greater for multiparous women (60 %) than for nulliparous women (40%) After successful ECV 3% of babies revert to breech Labor after ECV is associated with a slightly increase risk of cesarean sections and instrumental delivery when compared with spontaneous cephalic presentation due to obstructed labor and fetal distress ECV at term decreases non-cephalic presentation at delivery and decreases the rate of cesarean sections The risk of cesarean section may be greater with a shorter ECV to labor interval   TIMING of ECV In nulliparous women it is offered from 36 weeks In multiparous women from 37 weeks No upper gestational limit for when ECV can be offered Contraindications to ECV: Where an absolute reason for CS already exists Placental abruption Placenta previa Recent vaginal bleeding ( less than 1 week ) Severe PET Abnormal doppler or CTG Twins Rhesus isoimmunization Prelabor rupture of membranes   Complications of ECV Placental abruption Fetal bradycardia Fetomaternal hemorrhage Emergency CS due to abnormal CTG or vaginal bleeding or unexplained abdominal pain Who should perform ECV It should only be performed by a trained practitioner   Predictors for successful ECV Multiparity Non engagement of the breech Palpable fetal head Maternal weight less than 65 kg Posterior placental location Complete breech presentation Amniotic fluid index more than 10  Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist       https://www.layyous.com/en/pregnancy/external-cephalic-version-ecv Mon, 08 Mar 2021 05:25:19 AM Pregnancy after a miscarriage After any miscarriage, the woman waits with a lot of anxiety to get pregnant, meanwhile, a lot of attention and questions are raised about its establishment. It is known that a woman’s fertility is not affected after a miscarriage, but it is adviced to get some rest at least for two months before trying to concieve. Reasons for delayed pregnancy after miscarriage: • remained products of conception • infections • Asherman’s syndrome (inta-uterine adhesions especially after evacuation ) procedures to be done after the miscarriage before trying to get pregnant,: -blood tests -Chromosomal examination -The ultrasound as it will determine if there is a need for an MRI or dye, according to the doctor’s assessment. Post-abortion advice - Take your time to heal physically and mentally, and discuss with your doctor how much time your body needs before becoming pregnant again. -stop smoking -Maintaining BMI < 30 -keep any medical problem as DM , HTN under control  -keep on healthy diet rich in fruits, vegetables, and whole grains,  -Reduce fried and fatty foods. -Reduce caffeine -Taking vitamins and nutritional supplements after consulting a doctor, such as folic acid and pre-pregnancy vitamins Q : When should you see a doctor if pregnancy is delayed after a miscarriage? A miscarriage is considered a new menstrual cycle, and the menstrual cycle should return to normal 4-8 weeks after the miscarriage. If you do not get your period within 8 weeks, you should see your doctor.  If the miscarriage occurs in the first weeks of pregnancy, you can wait one month to re-experience pregnancy, but it is preferable not to become pregnant during the first two months of the miscarriage to overcome the stage of hormonal imbalance. Studies have shown that the risk of spontaneous miscarriage in a future pregnancy is about 20 percent after one miscarriage. Q :What causes BHCG to be falsely high? In some cases, there is a false positive test result, meaning that pregnancy hormone levels are high without the presence of an actual pregnancy, and these cases include: some types of cancer, such as breast cancer or lung cancer. Some medications that contain pregnancy hormones, especially medications to aid in pregnancy and endometriosis Q: How do I know that the uterus is empty after an abortion ? First, from the amount of blood upon leaving the hospital, if there is no bleeding, the uterus is usually clean, but it is preferable to have it checked by a doctor on an ultrasound a week after the bleeding stops. Q: Is delayed pregnancy after miscarriage normal? This is normal, as psychology may affect delayed pregnancy, and after a miscarriage a woman may feel depressed, anxious and stressed, so she must rest, avoid stress and anxiety, and prepare psychologically before trying to get pregnant. Q: When does the cervix close after a miscarriage? Within one to two weeks . Q:What happens if the uterus is not empty after the abortion? Uterine infections.  Heavy bleeding.. Abdominal pain...  Adhesions that may affect pregnancy later. Q: Does the evacuation process after a miscarriage have a role in delayed pregnancy? It generally does not affect future pregnancies, unless complications occur Q:Does retained products of conception appear on the ultrasound? Yes Q:When does the body get rid of the pregnancy hormone after a miscarriage? It remains for a period of 16-60 days, after which its levels decrease and cannot be detected by pregnancy tests, so taking a pregnancy test during this period may give a false positive result. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/pregnancy-after-a-miscarriage Mon, 08 Mar 2021 05:25:19 AM Obesity and pregnancy - Weight gain during pregnancy and after childbirth   Most overweight women c onceive and give birth to healthy babies, but excess weight increases the risk of complications for both mother and child. The higher the body mass index (BMI), the greater the risk. How can risks be reduced?  - Eat a healthy diet, making healthy changes to your eating habits to avoid excessive weight gain during pregnancy.  - Engage in physical activity such as swimming and walking, starting with 15 minutes three times a week and gradually increasing to 30 minutes daily. - Take an appropriate dose of folic acid (5 mg daily), ideally starting one month before conception.   Risks that may increase during pregnancy due to weight gain: - Blood clots (a blood clot in the leg or lung, which can be life-threatening).   - Gestational diabetes (women with a body mass index (BMI) over 30 are three times more likely to develop gestational diabetes than those with a BMI under 25). - Preeclampsia and gestational hypertension (the risk of developing these conditions increases 3 times if the body mass index (BMI) is over 30(especially if the mother is over 40 years old, has had preeclampsia in previous pregnancies, or had high blood pressure before pregnancy).   - Risks to the fetus (early miscarriage, fetal demise, birth of a baby weighing more than 4 kg and subsequent complications).   Therefore, it is recommended to lose weight before planning a pregnancy while keeping the body mass index (BMI) below 30.   The typical weight gain pattern during the nine months of pregnancy is as follows:   • From the first to the third month: Most women do not need to gain any weight, and if weight is gained, it is preferable that it does not exceed 0-2 kg.   • From the fourth to the ninth month: A steady weight gain is very important for fetal growth, at a rate of 1-2 kg/month. It is recommended to follow these guidelines during pregnancy:   • Eat a variety of light meals spread throughout the day, divided into five smaller meals. • Drink plenty of fluids, especially water.   • Eat fresh fruits and vegetables, which promote a feeling of fullness despite being low in calories.   • Reduce your intake of sweets and fried foods as much as possible. • Reduce your intake of fast food, which contributes to weight gain without providing any nutritional value for you or your child.   • Consume proteins essential for cell building, such as all types of meat, eggs, dairy products, and legumes.   • Eat calcium-rich foods like milk, yogurt, and cheese. What is a healthy weight gain rate during pregnancy? If your body mass index (BMI) is between 25 and 29.9, you will need to gain 7 to 11 kg. If your BMI is 30 or higher, you will need to gain 5 to 9 kg.   Is it possible to lose weight during pregnancy? If a pregnant woman decides to lose weight, she should do so in moderation, as this is not the time to try a strict diet or an intense exercise program. It is best to talk to your doctor before starting any exercise program during pregnancy to ensure you are eating healthily and exercising appropriately for your stage of pregnancy.   What is a suitable diet for pregnant women? Avoid fried foods and opt for grilled options instead.   It is recommended to eat thoroughly washed fruits and vegetables.   Avoid starting a weight-loss diet during pregnancy. Reduce your salt intake, as it causes fluid retention, which can lead to high blood pressure.   How can I protect myself from excessive weight gain during pregnancy?   Starting pregnancy at a healthy weight 1. Eat healthy foods during pregnancy 2. Drink enough water 3. Start a simple walking routine 4. Exercise during pregnancy   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/obesity-and-pregnancy-weight-gain-during-pregnancy-and-after-childbirth Mon, 08 Mar 2021 05:25:19 AM Nausea and vomiting during pregnancy or hyperemesis gravidarum Nausea and vomiting during pregnancy or hyperemesis gravidarum (which is the most serious form of the condition): The information here is intended to help you understand better the options for treatment and care. Your health care team is here to help you achieve the Decisions that are right for you. They can help by discussing your condition with you and answering your questions. the main points: **Nausea and vomiting during pregnancy is a common condition that settles after 20 weeks in 9 out of 10 pregnant women. **Hyperemesis gravidarum is a severe form of this condition and can affect up to 3 in 100 pregnant women. **Nausea, vomiting, and hyperemesis gravidarum can affect your mood, your work, your daily life, and your social life. **While most women can be treated at home or as outpatients in hospitals, 1 in 5 affected women may need to be hospitalized for the treatment. **There are many different anti-sickness medications available that may help treat symptoms. While some of these medicines may not be licensed for use during pregnancy, they are considered safe for you and your baby. **What is nausea and vomiting during pregnancy? Nausea and vomiting are common symptoms of pregnancy. It begins early in pregnancy, usually between the fourth and seventh weeks. It settles after 20 weeks in 9 out of 10 women, although it may last longer in some women. It's often called "morning sickness" but it can occur at any time of the day or night. It is believed that the cause are the hormones that are produced during pregnancy in all women. Research suggests that some women experience pregnancy nausea worse than others due to genetic differences, which leads to higher levels of a hormone called GDF-15. GDF-15 is a hormone produced by the placenta that causes loss of appetite and nausea. You are more likely to experience pregnancy nausea if: •You have ever had pregnancy nausea •Pregnant with more than one fetus (twins or triplets) It is important that other causes of vomiting are considered and considered, especially if: •You have pain in your stomach •You have other symptoms such as pain during urination •You suffer from other medical conditions, such as stomach ulcers, gallstones, or •Vomiting begins only after 16 weeks of pregnancy. What is hyperemesis gravidarum? If nausea and vomiting become so severe that it prevents you from doing your daily activities and you are unable to eat and drink normally, this condition is known as hyperemesis gravidarum. This may affect up to 3 in 100 pregnant women. It can cause you to become dehydrated. Signs of dehydration include feeling “dehydrated” or very thirsty, feeling sleepy or sick, or urine changing color from light yellow to dark yellow or brown. Women with this condition may need to be hospitalized. How would that make me feel emotionally? Nausea and vomiting during pregnancy can be a difficult problem to deal with. This can affect your mood, your work, your home situation, and your social life. Support from family and friends can help. In some women, symptoms can be so severe that they become depressed and need additional support such as counselling. If you find that you are feeling down, you should talk to your healthcare professional. Will it hurt my baby? There is no evidence that mild or moderate nausea and vomiting have a harmful effect on your child. Women with severe nausea and vomiting or with hyperemesis gravidarum may give birth to a baby who weighs less than expected. You may be offered scans to monitor your child's growth. If managed properly and in a timely manner it wouldn’t affect fetal growth or increase risk of miscarriage. How can I manage my symptoms? Most women with nausea and vomiting during pregnancy will be able to control their symptoms on their own. You could: Eat small amounts of foods that are high in carbohydrates and low in fat, such as potatoes, rice, and pasta, or foods that are easy to tolerate, such as plain crackers or pretzels. •Avoid any foods or smells that trigger symptoms. ​**drinking ginger or eating ginger candy can be helpful. If your symptoms do not settle or it affects your daily activities, see your GP urgently. They can prescribe anti-sickness medications that are safe during pregnancy. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/nausea-and-vomiting-during-pregnancy-or-hyperemesis-gravidarum Mon, 08 Mar 2021 05:25:19 AM Steroids for fetal lung maturity Steroids injections are one of the most important medical interventions during pregnancy with the aim of reducing complications resulting from premature birth. Complications resulting from premature birth are: **Respiratory distress syndrome in the newborn **Increasing the rate of newborn admission to intensive care (NICU). **Intraventricular hemorrhage ** Inflammation of the newborn's intestine (necrotizing enterocolitis) **Developmental delay compared to peers What are fetal lung maturity injections? These are steroids that are given in certain doses to reduce neonatal complications resulting from premature birth Is there a specific time for giving fetal lung maturity injections? It is given in cases of anticipated premature birth (spontaneous or due to medical reasons) or cases of premature preterm rupture of membranes. On what month of pregnancy are fetal lung maturity injections given? It is given between the 24th and 35th weeks of pregnancy Are there any possible harms of fetal lung maturity injections? Some studies have shown that giving lung injections in the later stages of pregnancy (after 37 weeks) may lead to a drop in the newborn’s blood sugar level (neonatal hypoglycemia) and may also lead to a decrease in the newborn’s weight, head circumference and length, and a decrease in neonatal blood pressure. Therefore, the decision to give fetal lung maturity injections after the thirty-seventh week of pregnancy must be made after weighing the benefits with the potential harms. Are lung injections given in cases of cesarean section? Babies born by caesarean section are more susceptible to respiratory distress syndrome and NICU admission (neonatal intensive care). Studies have shown that performing a caesarean section after week 39 reduces the occurrence of these complications. If there is a medical necessity to perform a caesarean section before the thirty-ninth week, it is recommended to give fetal lung maturity injections to reduce the rate of NICU admission and reduce the incidence of respiratory distress in the newborn. Are lung injections given during pregnancy with twins? Yes, especially since a pregnancy with twins is more likely to have premature birth and to have a caesarean section Can fetal lung maturity injections be given to pregnant women with diabetes? Yes, but the fetal lung maturity injections are steroids and lead to an increase in the blood sugar level of the pregnant woman, and this effect continues for 5 days after the injections are given. Therefore, it is recommended when giving the fetal lung maturity injections to pregnant women that the sugar be closely monitored for 5 days. What are the types of fetal lung maturity injections? Is there a difference between them in terms of effect? Dexamethasone Betamethzone There is no difference between them in effect, which is why the available type is used There is a difference between them in the method of preservation and cost In what cases is it not recommended to use fetal lung maturity injections? ** Cases related to the mother’s health, such as: A sharp rise in blood sugar, which may lead to acidity in the blood (diabetic ketoacidosis). Suspected sepsis (bacteremia). The mother's condition does not allow for delaying. childbirth until the lung injections take effect ** Cases related to the health of the fetus: Signs of acute inflammation inutero (chorioamnionitis). The condition of the fetus does not allow delaying birth until the lung injections take effect. How are fetal lung maturity injections? Two intramuscular injections, 12-24 hours apart When do the fetal lung maturity injections start taking effect? The effect begins 24-48 hours after the second dose and continues for up to 7 days When can fetal lung maturity injections be repeated? According to studies, we do not recommend repeating lung injections because of their potential harm to the fetus, but if the last dose of fetal lung maturity injections was more than 7 days ago and there is a high probability of premature birth during the following 7 days, then the injections can be repeated. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/steroids-for-fetal-lung-maturity Mon, 08 Mar 2021 05:25:19 AM Natural birth after cesarean section in the previous pregnancy It is known that the rate of caesarean section births has increased recently worldwide due to: ** Increasing the use of continuous fetal monitoring during natural birth, which leads to increased detection of changes in the fetal heartbeat that require emergency caesarean sections. **Increasing the rate of obesity, which leads to difficulty in natural childbirth (labor dystocia). **increased maternal age at conception and childbirth due to women’s preference to delay marriage and pregnancy for reasons of career and education. **Increase in the percentage of maternal requests for an elective caesarean section due to the mother’s fear of pain during natural childbirth. Therefore, the percentage of pregnant women who have had a previous cesarean delivery is high, and most of these women are looking for a natural birth in subsequent pregnancies. In what cases do we allow natural birth after a previous caesarean section? - There must be only one previous caesarean section. - The fetus’s head should be facing downward in this pregnancy (cephalic presentation). - The gestational age must be 37 weeks or more (term pregnancy). - There should be no contraindications to natural birth in general (a low lying placenta, a breech fetus, the fetus’s condition does not allow for a natural birth, that is, the fetus’s condition is unstable and the birth must take place quickly, the mother’s condition does not allow for a natural birth, that is, the mother’s condition is unstable and must give birth quickly) What are the contraindications for natural birth after a cesarean section? - The uterine incision in the previous cesarean section is located in the upper part of the uterus (classical incision) - The previous uterine cesarean incision was atypical (J-shaped or T-shaped). - There is a previous history of uterine rupture during previous natural births. - Some types of previous uterine surgeries, such as performing a procedure to remove uterine fibroids and breaching the uterine cavity. What are the signs that increase the success rate of natural birth in subsequent pregnancies after a previous cesarean section? - Having a natural birth in a previous pregnancy, this raises the success rate of a natural birth to 90 percent. - The birth should be spontaneous (uterine contractions begin spontaneously), as the need to induce labor reduces the chances of a successful natural birth in general. - The reason for performing a cesarean section in the previous pregnancy was fetal distress or fetal malpresentation. If the previous cesarean section was due to failure to progress, this reduces the chances of a successful natural birth in the subsequent pregnancy. -increased maternal height, the BMI must be less than 30, and the mother must be less than 40 years old. -The estimated weight of the fetus should be less than 4 kg and the gestational age should be less than 40 weeks. What are the concerns of vaginal birth after a previous cesarean section? rupture of the uterus during natural birth, which poses a risk to the mother’s life (bleeding and the need for a hysterectomy) and poses a risk to the fetus’s life (hypoxia or death). How is the natural birth monitored for a woman who has had a previous caesarean section? - Monitoring the fetus through continuous fetal heart monitoring throughout the birth process - Monitoring the symptoms of the mother (severe abdominal pain that does not respond to painkillers, abdominal pain other than during uterine contractions) - Monitoring the mother’s vital signs during childbirth - Monitor the progress of cervical dilatation and descent of the fetal head into the pelvis as expected What are the signs of uterine rupture during natural birth? - abnormalities in fetal heart rate - Severe pain in the mother’s abdomen that does not respond to painkillers and is present at times other than uterine contractions. - Vaginal bleeding - hematuria - The mother’s blood pressure drops, her heart rate increases, and she goes into shock - The fetal parts are palpable on the external abdominal examination - Loss of uterine contractions that were previously present Is it possible to induce labor for women who have had a previous caesarean section? Yes, but the use of medications (suppositories or oxytocin) increases the incidence of uterine rupture, and therefore it is recommended to use mechanical methods of stimulation (Hegar cervical dilators, Foleys catheter). What is the success rate of natural birth after a previous caesarean section? 72-75 percent Is a natural birth possible after more than one previous caesarean section? Yes, it is possible, but the incidence of uterine rupture during natural birth is higher with the increase in the number of previous cesarean deliveries. What is the incidence of uterine rupture during natural birth after a previous cesarean section? 0.5 percent Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/natural-birth-after-cesarean-section-in-the-previous-pregnancy Mon, 08 Mar 2021 05:25:19 AM Cervical stitch insertion for prevention of preterm birth and second trimester miscarriage Cervical cerclage during pregnancy is considered a preventive measure to prevent premature births or miscarriages in the second trimester of pregnancy. The procedure involves placing a stitch in the cervix. This stitch provides structural support for the structure of the cervix and enables it to support the pregnancy until term. Which women do we advise to put a stitch around the cervix? Women who suffer from a weak cervix, meaning they are more susceptible to premature birth or recurrent second trimester miscarriages. How is cervical dysfunction (weakness) diagnosed? The diagnosis of cervical weakness is based on: ** The medical history of what happened in previous pregnancies. **Ultrasound examination of the length of the cervix during pregnancy. **Internal examination of the cervix during pregnancy. Is there a test for cervical strength before pregnancy? There is no radiological/clinical examination to evaluate the strength of the cervix before pregnancy occurs. What is the benefit of cervical stitch? **Provides support for the structure of the cervix and prevents premature dilatation. **It maintains the cervical plug (mucous plug) inside the cervix, which prevents germs from entering through the cervix into the uterine chamber during pregnancy. How do we determine the need for a cervical stitch based on “medical history”? ** History of 3 previous premature births (before 37 weeks) **history of 3 previous miscarriages in the second trimester of pregnancy (where there is dilation of the cervix without pain or abdominal cramps) How do we determine the need for a cervical stitch based on the “ultrasound examination”? The cervix appears short on transvaginal ultrasound examination (less than 2.5 cm) with the presence of previous risk factors. Previous risk factors include: - Surgeries on the cervix - One or more premature births - Miscarriage in the second trimester of pregnancy or more than one miscarriage - Performing an emergency cesarean section in the previous pregnancy while the cervix was fully dilated at the time of emergency cesarean section. When do we start performing serial ultrasound scans for cervical length measurement? From week 14 to week 24, when the woman has risk factors for premature birth/miscarriage. In the case of a twin pregnancy, does a stitch prevent premature birth? Cervical stitch does not prevent premature birth/miscarriages in twin pregnancies. What are the types of cervical stitch? 1- Vaginal stitch (placed through the vagina). There are two types: McDonald’s and Shirodkar. 2- Abdominal stitch (placed through laparoscope or laparotomy), which we resort to when the vaginal stitch fails. When is the right time to place a cervical stitch? It is placed during pregnancy between weeks 11 and 14 of pregnancy. What do we mean by emergency cervical stitch? It is a stitch that is placed when there is dilatation of the cervix (dilatation appears on the ultrasound device or internal examination) and the fetal membranes are exposed vaginally. When can an emergency cervical stitch be placed? It can be inserted at any time up to 28 weeks during pregnancy. What are the contraindications for placing a stitch on the cervix during pregnancy? - The presence of signs of infection inside the uterus. - The presence of vaginal bleeding. - Premature rupture of membranes. - The presence of abnormalities in the fetus that are incompatible with life. - The presence of uterine contractions. What are the possible complications of placing a cervical stitch during pregnancy? - Bleeding - procedure failure - Bladder injury - Rupture of the membranes around the fetus - infection What tests should be performed before placing a stitch on the cervix? - Initial fetal health examination (fetal anomaly scan) to ensure that there are no chromosomal abnormalities/deformities in the fetus. - In cases of emergency cervical stitching, it is preferable to conduct inflammatory laboratory testing (c-reactive protein and white blood cell count) to ensure that there is no infection inside the uterus. When is the cervical stitch removed? - In emergency situations, such as contractions in the uterine wall (going into labor). - If the woman does not suffer from labor contractions, it will be removed between the 36th and 37th week of pregnancy. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/cervical-stitch-insertion-for-prevention-of-preterm-birth-and-second-trimester-miscarriage Mon, 08 Mar 2021 05:25:19 AM Smoking and pregnancy Smoking during pregnancy is considered a dangerous habit that negatively affects the health of the mother and the fetus. Studies have proven over decades that smoking during pregnancy leads to a number of complications: - Miscarriages - Death of the fetus inside the womb or immediately after birth - Placental abruption during pregnancy, leading to severe bleeding - Premature birth - Low birth weight - In the long term, it leads to poor neurological development in the child, endocrine problems in the child, and an increase in the percentage of tumors during childhood. - Sudden infant death syndrome - Poor academic performance of the child What are the harmful substances in smoke? - Nicotine - Carbon Monoxide - Many carcinogenic substances - Heavy metals - Tar What is the effect of carbon monoxide on pregnancy? Carbon monoxide binds to hemoglobin with greater affinity than oxygen… - This prevents the binding of oxygen to hemoglobin - Which prevents oxygen from reaching the placenta and fetus This leads to poor fetal growth and increases the rate of premature birth What is the effect of tar on pregnancy? - It accumulates inside the respiratory tract of a pregnant woman and accumulates on the mucous membranes, leading to the mechanical destruction of the respiratory system. - Toxic effect on the fetus, which limits the growth ability of the fetus (fetal growth restriction). What is the effect of nicotine on pregnancy? Nicotine is able to cross the placenta and reach the fetus directly. - It binds to brain receptors in the fetus and directly affects the development of the fetal brain. - When a child grows up, he is more likely to become a heavy smoker in the later stages of his life, and the risk of being addicted also increases. Is it possible to stop smoking during pregnancy? Yes, the rate of stopping smoking during pregnancy is one of the highest. What are the ways to help pregnant women quit smoking? - Psychological and social interventions (encouragement and motivation, cognitive behavioral therapy, support groups, etc.)  - Nicotine replacement therapy: where cigarette nicotine that contains toxic substances is replaced with pure nicotine substances free of the toxic elements found in cigarettes. How can nicotine replacement therapy be used to stop smoking? **It is known that nicotine is broken down in the liver. Therefore, taking nicotine through the digestive system/mucous membranes (chewing gum, pills and tabs, oral sprays, nasal sprays) reduces its bioavailability in the body. **It is also possible to introduce it through the skin (nicotine patches), as nicotine enters the body through the skin at a very slow rate. In pregnancy, nicotine metabolism is increased, so that nicotine that enters slowly through the skin is quickly broken down before its level rises in the blood. It is preferable to use nicotine replacement therapy as an adjunct to psychological and social interventions in order to increase the success rate. Are there side effects of nicotine replacement therapy during pregnancy? Studies have shown that it does not affect the growth of the fetus and does not increase the rate of premature birth. There may be local side effects of nicotine patches, such as skin irritation. What about the electronic cigarette and pregnancy?  An electronic cigarette is a battery-powered device that heats water, propylene glycerin, nicotine, and a flavoring substance, and the mixture turns into a spray that the user inhales. In this case, the percentage of nicotine in the blood is much higher than a regular cigarette and reaches peak at a faster rate.  The electronic cigarette does not contain carbon monoxide or tar, and in some new types the device works to get rid of many carcinogenic substances. It is believed that electronic cigarettes reduce the harmful effects of regular cigars by 95 percent. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist The electronic cigarette is one of the ways to help quit smoking. To date, there are no studies on the effect of electronic cigarettes during pregnancy. Some may use them as an adjuvant treatment for psychological/social interactions and nicotine replacement therapy. https://www.layyous.com/en/pregnancy/smoking-and-pregnancy Mon, 08 Mar 2021 05:25:19 AM Instrumental delivery (vacuum and forceps) Forceps and vacuum are considered important tools in obstetrics, they are used as assistive tools during natural birth (in the second stage of birth) to speed up the birth process due to the presence of maternal/fetal indications. What are the indications for using forceps/vacuum during natural childbirth? ** Reasons related to the mother’s health: - Heart failure (stage III or IV) - The mother’s fatigue and inability to push for a longer period during childbirth - The mother has neurological/muscular problems that reduce her ability to push - Some diseases that require avoiding high internal pressure in the body, such as heart disease and cerebrovascular disease - Prolonged second stage of labor ** Reasons related to the health of the fetus: - Weak fetal pulse during natural birth and the need to speed up the birth to expel the fetus as quickly as possible (fetal distress) - Fetal scalp blood sampling revealing that fetal blood PH is less than 7.2 - thick meconium Does epidural analgesia increase the rate of instrumental delivery? Yes How are forceps/vacuum births classified? Classification is based on the level of the fetal head (station) in the birth canal: - The middle of the birth canal - At the lower portion of the birth canal - At the outlet of the birth canal How long does the second stage of labor usually last? For women who have previously given birth (multipara): one hour in the absence of an epidural analgesia and two hours in the presence of epidural analgesia. For primiparas: 2 hours if there is no epidural analgesia and 3 hours if there is epidural analgesia What are the prerequisites for safe forceps/vacuum delivery? - Full cervical dilatation - Ruptured membranes - The level of the fetus’s head must be at least at the ischial spines (zero station). - The position of the fetus’s head must be known - The mother’s pelvic examination shows that the birth canal is wide and adequate - The mother’s consent to the procedure - There must be sufficient local anesthesia/analgesia - The mother's bladder must be completely empty - Aseptic technique - The doctor must have sufficient experience to use forceps/vacuum - There should be an operating room nearby in case the delivery with forceps/vacuum fails and there is a need to perform an emergency caesarean section. - There should be no severe swelling in the fetus’ scalp (caput) or severe overlap of the bones of its skull What are the harms of forceps compared to suction? Forceps cause more tears and wounds (maternal trauma) in the mother's birth canal than vacuum What are the disadvantages of vacuum compared to forceps? vacuum leads to more fetal trauma Is episiotomy always needed in instrumental delivery? This is based the doctor’s individualized assessment, but studies have shown that cutting an episiotomy when using forceps/vacuum reduces tearing of the anus (obstetric anal sphincter injury) Should antibiotics be given when using forceps/vacuum during childbirth? A single dose of amoxicillin is given intravenously What is the most important aspect of postpartum care after using forceps/vacuum? - Evaluating the patient’s need for anticoagulation - Ensure that the bladder is not injured and that the patient empties her bladder completely and without any difficulty. - Providing psychological care for the woman, as the use of forceps/vacuum during natural birth may negatively affect her psychology and make her afraid of natural childbirth. A detailed explanation must also be provided to both spouses after the birth about what happened and why we needed to use instrumental delivery. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/instrumental-delivery-vacuum-and-forceps Mon, 08 Mar 2021 05:25:19 AM Decreased fetal movements The mother's feeling of fetal movements during pregnancy is one of the most important indicators of the fetus's health inside the womb. Good fetal movements reflect the healthy interaction between the nervous system and the muscular/motor system in the fetus. Any change in the nature or number of fetal movements during pregnancy may reflect the presence of a problem affecting the health of the fetus. When does the mother begin to feel fetal movement? Between week 18 and week 20 of pregnancy, and it may start from week 16 for some women who have previously given birth. The number of fetal movements continues to increase until the 32nd week of pregnancy and then stabilizes. What are the factors that reduce the mother's sense of fetal movement? - The mother’s position, as the number of movements is more in the lying position and less in the standing position. - The time of day, as fetal movement is felt more in the evening. This may be due to the mother being busy in the morning and unable to concentrate on the number of fetal movements. - Location of the placenta, as the anterior placenta reduces the sensation of the number of fetal movements before 28 weeks - Use of certain substances such as alcohol and opiates. - Smoking, as the high percentage of carbon dioxide in the mother’s blood due to smoking leads to a decrease in the number of fetal movements. - Fetal lung maturity injections (cortisone injections) lead to a decrease in the number of fetal movements for 48 hours after they are given. - The presence of congenital abnormalities in the fetus. - Neuromuscular problems in the fetus. What is the best way to evaluate the number of fetal movements? The best way is the mother's perception of the movements. Are there other ways to evaluate the number of fetal movements? Yes, such as using an ultrasound examination to count the number of movements visible during the examination. How is fetal kick count performed correctly? The mother should lie on her left side in a quiet room for two hours. She must count at least 10 movements within two hours. What steps are taken when the mother complains of a decrease in the number of fetal movements? - Taking a medical history to determine whether the mother has risk factors that affect the health of the fetus (diabetes, high blood pressure, smoking, a previous history of fetal death in the womb, etc.) - Confirm that the number of fetal movements is low, as after speaking carefully with a number of pregnant women, it appears that the number of fetal movements is normal and there is no decrease in their number. - Confirm whether this is the first time that the pregnant woman feels a decrease in the number of fetal movements or if there have been previous times, as repeated visits due to a decrease in the number of fetal movements may be a red flag for sudden death of the fetus inside the womb. - Urine analysis to ensure that there is no proteinuria, as high blood pressure during pregnancy (preeclampsia) may be associated with some of these cases. What is the next step after making sure that the number of fetal movements is really reduced? Cardiotochography (CTG) if the gestational age is more than 28 weeks When is the ultrasound device used to examine the fetus when the number of movements is reduced? In one of the following cases: - If there are risk factors in the medical history that increase the incidence of sudden death of the fetus inside the womb - If the fetal CTG is normal, but the mother still complains of a decrease in the number of fetal movements What parameters are recorded during the ultrasound examination in evaluating the fetus when there is a decrease in the number of its movements? - The circumference of the fetus’s abdomen - Estimating the weight of the fetus - The volume of amniotic fluid around the fetus - Blood supply to the umbilical cord - Fetal anomaly scan to ensure that there are no congenital abnormalities What evaluation method is used when there is a decrease in the number of fetal movements before 24 weeks or between weeks 24-28 of pregnancy? - Listening to the fetal heartbeat (external auscultation) and making sure it is present - Reviewing the medical history looking for possible risk factors that may affect the growth of the fetus and its health inside the womb Pregnant women must be reassured that 70 percent of pregnant women who experience one episode of decreased fetal movements during pregnancy do not experience any subsequent complications. As for women who experience more than one episode, they must be evaluated more precisely and in-depth because they are more vulnerable to complications and intrauterine fetal death. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/decreased-fetal-movements.. Mon, 08 Mar 2021 05:25:19 AM Stress during pregnancy Psychological stress is considered to be a disease that negatively affects human health. Psychological stress during pregnancy is one of the most important reasons for the deterioration of the mother’s health. What is the definition of psychological stress? It is a state of anxiety and tension resulting from exposure to a difficult situation, and it is a natural response that prompts us to face challenges and threats in our lives. what is the physiological response to psychological stress? - Increased heart rate - Hypertension - Increased respiratory rate - Feeling tired and nauseous - Diarrhea - Increase appetite for food - Loss of appetite for food with weight loss - headache - Inability to sleep What hormones rise during psychological stress? - Adrenaline - Cortisone What is the effect of psychological stress on pregnant women? - Miscarriage - Premature birth - low birthweight Does psychological stress during pregnancy affect the future of the child? Some studies have proven that psychological stress during pregnancy may lead to difficulty concentrating during childhood and some psychological/mental problems. It also increases the risk of allergic diseases and asthma in the child. What are the causes of psychological stress during pregnancy? - financial problems - social problems - pregnancy after many years of infertility - Family-related issues - Domestic violence - Abuse of drugs and alcohol - The mother suffers from chronic psychological problems such as depression and chronic anxiety - The pregnancy is not wanted What are the possible ways to deal with psychological stress during pregnancy? - Providing psychological/social/family support - Do moderate exercise - Adhere to a healthy, balanced diet and compensate for vitamin deficiencies - Finding the cause of psychological stress and trying to get rid of it (solving the problem) - breathing exercises and muscle relaxation exercises - Practicing yoga and meditation - In severe cases, medications are given to help with psychological relaxation and are safe during pregnancy In cases of psychological stress resulting from pregnancy after many years of infertility, the doctor may resort to intensifying visits to the patient to reassure her about the fetus on a regular basis. Is psychological stress during pregnancy limited to the mother only? No, it includes the father as well, and helping the father during his wife’s pregnancy may relieve psychological pressure on his wife as well. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/stress-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Breast cancer in pregnancy Does pregnancy increase the risk of breast cancer? No What are the symptoms of breast cancer during pregnancy? The symptoms are generally: ** Breast pain ** Feeling of swelling or a lump ** Changes in the position and protrusion of the nipple ** Changes in the skin covering the breast **Bloody discharge from the nipple ** Weight loss and loss of appetite ** Symptoms of the spread of the tumor to other organs (for example, headache if it spreads to the brain) How are breast lumps treated during pregnancy? They are evaluated using breast ultrasound Can a mammogram be used during pregnancy? Yes, but a shield must be used to cover the abdomen and protect the fetus Can a breast biopsy be performed during pregnancy? Yes Can a CT scan be used during pregnancy? Not recommended due to the high level of radiation that the fetus is exposed to Can a bone scan using radioisotopes be used during pregnancy to assess the extent of the tumor spread? No due to the high level of radiation that the fetus is exposed to Is breast cancer during pregnancy a reason to terminate pregnancy? This depends on the extent of the disease, its stage, the patient's need for treatment, and the expected survival rate. What is the treatment for breast cancer during pregnancy? Care should be shared between the gynecologist, obstetrician, breast surgeon, oncologist, and other related specialties to ensure the best outcome for the woman. Treatment may be: ** Surgical removal of the breast and surrounding lymph nodes **Radiotherapy **Chemotherapy What are the precautions for radiation therapy during pregnancy? It is best to postpone it until after delivery, but if it is necessary during pregnancy, a shield should be placed on the abdomen to protect the fetus What are the precautions for chemotherapy during pregnancy? It should be avoided in the first trimester of pregnancy because it causes fetal anomalies Can drugs that act on estrogen receptors be used during pregnancy? No, their use should be postponed until after delivery When should delivery take place? This depends on the degree and stage of the disease, the mother's health condition and her treatment requirements Can a woman who was treated for breast cancer during pregnancy breastfeed after giving birth? If there is breast tissue left that produces milk, then yes she can breastfeed, but there are some treatments that are secreted with milk and therefore breastfeeding should be avoided while using them Can women who have had breast cancer use birth control pills? It is better to avoid them and use non-hormonal contraceptive methods When can a woman get pregnant after recovering from breast cancer? This depends on each case and its requirements, but in general, you should wait two years before getting pregnant again Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/breast-cancer-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM High bile salts during pregnancy - Obstetric Cholestasis What is meant by obstetric cholestasis? It is the high bile salts that occur in women during pregnancy When is obstetric cholestasis suspected? When a pregnant woman complains of severe itching, especially in the palms of the hands and soles of feet How is obstetric cholestasis diagnosed during pregnancy? By measuring the level of bile salts in the blood Do liver enzymes rise in pregnant women who suffer from obstetric cholestasis? Yes, in some cases How do we confirm the diagnosis of obstetric cholestasis? Retrospectively after the return of the level of bile salts and liver enzymes to their normal level 4 weeks after delivery What is the effect of high bile salts during pregnancy on the fetus? It may lead to sudden death of the fetus inside the womb, especially if the bile salt level is above 100 When should delivery take place when bile salts are high during pregnancy? This depends on the level of salts, as delivery takes place after the thirty-fifth week if the salt level is above 100, while we can wait until the 40th week if the increase is slight How can we prevent sudden fetal death due to high bile salts? Unfortunately, it cannot be prevented or predicted, as it occurs due to a sudden disturbance in the fetal heart's electricity Can a woman who suffered from obstetric cholestasis during pregnancy use birth control pills? No, as using birth control pills exposes these women to cholestasis again Does obstetric cholestasis recur in subsequent pregnancies? Yes, if it occurs in one pregnancy, the probability of its occurrence in subsequent pregnancies is high How is high bile salts treated during pregnancy? ** Monitoring the level of salts and liver enzymes periodically **Giving the mother treatments such as antihistamines to relieve symptoms of severe itching **Delivery at the appropriate time Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/high-bile-salts-during-pregnancy-obstetric-cholestasis Mon, 08 Mar 2021 05:25:19 AM Examination of the fetal genetic material in the mother's blood during pregnancy (cell free fetal DNA testing) What is meant by examination of the fetal genetic material in the mother's blood during pregnancy? It is the extraction of the fetus's genetic material from the mother's blood during pregnancy When does the fetus's genetic material appear in the mother's blood during pregnancy? After the tenth week of pregnancy What is the purpose of examining the fetal genetic material in the mother's blood during pregnancy? It is used to establish fetal chromosomal wellbeing In what cases is the fetal genetic material in the mother's blood examined during pregnancy? When there is a suspected chromosomal problem in the fetus (such as increased thickness of the fluid behind the fetus's neck or the absence of the nasal bone in the fetus or when the mother is advanced in age) Is the examination of the fetal genetic material in the mother's blood during pregnancy accurate? The accuracy rate is 97 percent What is the appropriate action if there is a suspicion of a chromosomal abnormality by examining the fetal genetic material in the mother's blood during pregnancy? Refer the patient to a maternal and fetal medicine specialist to conduct diagnostic tests by taking a sample from the fetal placenta to study its cells or taking a sample of the amniotic fluid around the fetus Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/examination-of-the-fetal-genetic-material-in-the-mother-s-blood-during-pregnancy-cell-free-fetal-dna-testing Mon, 08 Mar 2021 05:25:19 AM Numb hands during pregnancy Feeling numbness in the hands during pregnancy is one of the common symptoms that pregnant women complain of What are the causes of numbness in the hands during pregnancy? - Hypothyroidism - Vitamin deficiency during pregnancy, especially vitamin B12 - Increased congestion in the tissues around the nerve that feeds the hand, which leads to pressure on it and a feeling of numbness - The presence of neurological problems that affect the transmission of currents within the nerves (such as multiple sclerosis) - The hand nerve was injured as a result of fractures, for example, or was exposed to pressure due to the presence of tumors -The feeling of numbness may be due to a difficult psychological state that the mother is going through and which appears in the form of physical symptoms - The nerve roots are exposed to pressure due to the presence of a disc between the neck vertebrae - Problems in the hand joints When is numbness in the hand evidence of a serious health problem? - If it is accompanied by a loss of the ability to move muscles - If it is accompanied by muscle atrophy - If accompanied by loss of sensation - If it is accompanied by severe pain in the hand What is the most common cause of numbness in the hands during pregnancy? - Increased congestion in the tissues around the nerve that feeds the hand, which leads to pressure on it and a feeling of numbness How to deal with complaints of numbness in the hands during pregnancy? - First, take a medical history - Clinical examination and ensuring that there is no loss of motor ability in the hand or loss of sensation - Do some blood tests: thyroid, vitamin B12 - We may resort to making an MRI of the neck if there is a suspicion of a disc in the neck - Nerve conduction study if a neurological disease is suspected - Immune antibody tests in the event of suspected presence of an immune disease affecting the nerves/joints Treatment is directed to the cause How is numbness in the hands treated due to increased congestion in the tissues around the nerve that supplies the hand, which leads to pressure on it? - First, by reassuring the mother that this is very common during pregnancy and is due to an increase of fluid in the tissues - Encouraging her to use hand braces to make her feel comfortable - Ensure that the motor/sensory function of the hand is not affected - Reassure the mother that this numbness disappears completely after birth - In severe cases (when the motor/sensory function of the nerve is affected), we may make a surgical incision in the tissue surrounding the nerve to reduce pressure on the nerve. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/numb-hands-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Thalassemia and pregnancy Thalassemia is a blood disease resulting from hemoglobinopathy. thalassemia leads to chronic anemia. The degree of anemia in thalassemia patients depends on the degree of genetic defect. What are the principles of treatment for thalassemia patients? **Blood transfusion ** Removing iron accumulated in the organs How does thalassemia affect pregnant women? **Chronic anemia **The need for blood transfusion and the risks associated with blood transfusion ** Iron accumulation in the organs, which affects the functions of the organs How does thalassemia affect the fetus? **It may lead to restriction of fetal growth  **The fetus inherits thalassemia from the parents How are the maternal organs affected by iron accumulation? ** Heart: myocardial failure **Pancreas: diabetes **Thyroid gland: hypothyroid **Liver: cirrhosis and gallstone formation **Bones: osteoporosis How is thalassemia inherited? Autosomal recessive, meaning two genes must combine in the affected person for symptoms of severe disease to appear. A person carrying the gene suffers from mild chronic anemia Does thalassemia lead to infertility? Yes, due to iron accumulation in the testicles/ovaries, which leads to their damage and loss of function How can the disease be prevented from being transmitted to offspring if the parents carry the affected gene? By performing in vitro fertilization and testing the embryos before returning them into the uterus, and returning only unaffected embryos What is the follow-up of a pregnant woman with thalassemia? ** Monitoring the growth of the fetus regularly ** Diabetes screening and follow-up ** Examination and follow-up of thyroid function ** Checking CBC and iron stores and following them up **Blood transfusion when needed **Checking blood type and antibodies regularly If a pregnant woman has thalassemia, should she be given anticoagulants? Depending on the platelet count and the presence of a history of splenectomy, we may give aspirin pills only or aspirin pills with heparin injections. Is it necessary for a woman with thalassemia to give birth by caesarean section? No, it depends on the course of pregnancy and other health factors It should be noted that a pregnant woman with thalassemia is at high risk of blood clots formation after giving birth, and for this reason she must be given preventive doses of heparin. Can women with thalassemia breastfeed? Yes Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/thalassemia-and-pregnancy Mon, 08 Mar 2021 05:25:19 AM Fasting and Pregnancy There is no one rule that fits everyone regarding the possibility of fasting for a pregnant woman, as each case is different from the other . It does not depend on the mother's ability to fast only, but on her ability to meet her baby’s needs of important nutrients for growth. There are factors that may affect this, such as the nature of the pregnant woman's work or the country's conditions in terms of the number of fasting hours and the weather, so it is preferable to consult the doctor before deciding to fast. In the first three months of pregnancy, women suffer from nausea and vomiting and have no appetite, making it difficult to eat large meals. In some cases, nausea and vomiting become so severe that they threaten the life of the fetus and require hospitalization. In this case, fasting becomes harmful to the mother and the fetus. In cases where you do not suffer from nausea, it is better to eat small frequant meals scattered throughout the day, to maintain blood sugar levels for the benefit of the mother and the fetus. Hunger itself leads to nausea in the normal person (due to stomach acids) and the possibility of this happening increases in a pregnant woman who is fasting. In the second trimester of pregnancy, nausea subsides, which enables the mother to eat at least two meals, and sometimes three meals. If she decides to fast, she must compensate for her need of fluids and nutrients, especially protein. In the last third of pregnancy, the size and weight of the fetus increase, which puts pressure on the stomach and leads to heartburn. Therefore, the mother cannot eat large meals. Therefore, we prefer small, frequant scattered meals. There are other medical reasons that may prevent a pregnant woman from fasting, such as suffering from a certain disease, and not taking certain medications on time will worsen the disease.  When should a pregnant woman break her fast?  When she feels very weak, vomits, or feels nausea, or feels painful contractions in the abdomen, or water comes out or bleeding, or if the fetal movement decreases. When is a pregnant woman prohibited from fasting? Gestational diabetes. Severe vomiting, uncontrolled blood pressure. A pregnant woman who suffers from premature labor pain, and any pregnant woman who has treatments that must be adhered to and at a specific time. Is the fetus affected when the mother fasts?  Fasting during the month of Ramadan is not harmful to the fetus if the mother is in good health, because the fetus acquires the nutrients it needs from the mother’s stores (as long as the pregnancy is not high-risk and the mother does not suffer from any disease that requires her not to fast). Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/fasting-and-pregnancy Mon, 08 Mar 2021 05:25:19 AM Pre-conception care Pregnancy care should begin before pregnancy occurs to ensure the best outcomes for the mother and the baby. What are the parts of pre-pregnancy care? ** Taking a medical history to find out the chronic health problems the woman suffers from and trying to control these problems before entering pregnancy ** Making sure that the pregnant woman has taken all the necessary vaccinations ** Searching for genetic problems that may be transmitted to the fetus ** Getting rid of harmful habits such as smoking or drinking alcohol **Calculating the BMI and encouraging the woman to reach a normal weight **Evaluating the psychological/mental problems that the woman may suffer from and the treatments taken for these treatments **Starting to give the necessary vitamins such as folic acid **Searching for genetic problems in the family that require additional evaluation or giving specific treatments during pregnancy (heart problems, thrombophilia…etc.) What tests are required as part of preconception care? ** CBC to assess anemia ** HBA1C test ** Thyroid test ** Virus tests (HIV, hepatitis) ** Syphilis test ** Urine analysis What information should be given to the woman before pregnancy? ** Parts of health care and follow-up during pregnancy and the number of visits ** Tests performed during pregnancy to ensure the chromosomal and anatomical health of the fetus ** Modes of birth and their details (vaginal, caesarean) **Possible complications based on the woman's medical history **Medical reasons for cesarean section and its possible complications in the short and long term **Possible complications of vaginal childbirth Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/pre-conception-care Mon, 08 Mar 2021 05:25:19 AM Atypical Antibodies, Rh factor, and Anti-D injection Many pregnant women suffer from the presence of antibodies to antigens present on the surface of red blood cells. The presence of these antibodies negatively affects both the mother and the fetus during pregnancy. How are these antibodies formed in women? Because they are exposed to factors that stimulate their immune system to secrete these antibodies, such as: **Blood transfusion containing these antigens **Pregnancy with a fetus that has these antigens on the surface of red blood cells and mixing of the fetus's red blood cells with the mother's blood during pregnancy due to bleeding or miscarriage What is the effect of the presence of these antibodies on the mother? Difficulty in obtaining blood units that match her when she needs a blood transfusion What is the effect of these antibodies on the fetus? They cross the placenta and cause the breakdown of the fetus's red blood cells, which causes fetal anemia and causes cardiac failure and fluid accumulation in the body chambers and ultimately leads to the death of the fetus inside the womb What is the most common type of antigen found on red blood cells that leads to the formation of antibodies in the mother's body that affect the safety of the fetus and pregnancy? Rhesus factor How are these antibodies tested in the mother's blood? ** Testing the mother's blood type at the beginning of pregnancy and at the 28th week of pregnancy ** Testing antibodies in the mother's blood at the beginning of pregnancy and at the 28th week of pregnancy What can we do to prevent the formation of these antibodies in the mother if she is negative for the Rh factor and her husband is positive for the Rh factor?  1- Giving the ANTI-D  injection when anything happens during pregnancy that may lead to the formation of antibodies such as:  **Bleeding or miscarriage  **Trauma to the abdomen **Surgeries due to miscarriages or ectopic pregnancy **Given as a preventive measure at 28 weeks to all pregnant women **Given within 72 hours after birth 3- Ensure that the blood transfused to the mother at any time is compatible with her blood type and negative for antigens that she does not have How to deal with pregnancy if these antibodies are detected in the mother's blood? Check the level of antibodies in the mother's blood periodically to ensure that they do not reach a level that causes a problem What do we do if the antibodies reach a level that harms the fetus (i.e. they are able to cross the placenta and reach the fetus)? The fetus is monitored by ultrasound periodically to ensure that he does not develop anemia by monitoring the blood flow to the brain What do we do if antibodies cause fetal anemia? It depends on the gestational age. If the pregnancy is 35 weeks or more, then we deliver the fetus and transfuse blood to it in theNICU. However, if the gestational age is early, then we have to transfuse blood to the fetus inside the womb periodically until the fetus reaches a stage where we can deliver it. Who monitors the fetus for anemia and transfuses blood to the fetus inside the womb? Maternal and fetal medicine specialist Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/atypical-antibodies-rh-factor-and-anti-d-injection Mon, 08 Mar 2021 05:25:19 AM Fetal movement When does a mother feel fetal movement? It depends on the nature of the baby's movements, the mother's body, and the number of previous pregnancies. Although the fetus typically begins to move between the eighth and twelfth weeks of pregnancy, the mother may not feel fetal movement until the 16th to 22nd week. A pregnant woman usually begins to feel fetal movement around the 18th week of pregnancy if this is her first pregnancy, and around the 20th week if she has previously had a previous pregnancy. What is fetal movement? Fetal movement is the movement of the fetus's limbs against the anterior abdominal wall as it rotates and swims in the amniotic fluid. These pulses are subtle and barely felt by the woman in early pregnancy. The strength of these movements begins lightly and then becomes more intense from the beginning of the fifth month until the end of pregnancy. What does fetal movement feel like? It begins as intestinal cramps. Some women may find it difficult to identify fetal movements, but with experience and repeated pregnancies, they may be able to determine their movements and their frequency. The fetus often moves at certain times, especially when: - eating heavy meals and sweets. - Drinking cold drinks. - Listening to music. - After light jumping or brisk walking. - Gently massaging and pressing on the abdomen. - Focusing light on the abdomen, especially in the middle of the second trimester. Fetal movement also increases between 9 p.m. and 1 a.m., due to low blood sugar levels during this time. Fetal movement decreases during sleep or after intercourse. What is the average fetal movement rate? From the eighth month until the end of pregnancy, it should be 10 movements per day.  What should I do if I feel decrease fetal movement? Lie on your left side after eating something sweet, avoid any distractions, and wait approximately two hours. If you don't feel any movement, you should contact your doctor immediately. What foods increase fetal movement? Foods that rapidly raise blood sugar levels: - Cheese and dairy products. - Salty crackers. - Peanut butter. - Fresh juices and cold drinks. - Chocolate. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/fetal-movement Mon, 08 Mar 2021 05:25:19 AM Ovarian Cysts During Pregnancy Are ovarian cysts common during pregnancy? Yes. What types of cysts form during pregnancy? **Cysts may have been present before pregnancy. **Cysts may have formed during pregnancy. What is meant by an ovarian cyst that nourishes the pregnancy? It is the remnant of the corpus luteum (which forms after the egg is released from the ovary), which secretes the hormone progesterone. Fluid accumulates within it, and it grows to a size of more than 3 centimeters. This cyst secretes progesterone until the 9th week of pregnancy, after which the placenta begins to secrete it. Does the cyst that nourishes the pregnancy need to be removed? No, quite the opposite. Removing it could lead to a miscarriage. How is the cyst that nourishes the pregnancy treated? It should be monitored on an ultrasound to ensure its size does not exceed 10 centimeters. Does the cyst that nourishes the pregnancy disappear on its own? Yes, it usually disappears spontaneously at the end of the third month of pregnancy. When do we remove the cyst that nourishes the pregnancy? If it is causing severe abdominal pain in the pregnant woman due to ovarian torsion or bleeding within the cyst or from the cyst wall. What is the next step after removing the cyst that nourishes the pregnancy? The patient is given progesterone supplements to replace the cyst's function. What other types of cysts can we find on the ovary during pregnancy? ** Dermoid cyst ** Chocolate cyst (endometriosis) ** Mucinous cyst ** Cancerous tumors, which are rare How are ovarian cysts removed during pregnancy if necessary (severe pain, bleeding, ovarian torsion)? **Laparoscopy **Laparotomy for large cysts, advanced gestation, internal bleeding, or suspected cancer. In some cases, cysts are removed during a cesarean section. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/ovarian-cysts-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Fetal growth restriction during pregnancy What is fetal growth restriction during pregnancy? It is when the fetus does not reach the size that matches its genetic potential. It is worth noting that some fetuses are small because their genetic potential leads to their small size (the small size and measurements of the mother/father). What are the causes of fetal growth restriction during pregnancy? **Placental dysfunction **Chronic maternal conditions such as high blood pressure, diabetes, and thyroid problems **Chromosomal problems **Genetic problems How do we diagnose fetal growth restriction during pregnancy? **Small abdominal size compared to the calculated gestational age **Fetal measurements on ultrasound are small compared to the calculated gestational age How are pregnancies in which the fetus suffers from growth restriction managed? ** Ultrasound monitoring of the fetus (amniotic fluid, fetal blood flow, placental appearance, fetal brain blood flow) ** 4D scan to ensure fetal anatomical integrity ** Chromosomal/genetic testing if a defect is suspected ** Pulmonary maturation injections are administered in preparation for preterm delivery ** Periodic fetal heart rate monitoring through CTG When is a fetus with intrauterine growth restriction delivered? This depends on the follow-up results. Sometimes, we may have to deliver the baby early, but we try as much as possible to reach the 37th week of pregnancy. How is a fetus with intrauterine growth restriction delivered? The best way is by cesarean section, as the fetus is exhausted. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/fetal-growth-restriction-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Fetal death in the third trimester of pregnancy Some women experience fetal death in the third trimester of pregnancy and have the right to receive answers, as this is a traumatic experience for the mother, with psychological and social repercussions and can lead to depression and post-traumatic stress disorder. What are the causes of intrauterine fetal death? ** Placental dysfunction, which causes fetal anoxia and stunted growth. ** Chronic health problems in the mother, such as diabetes, high blood pressure, thyroid dysfunction, etc. ** Harmful daily habits practiced by the mother: smoking, drug use, alcohol consumption. ** Certain genetic/chromosomal problems. **Congenital abnormalities in the fetus **Maternal obesity **Poor social/financial status of the mother and living in poor, deprived areas **Bacterial/viral infections affecting the mother/fetus during pregnancy **Blood clotting factors and the presence of antibodies in the mother How is intrauterine fetal death diagnosed? Ultrasound (absence of fetal heartbeat) is used. The diagnosis must be confirmed by two doctors. What is the next step after an intrauterine fetal death is diagnosed? ** Tests are performed to ensure the mother's well-being and to ensure there are no health risks. ** Tests are performed to determine the cause of intrauterine fetal death. What is the importance of knowing the cause of intrauterine fetal death? **To provide answers to parents and family, thus alleviating their psychological/emotional burden. **To explore modifiable causes to prevent the same scenario from recurring in subsequent pregnancies. **To learn how to cope with subsequent pregnancies and what tests should be performed before/during pregnancy. Is it necessary to give birth immediately after a diagnosis of intrauterine fetal death? It depends on the cause and the mother's general condition. If there is no threat to the mother's health, we can wait between 48 hours and four weeks. However, it should be noted that waiting too long increases the risk of serious complications for the mother, such as blood clots and organ failure. Does the delivery have to be by cesarean section? No, delivery is vaginal unless there is a medical reason for a cesarean section. What is the recommended spacing period between pregnancies after intrauterine fetal death? 6-12 months If a woman has previously experienced intrauterine fetal death in the third trimester, at what stage should she deliver in subsequent pregnancies? 39 weeks of pregnancy, unless there is a medical reason for early delivery. What advice do we give to a woman who has experienced intrauterine fetal death and whose cause is unknown? ** Weight loss if obese ** Quitting smoking/drinking alcohol ** Taking 60-150 mg baby aspirin in subsequent pregnancies before the 16th week of pregnancy ** Testing for acquired clotting factors **Thyroid tests **Gestational diabetes screening and blood pressure monitoring **Chromosomal/genetic testing for the parents if suspected **Blood type and red blood cell antigen (RBC) immunological factors should be confirmed **Psychological support and counseling should be provided to the couple and their family members after this experience, given the severe psychological impact it can have Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/fetal-death-in-the-third-trimester-of-pregnancy Mon, 08 Mar 2021 05:25:19 AM Oligohydramnios Oligohydramnios is defined as decreased amniotic fluid volume (AFV) for gestational age. Isolated oligohydrominos is the presence of decreased liquor of an appropriate for gestational age , non compromised fetus with no maternal disease Causes : In general  Oligohydramnios is caused by a reduction in production of fetal urine due to placental insufficiency, fetal renal anomalies or obstruction of urine flow; or because the urine that is produced, drains away due to ruptured amniotic membranes Maternal - Medical conditions that cause utero-placental insufficiency (e.g., preeclampsia, chronic hypertension, collagen vascular disease, nephropathy, thrombophilia) - Medication: as  ACE inhibitors àFetal o Chromosomal abnormalities o Congenital abnormalities (renal agenesis ) o Growth restriction o Fetal demise o Post term pregnancy o Ruptured fetal membranes o Placental thrombosis o Twin to twin transfusion Early oligohydrominous complications : pulmonary hypoplasia , limb contrtactures , abnormal chest wall and lethal infection . Late oligohydrominous (in 3rd trimester )complications Fetal risks : stillbirth , neonatal death , fetal distress , low apgar score and neonatal complications Maternal risks: failure of VBAC or ECV and increase risk of urgent cesarean section, and post partum sepsis -Investigations : Ultrasound to check on the fetal kidneys and urinary bladder and fetal measurments,  with umbilical artery Doppler to check for IUGR and placental flow Time of delivery : -At gestational age >= 37 weeks Induction of labour should be considered. If not acceptable by the patient, after counselling, organise scans every week for liquor volume and Umbilical artery Dopplers, and twice weekly CTG. - Steroid should be considered if cesarean delivery is planned at less than 39 weeks. -   patient should report any change in fetal movements. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/oligohydramnios Mon, 08 Mar 2021 05:25:19 AM Sleeping problems during pregnancy   It is known that pregnant women struggle with sleep during pregnancy for many reasons such as: hormonal fluctuations, growing belly and emotional changes the prevalence of sleep disturbance in pregnancy ranges between 65-75%. What are the causes of sleep difficulties during pregnancy? ** progesterone and estrogen hormonal changes that lead to drowsiness and night sweats. ** urinary frequency due to the pressure applied on the urinary bladder by the enlarging uterus. ** increased weight leading to back and hip pain. ** increased gastric acid reflux while lying down ** tingling sensation in the legs that worsen during the night ** difficulty breathing when lying down because of the pressure applied by the growing uterus on diaphragm. ** anxiety due to fear of childbirth and the responsibility of motherhood. Do hormonal changes in pregnancy cause nightmares? Yes, they lead to vivid dreams. How does sleep deprivation impact maternal health? It leads to increased risk of the following: ** hypertension ** gestational diabetes ** mood swings which might affect her social and family life in addition to her career ** problems with concentration ** fatigue and malaise ** preterm labor and birth Interventions that help pregnant women get enough sleep: ** sleeping on the left side ** avoid heavy or spicy food at least 2 hours before going to bed ** reduce fluid intake 2-3 hours before going to bed in order to reduce urination frequency at night ** magnesium supplements ** limit caffeine intake ** relaxation techniques like yoga and deep breathing ** warm shower before going to bed ** use PPIs for severe heartburn ** sleep in a quiet dark room and keep your mobile phone away Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/sleeping-problems-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Cardiac disease in pregnancy   Cardiac diseases are common and they are a leading cause of maternal mortality. Many cardiac diseases go undiagnosed throughout life and first manifest during pregnancy due to increased cardiac workload. Having a cardiac disease warrants intensive monitoring throughout pregnancy to ensure maternal and fetal wellbeing and to avoid morbidity and mortality. What are the hemodynamic changes that happen during pregnancy and affect cardiac function? ** increased plasma volume ** increased cardiac output ** increased heart rate These changes can make underlying heart disease symptomatic or worse.   What are the types of heart diseases? ** congenital: the lady is born with it ** valvular heart disease ** cardiomyopathy: problems with the heart muscle itself ** coronary artery disease ** arrythmias: problems with heart electricity ** increased pressure in pulmonary blood vessels What are the symptoms of cardiac disease in pregnancy? ** shortness of breath ** chest pain ** exertional dyspnea ** palpitations ** bilateral lower limb swelling ** shortness of breath that awakens the lady t night **dizziness and loss of consciousness ** fatigue and malaise What are the investigations that are done to assess the heart? ** auscultation using stethoscope ** ECG **echocardiography ** stress test (walking on treadmill with ECG electrodes on) what are the complications of cardiac disease in pregnancy? ** infective endocarditis, thus the lady must be covered with appropriate antibiotics ** heart failure ** thrombotic events ** problems with fetal growth leading to preterm birth ** maternal death   Who should care for a pregnant lady with cardiac disease? It should be conjoined between the obstetrician and the cardiologist How to care for pregnant ladies with cardiac disease? ** avoid anemia ** correct thyroid dysfunction ** control hypertension and diabetes (if they exist) ** manage fluid balance in cases with advanced cardiac disease ** avoid intrapartum excessive blood loss or fluid overload ** give adequate intrapartum analgesia (can go for epidural but must avoid hypotension) ** serial monitoring of fetal growth throughout pregnancy ** regular follow-ups with the cardiologist ** give anticoagulant if indicated by certain scores ** go for vaginal delivery unless cesarean section is indicated for obstetric reasons ** use instrumental delivery (vacuum or forceps) to shorten the second stage of labor in cases of maternal exhaustion or advanced cardiac disease Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/cardiac-disease-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM What to avoid during pregnancy?    During pregnancy, it's best to avoid certain things as they can affect the fetus or the mother's health. Regarding food: Raw or undercooked meat. Raw eggs or foods containing them. Unpasteurized cheeses. Fish with high mercury levels. Excessive caffeine; it's best not to exceed two cups per day. Processed foods such as sausages and excessive consumption of chips. Regarding habits: - Smoking - Alcohol - Drugs Regarding activity: -It is preferable to avoid strenuous exercise or any activity that carries a risk of falling. -Avoid lifting heavy weights. It is advised to avoid exposure to chemicals such as paint and strong detergents. What is recommended during pregnancy? Regarding diet: - Foods rich in iron, such as well-cooked meat, lentils, and spinach. - Foods rich in calcium, such as milk and yogurt. - Fresh vegetables and fruits, as they boost immunity and prevent constipation. -Whole grains such as oats and whole-wheat bread. -  fish (twice a week) such as salmon and sardines, as they are rich in omega-3 fatty acids. - Drink 8-10 glasses of water daily. Regarding activity:  - Light exercises to improve blood circulation, such as a half-hour walk daily. - Adequate rest and sufficient sleep. Monitore weight to avoid excessive weight gain. Avoid stress and anxiety as much as possible. Set aside time for relaxation. - It is recommended to adhere to nutritional supplements and attend regular doctor's appointments. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/what-to-avoid-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Kidney Problems During Pregnancy   Kidney problems during pregnancy are complex and can make the pregnancy high-risk due to the physiological changes that increase the demands on the kidneys. If kidney problems during pregnancy are not properly managed, they can lead to serious complications for both the mother and the fetus. What physiological changes occur in kidney function during pregnancy? **Increased blood plasma volume flow to the kidneys **Increased glomerular filtration rate **Decreased blood urea and creatinine levels **Slight dilation of the renal pelvis Types of kidney problems during pregnancy: ** Chronic problems (pre-existing before pregnancy) ** New problems that develop during pregnancy What are the causes of chronic kidney problems? ** Diabetes ** Autoimmune diseases such as lupus ** Polycystic kidney disease ** Renal vasculitis ** Ureteral valve reflux leading to kidney damage What are the causes of kidney problems during pregnancy? ** Preeclampsia and high blood pressure during pregnancy ** Severe infections that reach the kidneys via the bloodstream ** Bleeding leading to kidney tissue death ** Acute fatty liver disease during pregnancy What are the risks of kidney problems for mothers during pregnancy? ** High blood pressure and preeclampsia ** Fluid buildup in the lungs ** Fluid retention ** Anemia due to erythropoietin deficiency ** The need for dialysis ** Recurrent kidney/urinary tract infections during pregnancy What are the risks of maternal kidney problems to the fetus during pregnancy? ** Intrauterine growth restriction ** Premature birth ** Low amniotic fluid ** Intrauterine fetal death What tests are performed to check/monitor kidney function during pregnancy? ** Kidney function blood test ** Urinalysis to check for blood or protein ** Blood pressure monitoring ** Kidney ultrasound Should fetal growth and measurements be monitored regularly during pregnancy when the mother has kidney problems? Yes What should the blood pressure of a pregnant woman with kidney problems be? Below 135/85 It should be noted that the monitoring of a pregnant woman with kidney problems should be a joint effort between an obstetrician and a nephrologist. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/kidney-problems-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM The Placenta: The Hidden Factory of Life   The placenta is known to be the vital bridge between mother and fetus, responsible for nourishing the fetus throughout pregnancy and during birth. What are the functions of the placenta? ** Delivering oxygen to the fetus ** Delivering nutrients to the fetus, such as: - Sugars - Amino acids - Fatty acids - Minerals - Vitamins The placenta stores certain elements such as glycogen, iron, and proteins. It produces hormones that support pregnancy, such as:  - Pregnancy hormone (hCG)  - Relaxin, which softens the cervix and loosens the ligaments  - Progesterone  - Estrogen It also removes toxins such as urea and carbon dioxide. **An immune function that prevents germs from reaching the fetus and allows the arrival of antibodies that protect it. **Maintaining the fetus's temperature (keeping it warm). **Performing some metabolic processes. When does placental formation begin during pregnancy? It begins from the time of implantation of the embryo in the uterine lining (around day 7 after fertilization). The placenta reaches functional maturity by the end of the third month of pregnancy. The placenta reaches anatomical maturity (complete formation) by the end of the sixteenth week of pregnancy. What are the potential placental abnormalities? ** Placental position problems (such as placenta previa) ** Placental implantation problems (placenta accreta) ** Placental abruption ** Preeclampsia ** Chorioamnionitis ** Placental thrombosis ** Chorionic cell tumors ** Placenta with larger than usual size ** Placenta with smaller than usual size ** Accessory placental lobe (placenta with two parts) Thus, the placenta is a single organ that performs several functions; it is a biological miracle that creates a human being and represents the lifeline before birth. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/the-placenta:-the-hidden-factory-of-life Mon, 08 Mar 2021 05:25:19 AM Group B Streptococcus Bacteria (GBS) IN Pregnancy   Group B streptococcus is one of many types of bacteria that naturally live in our bodies and usually do not cause any harm. A baby is often born healthy and uninfected if the mother is a carrier of the bacteria. What is Group B Streptococcus Bacteria (GBS)? It is a common bacterium found in the vagina and rectum in 2-4 out of every 10 women. It is not transmitted through sexual contact. Most infected women do not show any symptoms. It can affect babies during childbirth and can cause a serious infection in the newborn. How is it detected? It is detected during pregnancy through a vaginal or rectal swab or urine test during routine checkups. What are its effects on the child? Group B streptococcal infections commonly affect newborns and can lead to bloodstream infections, pneumonia, and meningitis, and may be fatal. With prompt treatment, most children recover completely. The risk of infection increases in the following cases: - Delivery before 37 weeks - A previous child affected by group B streptococcal infection - Fever during labor - Rupture of membranes more than 24 hours before delivery - A positive urine test result during this pregnancy When do we start antibiotics (penicillin)? If it's detected through a vaginal or rectal exam, we don't need to take antibiotics until labor begins; then it's given intravenously. If it's detected through a urine test, an antibiotic is given immediately upon diagnosis, in addition to the intravenous antibiotic at the start of labor. - If the amniotic fluid ruptures before week 37 but labor doesn't begin, antibiotics may be given.  - If a cesarean section is planned, antibiotics are not necessary unless labor starts. - If the mother has had a previous child with group B streptococcal infection, antibiotics should be given at the onset of labor in this pregnancy. - The baby benefits if the antibiotics are taken at least 4 hours before delivery. What symptoms might a child infected with this bacteria experience? - Snoring and noisy breathing - Excessive drowsiness - Unresponsiveness - Incessant crying - Poor feeding - Fever - Rapid or slow breathing rate - Low blood sugar - Low blood pressure Why aren't all pregnant women tested for these bacteria? Because there is no completely accurate test, and a negative result doesn't necessarily mean the person is not infected. Most women who carry these bacteria give birth to healthy babies, and giving antibiotics to all pregnant women who carry it would mean a large number of women undergoing unnecessary treatment.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist   https://www.layyous.com/en/pregnancy/group-b-streptococcus-bacteria-gbs-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM Pre-Eclampsia and Pregnancy Hypertension   -Affects 1-5 out of every 100 pregnant women -It is usually diagnosed in the second half of pregnancy after the 20th week, during labor, or shortly after delivery. -Signs include high blood pressure and protein in the urine. -It can affect the liver and kidneys, cause blood clots without protein in the urine, and may lead to seizures. What are the symptoms of preeclampsia? - Severe headache - Blurred vision - Severe pain below the ribs - Heartburn - Rapid swelling of the face, hands, or feet - Nausea and vomiting What does this mean for the baby? High blood pressure during pregnancy affects the placenta, which can lead to the baby being smaller than it should be, and in some cases, it can cause fetal death in utero. Who is most at risk? - Those who had high blood pressure before pregnancy. - Those with high blood pressure in previous pregnancies. - Those with kidney problems or autoimmune diseases such as lupus. - Those with diabetes. - First pregnancy. - Age over 40. - More than 10 years have passed since the last pregnancy. - Body mass index (BMI) over 35. - Multiple pregnancies. When does delivery occur? If the pregnancy is 37 weeks or more, delivery usually takes place. If the mother's or fetus's health deteriorates before week 37, delivery is recommended as it is safer than continuing the pregnancy. The only way to treat preeclampsia is to terminate the pregnancy. Each case is assessed to determine whether a vaginal or cesarean delivery will be performed, regardless of the gestational age. What is the likelihood of developing preeclampsia in future pregnancies? It depends on which week of pregnancy the preeclampsia occurred during. - If the delivery occurred between weeks 28 and 34, one in three women who had preeclampsia will experience it again. - If the delivery occurred between weeks 34 and 37, one in four women who had preeclampsia will experience it again - If delivery occurs after 37 weeks, one in six women who have had PET will have it again. Therefore, they may be advised to take baby aspirin 81 mg in subsequent pregnancies, and to avoid smoking, adopt a healthy lifestyle, and maintain a healthy weight. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/pre-eclampsia-and-pregnancy-hypertension Mon, 08 Mar 2021 05:25:19 AM Sepsis in pregnancy   Sepsis is defined as an infection that reaches blood stream and causes systemic manifestations with possible multiorgan failure. Pregnant women are known to be immunocompromised and hence are at higher risk of sepsis. Factors in pregnancy that increase the risk of sepsis: ** diabetes **prolonged rupture of membranes **invasive procedures **recurrent vaginal bleeding **foul smelling vaginal discharge **pregnant ladies are generally immunocompromised   Assessment of patients with suspected sepsis: **history taking focusing on recent contact with sick individuals **physical examination looking for: skin rash, cyanosis, breach of skin integrity and looking for sources of infection that might need drainage **vital signs: temperature, pulse rate, oxygen saturation, blood pressure **blood tests **imaging of body cavities looking for a source of infection that needs surgical intervention Note that alteration of mental status is a red flag in sepsis Blood tests to be done in sepsis: blood gas, including glucose and lactate measurement  blood culture  full blood count reactive protein  urea and electrolytes Creatinine liver function tests a clotting screen management of pregnant ladies with sepsis: broad spectrum IV antibiotics IV fluids to maintain good tissue perfusion Admission to intensive care unit Multidisciplinary care Close observation of vital signs Vasopressors if in shock Daily blood tests Note that the antibiotic can be changed according to the culture results. What is the target oxygen saturation? 94-98% Does sepsis need early delivery or termination of pregnancy? ** early delivery can be considered if the maternal condition is deteriorating in order to save the fetus if viable ** early delivery can be considered if the infection was inside the uterus ** termination of pregnancy can be considered if the source of infection is the pregnancy tissue Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/sepsis-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM Cesarean birth Cesarean section is needed for delivery in 25-30% of ladies. There are many indications for cesarean birth. Cesarean birth has many benefits, yet it also has many disadvantages. Indications for cesarean birth: ** breech presentation ** previous cesarean birth ** pre-eclampsia with unfavorable cervix ** chorioamnionitis ** active genital herps/warts ** multiple pregnancy ** placenta previa ** placenta accreta ** fetal distress ** cephalopelvic disproportion ** slow progression of labor ** maternal choice after full counselling   Complications of cesarean birth: ** bleeding ** the need for blood transfusion ** ICU admission ** neonatal ICU admission ** placenta previa and accreta in future pregnancies ** more postpartum pain ** infection ** formation of future adhesions with subsequent infertility ** stress urinary incontinence   What to do to reduce the rate of infection? Give intravenous antibiotic prophylaxis 30 minutes before skin incision   How do we reduce the risk of thrombosis after cesarean section? ** early ambulation ** encourage hydration ** anticoagulation   Which mode of anesthesia is better for cesarean section? The mode of anesthesia is determined according to many factors, but generally spinal anesthesia is preferred.   how is pain managed after cesarean section? ** intramuscular analgesia or intravenous analgesia: Narcotics NSAIDS Paracetamol ** patient-controlled analgesia through special devices   For how long do we keep the urinary catheter after cesarean section? Depending on the case, usually it is removed 6-8 hours for early ambulation What is the length of hospital stay after cesarean section? usually, 24-48 hours but might be longer depending on the case itself wound care after cesarean section: Daily showers with water and soaps to keep the wound clean Avoid excessive sweating Wear loose cotton clothing Avoid heavy lifting or straining Take antibiotics as prescribed Monitor for any change in wound color or foul-smelling discharge Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/cesarean-birth Mon, 08 Mar 2021 05:25:19 AM Twin Pregnancy   Twin pregnancies are considered high-risk because they are prone to a number of potential complications. Twin pregnancies require close monitoring throughout the pregnancy to ensure the health of both the mother and the babies. A twin pregnancy is a pregnancy involving more than one fetus in the uterus. What are the types of twins? - Twins with separate placentas - Twins sharing a placenta What factors increase the likelihood of having twins? ** Genetic factors, as twin pregnancies run in some families. ** Use of ovulation-stimulating drugs. ** Assisted reproductive technologies such as artificial insemination and in-vitro fertilization (IVF). ** Advanced maternal age.  All these factors increase the likelihood of having twins, but they do not guarantee it.   What are the potential complications that increase during a twin pregnancy? ** Increased risk of miscarriage ** Increased risk of premature birth ** Increased risk of fetal malformations ** Increased risk of anemia in the mother ** High blood pressure during pregnancy and preeclampsia ** Increased risk of newborns requiring intensive care after birth ** Increased risk of postpartum hemorrhage due to uterine atony How does a woman pregnant with twins give birth? This depends on the position of the babies' heads. A vaginal birth is possible if the first baby is head down, but the medical community generally prefers a cesarean section to minimize complications. When does a woman pregnant with twins give birth? It depends on the number of fetuses in the uterus: **Two fetuses: Week 37 **Three fetuses: Week 35 **Four fetuses: Week 32   What are the complications of a twin pregnancy for the fetuses? ** Intrauterine growth restriction ** Blood transfusion between fetuses if the placenta is shared ** Premature birth and its associated complications ** Increased risk of miscarriage ** Increased risk of birth defects Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist   https://www.layyous.com/en/pregnancy/twin-pregnancy Mon, 08 Mar 2021 05:25:19 AM Mental health in pregnancy   Pregnancy is a life event; it is normal to feel a lot of different emotions. But if it started to affect your life, there are things to try that might help talk about your feelings to a friend, family member or doctor try calming breathing exercises  eat a healthy diet with regular meals and try to exercise do not compare yourself to others (everyone experiences pregnancy in different ways) do not use cigarettes or drugs to try and feel better – these can affect your baby's growth and wellbeing.   If you're feeling sad and it's not improving, a talking therapy might help. You may be offered medicine to treat the symptoms. Before taking medicine while you're pregnant or breastfeeding consult your doctor to weigh up the risks and benefits to have the safest medicine at the lowest amount that will work. Mental health problems There are many mental health problems you could experience in pregnancy. They can happen at any time, even if this is not your first pregnancy up to 12 weeks post-partum. If you feel sad all the time, you may have depression. If you have flashbacks, nightmares or feel intense distress when reminded of a past experience you may have post-traumatic stress disorder (PTSD) ( especially if you've had a pregnancy go wrong or a traumatic birth ). If you have sudden attacks of panic or fear, then you have panic disorder. If you have obsessive thoughts and compulsive behaviors then it is obsessive compulsive disorder (OCD)   If you have extreme fear of giving birth then it is tokophobia You may also find it hard to cope with your body changing shape, particularly if you have had an eating disorder. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/mental-health-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM Foods to avoid in pregnancy   Milk and cheese: You can eat: pasteurized milk, yoghurt, cream and ice cream pasteurized or unpasteurized hard cheeses, such as cheddar and parmesan pasteurized semi-hard cheeses, such as edam pasteurized soft cheeses, such as cottage cheese, mozzarella, feta, cream cheese, paneer, ricotta, halloumi, goats' cheese without a white coating on the outside and processed cheese spreads soft or blue cheese (pasteurized or unpasteurized) that has been cooked until steaming hot avoid foods made from unpasteurized milk pasteurized or unpasteurized mold-ripened soft cheeses with a white coating on the outside, such as brie, camembert and chèvre (unless cooked until steaming hot) pasteurized or unpasteurized soft blue cheeses, such as Danish blue, gorgonzola and roquefort (unless cooked until steaming hot) unpasteurized cows' milk, goats' milk, sheep's milk or cream Why There's a small chance that unpasteurized or soft ripened dairy products may contain Listeria bacteria. This can cause listeriosis which may lead to miscarriage or stillbirth, or affect the newborn. Soft cheeses with a white coating on the outside have more moisture which make it easier for bacteria to grow. That’s why we advise cooking cheese until it's steaming hot to kill the bacteria. Meat and poultry you can eat chicken, pork and beef, as long as they're well-cooked with no trace of pink or blood; be careful with sausages and burgers cold, pre-packed meats   What to be careful with cold cured meats, such as salami, pepperoni, chorizo and prosciutto (unless cooked thoroughly) What to avoid raw or undercooked meat liver and liver products Why You may get toxoplasmosis that can cause miscarriage. Cured meats are not cooked, so they may have parasites in them that cause toxoplasmosis. Liver and liver products have lots of vitamin A in them which is harmful to the unborn baby. Eggs you can eat foods made with raw hen egg, such as mousse and mayonnaise well cooked eggs (white and yolk) from any hen eggs. well cooked eggs (white and yolk) of all other eggs, including duck, goose or quail What to avoid raw or partially cooked hen eggs raw or partially cooked duck, goose or quail eggs Why They may have salmonella in them that cause a food poisoning. fish you can eat cooked fish and seafood sushi, as long as the fish has been cooked thoroughly cooked shellfish, such as mussels, lobster, crab, prawns, scallops and clams What to limit you should not eat more than 2 portions of oily fish a week, such as salmon, trout, mackerel or herring you should not eat more than 2 tuna steaks (about 140g cooked or 170g raw) or 4 medium-size cans of tuna (about 140g when drained) per week   What to avoid swordfish raw shellfish cold-smoked or cured fish (for example smoked salmon or gravlax, including in sushi), unless it has been cooked until steaming hot Why because it could be contaminated with listeria bacteria  which cause listeriosis. Cooking smoked or cured fish until it's steaming hot will kill any bacteria that may be present. You should limit tuna because it has more mercury in it than other fish. You should limit oily fish because they can have pollutants such as dioxins and polychlorinated biphenyls in them. You should avoid raw shellfish because they can have harmful bacteria, viruses or toxins in them.   Caffeine You can have caffeine not more than 200mg per day. more than this amount can increase the risk of having a miscarriage or low birth fetus. Herbal teas Some contain no caffeine, while others may have quite high levels. Some of the herbs used in herbal tea can also be potentially dangerous if you have a lot of them during pregnancy; especially during first trimester. As a general rule, we advise not to take more than two cups of herbal tea a day during your pregnancy. Fruits and vegetables Be careful with fruits, vegetables and salads as they can have soil on them, which can make you unwell. Make sure to thoroughly wash it. Vitamins Do not take high-dose multivitamin supplements, or any supplements with vitamin A in them.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/foods-to-avoid-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM Cervical cerclage   Cervical cerclage is an intervention done in pregnancy to prevent preterm birth or second trimester miscarriage due to cervical incompetence. The string is applied to strengthen the cervix. What are the indications of cerclage? **history of preterm birth  **history of second trimester miscarriage Usually, the history entails painless dilatation of the cervix (not preceded by uterine contractions) thus establishing the diagnosis of cervical incompetence. How does the patient with cervical incompetence present? **feeling of pelvic heaviness **increased vaginal discharge **feeling of downward pressure **low back pain **watery vaginal discharge Upon examining the patient, the cervix is found to be dilated without any pain. What are the types of cervical cerclage? **vaginal **transabdominal What are the contraindications of cervical cerclage? **active infection **ruptured membranes **vaginal bleeding **fetus incompatible with life **dead fetus At what gestational age is it applied? Between 11-14 weeks When is it removed? **At 36-37 weeks of gestation in cases of vaginal delivery **At the end of cesarean section  What are the possible complications of cervical cerclage? **bleeding **infection **ruptured membranes **complications of anesthesia **failure of cerclage When is cerclage removed urgently? **uterine contractions leading to cervical dilatation (tightening of stitch) **active vaginal bleeding **active infection **ruptured membranes **intrauterine fetal death Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/cervical-cerclage Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/gynaecology/having-daughters:-when-females-excel-in-the-balance-of-giving Mon, 08 Mar 2021 05:25:19 AM Situations that require you to go to the emergency room during pregnancy   There are several situations that require emergency medical attention during pregnancy because they pose a risk to the life of the mother or fetus. 1- Vaginal bleeding: Vaginal bleeding at any stage of pregnancy, especially if it is heavy or accompanied by pain, may indicate: - Miscarriage - Ectopic pregnancy - Placental abruption - Uterine rupture - Molar pregnancy 2- Severe abdominal pain: Especially if it doesn't subside with mild painkillers or worsens over time. 3- Severe or sudden headache: This may indicate: - Preeclampsia if accompanied by protein in the urine, high blood pressure, facial swelling, or blurred vision. - Problems with the brain or nervous system. 4- High blood pressure above 140/90. 5. Vaginal discharge, which may indicate: - Severe fungal or bacterial infections - Rupture of membranes (water breaking) 6. Regular and strong contractions:  - If they occur before the expected delivery date, this puts the baby at risk of premature birth.  - If the patient is in her ninth month of pregnancy, this means she has started labor. 7- Severe constipation or diarrhea: - Laxatives may be given in cases of severe constipation, or an enema may be administered. X-rays may be performed to ensure there is no intestinal obstruction. - In cases of diarrhea, a stool analysis is performed, and intravenous fluids are given to replace lost salts and prevent dehydration. 8. Persistent vomiting that prevents the pregnant woman from eating and drinking; intravenous fluids are administered to replace lost salts and prevent dehydration. 9. Fever above 38°C: - To investigate the source of infection.  - To administer appropriate antibiotics to prevent the spread of bacteria through the bloodstream to the uterus. 10- Rapid heartbeat or chest pain: - An electrocardiogram (ECG) is performed to diagnose whether or not a heart attack is present. - Some cases may require an emergency cardiac catheterization. 11- Severe shortness of breath: The heart and lungs are evaluated to look for possible pulmonary embolisms. 12- Severe burning during urination or blood in the urine: - A urinalysis is performed to check for infection. - Kidney function tests are performed. 13- Fall or traffic accident: - The fetus is assessed via ultrasound to ensure it is not injured and that there is no placental abruption. - Necessary X-rays are taken of the mother, and fractures and bruises are treated if required. 14- Decreased or absent fetal movements   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/situations-that-require-you-to-go-to-the-emergency-room-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Examples of Dietary Guidelines for Pregnant Women During Ramadan   Ramadan is a spiritual opportunity eagerly awaited by Muslims worldwide, a time when the values of patience and getting closer to God are manifested. It is well known that pregnancy is a sensitive stage requiring special attention to nutrition, and for this reason, God Almighty has permitted pregnant women to break their fast during the blessed month of Ramadan. Pregnant women often find themselves facing important questions about their ability to fast and its impact on the health of their unborn child. One of the most frequent questions we receive at our clinic is from pregnant women about a suitable diet to follow while fasting during Ramadan, so they can obtain the necessary nutrients without compromising their health or the health of their baby. In this article, we will provide examples of suitable iftar and suhoor (pre-dawn meal) meals for pregnant women. iftar 1: - Two dates + a cup of milk - Lentil soup (rich in protein and iron) - Grilled chicken breast - Half a cup of brown or white rice - Fattoush salad or green salad with olive oil Benefits of this type of iftar: ** High protein content from chicken and lentils ** Fiber to improve digestion ** Vegetables containing vitamins ** A source of energy from brown rice Suhoor 1: - Two boiled eggs - One slice of whole wheat bread - Cucumber + Tomato - One cup of whole milk iftar 2: - Two dates + a glass of natural juice (orange or lemon) - Grilled salmon - Quinoa salad with vegetables - Greek yogurt with nuts - Half a cup of brown or white rice Benefits of this type of iftar: ** Omega-3 from the fish ** Protein from the Greek yogurt ** Fiber from the salad ** protein from the Greek yogurt ** Energy source from the rice Suhoor 2: - Half a cup of cooked oatmeal with milk - Sliced berries or banana - A handful of almonds or walnuts - A cup of fresh orange juice - Toast bread with cream cheese iftar 3: - Two dates + a cup of milk - Roasted veal - Spaghetti made from wheat with a natural tomato sauce - Tabbouleh Benefits of this iftar: ** Protein from the meat ** Calcium from the milk ** A source of energy from the spaghetti ** Fiber from the tabbouleh to aid digestion Suhoor 3: - Toast with avocado - Two boiled or fried eggs - A cup of yogurt with nuts Suhoor 4: - Hummus with olive oil - Whole wheat bread - Cucumber + tomato - A tablespoon of peanut butter - Herbal tea without sugar Now let's talk about a suitable Ramadan diet for a pregnant woman with diabetes: ** It should be noted that a pregnant woman with diabetes should receive close monitoring from her internist because any rise or fall in blood sugar may affect the mother and the fetus. Example of iftar for a pregnant woman with diabetes: - One date with a glass of water - Lentil soup (no potatoes) - Grilled chicken breast, lean meat, or grilled fish - Half a loaf of grain bread, or 4 tablespoons of brown rice, or half a cup of quinoa/bulgur - Green salad with olive oil, or chickpea salad, or bean salad, or avocado slices - A glass of milk or natural yogurt We advise fasting pregnant women to have a glass of yogurt with nuts after Taraweeh prayers. Example of a pre-dawn meal (suhoor) for a pregnant woman with diabetes: - A boiled egg or low-fat cheese/labneh - A slice of whole-wheat bread or a whole-grain pita - Vegetables (cucumber, tomato, lettuce) - A spoonful of chia or raw nuts - A glass of low-fat milk or natural juice such as orange juice - Oatmeal cooked with low-fat milk or oatmeal with honey and raw nuts ** It should be noted that it is not recommended for a pregnant woman who suffers from diabetes and takes insulin to fast, as this poses a risk to her, since she is more prone than others to fluctuations in blood sugar and the potentially fatal effects of such fluctuations. Pregnant women with diabetes should avoid: - Fried foods - Ramadan sweets - Artificially sweetened juices Pregnant women with diabetes should ensure they take their medications on time to avoid complications. Important tips for pregnant women during Ramadan: - If you suffer from high blood pressure, avoid salty foods. - Start your Iftar with liquids and wait 10 minutes before your main meal. - Avoid fried foods. - Avoid carbonated drinks. - Make sure to dirnk 6-8 glasses of water between Iftar and Suhoor. - Walking for half an hour every day after Iftar helps with digestion and regulating blood sugar levels. We wish you an accepted fast and a blessed Iftar! 😊 Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/examples-of-dietary-guidelines-for-pregnant-women-during-ramadan Mon, 08 Mar 2021 05:25:19 AM Anxiety during pregnancy Pregnancy is a stage filled with a lot of emotions: joy, anticipation, fear, and endless questions. But is it normal to worry? The short answer is yes, but only up to a certain point. Why does anxiety increase during pregnancy? 1. Hormonal changes that affect mood. 2. Fear for the baby's health. 3. Past experiences (miscarriage, difficult delivery). 4. Hearing negative stories from those around you. 5. Excessive internet browsing. Mild and intermittent anxiety is normal, especially in the first trimester and around the time of delivery. When is anxiety abnormal? - If it persists almost all day. - If it affects sleep and appetite. - If it causes palpitations, shortness of breath, or panic attacks. - If it causes the pregnant woman to obsessively think about worst-case scenarios. - If it prevents the pregnant woman from living her life normally. In this case, it's considered pathological pregnancy anxiety and requires support. Does anxiety affect the fetus? Transient anxiety doesn't harm the fetus, but severe and persistent stress may be linked to an increased risk of certain complications such as: high blood pressure, sleep disturbances, and premature birth in some cases. Therefore, paying attention to mental health is not a luxury but an integral part of pregnancy care. What can a pregnant woman do to alleviate anxiety? - Reduce random internet browsing.  - Take a light walk daily.  - Practice deep breathing exercises for 5-10 minutes.  - Talk about your fears instead of suppressing them. - Get regular sleep.  - Consult a psychiatrist when needed; this is not a sign of weakness. You are not required to be strong all the time. Not every scary thought means that something bad will happen. Pregnancy is a journey, and reassurance is part of taking care of yourself and your baby. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/anxiety-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Bleeding in the first trimester of pregnancy: Does it always mean miscarriage?   Bleeding in early pregnancy is one of the most common causes of anxiety for pregnant women, but not all bleeding means pregnancy loss. What are the common causes? - Implantation bleeding - Small blood clot around the gestational sac - Cervical irritation - Miscarriage - Ectopic pregnancy The assessment is based on: - Severity of bleeding - Presence of abdominal pain - Gestational age - Ultrasound examination - Follow-up hormonal pregnancy test results if needed In many cases, the pregnancy continues normally despite bleeding. When should you seek emergency medical attention? - Heavy bleeding that soaks up a sanitary pad in less than an hour.  - Severe pain or shoulder pain.  - Dizziness or fainting. Bleeding is a symptom, not a diagnosis. With medical follow-up and evaluation, many pregnant women who experience light bleeding at the beginning go on to have healthy pregnancies, God willing. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/bleeding-in-the-first-trimester-of-pregnancy:-does-it-always-mean-miscarriage Mon, 08 Mar 2021 05:25:19 AM Vaccination during pregnancy   Vaccination during pregnancy is an important measure to protect both the mother and fetus against certain infections. Some vaccines are recommended during pregnancy as they are safe and lead to the production of antibodies that cross the placenta and help protect the baby in the first 6 months of life against serious infections. Pregnant women are immunocompromised and are more prone to serious complications subsequent to any infection.   Importance of vaccination in pregnancy: Protects the mother from infections that might be more severe in pregnancy Protects the fetus and transfer through transplacental antibody transfer Prevents obstetric complications such as preterm birth or neonatal infections   Vaccines that are recommended in pregnancy: Influenza vaccine: ** given during any month of pregnancy ** protects against seasonal influenza **protects newborn during first 6 months of life **the virus is inactivated in the vaccine (not alive)   Pertussis vaccine: **given in addition to tetanus and diphtheria **recommended between 27-36 weeks of gestation **repeated in each pregnancy **the aim is to protect the infant from severe pertussis which might be life-threatening in infant age **part of Tdap vaccine   Tetanus vaccine: **given in situations with increased tetanus risk ** given in addition to pertussis and diphtheria **prevents neonatal tetanus **part of Tdap vaccine     Note: Tdap vaccine contains inactivated toxins and protein antigens   Some vaccines are given if needed and not as routine: ** hepatitis B vaccine **covid 19 vaccine **rabies vaccine (if exposed to animal bites) **meningococcal vaccine in outbreaks or travelling to areas with high-risk exposure   Vaccines that are contraindicated in pregnancy: Measles vaccine Mumps vaccine Rubella vaccine Varicella vaccine Tuberculosis Generally, vaccines that contain live viruses are not allowed in pregnancy as the pregnant lady’s immunity is weakened during pregnancy and live vaccines contain organisms that are able to replicate and infect the fetus. These are all live vaccines, and that’s why they should be given before pregnancy or after birth.   Side effects of vaccines: Pain at injection site Mild fever Fatigue Headache Severe side effects are rare     If a live vaccine is given during pregnancy, should the pregnancy be terminated? No, because the risk is very small. But close monitoring of the mother and fetus are needed.   How long should I wait before getting pregnant after I take a live vaccine? Four weeks   Are live vaccines safe during breastfeeding? Yes, because the transmission rate through breast milk is very low Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/vaccination-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Body swelling during pregnancy: its causes and when to be concerned   Body swelling during pregnancy is a common symptom experienced by a large percentage of pregnant women, especially in the second and third trimesters. This swelling occurs as a result of a range of normal physiological changes that accompany pregnancy.   What causes swelling during pregnancy?   During pregnancy, the volume of blood and fluids in a woman's body increases by up to 50% to support the growth of the fetus and placenta and to prepare the body for childbirth. This increase in fluids can lead to their accumulation in the tissues, causing what is known as edema, which often appears in the feet and ankles, and sometimes in the hands and face. Hormonal changes also play a significant role. Progesterone causes the walls of blood vessels to relax, making it easier for fluids to leak into surrounding tissues. Additionally, an enlarged uterus compresses the veins in the pelvis, slowing the return of blood from the lower extremities to the heart and increasing swelling.   When is swelling normal?   it is often normal when: - Appears gradually during pregnancy. - Increases towards the end of the day or after prolonged standing. - Improves with rest or elevating the feet. - Primarily affects the feet and ankles.   When should you see a doctor?   Although swelling is often normal, some cases may indicate a medical problem such as preeclampsia. Therefore, you should see a doctor if the swelling is: - Sudden and severe. - Accompanied by significant swelling in the face and hands. - Accompanied by severe headaches or blurred vision. - Accompanied by high blood pressure.     Tips to reduce bloating during pregnancy: - Avoid standing or sitting for long periods. - Elevate your feet when sitting. - Drink plenty of water. - Reduce your intake of salty foods. - Take light walks to improve blood circulation. - Wear comfortable shoes and avoid tight ones.   Body swelling during pregnancy is a normal change in most cases, resulting from increased fluids and hormonal changes in the body. However, any sudden or severe swelling should be monitored, and a doctor should be consulted to rule out any complications.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/body-swelling-during-pregnancy:-its-causes-and-when-to-be-concerned Mon, 08 Mar 2021 05:25:19 AM Body swelling during pregnancy: its causes and when to be concerned   Body swelling during pregnancy is a common symptom experienced by a large percentage of pregnant women, especially in the second and third trimesters. This swelling occurs as a result of a range of normal physiological changes that accompany pregnancy.   What causes swelling during pregnancy?   During pregnancy, the volume of blood and fluids in a woman's body increases by up to 50% to support the growth of the fetus and placenta and to prepare the body for childbirth. This increase in fluids can lead to their accumulation in the tissues, causing what is known as edema, which often appears in the feet and ankles, and sometimes in the hands and face. Hormonal changes also play a significant role. Progesterone causes the walls of blood vessels to relax, making it easier for fluids to leak into surrounding tissues. Additionally, an enlarged uterus compresses the veins in the pelvis, slowing the return of blood from the lower extremities to the heart and increasing swelling.   When is swelling normal?   it is often normal when: - Appears gradually during pregnancy. - Increases towards the end of the day or after prolonged standing. - Improves with rest or elevating the feet. - Primarily affects the feet and ankles.   When should you see a doctor?   Although swelling is often normal, some cases may indicate a medical problem such as preeclampsia. Therefore, you should see a doctor if the swelling is: - Sudden and severe. - Accompanied by significant swelling in the face and hands. - Accompanied by severe headaches or blurred vision. - Accompanied by high blood pressure.     Tips to reduce bloating during pregnancy: - Avoid standing or sitting for long periods. - Elevate your feet when sitting. - Drink plenty of water. - Reduce your intake of salty foods. - Take light walks to improve blood circulation. - Wear comfortable shoes and avoid tight ones.   Body swelling during pregnancy is a normal change in most cases, resulting from increased fluids and hormonal changes in the body. However, any sudden or severe swelling should be monitored, and a doctor should be consulted to rule out any complications.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/body-swelling-during-pregnancy:-its-causes-and-when-to-be-concerned Mon, 08 Mar 2021 05:25:19 AM Intense cravings/aversions during pregnancy   Cravings are a common symptom during pregnancy. They refer to a strong desire for something (such as certain foods) or a strong aversion to something else. They usually occur during the first trimester and tend to lessen in intensity as the pregnancy progresses. Cravings are considered a normal change during pregnancy and are not a pathological condition.   Pregnancy cravings timing: - They typically begin between weeks 5 and 8 of pregnancy. - They usually lessen or disappear after weeks 12 and 14 of pregnancy. - Some women may experience them for a longer period.   Why do pregnancy cravings occur? - Hormonal changes. - Increased sensitivity of certain senses, such as taste and smell, which may make some foods unpalatable. - Emotional and psychological changes that affect appetite. - Nutritional deficiencies that affect the body's dietary needs.   Types of cravings: - Intense cravings for certain foods - Intense aversion to certain foods - Cravings aren't limited to food; a heightened sense of smell during pregnancy can lead to aversions to certain people or places due to their scent.   Is craving for food dangerous? No, but it can become dangerous if accompanied by severe nausea and vomiting leading to: ** Weight loss ** Signs of dehydration ** Dizziness and fainting   What are the recommendations for managing food cravings during pregnancy? - Eat several small meals.  - Avoid foods that trigger nausea.  - Drink plenty of water. - Eat salty snacks like crackers, but in moderation.  - Get enough rest. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/intense-cravings-aversions-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Recognizing warning signs during pregnancy: what to do in an emergency The pregnant lady’s guide   It is important to educate pregnant ladies about what to do in cases of an emergency, because acting right during an unexpected emergency will lead to better maternal and fetal outcomes.   Heavy vaginal bleeding: Stay calm, don’t panic Avoid inserting anything (like a finger) inside the vagina Call an ambulance immediately Go to the nearest hospital Bring all of your prenatal records if possible If offered admission for observation accept it and don’t sign any paper against medical advice   Severe abdominal pain: Stop any physical activity Rest in a comfortable position Drink some water if you are dehydrated Seek medical help immediately Don’t take analgesia before medical assessment If offered admission for observation accept it and don’t sign any paper against medical advice   Decreased fetal movements: Sit on your left side Eat something sweet if not diabetic Focus on the fetal movements for 2 hours, if less than 10 kicks then you should seek medical help Fetal movements are only reliable after 28 weeks of gestation   What to do if your water breaks early: Note the color and amount of fluid Avoid sexual intercourse Don’t insert anything inside the vagina Seek medical help immediately Must go for the hospital for evaluation because of increased risk of infection   When to call emergency services immediately: Severe chest pain: risk of myocardial infarction or pulmonary embolism Difficulty breathing: risk of pulmonary embolism Convulsions: risk of maternal/fetal anoxia Loss of consciousness Severe headache with visual disturbance (risk of preeclampsia) Severe trauma Heavy bleeding No fetal movements   Important notes to keep in mind during pregnancy in case any emergency happened: Keep your doctor’s phone number with you Know which hospital is nearest to you Keep a hospital bag prepared Keep your prenatal records accessible and with you Keep a family member informed for cases of emergency   Being prepared, recognizing the warning signs and responding in a timely manner ensures the safety of both the mother and baby.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/recognizing-warning-signs-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Physiological changes in pregnancy   Pregnancy represents a special physiological state during which the woman’s body undergoes extensive changes in order to adapt to the growing fetus and support its health. These changes also prepare the mothers body for childbirth and lactation. Every organ system is affected, and the effects are mainly caused by placental hormones and maternal glands.   Why is it important to know about the physiological changes in pregnancy? In order to distinguish them from pathological changes.   Hormonal changes: ** hCG hormone: supports corpus luteum in early pregnancy to maintain progesterone production **progesterone: relaxes uterine muscles and prevents premature contractions **estrogen: promotes uterine growth, breast development and increased blood flow **hPL hormone: modifies maternal metabolism **relaxin: soften the cervix in preparation for delivery   Cardiovascular system changes: ** increased blood volume by 50% ** increased cardiac output by 50% **decreased systemic vascular resistance ** physiological anemia **decreased blood pressure   Respiratory system changes: ** increased tidal volume ** increased ventilation per minute ** respiratory alkalosis ** elevated diaphragm due to enlarged uterus ** improved oxygenation   Renal system changes: ** increased blood flow to the kidneys ** increased glomerular filtration rate by 50% ** mild glucose in urine ** dilatation of ureters   Gastrointestinal system changes: ** nausea and vomiting ** reduced motility ** constipation ** heartburn ** increased appetite   Hematological changes: ** increased clotting factors leading to thrombosis tendency ** physiological anemia ** increased blood cell mass   Musculoskeletal changes: ** relaxation of pelvic ligaments ** lumbar lordosis ** loosening of pelvic joints These changes lead to lower back pain and altered posture   Skin changes: ** increased pigmentation ** increased sweating ** increased activity of sebaceous glands ** palmar erythema   Understanding these changes helps the obstetrician differentiate normal physiology from evolving pathology to provide optimal maternal and fetal care.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/physiological-changes-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM Dating of the pregnancy   Dating the pregnancy refers to: Determining the gestational age of pregnancy Determining the expected date of delivery   Accurate dating is important because: It guides antenatal care appointments Guides timing of investigations Allows proper assessment of fetal growth Helps in proper management of preterm birth or post-term pregnancy Incorrect dating might lead to inappropriate obstetric interventions.   Stages of gestational age: ** first trimester: 0-13 weeks ** second trimester: 14-27 weeks ** third trimester: 28-40 weeks Pregnancy is 40 weeks (280 days) calculated from the first day of the last menstrual period.   Last menstrual period (LMP): The most commonly used method to date a pregnancy We use the first day of the last menstrual period The expected due date is calculated using Naegele’s rule which depends on the last menstrual period It is simple to use Has some limitations like irregular cycles, uncertain LMP, breastfeeding or using OCPs   Using ultrasound for dating: The most accurate method In the first trimester we measure crown-rump length In the second trimester we measure head circumference Used if LMP unknown, irregular cycles or if there was a discrepancy between calculated dates and fetal measurements Cany be used to change dates in the third trimester (increased margin of error)   Clinical examination for dating: Abdominal exam to estimate uterine size Fundal height measurement Maternal feeing of fetal quickening This is the least accurate method   It is best to date pregnancy as early as possible, because with advancing gestations the margin of error of different dating methods increases which leads to poor maternal and fetal outcomes should intervention be needed.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/dating-of-the-pregnancy Mon, 08 Mar 2021 05:25:19 AM Role of chromosomal abnormalities in pregnancy complications   Chromosomal abnormalities mainly affect early fetal development, placental function and structural integrity of fetal body systems. That’s why chromosomal abnormalities lead to problems with fetal growth and congenital anomalies. The most common presentation of chromosomal abnormalities in early pregnancy is pregnancy loss (miscarriage).   Early pregnancy loss: Errors of chromosomal distribution during cell division leading to abnormal number of chromosomes. Embryos become non-viable Up to 75% of early pregnancy loss is due to abnormal chromosomes The most common are: trisomy 16 and turner syndrome   Recurrent miscarriage: Chromosomal rearrangements of parental chromosomes lead to repeated pregnancy loss.   Birth defects: Down syndrome (errors in chromosome 21): heart defects and intellectual disability Edwards syndrome (errors in chromosome 18): severe developmental delay and high neonatal mortality Patau syndrome (errors in chromosome 13): brain and fascial abnormalities Usually, chromosomal abnormalities present with congenital anomalies affecting multiple organ systems.   Restriction of fetal growth: Chromosomal abnormalities impair placental function This leads to restrictions of fetal growth with poor outcome   Intrauterine fetal death: Chromosomally abnormal fetuses are more prone to die inside the womb   Placental abnormalities: Poor implantation and preeclampsia can be caused by chromosomal abnormalities   Molar pregnancy results because of abnormal chromosomal fertilization leading to abnormal placental tissue growth instead of a viable fetus.   Infertility: Because placental abnormalities lead to prevention of embryo implantation and sometimes early pregnancy loss before even knowing that the lady is pregnant.   How to screen for chromosomal abnormalities? Measuring nuchal translucency in the first trimester Blood biochemical markers Cell free fetal DNA testing Combination of these methods with each other and with maternal age   How to diagnose chromosomal abnormalities in pregnancy? Chorionic villus sampling: taking a placental sample and culturing it in the laboratory to study fetal cells chromosomes Amniocentesis: taking a sample from amniotic fluid and culturing it in the laboratory to study fetal cells chromosomes Karyotyping/ genetic testing of products of conception after miscarriage or pregnancy termination   Is there a way to prevent pregnancy with chromosomally abnormal fetuses? Yes, through invitro fertilization and testing fetal chromosomes before transferring them inside the uterus, but this doesn’t guarantee that the pregnancy won’t have any complications such as miscarriage or congenital anomalies or other above-mentioned complications that might happen due to other causes besides chromosomal abnormalities. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/role-of-chromosomal-abnormalities-in-pregnancy-complications Mon, 08 Mar 2021 05:25:19 AM Tips for Pregnant Women During Eid   Eid is a wonderful opportunity for family gatherings and celebrations, but for pregnant women, it can present some challenges. Therefore, it's important to pay attention to a few things to maintain your health and the health of your baby during this period.   Don't overexert yourself. Eid is full of visits and preparations, but don't try to do everything yourself. Take sufficient breaks and delegate tasks to those around you. Pay attention to the type of food you eat. During Eid, sweets and fatty foods are abundant, so: - Eat moderate amounts of cakes and maamoul.     - Avoid undercooked foods. - Focus on vegetables and fruits. Can cakes and maamoul cause labor pains?   In some cases, they can cause abdominal pain similar to labor pains due to:   • Bloating and gas. Fat and sugar contribute to slow digestion and abdominal bloating. This pain can be intense and intermittent, thus being mistaken for labor pains. • Irritable bowel syndrome. • Increased bowel movements. • Dehydration with sugar. Excessive sugar intake without drinking enough water can increase muscle tension and may lead to mild uterine contractions.   Drink plenty of water.  Dehydration can cause fatigue and dizziness, especially with movement and travel. Make sure to drink water regularly throughout the day.   Move in moderation. Light walking is very beneficial: it improves blood circulation and reduces swelling. However, avoid standing or walking for long periods.   Choose comfortable clothing. Avoid tight clothing. Choose comfortable shoes to prevent swollen feet. Cotton clothing is best, especially in warm weather.   Don't neglect sleep. Staying up late during the holidays can increase fatigue, so: - Try to get enough sleep. - Go to sleep when you feel tired, even during the day.   Pay attention to symptoms. If you experience: - Severe dizziness. - Abdominal pain. - Bleeding or abnormal discharge. Don't hesitate to see a doctor immediately.   8. Take your medications as prescribed and do not stop any treatment without consulting your doctor.   9. Enjoy the holiday without stress. The holiday is a time of joy, so try to relax and avoid stress and pressure. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/tips-for-pregnant-women-during-eid Mon, 08 Mar 2021 05:25:19 AM Urinary Tract Infections During Pregnancy   Urinary tract infections during pregnancy reveal many problems that pregnant women face, especially regarding their impact not only on the mother but also potentially on the fetus if not diagnosed and treated correctly.   What are urinary tract infections during pregnancy?   They are infections affecting any part of the urinary system (urethra, bladder, ureters, etc.), most often caused by bacteria such as E. coli. They are also often accompanied by partial damage due to vitamin and physiological deficiencies.   Why is treatment necessary during pregnancy?   • Increased tanning is caused by relaxation of the ureteral muscles, resulting in slower albumin flow. • The enlargement of the uterus in the bladder and medulla oblongata. • The development of the urinary system. • Changes in blood sugar levels. All of these factors contribute to bacterial growth. Types of Urinary Tract Infections During Pregnancy 1. Asymptomatic Bacterial Urine Infection (Asymptomatic Bacteriuria): - No symptoms - Detected during routine urination - Very important because it can develop into a kidney infection (pyelonephritis)   2. Cystitis (Bladder Infection): - Burning sensation during urination - Frequent urination - Lower abdominal pain - Sometimes blood in the urine   3. Pyelonephritis (Kidney Infection): - High fever - Flank pain - Nausea and vomiting - May lead to serious complications Diagnosis: - Urinalysis - Urine culture - Sometimes additional tests are needed in complex cases   Potential Complications: - Premature birth - Low birth weight - Maternal sepsis in severe cases - Anemia - Acute kidney infection   Treatment: Depends on the type of infection, and a pregnancy-safe antibiotic must be chosen.   Prevention: - Drink plenty of water - Urinate regularly and do not hold your urine - Urinate after intercourse - Maintain good personal hygiene (wiping from front to back) - Avoid tight and damp clothing - Treat constipation   Urinary tract infections during pregnancy are not as simple as they seem, especially since some may be asymptomatic. Therefore, routine checkups and early treatment are essential to avoid complications that could affect both the mother and the fetus. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/urinary-tract-infections-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Coffee and Pregnancy: What You Should Know   Coffee is one of the most popular beverages worldwide and forms part of the daily routine for many people. Therefore, many women find it difficult to give it up during pregnancy. At the beginning of their pregnancy journey, many women wonder about the safety of caffeine and its effects on the health of both mother and baby. Is coffee safe during pregnancy? Pregnant women can drink coffee in moderation and without excess. How does pregnancy physiology affect blood caffeine levels? Pregnancy slows down the elimination of caffeine, and some of it reaches the fetus through the placenta. What is a safe amount of caffeine during pregnancy? It should not exceed 200 mg in 24 hours, which is equivalent to: - One to two cups of medium-strength coffee - Several cups of light tea What happens when you consume too much caffeine? - Increased heart rate - Difficulty sleeping and insomnia - Increased stomach acidity - Stomach upset - Decreased iron absorption - Negative effects on fetal growth when caffeine is consumed in high concentrations Recommendations for coffee consumption during pregnancy: - Try to limit yourself to one small cup per day, especially during the first few months of pregnancy. - Avoid drinking coffee on an empty stomach, as it can increase acidity and nausea. - Be mindful of other sources of caffeine, such as tea, soft drinks, chocolate, and energy drinks. - Look for healthier alternatives, such as decaffeinated coffee, warm milk, and herbal teas (after consulting your doctor). In which case is it advisable to reduce or eliminate coffee consumption? - High blood pressure - Sleep disturbances - Heart palpitations - High-risk pregnancy with a risk of miscarriage or premature birth So, coffee isn't completely forbidden during pregnancy, but moderation is key. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/coffee-and-pregnancy:-what-you-should-know Mon, 08 Mar 2021 05:25:19 AM Folic Acid Before Pregnancy   Folic acid is one of the most important vitamins a woman needs before pregnancy, especially during the first trimester. It plays a vital role in supporting healthy fetal development and reducing the risk of birth defects. What is folic acid? It is a type of vitamin B. What roles does folic acid play in the body? - It helps the body form new cells.  - It supports normal blood production.  - It plays a vital role in the development of the fetal nervous system. Why do we recommend taking folic acid before pregnancy? - It plays a crucial role in the formation of the neural tube in the fetus, which later develops into the brain and spinal cord.  - Folic acid deficiency during this period can lead to neural tube defects in the fetus, such as spina bifida or craniofacial anomalies. When should I start taking folic acid before pregnancy? At least one month, and preferably three months, before conception. How does taking folic acid affect the mother's health? It protects her from anemia. Does folic acid play a role in reducing the risk of preeclampsia? Yes, it contributes to healthy placental development, which reduces the risk of high blood pressure during pregnancy and preeclampsia, as preeclampsia occurs due to placental dysfunction. What is the recommended dose of folic acid? 400 micrograms daily before pregnancy and during the first trimester. In which cases do higher doses of folic acid are needed? - A previous pregnancy with a fetus that had birth defects, especially those affecting the nervous system.  - Diabetes.  - Taking certain medications for epilepsy. What are the natural sources of folic acid? - Green leafy vegetables - Oranges and citrus fruits - Lentils and beans - Avocados - Nuts - Fortified cereals When should you stop taking it during pregnancy? Usually, after the first trimester, but there are some cases where it's necessary to continue taking it throughout the pregnancy. Are there different folic acid formulations available in pharmacies? Yes, there is the baseline formulation, which requires enzymatic conversion to the active ingredient in a woman's body, and there is the active formulation. Women with an MTHFR mutation require the active formulation directly because their bodies are unable to enzymatically convert the baseline compound to the active ingredient. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/folic-acid-before-pregnancy Mon, 08 Mar 2021 05:25:19 AM The Importance of Omega-3 During Pregnancy   Omega-3 fatty acids are essential nutrients for the health of both mother and baby, playing a vital role in supporting the development of the baby's nervous system. What is Omega-3? They are healthy fatty acids that the body needs for important functions but cannot produce in sufficient quantities. Therefore, they must be obtained from food and supplements. What are the main types of Omega-3? DHA EPA What is the most important type of Omega-3 during pregnancy? DHA Benefits of Omega-3 during pregnancy:  - Supports fetal brain development, especially during the last months of pregnancy.  - Promotes eye health by supporting the development of the fetal retina and improving vision.  - Reduces the risk of premature birth.  - Supports the mother's mental health and reduces the risk of depression during and after childbirth.  - Promotes the mother's heart health and supports blood circulation. What are the natural sources of Omega-3? - Fish - Walnuts - Chia seeds - Flax seeds - Prenatal supplements Can I take Omega-3 supplements during pregnancy? Yes, but only under the supervision of a doctor to ensure a safe type that does not contain mercury. Can pregnant women eat fish? Yes, provided it is of a type that contains very low levels of mercury. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/pregnancy/the-importance-of-omega-3-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Childbirth and Newborn https://www.layyous.com/en/childbirth-and-newborn Mon, 08 Mar 2021 05:25:19 AM Childbirth - Ways to relief pain during childbirth   Here is some information you need to know about labour, its stages and analgesia that can be used : What is labour? When the time comes, uterine contractions will make the baby to go out to life. There are signs for labour but it is difficult to know its time. Video of normal vaginal delivery | Video Stages Of Labour Video Explanation of the Labour Process Stages of labour: There are three stages of labour: 1st stage: It takes between 8-12 hours in primigravida, 4-6 hours in multipara; it may shorten or lengthen according to the patient condition, when labour starts it continues till full dilatation of the cervix 10 cm to allow the passage of the head.   2nd stage: Its length between 10-30 minutes in multipara, or more than 42 minutes in primigravida. It is the stage of passage of the head.   3th stage: It takes 10-20 minutes, and it is the stage of passage of the placenta. You may feel irregular, and separate labour pain in the last weeks of pregnancy, and once they become regular intervals, about 5 minutes, it is the time for delivery. During the second stage you will start to feel pushing down. Feeling pain is different from one patient to another, even if it was less severe. The cause of pain is the pressure made on the nerves near the uterus.   Causes of labour pain: Cervical dilatation in response to uterine contraction. Contraction and retraction in the lower uterine part in preparation to dilate the cervix. Contractions and retractions affect blood vessels which supply the uterine muscles and this will cause accumulation of metabolites which leads to pain. Once contractions occur they will cause tension on the ligaments that hold the uterus, and by that it will cause pain. Where you may feel pain? Most of the time it concentrates down in the abdomen. At the sides of the pelvic bone. From the umbilicus down to the genital area. Lower back. Signs of labour: Labour pain which is regular uterine contraction separated by short interval of time that can’t be relieved by analgesia. Bloody show. If you are primigravida you may feel irregular uterine contractions ½-1 hour apart, and that can be relieved with analgesia. When should you go to the hospital? If labour pain started. Heavy sudden bleeding. Passage of watery vaginal discharge wetting your clothes. Passage of greenish watery vaginal discharge What should you do during labour? 1st stage of labour: Don’t push downward. Take slow deep breath. Lie on the left or right side. 2nd stage of labour: Follow your doctor’s instructions, that is, by taking deep breaths, then push downward with each contraction (as if you want to defecate), then rest and relax in between contractions. Please do not scream in this stage, or pull your hair, or jump from the bed. Your doctor may need to cut an incision in your perineum especially in primigravida to help your baby through the process. This is done under local anesthesia.   3rd stage of labour: Empty your bladder. When blood gushes out of your vagina your doctor will pull the umbilical cord, so try to help by pushing down, then he will do uterine massage to help the uterus to contract. Once labour is finished, your doctor will start suturing your perineum under local anesthesia. In cases of difficult labour, your doctor may need to use vacuum or forceps, in order to get the baby out, so you need to know what type of delivery may be necessary. Caesarean section: Caesarean section Video It can be done under general or spinal anesthesia. It is done to save the life of the mother or her baby as in cases of: Cephalo-pelvic disproportion, fetal distress, placenta previa, severe bleeding, severe pre-eclampsia. How pain could be managed during labour? Psychoprophylaxsis or natural birth: In this method, no analgesia is used but it involves increasing the spirit of the pregnant woman, and asking her to relax, breathe deeply and slowly, during labour. So, if the doctor explains what will occur during labour to the pregnant woman, especially to primigravida, this will help her to tolerate pain. Pain Killing Drugs Which are given either intramuscularly or intravenously. Type of analgesia, its method of administration, amount of medication, (depends on the patient condition during labour). Epidural analgesia In this method, the drug is inserted in the epidural space after local anesthesia. The anesthesiologist will test the efficiency of the drug by pricking the patient gently, starting from the thigh to the abdomen...... -Does this type of anesthesia affect labour? It usually has no direct effect. It may lengthen, shorten or not affect the duration of delivery. Video of normal vaginal delivery | Video Stages Of Labour Video Explanation of the Labour Process | Caesarean section Video   Few notes to add : Analgesia during labour is a choice left for the pregnant woman, and her doctor, to determine if this is possible or not. If you notice any of these things, call your doctor immediately: Bleeding. Passage of watery vaginal discharge. uterine contraction lasting 15-20 seconds in the beginning then increase to 40-50 seconds, occuring at 2-3 minutes intervals. At this time, concentrate on taking deep and slow breaths. Preparation for Birth When you arrive to the hospital, the nurse and the resident doctor will assess your condition, if it is early labour, then you may be discharged home. If you are in true labour you will be admitted to the hospital. You also may be admitted to the hospital if you are hypertensive, or complain of pre-eclampsia, diabetic, or if there is fetal distress. After delivery, your baby’s mouth and nostrils will be cleaned from mucus, and covered. The umbilical cord will be cut in order that your baby will breathe from his nose and mouth. Then another sequence of contractions will occur in order to deliver the placenta. You will carry your baby between your hands and his weight and length will be measured. Baby Names Book, Arabic Baby Names http://www.babynamesbook.net   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/childbirth-ways-to-relief-pain-during-childbirth Mon, 08 Mar 2021 05:25:19 AM Preparations For Delivery - How to prepare your Delivery bag   After a while you will have the chance to meet your baby, so how would you prepare for this day: Put a plan in cases of emergency: Your husband’s mobile. The hospital phone. Your relative’s phone. The phone of the person who will help you during your stay in the hospital and afterwards. Police emergency phone. Arrange someone to help you after discharge and take care of your house and mail while you are in the hospital. Be sure that you have the proper hospital address. Arrange how you will be transported to the hospital in case your family are away. Make a list for your husband to follow when you are in the hospital, admission, paying bills etc. Take with you shower gel, hair shampoo. Before you go to the hospital: Take a warm bath. Shave your pubic hair. Remove any Jewelry. Don’t forget your obstetric card. Empty the bladder, and have rectal enema. Prepare your bag that you will carry to the hospital, once you are in the 8th month, and tell the family about its place. Suggestion for the delivery bag: Identification card, insurance card, Family document. Your delivery plan. Your glasses if you wear once. Tooth brush and tooth paste. Lipstick. Deodorant. Hair brush. Your makeup tools. Hair clip. Hair shampoo, body shampoo, body lotion, (some hospital provides these material, but you may prefer to bring your own shampoo). Hair dryer, your own towel. Bathrobe, night gown (try to bring a pajama that makes it easy for you to lactate your baby), slippers, socks, underwear, breastfeeding bra and sanitary napkins. Nipples balm. Wet napkin. Anything that helps you to relax as your own pillow, music, books. Going home clothes and its shoes. Camera and its batteries (be sure it is fully charged in order to record the first moment in your child's life. A phone number list of your friends and family, who you want to inform them that you gave birth. A bottle of water so that you can drink small amount of water during labour. High calorie foods as bananas, chocolate and biscuits in order to eat after delivery. Baby's bag: 3 pajamas hat and socks. Going home clothes. Car seat. Diaper. Nail scissor in order not to hurt himself. You also should bring some stuff for your husband, if he will stay with you in the hospital: Shaving tools, shampoo, soap, bathrobe. Snacks. Books. Money. Wish you and your baby a happy wonderful experience. Baby Names Book, Arabic Baby Names http://www.babynamesbook.net   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/preparations-for-delivery Mon, 08 Mar 2021 05:25:19 AM Instructions after delivery   Maternal health after delivery Maternal health is as important as the baby’s health, so she can care for her baby. After delivery the Mother needs a minimum of 2 weeks rest. She should avoid heavy work and` parties for at least 1 month after delivery. Caring for her baby is a simple thing she can do, and she should sleep when the baby sleeps. Eat a healthy, balanced diet that contains meat, fish, cheese, eggs, and milk, vitamins from liver and kidneys, vegetables and fruits. The Mother is asked to ambulate, 6 hours after delivery. Treat constipation in order to avoid hemorrhoid. Do not return to work for 6 weeks after delivery. Exercise regularly, so that your body may return to its previous healthy condition. Visit your doctor, after delivery for counselling, regarding lochia, lactation, and menses and how to stop breast feeding. Also, your Doctor needs to check blood pressure and weight and compare it with readings before delivery. You also should ask about continuing multivitamins, and ask about your next pregnancy, if planned. There are some emotional and physiological changes that occur to the postpartum female: Emotional changes: Most Mums experience stress and depression post delivery. This is because of sudden changes in their life, and the increase in responsibility and hormonal changes. So, you need to talk to your husband about this, because a new baby does not mean only new responsibility, it also mean a lot of happiness and joy. You may face some problems when you carry your baby, like fatigue, infection or confusion. Most of these problems will not be dangerous, but you should consult your doctor immediately if you notice anything out of the ordinary. You may be exhausted or moody because you are taking the responsibility of your baby and your husband. You may lose interest due to hormonal changes, biochemical changes or electrolyte imbalance. All these can be managed by encouragement, love and cooperation from your family. Physiological changes after delivery: Post partum period extends from 6-8 weeks after delivery, and by this time your organs return back to their previous status before pregnancy: Uterine contractions: 10 days after delivery, the uterus begins to contract in order to return back to the pelvis. After 6 weeks, it returns back to its normal size, pre-pregnancy. If you are still feeling your uterus in the abdomen, 2 weeks after delivery, you should consult your doctor. Care about your perineum: Your vagina will return back to its normal shape 10 days after delivery unless there is infection so, be careful about your perineum, and use hydrogen peroxide cottons to clean your perineum from front to the back in order not to get infections from your anus. Bowel motion and urination after delivery: You may notice an increase in your urine volume because your body wants to get rid of excess water through your kidneys. Also, because of abdominal muscles relaxation, a full bladder may cause post partum hemorrhage. You may have constipation or hemorrhoids after delivery so try to pass motion daily and clean your anus very well, you can use laxative to help you. Breast Care: Your breasts may enlarge suddenly after delivery, due to the increase in your prolactin level, which produces milk. You may experience breast engorgement on the 3rd/4th day after delivery so you need to do gentle massage daily. You should care for your breasts, and moisturize your nipples, so that you do not end up with mastitis and fever. You should masaage old milk out before breast feeding your baby. Firstly, put a warm towel on the breast. Try to massage around your breast by doing circular movements. Hold your breast between the thumb and the index finger, as if you are milking it and do this in different directions, and pull your nipples up also in different directions to milk it. Breast feeding ideas: To know if the amount of milk is enough, you can ask your doctor, but you can do these tests to figure it out: If your baby is gaining weight or not. If your baby leaves your nipple easily after feeding him. If your baby has normal bowel movement. If your baby sleeps long hours. If you feel it is not enough, give your baby 100cc from appropriate baby’s milk after you have breast fed him. To produce more milk, do not give your baby a bottle before breast feeding. Hold your baby on your breast for 20 minutes, try to relax and drink a lot of water, juice, vitamins. How to Care For Your Health After Delivery: After delivery, you will start to lose, “baby fat,” as you return back to your pre-pregnancy weight. This should take up to the 6th week post partum. To produce more milk, do not give your baby a bottle before breast feeding. Hold your baby on your breast for 20 minutes, try to relax and drink a lot of water, juice, vitamins. You need to eat 4 meals daily at least, in order to meet your daily requirement. Try to include protein such as meat, eggs, milk and grains in your meals. Ambulate early and take a shower within 24-48 hrs after delivery. Excessive bed rest, for a long period, may cause abnormal positioning of the uterus, and back pain. Exercise regularly beginning 2 weeks after delivery. Visit your doctor 5-6 weeks after delivery in order to check your health. Take special Care of your diet and weight: Most women complain of weight gain after delivery, more than pre pregnancy weight, which decreases 2-3 days after delivery. Most of the weight was in the baby’s weight, amniotic fluid, placenta and increased blood volume. All of these will disappear after delivery. During the last month of pregnancy, the uterus weight may reach 1 kg, then it decreases gradually down to 50-60 gm, so, it may temporarily feel that you are walking on air, (floating). Fat cells may take a long time to disappear, but do not follow a strict diet because it will affect your health. Try to eat a balanced diet and get sufficient rest. You will also lose more fat and amino acid in milk when you breast feed your baby. If you gain weight, this is not due to pregnancy but because of bad habits. Avoid fatty and high calorie foods and stick with a lot of milk, fruits, vegetables and a high protein diet. You may need somebody to help you in daily house work until you feel strong enough to resume it on your own. Do not use the bath tub until vaginal discharge has stopped. Try to take a warm shower for 10 minutes only, each time. Advice regarding Room temperature after delivery The best temperature is 20c (68f), 60% moisture and good ventilation is required. Avoid the use of air conditioning as sudden changes in temperature may cause you to contract the flu. Menstruation differs from one female to another. Some will have menses after a few weeks others may need up to 1 year. More than 90% of Mothers will menstruate within a month, but lactating mothers may take a longer time, sometimes up to 3 months after delivery. Do not be worried that you may be pregnant, unless you notice nausea. Intercourse should be avoided in the last 2 month of pregnancy as there is a danger of rupturing membranes, vaginal infection, and preterm labour. After delivery, there will be excessive vaginal discharge called lochia. It is not appropriate to have intercourse. After your incision is healed and lochia disappears, you can resume intercourse. This will be 6-8 weeks after delivery. Family planning - Contraception: The appropriate time to have another child will be 6 month-1 year after delivery. The mother must be allowed to returned to good health. Women menstruate usually after 1-2 month after delivery but it may tarke 3 months. Mother can ovulate 40-50 days after delivery. She should talk to her husband and consult her doctor regarding contraception. About family planning methods: There are 2 methods for family planning: Temporary:   As with using male condom, oral contraceptive pills intrauterine device (IUCD) vaginal ring. Premenant:   As with tubal ligation Regarding the efficacy of each method: Failure rate for oral contraceptive pills is 0.1%. Failure rate for IUCD 2-4%. Failure rate for vaginal Ring 1%. Failure rate for condoms 14%. You need to consult your doctor about the appropriate method for you. If you are breast feeding, you need to take a special type of medication. You should be examined 6 weeks after delivery, including your blood pressure, weight, urine, breast and perineum. Baby Names Book, Arabic Baby Names http://www.babynamesbook.net/   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/instructions-after-delivery Mon, 08 Mar 2021 05:25:19 AM Postnatal Exercises - Exercises after delivery   After delivery, the female needs to exercise in order to strengthen the pelvic muscle which is affected during pregnancy and delivery. These muscles are beneath the buttocks and they support the bladder, uterus and bowel effectively. The exit of all these parts pass through these muscles and you can feel them if you hold the passage of gases or urine. What you will benefit from these exercises?: Better control of urination. Less frequent voiding. Better bowel movement. During pregnancy, support your baby’s weight and allow its delivery, when the time comes. How to do these exercises? Sit forward with your elbows over your knees, exhale your breath, then: Hold your vagina inward. Hold your anus as if you are holding gases from passage through it. Also hold your urethral sphincter as if you are holding urine from releasing. Be aware that you are breathing normally and keep holding for 1-3 seconds, then relax slowly. Make sure that while you are contracting your muscles, continue to breathe, consciously. Do not pull your abdomen inward and do not hold your legs tightly, or your buttocks. Start doing these exercises while you are sitting, then do them while you are standing or lying down. Lactation Video   Controlling defecation: While you are sitting on the toilet, use your muscles in the following way: Hold your urine for one minute even if you have a strong desire to void. Hold your urine even after coughing. Start doing this when your bladder is empty. Then do it when your bladder is full. Do this 50-100 times/day. When you do these exercises you may feel mild pain in the knees and ankles. This pressure will extend into the thighs and pull on the pelvic bone, and its organs, which helps the uterus to return back to its normal size, gradually. Doing the exercises will improve blood circulation and also helps in your recovery. Keep your back straight from the coccyx (base of the spine), to the head. Sit on the edge of a pillow to prevent slippage. These exercises give elasticity to the buttocks, trunk, thighs and pelvic organs. They will also strengthen the lower back and help in contracting your abdominal muscles. This will help you keep a good looking figure. Start the exercises on one leg then switch to the other one. If you delivered by caesarean section, you should consult your doctor before exercising. If approved, start off gradually. You may feel cramping pains in the buttocks, thighs and abdominal muscles, in the beginning. These exercises give strength to the lower back and help keep the elasticity of your hip joints. They may also relax your chest and shoulder muscles. The objective of these exercises is to improve fitness and energy. The exercises will improve your blood circulation, muscle fitness and joint elasticity. After delivery, the pelvic area and the back will return to their normal pre-pregnancy position and these exercises will help. You can also experience improved general body condition, becoming more flexible and firm, especially in the abdominal area and the lower back. Do not bend your shoulders. These exercises help you in keeping the flexibility of the back and posterior thigh muscles. Improve the circulation in the lower part of the body. These exercises give you energy and help reduce fatigue. You may feel tightness in the posterior thigh, chest and shoulder muscles. You may also feel more comfortable in the thigh muscles as they return to their toned and healthy shape. Improving your circulation will give you the energy to overcome fatigue. Helps you improve your breathing. Try to keep your back straight from the head to the lower back, and observe yourself in the mirror to correct. Body exercises after delivery: Most women who have delivered normally, can ambulate a few hours after delivery, and by doing this, they will prevent the formation of varicose veins. Also, this will improve the uterine contraction pain, as the lower uterine part will be near the flank and its fundus will elevate, 4-5 days after delivery. Do not exercise in the first 2 weeks after delivery. But, you may walk, stretch your toes, elevate your head while you are lying down and after 2 weeks you can do the recommended exercises. These exercises help you to tighten your body muscles and return to your previous shape. At the beginning you need to pick up a few easy exercises and repeat them 6 times. Then, when you get used to it, you can increase them up to 12 times per day. If you feel tired, stop exercising. Exercise (1): This exercise will improve your metabolism and blood circulation: Lie on your back, stretch your arms, put your hands over each other as a cross while you are exhaling air, then return them back while inhaling. This will decrease the tension in the belly area and improve circulation. Exercise (2): Helps in the pelvic area recovery: Lie on your back, bend your knees while your feet touching the floor, let your arms relaxed on both sides, elevate your waist and count to six then return back to your previous position and relax. Exercise (3): Exercises for the belly area, for flexibility: Lie on your back and bend your knees while your feet are touching the floor. Elevate your head, trying to touch your knees, and then lie down again. Exercise (4): Exercises for your belly: Lie on your back, elevate your legs and hold the leg of the bed firmly. Bend your knees slowly and elevate them while breathing out. Then, return to the previous position while inhaling and repeat it 4 times. Exercise (5): Exercises for the belly and leg muscles: Lie on your back and elevate one leg in 90° angle, then change with the other limb and then elevate both limbs together. Exercise (6): Exercise for the belly muscles and the back bone: Lie on your back, bend your knee and elevate it towards your chest. Hold it tightly with your hand, tighten your belly and thigh and push downward. Then return your leg slowly and repeat the same exercise with the other limb. Exercise (7): Massaging your back muscles: Sit on the floor, stretch your arms backward and support your upper trunk. Bend your knees while your feet touch the floor. Then drop your knees down one side, to the other, until you feel the effect of this massage. Repeat at least 10 times. Exercise (8): Thigh and back exercise: Lie on your back, stretch your arms out from your body Elevate one leg perpendicular and bend it around your body in a way that allows the big toe to touch the floor during a breath out. Return your leg during an inhale. Change legs and repeat the exercise 4 times for each limb. Exercise (9): Exercises to strengthen the back muscles: Stand on your hands and knees. Put one limb towards your chest during inhalation, then extend it backward during expiration. Repeat this 4 times and change legs. Exercise (10): Exercises to prevent varicose veins: Lie on your back, elevate one limb upward in a perpendicular angle and hold it with your hands. Swing it forward and backward and at the same time do circular movement with your big toe. Repeat it 10 times and change legs. Exercise (11): Exercises for the leg and belly muscles: Lie on your back as if you are riding a bicycle, your hands behind your head and do 4 circular movements with your legs as you exhale, then repeat 4 more as you breathe in. Repeat this exercise until you feel tired. Exercise (12): Lie on your back, put your left leg over the right one forming an (X). Then put your left foot over the right knee. Then bend and elevate your body slowly. Change your limbs and repeat the exercise 4 times on each side. Exercise (13): Exercise for a thinner waist: Lie on your back, bend your knees and stretch each foot in the direction of your waist then drop down slowly. Do not elevate your shoulders while you are dropping your ankles. Rest for a while and repeat the movement 10 times. Exercise (14): Exercises for the waist: Stand placing feet shoulder width apart. Put your left hand on your left side waist, elevate your right hand and move it above your head while you are bending your waist to the left, repeat this 4 times and change arms. Exercise (15): Exercises to return your activity: Stand up, holding your legs side by side. Elevate your arms forward during inhalation and bend your back and knees slightly. Swing your arms backward during expiration and return to your previous position. Repeat this 6-7 times. Exercises to strengthen the belly muscles for new mums: These exercises help you to strengthen your belly muscle after delivery. It is better to do this 3 times a week on a carpet.   1 - a. Lie on the floor; bend your knees while putting your feet on the floor, and separating your buttocks apart and parallel to each other. b. Exhale and pull your belly inward. Push your upper back downward to the floor while you are elevating your buttocks slightly. Take a deep breath and relax. 2 - a. Lie on the floor, bend your knees towards your chest, knees about shoulder width apart. Elevate your arms between your knees. b. Elevate your head and shoulders off the floor, keep them in this position for 3 seconds, then relax. Repeat the exercise starting with 10 times/day then increase the number up to 20 times per day. 3 - a. Lie on the floor, pull your belly inward, and elevate your knees while bending them towards your chest and elevate your arms beside you slightly. b. With your chin over your chest, elevate your shoulders and head away from the floor and pull your head toward your knees. Then return back to your previous position and repeat again. Start with 10 times and increase the number of repetitions from there. 4 - a. Squat on the floor; elevate your arms over your head. b. Pull your belly inward; bend forward while keeping your buttock on the floor, till your head reaches the floor. Breathe normally and keep this position for a count of 20. Consult your doctor before doing any of these exercises, or, if you have a problem, or complications from doing these exercises. Baby Names Book, Arabic Baby Names http://www.babynamesbook.net/   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/postnatal-exercises-exercises-after-delivery Mon, 08 Mar 2021 05:25:19 AM Newborn characteristics   Physical characteristics:   “Neonate,” is the name for newborn babies from birth till the age of one month. If the neonate has a strong cry and moves actively, with pink skin and nails, that means he is in a good health. Most newborns breathe faster than adults, usually more than twice as fast. The respiratory rate for newborns (40-50 times/minute), and heart rate, (140-180 beat/minute). These vital signs increase when the baby cries or when disturbed, due to any reason. After the second month of birth, respiratory rate will decrease to (30-40/minute), and heart rate decreases to (120-140 beat/minute). Neonate body temperature is around 37c◦ (98.1f), and are very sensitive to the surrounding temperature as their capacities to detect temperature adjustments are not yet well developed. Thus, room temperature has to stay constantly warm, and the neonate shouldn’t be covered completely. Put your hand behind his back if there is sweating. This means your child is too warm, either due to high room temperature or heavy, warm clothes. Within days, the umbilical cord dries and turns to a black color. It falls off within two weeks and ends at the umbilicus. Before it falls off, it is advised to give the neonate a sponge bath. When it falls off, clean the area with an alcoholic bandage once or twice daily until it heals completely. You should ensure that the area does not become irritated when you change your baby. If it is persistently red and it does not dry during the first three weeks, you should consult the pediatrician immediately. Neonatal reflexes:   Reflexes are the actions of the neonate in response to certain influential factors. It is so important in neurological and muscular maturation, though it does not seem to be highly specialized. There are some reflexes that are considered a sign of, “self-dependence,” of the baby, in the future: Sucking reflex: The baby starts lactation the moment he is born and he acts similarly when you touch his cheek, the baby tries to turn his head and suck anything that touches his cheeks, this is related to his ability to swallow and breathe, and they are important survival actions. Catch reflex: It is an obvious reflex, just like the sucking reflex. If you extend your fingers toward your baby, he will catch them and he might even elevate his body a little bit. Toes are not that sensitive but if you touch his foot he will extend his toes and flex them again, this involuntary reflex means that the baby needs to be held by his mother. Stepping reflex: A Newborn can take a few steps, if you hold him, put the baby in a horizontal position with his feet touching the ground. You will notice that the baby will step on the ground by bending his back forward a little. This can be noticed shortly after birth. Startling Reflex in newborn baby: It is related to the sudden loss of balance, due to loud sudden sounds, or it may be related to a sudden change in position. The baby extends his arms and legs and moving fingers and toes. Then all the limbs are extended like he is hugging something. He may cry at the same time. If this reflex continues for 3 to 4 months after birth, you should consult a doctor as this may be related to brain problems in the newborn. Video of lactation Harmonious neck reflexes in newborn baby: This reflex can be seen after the first four weeks of birth. The baby is lying on his back, and moving his head in a certain direction while the arm on the same side extends. At the same time, the limb on the other side is flexed with the hand directed behind the head. This kind of reflex shows the stronger, more dominant hand, which is usually the right side. Brain development in newborns:   Brain cells that are responsible for mental processes start developing early in fetal development. Studies have shown that the highest rate of brain cell development is at 18 weeks of pregnancy and continue until the first two years after birth. During the second stage of development, from 2 to 4 years, further developments are still fast but occur at a slower rate than experienced during the first stage. At 8 years of age, these cells are barely growing. Full brain development is reflected by the feeling of stability, strong curiosity, the ability for accurate observation and conclusions as opposed to, “stuffed information.”   What is the parent's role in helping their child during the rapid stage of brain development Parents should make their baby feel their endless love and concern. Also, recognize his movements and signals. And, the most important thing they should give them is the nutritional supplements necessary for brain growth, during this period. Stimulus and response for newborns:   It has always been thought that the most important senses for the newborn appear late, but it has been found that they do start developing early, since birth. For example, if the newborn hears a voice, he turns his head and eyes toward the voice. This means that he wants to know what he is hearing. Visibility for the newborn is limited, usually from 20-30cm. He is able to see shades and can observe darkness and light. But it is so important to know that vision and hearing are quite joyful for your baby. Hearing develops gradually for the fetus. That is when he hears his mother's heart beat. The experienced mother knows how to calm her baby with soft synchronized voices, such as soft music to sleep. The ticking clock, pillows and colored covers, voice activated moving toys, all these things can affect the baby. Touching is the most developed sense for the newborn. If you touch the newborn, you will notice his reaction immediately, or his happy reaction when his parents hold him in their arms. It might seem a natural thing, but it is a major necessity for the development of our touching sensation. When the baby feels his parents' love and care, a positive concept for his, “self,” develops. It is also important for emotional, physical and mental development. Smell and taste are as sensitive as touch sensation. This can be proved by observing the reaction of the baby to breast milk and to synthetic milk. When his mother gives him the bottle after breast feeding he refuse it as he has become used to the smell of his mother and the taste of breast milk. So, as said before, the baby has major physiological functions that makes him able to react to different external stimuli. The desired stimuli will enhance the growth of the baby. If there is over stimulation, this will confuse and disturb the baby.   Deciduous teeth: The first teeth start to develop between 5 to 8 months after birth. They may appear earlier or later but this shouldn’t be a concern if the baby is in good health. If the baby develops some symptoms, such as, excessive salivation, desire to bite anything in his hands, this may indicate that his teeth are about to appear. You can feel his teeth if you touch his gum with your finger. Give him something to bite, like a carrot, biscuit or a rubber biter. You should acknowledge the strong association between teeth and fluoride. Regardless of the time these teeth appear, the permanent teeth are hidden in gum tissues, so to keep your baby's teeth healthy and free of cares, you should supply him with a fluoride treatment available through your Dentist and some doctors.   Taking care of newborn skin: The most important reason why parents like holding and touching their baby is his soft and delicate skin. You should moisturize his skin with lotion around his heals and elbows and folded areas, because these areas are prone to dryness. After a bath, use the powder on the folded area to prevent skin lesions. Cut the nails while he is sleeping to prevent scratches. Avoid harsh clothes as these will cause skin redness. Your baby should wear a hat when going out. In addition to moisturizing lotion to protect his skin, it is advised not to expose him to direct sunlight for long periods.   Sunbath: Babies need a certain amount of sun light, and fresh air for healthy and good growth. Sunlight is important as it produces Vitamin-D, which is important for bone, skin development and blood circulation. At two months of age, it is preferred to expose your baby to fresh air and sunlight unless his weight is less than 4.5kg. Pick a sunny, warm day to take time for a walk in his stroller. This helps in adjusting his body temperature in a steady manner when he is exposed to different temperatures outside. On your first day, do not take a long time, on average 20 minutes. You can increase your time outside gradually up to an one hour if he is in good general condition. If he is exposed to direct sunlight for long period, he may get sunburned. That is why you should put some cream on exposed skin before going out, in addition to wearing a hat. It is preferred to use a comfortable stroller that is bent a little bit backward. You should also make sure that he is not wearing too many clothes. This is the best way to expose the baby to sunlight. A nice sunbath can be given to the baby on the balcony, or close to the window. The best time is between 10 AM and 3 PM during spring and autumn, or between 1 PM to 2 PM during winter months and just before sunset in the Summer. It is appropriate to be done one to two hours after a meal. The baby’s head should be covered or put under an umbrella to avoid direct exposure to sunlight.   Taking care of the baby during summer: Your baby will face difficult times during hot summer days. He may not have a desire to eat, and his digestive functions may weaken. And he may become upset more often. The main concern for his mother is how to protect him from summer diseases. First, you have to keep him at home in the coolest room. You can give him several baths on hot days. Do not allow him to lay naked. Instead, put some light clothes on him and change him continuously. Cover him with light sheets when he sleeps and do not force him to eat. Give him good amounts of fluids such as juice, vegetables and barley tea. Give him his milk or food cold, and mash his food so that it will be easy to digest. Keep his bottle and plates clean and keep them sterilized by boiling them. The baby should be kept away from fans or air conditioners. Natural air is preferred but if the room temperature is above 30c° (86f), you can switch on the AC. If you have to use pesticides, your baby should stay outside for more than one hour after refreshing the air in the room. It is preferred to use screening against mosquitoes instead of pesticides. Do not forget to take him to the Doctor for his vaccinations, as scheduled.   Taking care of the baby during winter: Winter is a difficult time as is the case in summer. As said before, temperature regulation centers in the baby as he still immature. He can easily get cold and flu, which may lead to serious diseases, if not treated properly. Keep your baby in a warmer area at home. Usually, it is the room and / or window toward the Southern area. Keep the room temperature around 20C°. If it is less than 10C°, he will be at a risk of having a cold and if it is less than 5C° he will suffer from frail frost. This is not good care. The best method for warming the room is an electrical heater. If you choose gas or kerosene, you should pay attention to the potential of poisonous gases and make sure that there is good ventilation. Put a protective barrier around the heater, to protect the baby from burns. Do not over dress him, as this will impede his movement. When the weather gets better and it becomes warm, open the windows to refresh the air and try to let him enjoy the warm sunlight. It is difficult to keep the baby warm during a bath. It is better to bathe during the daytime when the weather is relatively warm. The baby’s appetite does not change during the winter. Give him good amounts of warm food, rich with vitamins.   The usual physical examinations: It is so important to visit the pediatrician on a regular basis to check on your baby and make sure that his growth is appropriate to his age. The first visit should be 4 weeks after delivery, then every 2 months until your baby is one year old. These regular visits are as important as visiting the pediatrician when he is sick; you can talk with your baby’s doctor, take some advices about unusual behaviors and about his growth and development. It is preferred to choose the clinic that is close to your home in emergencies. You can check your baby’s temperature. If it is between 37C° to 37.5C°, this is normal. Body temperature may normally decrease a little in the morning and increase in the afternoon. The best way to measure his temperature is rectally. Hold your baby while he is lying on his abdomen, shake the thermometer till the red point drops below 37C°, put the thermometer gently in the anus, for 1-3 minutes, and do not ever leave your baby with the thermometer still in his anus. If you must leave him, remove the thermometer and start again later. Vomiting: Newborn babies usually vomit what they had eaten last. His stomach is like a bottle in shape, unlike the adult stomach, which is like a sac in shape. Babies can easily vomit if you bend his back forward. When you have to take your baby? If he is vomiting for long time and if he vomits large amounts frequently, you should visit the doctor to check if there is something abnormal, like asthma, meningitis or duodenal stenosis. Diaper rash: The genital area in the baby can be irritated and red from urine, stool or diapers. To avoid these problems, change the diaper frequently. Use moisturizing cream or powder or special ointments described by the doctor. When the area is red, try to expose it to the air, several times a day. Fever: If the body temperature is above 38C°, use cold compresses on his forehead, or use skin patches, or keep his feet warm when you use skin patches. Cover them with dry towels to prevent direct contact with the skin. If the fever continues for hours, (< 37.8) you should consult a doctor. Constipation: If the baby has difficulties in defecation, or his stool is hard, this does not mean he has constipation. The most important factors causing constipation are inadequate nutritional supplements, or frequent vomiting before giving any medication. You should try to realize the precipitating factors. If it is not due to a certain disease, give your baby adequate amounts of fluid. A warm sits bath can be helpful. You should keep in mind that some babies may defecate twice weekly without having any medical problems so always check his stool characteristics before becoming concerned. Jaundice: Most babies will have jaundice in the first few days after birth. That is due to incomplete development of liver function. The liver is not capable of handling the yellow dye (bilirubin) from dead red blood cells. Functional jaundice (hyperbilirubinemia) disappears usually within two weeks. If the baby is not fully mature, if it persist for more than two weeks or if the baby has a serious condition, his head and toes get yellowish in color. This will be a pathological jaundice and the baby will need special care if the bilirubin level (yellow dye) increases to 20%mg. This may lead to a serious condition in which the brain cells will be affected and may be destroyed. Paralysis may occur so take care of this and do not wait too long before taking your baby to the doctor. Colic: It is not a disease. Instead, it is a physiological thing during growth. The baby may cry without any symptoms such as fever, vomiting or diarrhea. Colic starts 3 weeks after delivery and may continue until 3 months old. In this case, the baby doesn’t sleep at night and cries in panicky way. Consequently his parents do not sleep and they may have difficulty tolerating this situation. The most important causative factors are psychological stresses, strong intestinal cramps, intestinal dilatation due to environmental factors, or indigestion from over eating. If the colic worsens in the evening, it is due mostly to pressure caused by several factors, such as, sound of television, loud voices or changes in the environment of the house. Sensitive babies are more prone to colic. If you face this problem with your baby, it will be difficult to calm him. You should try as much as possible to make him comfortable with the help of your family. If it is caused by the air, put the baby on your shoulder until he burps. Patting on his back may help him along. Sometimes, these symptoms might be due to other causes such as allergy, gastrointestinal disorders, or peritonitis. If there is blood in his stool from the anus, take him immediately to the hospital without changing his diaper to show it to the doctor.   Growth and development during childhood: Most of the development in everyone’s life happens during this period. During the first year, the baby has major developments in almost every area. He starts to respond to his surrounding environment and adapt to it. He tries to regulate and change his functional abilities and potentials to become a complete, small human being. Parents can not determine certain goals for their baby, the desired length and weight, or the potentials he should have. These things make every human unique from the others. Parents should give much attention to these things. If their baby does not have these desired goals, these important feelings will affect his emotions, making him over sensitive. Parents should be relieved and give their baby the required attention and passion, in order for the baby to be able to achieve the ideal development. Baby Names Book, Arabic Baby Names http://www.babynamesbook.net   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/newborn-characteristics Mon, 08 Mar 2021 05:25:19 AM Nursing Your Baby and Newborn Care   Every mum should breast feed her newborn for the following reasons: Breast milk is the best to ensure the health of your Baby. It is the safest method for Mother and Baby. Provides the Baby with a fresh, easy, digestible meal. Provides the Baby with immunity against diseases. Strengthens the bond between the Mother and her child. Always available. Decrease the potential for contracting allergies. Easy to provide anytime, no need to clean bottles or to prepare. Most babies grow normally during the first 4 months or the first year of life Less expensive. Most Mothers find pleasure and relief in breastfeeding. We hoping you will agree. Video of lactation   Symptoms that need an immediate visit to your doctor if you notice that your Baby has: High or low body temperature. Poor feeding, crying, activity. Cyanosis. Jaundice. Paleness. Convulsion and abnormal movement. Cough dyspnea. Vomiting, diarrhea and constipation. Bleeding from the site of circumcision or from the umbilicus. Care for the umbilicus: you need to clean it with alcohol and wrap it with sterile gauze around the rest of the remnant of the umbilical cord. You should visit your doctor after 3 months to check on your Baby’s health, and to examine for the presence of congenital hip dislocation. You should give your Baby scheduled vaccines from the second month after birth in order to prevent serious diseases in the future. Baby’s weight at time of delivery: There are many factors that affect the Baby’s weight: The duration of pregnancy. Maternal condition during pregnancy such as blood pressure, diabetes, blood supply to the uterus. Genetic factors. If both parents are tall the Baby will be tall .if the Mother is diabetic the Baby will be heavier in weight. The average weight at birth is between 2.5-4.5 kg. How to care for your newborn: Changing diapers: Your Baby’s first day, start with using diapers. The appropriate one will keep skin healthier, and will keep your Baby more satisfied. The diaper should be made of good absorbent material, and should be comfortable for movements. What you need when you want to change your baby’s diapers: Diaper sheet, diaper, warm water, towels, clean gauze, Baby's body soap, and Baby’s body powder. Put your Baby on a clean towel, remove the wet diaper, and clean the buttocks from the anterior side of the anus, backward especially for female Babies to avoid contamination and infection of the genital area. Once the skin dries, apply a small amount of Baby’s body lotion, then Baby’s body powder in the curves of the skin. If your Baby’s skin is sensitive, you may use Baby oil instead, then wipe the excess using gauze.   How to treat skin irritation (scalding): Your Baby’s diaper should always be clean and dry. Expose the lower part of your Baby’s body to air especially if the weather is warm. Avoid using plastic underwear all the time. Some symptoms that shouldn’t worry you: Sneezing, yawning, and crying. Breast bud swelling. Vaginal discharge in a female Baby. Knee and joint bending. The sleep of the newborn baby: Newborn babies spend most of their time sleeping except when they eat or while wetting their diaper. Babies sleep more at night as they grow. Some Babies prefer to sleep on their stomach. Watch your Baby’s breathing for a while to be sure that there is nothing impeding or closing the airways. If your Baby sleeps immediately after feeding, or was sick, watch their breathing more carefully. Newborn shower: You can shower your Baby before feeding, or in the morning or before bed time at night in order to have a better sleep. In the first 2 weeks before the umbilical cord drops, it is better to shower your Baby with a sponge. Before starting the shower, be sure that the room is warm enough, wash your hands carefully, prepare warm water 40c◦ (104f), Baby’s bath, Baby’s shampoo, thermometer, soft towel, Baby’s body shower shampoo, gauze, Baby’s body lotion, Baby’s oil, Baby’s powder, small nail clipper, Baby’s comb, clean diaper and clothes. 1- Bathing with a sponge: In the first 2 weeks of your Baby’s life, it is preferred to sponge bathe rather than using a bath tub. Put your Baby on a clean towel; wash the eyes, nose, and ears with wet, soft cotton. When you are cleaning your Baby’s eyes, wipe from inside to the outside of the eye, you can use a wet clean cotton to clean the external part of the nose and ears, but do not try to clean the inner part that you cannot see, as you may harm the soft skin which can cause infection. You may wash the anus with warm water, and then wash the hands, feet and trunk (abdomen). Use the previously boiled water which will cool to the appropriate room temperature after covering your Baby’s body, wash the hair with shampoo, hold the head and neck with your waist and wash the hair gently with a Baby’s shampoo, then rinse it with water.   2- Bathing: Fill half of the Baby’s Bath with warm water 40C° (104F°). You may use a thermometer or you may put your elbow in the water and feel its temperature, it should be warm enough so that your Baby will enjoy the bath. Put your Baby in the Bath gradually, step by step. Hold the head and neck gently and put the feet in the water. Then wet the hands, wash the trunk (abdomen), anteriorly, then hold your Baby upside down and wash the back. Wash the curves of the body carefully and wash the anus. Do not leave the Baby alone in the Bath. A healthy Baby needs to do exercises such as bending, followed by stretching of the hands and legs. These exercises will increase the metabolism and activate blood circulation. To help the child's moving, choose warm, light and comfortable clothes. When you change your Baby’s clothes you may turn on calm music or distract with a beautiful doll, till 3 months. Keep your hand underneath the head and neck to support them. If the weather is warm, expose your Baby to sun, in order to stimulate Vitamin A production. But be sure that the sun is light and gentle. Do not expose your Baby to direct sun as this will burn sensitive skin. This is important for the Mother too. Breast feeding: Video about lactation Breast milk is the best milk for feeding your Baby in order to grow healthy. It contains immunoglobulins which defend against infections. It is also important for strengthening the bond and building self-confidence in the maternal child. It also helps the Mother to recover quickly. When the Baby sucks the nipple, this stimulates uterine contractions as with other uterotonic medication. Even if you are in a position to choose between breast feeding your Baby or milk, choose the one that has a close composition to breast milk. How to breast feed your baby: You should be in the most comfortable position you can find when you are breast feeding your Baby. You may prefer that your Baby is beside you in the first few weeks, but then you will prefer breast feeding while you are sitting. Before breast feeding your Baby, you need to wash your breast with warm water. Do not use soap as your Baby may ingest it. Breast feed your Baby from one breast for 10 minutes then on the other breast for another 10 minutes. You may put a safety pin on the side that you breast fed from in order to remember, from which one you beast fed last. Actually, the Baby will have enough milk from the first breast, but in order to stimulate both breasts to produce equal amount of milk, both should be used. You may notice that your Baby finds difficultly in holding your large nipple. Although your baby knows how to suck, you need to hold your nipple between your index and middle fingers and put it inside your Baby's mouth. Be sure that your Baby is holding not only your nipple but also your areola. Direct your areola downward to stimulate more milk production and to protect your Baby from choking. Feed your Baby for 20 minutes each time. To release the nipple, put your finger between your Baby’s mouth, and the breast. If your Baby has had enough, they will release your nipple, naturally. Let your Baby eructate, (belch or burp), during feeding and after breast feeding. Allow your Baby to relax over your shoulder. Put a towel over your shoulder as your Baby may vomit on you. You may weigh your Baby once a week in order to check progress. After breast feeding, wash your nipples with warm water and allow them to dry. Put two pieces of cotton inside your bra in order to absorb leaking milk. If your nipple cracks, you can use cream or a moisturizer containing vitamin A. Breast feeding schedule: You need to set a schedule that fits your Baby’s needs. In the first week, your Baby needs a feeding every 2 to 3 hours, even at night. After 1 to 2 months, your Baby needs a feeding every 4 hours (5 times/day), and your breast will meet these needs. Milk production: In the first few days, your breast will produce milk spontaneously, which is called colostrum, and it is highly concentrated yellow milk, rich in immunoglobulin’s, which stimulates the Baby’s bowel to get rid of meconium. After that, milk will be whiter and increase in quantity as your Baby sucks it more. As you are breast feeding your Baby, you need to limit your consumption of coffee and tea up to 2 to 3 cups/day. Do not drink alcohol and avoid smoking. Do not take any medication before consulting your doctor as it may be secreted in your milk and by that, reach your Baby. Clean your breast and nipple to avoid mastitis. In order to secrete more milk, drink a lot of water, herbal tea, milk and juice with balanced food. Avoid eating beans and cabbage, because they may cause you gas. Eat fruits and vegetables and a high protein diet. Breast feeding is not an activity only. It also gives you a lovely relationship with your Baby that you will not forget. Video about lactation   How to prepare a bottle of milk? You need to clean all the bottles, bottle covers and tubes correctly and sanitize them before each meal as food can easily contaminate them with bacteria. Be careful when you prepare your Baby’s bottles. Please follow these instructions: Wash your hands with water and soap before preparing the meal for your Baby. Boil an amount of water in a clean pot. Wash all the bottles, its covers and tubes with water and soap using a special brush, then rinse them with cold water, till all the soap has been washed away. Then put all of them in boiled water and let it boils for 10 minutes at least. After 10 minutes remove all the tools using clean forceps and put them on a clean board till they are dry. Place the bottles upside down so that all the water may drain properly. Then boil some drinking water in a clean container and let it boils for 5 minutes. Then pour it in the bottles, and let it cool to 50C°. Put in the proper amount of milk as your doctor informs you. Close the bottle with its cover. Shake the bottle till the powders melt completely. Put the nipple on the bottle without touching the part that will be inserted into the Baby’s mouth, then let it cool until reaching the drinking water temperature. The temperature of the bottle should be the same as the body temperature once feeding your Baby 35-37C°, not cooler, nor hotter, check the temperature of the bottle on your cheek till you are satisfied of the correct temperature, or put a drop of milk on the back of your hand till you feel it has the right temperature, then it is ready for your Baby. Caring for the newborn: 1- Crying: It is the only way that your Baby can express needs. Most of the time, it will be to change his diaper, or your Baby is hungry, thirsty, or uncomfortable, or needs to be carried. After a while, you will know what your Baby needs. 2 - Differences between babies: - Every child has a special reaction, and it almost always is affected by: 1 - Body growth. 2 - Genetic material. 3 - Surrounding environment. - The Baby’s recognition of the surrounding environment is different from one Baby to another and it almost reaches 280 days. - The Baby can grow every day in the uterus, so within a few days will begin to grow rapidly. - The Baby’s reaction to their surrounding environment is complex, and differs according to the different circumstances exposed to. - Some babies are calm and funny. Some are distempered and do not sleep well. Others are active and sensitive so you cannot compare your Baby with others. Instead, you should admit that your Baby is very special, has unique features. Do not hesitate to express your love and care for your Baby, and after a while they will grow healthy. 3- Family role: For the newborn, the new home is exciting. Your Baby sees the Sun and hears different voices, the touch of clothes over the body and the feeling of the hard floor while walking over it. The feeling of the air entering the nose, all these things make your Baby unable to deal with them all at once. Your Baby needs your care and love. Your Baby needs both parents to react with and to care about them more and more. Once Your Baby feels your love, they will feel satisfied and safe and grow healthy more and more. Baby Names Book, Arabic Baby Names http://www.babynamesbook.net   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/nursing-your-baby-newborn-care Mon, 08 Mar 2021 05:25:19 AM Stages of infant development - Baby Development Stages   Childhood consists of most of the developments in someone’s life. During the first few years of life, the child develops almost in everything. The child starts responding to the surrounding environment and learn to adapt with it. The child tries to organize and change functions and potentials to become a complete, small human being. Parents cannot determine certain things for their baby, such as, the desired length, weight or potentials they will have. These things make each person unique and special from others. If the child does not have these desired symptoms, these concerning feelings may affect the child’s emotional development making them hypersensitive. Parents should react in a comforting manner and give their child enough care and love to achieve the ideal development. Video Infant Development 1-Early Infancy: The Infant sleeps mostly in the daytime hours except those while eating. Most behavior is simply reflexes. Your Baby has newborn characteristics like sucking the lips when hungry. Clenching Mother’s finger when she puts it in the palm of the hand. It is not familiar for the child to express feelings, but occasionally they will smile subconsciously. 2- The Infant From one month to two months old: The Infant grows quickly day after day. When the Baby is in the prone position, (lying on the stomach), they will elevate their head with an angle of 45°, and move the head right and left. When lying on the back, they can concentrate their eyes on something, and stare at it. In this case, toys like a rattle, or alarm can be a stimulant for them. Most babies clench their fist strongly while they are sleeping and sometimes they will suck their thumbs subconsciously, or even put all their fingers in their mouth. The child may suck their thumb frequently, and when they feel hungry, they will cry sometimes. You may notice that your child is staring at one side continuously. This is related to their position. In order to keep their head in good condition, you should move them, change their position occasionally. The Infant From two to nine months of age: 3- Two months old Infant: At this time, the child starts smiling, and this makes Mother happy, consequently the Mother / child relationship becomes more passionate. The child becomes happier and emotionally stable towards others. The child also stays awake more hours during the day and starts sleeping at night. 4- The Infant Three months after birth: Your child starts to show their initial social behavior, and tries to express themselves by kicking, shaking, smiling or making bubbles, as a reaction to Mother's actions. Their own personality starts to appear. The primitive reflexes disappear, and the voluntary potentials increase. Neck reflex will be replaced by synchronized eye and hand movements i.e. the child tries to touch everything they see. It is the intermediate process to next one. When the child starts playing with toys, any moving and noisy toys are a good option. The child can keep the head in one position for a short time and can suckle and look around at the same time. Making bubbles with the mouth is a way to express happiness and feeling of success and a basic to developing language. Sometimes, they may also seem to play with their voice, using it as a tool to control their feelings, and learning to speak. During this period, the child needs continuous care from their parents. If the way of raising the child is not synchronized, and unstable, this was learned from the parents, or from the surrounding environment. The child will be unable to organize their habits. This does not mean that parents should follow certain rules or protocols, but they should not change their usual routine of handling their child, especially feeding, playing or when they put the child down to sleep. You may notice that when your child feels bored they may cry. Try to tell a story in a low voice, or lie beside them, and put your hand gently on their back, At the same time, you may also need some rest. If your child is playing, leave them for a while, as long as it is safe around them. 5- Infant Four months old: At this age, the child starts acting, eating and sleeping in their own special way. They sleep more hours during the night and stay awake more during the day. They can stretch their hand out to reach for the things they want, and can also keep the head in a steady position and support the upper part of the body with both hands while in a prone position. The neck muscles and the back gets stronger, so they can sit for awhile on their own. If the back and hands are supported, when the child elevates themselves in a vertical way, they stretch their legs, trying to standup. During this time, their weight will be double their birth weight. The best position is lying flat on their back because they can play. Most of the time, they play with their body such as, playing with the hands and put them inside their mouth. When they see their food, they try to put it inside their mouth. At this age, they start to explore and discover things around them by putting things in their mouth and by different feelings they feel. They can begin to differentiate things. At this age, their vision is still weak, but he can immediately identify their parents and connect them together. If the child is sensitive to voices, they may show interest in the noise made by papers, ticking of clocks. The child can memorize certain events for a few seconds. You can read for your child to improve their potentials and at the same time, it allows your child to know you much better. Video of lactation 6- Infant Five months old: The quick gain of weight will decrease, but the activity and social changes are special. During this period, the baby can sit with their back supported by a chair. They can flip on their back or abdomen easily, and can support the upper part of their body, hands and legs upward, higher than the previous period. It is easily noticed also, that synchronization of hand and eyes are more obvious. They can also stretch their hands freely to reach for something. Hearing responses develop and the baby can move their head toward the voice source. They can also show obvious expressions such as, expressing what they like or dislike. They become happy when they see their bottle if they are hungry, and will cry if you take their toy away. The child seeks their Mother's attention by crying, screaming or bubbling. When their Mother is sitting with her guests, if Mother ignores them, they may deliberately cry more and more. The Mother can work to develop her baby’s emotions by listening to soft music with her baby. During this period, the mouth becomes an experimental tool by trying to suck anything reachable with their hands. You should be careful to keep harmful and dangerous things from your child. And even if they are playing alone, you should keep an eye on them. Their clothes should be comfortable so they can move using a diaper to prevent wetting their clothes. At this age, parents can start training linguistic potentials for their child. The following advice can be given. You can stimulate your child to talk by developing this behavior and trying to make it a joyful thing. This can give the child a chance to make noises and repeat them. This will stimulate their hearing potential. The child's potential will allow them to transfer information developed by their continuous experience of their own senses such as: Hearing, vision, and touching. These things will be the basics for symbolic thinking. They can fail many times and this is natural. Do not push or blame them. Instead, give them encouragement, regardless of the trial. By this, they will become more confident and at the same time feel their Mother’s care and passion. If they prefer to play alone, leave them alone, but always keep an eye on them. 7- Infant Six months old: They get very busy at this age. They start crawling and can sit alone, but not for a long time. They become curious and want to know what is going on around them and express their interest in different things. The child shakes anything in their hands. They may focus on a particular part of their body like fingers, toes, ears or nose. Most of the deciduous teeth start to show up at this age. If you hold them from their armpits, they will try to stay in a standing position with little bending of the knees, but still are not able to stand. Usually, growth is directed from the head to the feet. That is why the child is still unable to control their legs. But they continue training by bending the knees, extending them and kicking. Crawling is a totally different period for the child. It is more than moving the muscles. They will balance themselves and use each muscle depending on the other one in order to crawl. During this period, the child can hold moving objects. They can also recognize voices and is able to recognize their parents` voices. The child is psychologically and physically connected to their Mother. That is why they cry if they see their Mother holding another child, not because they are jealous, but they want to show that they are attached to their Mother, and do not want to be left out. They still cannot realize what is safe for them, and at the same time, Mother cannot isolate them from the surrounding environment. You can improve your child's potential by playing with them. For example, hold your baby between your arms in front of a large mirror and allow them to see their reflection on the mirror. They will be amazed by this, the first step to differentiating between themselves, and surrounding things. Point to your reflection and say, “Mama,” and to their reflection, and call their name. It will take some repetition but they will learn much from doing this. Bathing is another way to have fun and play. Bring some floating toys so they can play with them during the bath. Do not leave them alone as they can drown, even in water only 2 – 3 cm deep. 8- Infant Seven months old: During this period, you should give more attention to your baby. Prepare some safe tools for maximum protection such as, from sharp angles, walls, electric plugs, gas sources. Do not leave any harmful objects on the floor or ground, because, at this age, the child wants to grab, hold and examine everything around them, then throw it away. Provide them with suitable soft clothes that protect them, and does not restrict movements. They may also start to recognize faces, and be more careful when they see a stranger's face. They do not allow their mother to go to a strange person, and cry and may also call her with a voice that mimics (mama) or (dada). They can recognize a compliment, rejection or blaming from their parents. Most of their first group of teeth will have appeared by this time. Some may develop their teeth earlier, and others may be delayed till the first year of age. This is a normal variation. When the child feels upset and tries to chew things, it means that the teeth are beginning to show. You can massage the gums lightly with your finger. Cover them snugly because they often try to kick their covers during the night. 9- Infant Eight months old: He starts to play actively, can jump up and down, and tries to strongly grasp anything they can touch. At this age, they act more freely, plays with the curtains and hide inside. You may accidentally find them beneath any object that they can crawl under. They can also hold toys with both hands, can sit alone for awhile and stand up, if you hold their hands. The child starts to express their feelings in different ways, becomes more skillful in using their hands and may grasp little things with their fingers. Their ability to memorize is still limited, but it is developing. They remember how to notice any changes that happen and behave better socially. They may become more stubborn, which is hard for Mother. Try to respect their willing, and feelings as much as possible. But limit some of their desires by justifying the reasons in gentle and low voice. Most children start making voices like, “mama and dada.” There can be some delay in this for normal children, but if they are unable to make any sound, you should take them to a pediatrician. 10- Infant Nine months old: During this period, they will move here and there, and once they are awake, they may put their finger between the wall and door, or even in the drawer. They will fall many times and roll on the stairs, tear books and tissue paper and throw it on the ground. They like their Mother following them. They try to mimic her, ask for too many things, too many questions, and refuse to be held, if they were enjoying their time. Prepare yourself for emergencies, but do not restrict their freedom in exploring things. They may hold a cup or glass and put it inside their mouth. By this age they will have 4 - 6 teeth. When they are bored from a toy, they throw it away, and watch how things fall to the ground. They stare at moving objects for a short time and then they try to catch it to look at it closely. If you find a toy that makes your child move their fingers or stabilize and move their body in an active way, it is the best toy for him and will become a favorite. Speech development is not as great compared to behavioral development. Areas responsible for speech are not well developed, but they learn to talk faster. Speak with your child. Pronounce the words clearly. This will help speech development develop faster. 11- Infant From 10-12 month old: You will be amazed when you watch your child's first steps until they are one year old, even if the steps were not steady. You will feel like your child was born yesterday. This makes you happy, but your child does not remember these things as you only care about current things like washing dishes, clearing the room or preparing bottles. They are also interested in what Father is doing, like reading a newspaper or helping Mum. They try to simulate their parents and at the same time try to learn good behaviours and manners. Though the child does not like dealing with strangers, they enjoy watching themselves in the mirror, and sometimes they will spend time watching themselves or walking around at home. They can express themselves using yes or no. It seems that children understand words more than what they can speak. If you asked your baby, “where is dad?” they look at their Father. They also like to hear compliments and shows dissatisfaction when hearing negative words like, “no,” or, “don’t do this.” Most children refuse to deal with strangers. At this age, they are able to differentiate between inside and outside, and choose the toy they like most, make noise by throwing toys around. This demonstrates they are feeling lonely. By this their mental status develops. Coordination between eye and fingers becomes more focused, similar to adults. They may pick up small things using their thumb and middle finger, and if they want to pick up smaller things, like a small thread they will rotate the fingers. They are not dependent on their Mother and does not like her help, such as trying to drink on their own, even if this causes a fuss. In fact, parents insist that it is not necessary to buy every toy for their child. Clock ticking sounds and ringing phones amuse their child. Each child shows their individual interests, but most of them enjoy playing with makeup, their dad’s watch and key chain. Do not ignore their curiosity and try to respect their independence. - Physical exercises for the Infant: During each period of age, they need certain exercises to grow in a healthy way and hels in the development of the next step or milestones. You will notice that they enjoy these exercises with his father; every child likes movements and exercises: 1 - Exercise is the perfect way to help the child in dealing with their surrounding environment. 2 - Improves physical and mental potentials. 3 - Helps the child to behave in a reasonable way. 4 - Improves self dependence and confidence. 5 - Improves immunity against diseases. 6 - It helps them to become more socially active. 1- The beginning of small activities: Parents plays a major role in the first month. The baby cannot do anything on their own and wait for Mother to help. It is so important to say, “I am so glad to take care of my baby.” The following are just some of the possible exercises. It helps normal growth and its effect is different from one child to another. At the beginning, your Baby is used to lying down all the time. After awhile, they start sitting, standing, climbing, then walking. Before starting the first exercise, parents should take care of the following: 1 - Your child will do best, if they feel joy. 2 - It is advised to do exercise 5-10 minutes each time, several times/day. 3 - The best time is before meals or before changing their clothes. 4 - If your baby is very small, you can exercise on a table or on the ground when they become larger. When they are small, cover the surface with a large towel first. 5 - Adjust room temperature to 22c° (72f); take off their clothes and diapers. 6 - Let them get used to these exercises the first time and repeat each movement 4 times. Increase the frequency a little each day. After 14 days, you can change the movements. If you have noticed that they like certain movements, repeat it several times. 7 – Do not force them to exercise when they are in a bad mood. Smile during exercises, talk to them to make them happy, check them carefully, and be careful of their condition and needs. Respect their desires as much as you can. 2- Exercises from 2-6 month of age: 1 - Put your child on their back at the table. Put your thumb in their palm and stretch the arms with the other fingers. Do the same with the other arm. Raise one of the arms above the head slowly, then put it back as you switch to the other arm. 2 - Flip your child on their abdomen and raise the arms to stretch the abdominal muscles, several times after this exercise. Raise the upper part of the body to strengthen the back muscles and it also helps to hold the head much better. 3 - While your child is lying on their back, hold one shoulder, and push it down gently, hold the other arm and bend the elbow several times, then rotate it around the shoulder making big circles and watch how they feel during this exercise. 4 - Put them on their back, hold the arms and support the front of their shoulder at the same time. Let the arms cross like an, “X.” Repeat it in a synchronized way. 5 - Flip them onto their abdomen, stretch the fingers, hold the chest and abdomen and raise them gently. If they are older, you can support the front side of the shoulders, moving them like a bird. 6 - Put them on their abdomen, hold the feet and knees with your hands, and flip them from the right side to the other side. If you want to flip them on their back, raise the feet and legs. 7 - Support the chest and abdomen while they are lying on their abdomen. Do not raise the body, but help them in doing it. 3- Exercises from 7 to 12 month: 1 - Put your baby on their back, sit on your knees, and hold their ankle with your hand, and put them on your bosom, raise their ankles up to raise their whole body. Then put them back slowly (start from the lower part, then the back), then flip them on their abdomen. 2 - Sit on your knees, and put your baby in a squatting position. Hold them at the upper thighs and raise them slowly until you raise the whole body, while the hands and feet are still on the ground, for support. 4- Exercises after 12 months: 1 - Sit on your knees, and get your baby to stand on your lap, facing you. Then hold the shoulders to support them, and help them to climb till they reach your shoulders. Bend backward a little bit to make the climbing a little easier. 2 - Put your baby on their back, sit on your knees in front of them, hold the hands directly with your hands or use a stick from one side, and let your baby hold the other one, raise the stick vertically, so that when they see it, they will grasp it and stand up. This exercise strengthens arms and shoulder muscles. 3 - Put your Baby on their abdomen, hold and support the abdomen, then extend their fingers, raise the body and swing them right and left. If you are moving with your child they will feel as if they are riding on a swing.   Baby Names Book, Arabic Baby Names http://www.babynamesbook.net/   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/stages-of-infant-development-baby-development-stages Mon, 08 Mar 2021 05:25:19 AM Epidural Analgesia In Labour Indications, Various techniques its advantages and Contraindications   when to have lumbar epidural analgesia - Pain - Pre-eclamptic toxaemia - High risk fetus group - Breech delivery/ twin delivery - Trial of prolonged labour - Patient request - Symptomatic heart disease - Respiratory disease - Cerebrovascular disease - Abnormal or dead fetus - Inco-ordinate uterine action Prerequisites for epidural - Maternal consent - Maternal /fetal status - Progress of labor - Nursing - IV bolus - Monitor B/P - Continuous fetal monitoring - Catheter - Safety - Muscle weakness Epidural Analgesia -The Most effective form of pain relief for labor. - Opioids Combination with low concentrations of local anesthetics provided effective analgesia whilst reducing some of the unwanted side effects such as a motor block Extradural analgesia advantages over subarachnoid block - Amount of and Incidence of maternal arterial hypotension is less - Incidence of post puncture headache and serious neurological sequel are less - It is safer in theory to use the continuous technique in the extradural space than in the subarchnoid space. Different techniques of Extradural analgesia - Lumbar epidural block 1. Standard block T10 to S5 ---A - Single Dose ---B - Continuous Technique: Repeated Injection Through Catheter 2. Continuous segmental block, ---A - Initially Segmental T10 To L1 Block ---B - In Second Stage Extended To Sacral Segments - Caudal block - Single dose - Continuous technique - Double catheter technique - Upper catheter for segmental block - Lower catheter for sacral block Advantages of Epidural Analgesia - It gives superior pain relief during first and second stages of labor. - mother cooperation during labor and delivery will be easier. - It gives anesthesia for episiotomy or forceps delivery - extending of anesthesia for cesarean delivery is possible. - opioid -induced maternal and neonatal respiratory depression will be avoided. How does the epidural anesthesia work ? - An epidural anesthetic blocks the nerve roots that lead to the uterus and lower half of the body. The roots are located in a space near the spinal cord (epidural space). Which lies within the spine just outside the outer covering of the spinal cord. Epidural Block - Continuous block - Lies between Dura mater and ligamentum flavum - Does not enter CSF space - Give the bolus- observe for hypotension - Change position frequently - respiratory depression can result if narcotics are used Contraindication to epidural analgesia - Patient refusal - Active maternal hemorrhage - septicemia in the mother or untreated febrile illness - Infection at or near needle insertion site - If there is maternal coagulopathy (inherited or acquired) Anatomy of epidural space THE PROPER POSITION OF THE PATIENT TO APPLY EPIDURAL CATHETER Epidural Procedure done by Dr. Najeeb Layyous in 1982   ANATOMICAL CONSIDERATION - PAIN IN EARLY 1st STAGE :- T10 – Ll - PAIN IN LATE 1st STAGE AND IN 2nd STAGE :- T10 - Ll AND S2 - S4 Physiology of labor pain(1st. stage - Lower uterine segment distention, - Mechanical dilatation of the cervix - And due to stretching of excitatory nociceptive afferents resulting from the contraction of the uterine muscles. Timing Consideration for epidural block - Cervical dilation 3-5cm. - Diagnosis of active labor has been established, and the patient has begun to request pain relief. Epidural anesthetic agents - The mostly used drugs are lidocaine 1 – 2 % for short or intermediate action. - Bupivacaine 0.25 - 0.75 % for long action . Ropivacine 0.2 – 1.0 % for long action. Epidural anesthetic agents - The adult dose 1 -2 ml / segment bolus for anesthesia, the dose decreases with pregnancy and age, increases with height. - third or half of the initial dose can be re- injected when needed. - Test dose (3-5 ml) must be injected first to be sure of the proper space. - Opioids (morphine 2 -5 mg, fentanyl 0.05 – 0.1mg( may be added to local anesthetic drugs for epidural anesthesia. Complications of epidural analgesia Immediate - Hypotension (systolic blood pressure <100 mm Hg or a decrease of 25 percent below pre-block average) - Urinary retention - Convulsions*induced by local anesthetic - Cardiac arrest*­induced by local anesthetic Delayed - Postural puncture headache - Transient backache - Epidural abscess or meningitis* - Permanent neurological deficit* is very rare - Epidural abscesses; extremely rare Fetal Complications of epidural - Hypotension ; - May cause fetal distress and if not corrected within 3 minutes may lead to neurological sequalae and low APGAR - Fever - May result in unnecessary septic work up investigations for the newborn   Lumbar epidural analgesia Complications - Headache - backache - Haemorrhage - Respiratory depression - Retention of urine - Infection - Fetal depression from local anaesthetics - total spinal block - Convulsions*induced by local anesthetic - Cardiac arrest*­induced by local anesthetic - Epidural abscess or meningitis* - Permanent neurological deficit* is very rare Combined spinal epidural anesthesia. - Also known as needle through a needle technique - Introduced in the 80’s - Epidural needle inserted, followed by a spinal needle is introduced through it into the subarachnoid space and an opioid or local anesthetic is injected, needle then withdrawn and epidural catheter inserted for top up doses when needed. - Opioids given intrathecally or epidurally to cover the first stage of labor - For the second stage of labor a local anesthetic is required - A mixture of sufentanil with bupivacaine is given to cover early and late stages of labor with mild motor block, faster labor and less instrumental delivery rate Why combined procedure is better than epidural? - More rapid onset - The anesthetic blood level is less in maternal and fetal serum - More intense motor block for c/s - Asserting the position of the epidural catheter - Allows extension of sensory level or duration of spinal block; for a trial of forceps to c/s. - The use of different agents later on in the post- operative period; pain relief is possible. Combined spinal epidural - Confirming the site of epidural catheter decreases the risks of dural puncture - Not suitable for patient; if labor progresses rapidly this leaves the epidural catheter untested should an emergency rise requiring its immediate use for a c/s. Spinal anesthesia complications - Hypotension; due to sympathetic block. Which Is Treated By Uterine Displacement, Hydration And Ephedrine (10-15 Mg) I.V.? - Total spinal block; due to overdose. Symptoms include hypotension, apnea and cardiac arrest!!! - Spinal post puncture headache; it occurs in 1.5% of cases if the gauge 22-24 needle used. A result from CSF leak and prevented by using small gauge needles; placing the woman flat on her back for several hours post- procedure and avoiding multiple punctures. - Convulsions; resulting from CSF hypotension - Bladder dysfunction - Hypertension with oxytocics used postpartum is seen more commonly in females who received regional anesthesia - Arachnoiditis & meningitis; it used to occur due to preservatives found in anesthetics; nowadays, a rarity. How epidural Affect labor and delivery - No effect on the conduct of labor - Increase the rate of instrumental delivery. - Prolongation of second stage; allow the fetal head to proceed and crown spontaneously without necessitating bearing down provided fetal heart monitoring is reassuring. - Rate of malposition and malpresentation are increased with epidural due to the decreased tone of the pelvic floor muscles and subsequently malrotation of fetal head and increased incidence of deep transverse arrest - Early bearing down result in obstructed labor and requires intervention. - When full dilatation allowed fetal head to descend, rotate and flex without undue bearing down. - Remember mothers can’t feel the pushing to so allow the head to push down against the pelvic floor to be delivered - Keep in mind!!!!! Crowning needs time; allow 3 hrs in primigravidas and 2hrs in multgravidas as long as the fetal heart is “ok” How to avoid instrumental delivery - Try not to give top up doses after full dilatation (at the expense of feeling pain in second stage) - Limit the dose given of the local anesthetic close to the end of the first stage - Avoid the urge to crowning the patient, as soon as she reaches full dilatation. Allow spontaneous descent of the head - There’s no difference (as shown in studies) in the apgar scores amongst those who are allowed delivery without urging to push down early and those who deliver via instrumental delivery early after full dilatation - Active management of the second stage of labor; - make sure that there are good effective uterine contractions - Encourage mother to push with uterine contractions - Selective epidural block of the lower thoracic segments only which also covers perineal sensation whilst preserving pelvic floor muscle tone - Caudal and lumbar epidural effect leads to absent or diminished bearing down reflex thus increased rate of instrumental delivery - Give a segmental epidural at the level of t10-t12 that pertains to the bearing down reflex - If you give analgesics with the anesthetic, you will decrease the dose of the anesthetic used thus the motor block,and its side effects are decreased   Baby Names Book, Arabic Baby Names http://www.babynamesbook.net/   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/epidural-analgesia Mon, 08 Mar 2021 05:25:19 AM 5 Science-Backed Up Benefits Of Breastfeeding Over Formula Feedi   As a new mother, you will be faced with a barrage of information. Almost everyone you know will have an opinion about everything, right from what you should eat and what you should do. And, one extremely crucial and controversial topic is breastfeeding. The old school of thought believes that only a baby who is breastfed will develop fully. However, some mothers prefer formula over breastfeeding. They find breastfeeding completely overrated and prefer the control and convenience that baby formula provides. So who is right? And what is at stake for your child? Here are five reasons breastfeeding a baby trumps formula feeding.   1. Breastfeeding Builds Immunity   A baby is most vulnerable to sickness during the first few months of their lives Studies conclude that breastfeeding a baby helps reduce the chances of contracting communicable diseases, which can severely limit your kid's development during this crucial period. Antibodies in the breast milk play a major part. Moreover, breastfeeding increases the potency of the immune system, thus keeping your little child sickness free.   2. Easily Digestible   You wouldn't have your baby to have indigestion or gut problems would you? This is a recurring problem associated with baby formula. It can be hard to digest for an infant. And, breast milk is crammed with nutrients, and is from an environment the baby recognizes, which makes it easily digestible. This means your baby will receive high-quality nutrition and will avoid problems like diarrhea and vomiting.   3. Baby Determined Quantity   Unlike with bottle feeding where you decide the amount that the baby is fed, breastfeeding is child led. Your baby will naturally stop eating when she is full. This prevents overfeeding. Also, because breastfeeding is a natural cycle, the amount of milk being produced coincides with the babies requirements. Meaning as the baby is ready to switch off a liquid diet, the mothers production also reduces. Additionally, breast milk is higher in protein and lowers in sugar than other sources. This means your baby stays fuller for longer and is better nourished than he would be with formula milk.   4. Smarter Children:   One of the biggest arguments that people make for using breast milk over formula is that it produces smarter babies. Studies have shown that your child could potentially become much smarter than his bottle-fed counterparts, just because they were breastfed. A recent survey was conducted with over 17,000 infants that were followed from birth to the 6th year. Researchers, through IQ scores and other intelligence tests, found that there was a significant increase in cognitive development in babies that were exclusively fed on breast milk.   5. Reduced Risk Of SIDs   The risk of SIDs or Sudden Infant Death Syndrome can be reduced through breastfeeding. While SIDs is still a largely unexplained phenomenon, a German study found a link between breastfeeding and SIDs. Babies that were breastfed till at least the first month were 50% safer than those that were bottle fed. The reason behind this could be due to reduced risk of infections and a higher immunity rate. Even the American Center For Disease Control recommends feeding a baby on breast milk for as long as possible to avoid sudden death in infants. Breastfeeding is said to create a close bond between the mother and child. It is also cost effective as even the cheapest formula can't match the ease of free, anytime, anywhere breast milk.   Forced bottle feeding: There are certain times when a mother could be forced to abandon temporarily breastfeeding due to physical issues. Under these circumstances, it's advised to pump breast milk into a bottle and then feed the child. Leave formula as a last resort when there is absolutely no other option. With all the amazing benefits that breastfeeding offers, why wouldn't want your baby to receive all of them?   Written by: Aradhana Pandey Author Bio Aradhana is from India. She is a veteran writer on topics concerning parenting, child nutrition, wellness, health and lifestyle. As a regular contributor to popular sites like Huffington Post, Natural news, Elephant journal, Thehealthsite, Naturally Savvy, Curejoy and MomJunction.com, Aradhana writes to inspire and motivate people to adopt healthy habits and live a stress-free lifestyle.   Baby Names Book, Arabic Baby Names http://www.babynamesbook.net/   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/5-science-backed-up-benefits-of-breastfeeding-over-formula-feeding Mon, 08 Mar 2021 05:25:19 AM Plan for Perfect Babys Feeding Schedule   So, you’re a new mother! Congratulations! Your baby is undoubtedly the apple of your eye. As you look to take care of your little one, there are a number of things that you need to be watchful for. One of the most important is your baby’s food and sleep schedule. During the first few months, a baby is extremely sensitive to sleep. They also require to be fed at regular intervals. Failing to do this could result in growth problems and stunted development. That’s why it is essential to develop a feeding schedule for your baby. This will ensure your baby is taken care of. It will also give you, the mother, adequate rest.   It’s important to remember that each baby is different. Some babies require a little extra sleep while others require more food. It’s crucial to plan as per your baby’s needs to reap the most benefits from it. The plan can also function as a schedule for parents. It will allow both parents to schedule some personal time to pursue a hobby or meet some friends. This will ensure they don’t burn out, which is essential for them to take care of their babies effectively.   A baby under three months old is considered a newborn. Newborns are sensitive to even the slightest change in timings. Follow your timetable strictly. Newborn babies typically nap anywhere between 40 minutes to three hours. They are also not sensitive to day or night, meaning for the first few months you will be up at odd hours in the night to feed and take care of them. They also require food quite frequently; this will gradually decrease as they enter the next stage of development. You will also use more diverse foods like barley and brown price porridges, as you switch from a liquid diet to solid food. You will also come across people that warn against waking a sleeping baby. However, when your baby is in their first few weeks, it is okay to wake them as they need to be fed at regular intervals.   A sample feeding schedule for your newborn child can look something like this:   9:00 AM – Wake your baby and feed 10:00 AM – Allow them to nap for up to an hour 11:00 AM – Wake your baby and feed again 12:30 PM – Another hour long nap 1:30 PM–Wake and feed baby 3:30 PM – Longer nap up to two hours 4:30 PM–Wake and feed your baby 6:00 PM – Nap for up to 90 minutes 6:30 PM–Feed 7:30 PM – Quick 30‐minute nap 8:00 PM – Feed 9:30 PM – Another short 30‐minute nap 10:00 PM–Feed 11:30 PM – Feed and sleep 3:30 AM – Wake after long nap and feed 6:30 AM – Feed followed by a long nap   As mentioned earlier, this is a sample schedule and should be modified to suit your baby’s requirements. You will also need to monitor your breastmilk quantities as some babies require more than others. If you're feeding your baby on formula, you can give them longer gaps between feeds as formula takes longer to digest. It also keeps them full for longer. If you're using formula, have them plenty in stock as once your child gets set in a routine, they will find it hard to adjust to any gaps in the schedule.   As your child grows up, you will see that this program will allow you as parents more freedom. The routine will allow the baby to get all the nutrition and rest that they need to grow strong and healthy. It will also enable the mother to get used to breastfeeding and avoid any problems. What does your perfect feeding and sleep schedule look like?   Written by: Aradhana Pandey Author Bio Aradhana is from India. She is a veteran writer on topics concerning parenting, child nutrition, wellness, health and lifestyle. As a regular contributor to popular sites like Huffington Post, Natural news, Elephant journal, Thehealthsite, Naturally Savvy, Curejoy and MomJunction.com, Aradhana writes to inspire and motivate people to adopt healthy habits and live a stress-free lifestyle.   Baby Names Book, Arabic Baby Names http://www.babynamesbook.net   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/plan-for-perfect-babys-feeding-schedule Mon, 08 Mar 2021 05:25:19 AM Depression in Women and Postpartum Depression   It is caused by the rapid drop in pregnancy hormonal levels after delivery leads to chemical changes in the brain that may trigger mood swings, with the stress and sleep deprivation after delivery, can increase the risk in susceptible people. Also, many new parents find it difficult to get the rest they need after giving birth. Sleep deprivation can lead to body pain and exhaustion, which also may contribute to the symptoms of postpartum depression.   Women with postpartum depression experience intense feelings of sadness and anxiety, that prevent them from being able to do daily tasks. Postpartum depression usually begins about one to three weeks after childbirth but can occur up to one year after delivery. After giving birth, feelings of sadness and fatigue are normal and usually fade within a week without treatment. It usually doesn’t interfere with a parent's ability to care for their baby. Nearly 80% of new parents report feeling depressed, anxious, irritable, or even angry in the first weeks with a new baby. But post-partum depression could interfere with a parent's ability to care for their baby . It could happen after a successful pregnancy and childbirth or after a pregnancy or childbirth with complications or during pregnancy (prenatal depression) or after a stillbirth or miscarriage. People at risk of developing postpartum depression include: People with a lot of other stress in their life. Parents of a sick baby. People who had depressive episodes before or during pregnancy. Those without enough support from their spouse, family, or friends. People with children to care for. Younger parents. Moderate to severe premenstrual symptoms Formula-feeding instead of breast-feeding Smoking unemployment   Common symptoms of postpartum depression include: Constant feelings of sadness, restlessness, anxiety, or hopelessness. Detachment from family and friends. Extreme fatigue and either sleeping too much or too little. Low self-esteem and feelings of worthlessness. Lost interest in their baby or in their favorite activities. Persistent physical problems, such as headaches or an upset stomach. Severe mood swings, including irritability, anger, and sadness, but no joy. Thoughts about hurting themselves or their baby. Trouble concentrating or remembering. Withdrawing from loved ones, including their baby, due to feelings of guilt or shame. Treatments include lifestyle changes, counseling, and medicine. Possible dietary supplements aimed at preventing postnatal depression include omega‐3, iron, folate, vitamin B12, B6 (pyridoxine), B2 (riboflavin), vitamin D and calcium. Lifestyle changes Exercise can help improve mood. Stress management and relaxation training. Emotional support from a spouse, friends, and family and help with caring for the baby or the home. Counseling Assertiveness training can help people learn to set limits and reduce overwhelm. Peer support groups or educational classes. Counseling and talk therapy one-on-one with a mental health professional helps develop coping skills. Group therapy sessions. Medical treatments Hormonal treatments Antidepressants act on the chemicals in the brain that affect mood and its regulation. Anti-anxiety medication to help with panic attacks and anxiety Postpartum blues Postpartum blues occur within a few weeks of delivery and usually last a few days. They go away completely within two weeks. They are considered normal and not serious. The baby blues has milder symptoms than post-partum depression such as mood swings, trouble sleeping, crying and inability to concentrate.   Dads can get postpartum depression too Researchers found that postpartum depression may affect between 8 and 13% of fathers (called paternal PPD) Risk factors for paternal PPD include: Age (Older parents are more likely to be affected) A history of depression, anxiety, or other mental illness. Financial worries. Having a partner who has a mood disorder or post-partum depression Lack of social support. The symptoms of paternal PPD are the same as PPD in the birthing parent. However, it may not be as obvious (even to the person). Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/depression-in-women-and-postpartum-depression Mon, 08 Mar 2021 05:25:19 AM Postpartum hemorrhage (prevention and treatment) What is postpartum hemorrhage? It is the loss of blood through the vagina after childbirth in quantities greater than the expected amount What are the causes of postpartum hemorrhage? ** Relaxation of the muscles in the wall of the uterus (the most common cause)  .. known as uterine atony ** Lacerations in the birth canal (injury to the cervix, injury to the walls of the vagina) ** Hematological diseases that cause bleeding tendency ** Some medications that cause bleeding tendency ** Retained parts of the pregnancy tissue (the placenta) inside the uterus What are the causes of relaxation of the muscles in the uterine wall after childbirth? ** Primary ** Secondary due to the presence of uterine fibroids or increased amniotic fluid around the fetus or pregnancy with twins or pregnancy with a large sized fetus How to prepare for postpartum bleeding? By monitoring the hemoglobin level during pregnancy and ensuring that the patient does not have anemia at the time of birth Does postpartum hemorrhage increase the risk of postpartum hemorrhage in subsequent pregnancies? Yes, the recurrence rate is high How to deal with postpartum bleeding? **Massage the uterine fundus **Using medications to increase the uterine muscles tone **Using a balloon placed inside the uterus to put pressure on the bleeding areas of the uterine wall **Surgically, which may end with a hysterectomy **Suturing the lacerations causing bleeding in the birth canal **Blood and plasma transfusion **Removing the remnants of the stuck placenta Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/postpartum-hemorrhage-prevention-and-treatment Mon, 08 Mar 2021 05:25:19 AM Genital (pubic) Care After an Episiotomy   An episiotomy is a procedure performed during vaginal delivery to reduce the severity of tearing caused by the baby's head emerging from the vaginal opening.   It is usually performed more often on first-time mothers, but it may be necessary for women who have previously given birth vaginally, depending on the individual case and the doctor's assessment.   What is a perineal tear?   (The perineum is the area between the vaginal opening and the anus.) A perineal tear, if it's in the skin, is called a first-degree tear and usually heals naturally. If the tear reaches the muscles, it becomes a second-degree tear and requires stitches. If the tear reaches the muscle that controls the anus, it becomes a third-degree tear. If it reaches the lining of the anus or rectum, it becomes a fourth-degree tear. A third- or fourth-degree tear is where the tear in the perineum extends to the anus What can be done to speed up recovery?   - Keep the perineal area clean by washing it daily with water and changing sanitary pads regularly. Wash your hands before and after using the toilet to reduce the risk of infection of the stitches. - Drink plenty of fluids to avoid constipation; aim for at least two liters of water daily. Maintain a balanced diet (vegetables, fruits, grains, and whole-wheat bread). - Start pelvic floor exercises as soon as possible after giving birth. - Avoid strenuous exercise and lifting heavy objects for at least 4-6 weeks. -  Take the pain medication prescribed by your doctor. Take the prescribed antibiotics to prevent infection of the wound. -  Consult a doctor immediately if you notice any of the following signs: (foul-smelling discharge, fever, chills, redness in the area, bleeding from the stitch site, wound separation)   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/genital-pubic-care-after-an-episiotomy Mon, 08 Mar 2021 05:25:19 AM Physical Activity Throughout the First Year Postpartum   Moderate – vigorous intensity physical activity •    Encourage starting or coming back to heavy activity in the first 12 weeks after childbirth to support mental health. •    Suggest early mobilization with light-intensity activity, progressing to moderate  once surgical incisions or perineal tears have healed and vaginal bleeding does not increase with activity. •    Ensure adequate nutrition and hydration to help prevent low energy availability. •    Suggest breastfeeding or expressing milk before exercise sessions to reduce breast weight and improve comfort during physical activity. •    Recommend adopting a healthy sleep hygiene routine to support maternal mental health. •    Suggest limiting sedentary time to ≤8 hours daily, including no more than 3 hours of recreational screen time, and breaking up long periods of sitting when possible. •    Recommend daily pelvic floor muscle exercise to reduce the risk of urinary incontinence and rehabilitate pelvic floor muscles. Assess the following factors, as they are key barriers to vigorous activity: o    mental health status (including eating disorders) o    musculoskeletal pain o    lactation status o    perineal tears and surgical incisions o    relative energy deficiency in sport o    sleep quality o    fear of movement or injury (kinesiophobia) o    pelvic floor and abdominal wall function o    availability of social/emotional support. Contraindications to heavy exercise: •    For postpartum people with potential contraindications to physical activity, advise them to obtain medical guidance about beginning or continuing exercise following childbirth. •    Vigorous activity may proceed in most cases, but modifications may be required until the medical condition or symptom has resolved. •    Be aware of the following relative contraindications in the first year after childbirth, which may require further medical consultation: o    dizziness or light-headedness during exercise o    severe abdominal pain o    Caesarean section with symptoms that worsen (for example, surgical incision pain) o    unstable high blood pressure (>140/90 mmHg) o    kidney disease o    eating disorders or malnutrition o    postpartum cardiomyopathy o    fractures or other significant musculoskeletal injuries o    vaginal bleeding not associated with menses o    haemodynamic instability o    acute systemic infection accompanied by fever, body aches, or swollen lymph glands o    calf pain or swelling indicative of DVT o    breathing difficulties at rest that are not resolved with medications o    excessive fatigue suggesting anaemia or low energy availability . o    new onset of chest pain, discomfort, and other angina-like symptoms with exertion. o    loss of consciousness for any reason. o    neurological symptoms (for example, ataxia or muscle weakness that affects balance). o    other medical or physical conditions that may affect the ability to be physically active. •    Avoid a rapid return to vigorous activity, especially if the patient is experiencing symptomatic musculoskeletal pain, incisional pain, heavy vaginal bleeding, pelvic floor dysfunction, or mental health concerns. Lifestyle Changes Exercise •    Recommend all postpartum people without contraindications be physically active to obtain clinically meaningful benefits, such as preventing and reducing depressive symptoms. •    Recommend that the person follows an individualized and gradual progression to the point when she is doing a minimum of 120 minutes of moderate to vigorous pgysical activity (which could include brisk walking or cycling, and should also incorporate a variety of aerobic exercises and resistance training activities)spread over ≥4 days of the week. •    Suggest initiating early mobilisation with light-intensity physical activity, such as gentle walking, and progressing to heavy exercise once surgical incisions or perineal tears have sufficiently healed and vaginal bleeding does not increase with the activity. •    Ensure adequate caloric intake and hydration (understanding that needs will be greater during lactation) to prevent low energy availability, which can lead to poor recovery, decreased bone health, amenorrhoea, sleep disturbances, and fatigue. •    Advise patients that breasts will rapidly change size during lactation, and a bra with good support is required to minimise mobility during exercise. A tight-fitting or binding bra should be avoided to ensure that breastmilk supply is not compromised. Advice :[2] •    regular activity can relax you, keep you fit, and help you to feel more energetic •    it can also help your body to recover after childbirth and may help to prevent postnatal depression •    if you had a straightforward birth, you can start gentle exercise as soon as you feel up to it; this could include walking, gentle stretches, and pelvic floor and tummy exercises. •    it's usually a good idea to wait until after your 6-week postnatal check before you start any high-impact exercise, such as aerobics or running. •    your lower back and core abdominal muscles may be weaker than they used to be, and your ligaments and joints are also more flexible for a few months after birth, so there's an increased risk of injury. •    listen to your body; pace yourself and make sure that you get plenty of rest too. Sleep •    Encourage the postpartum woman to prioritize quality sleep, to support mental health, physical and cognitive recovery, and to reduce the risk of injury. •    Advise the person to adopt a healthy sleep hygiene routine to support maternal mental health, which could include avoiding screen time and maintaining a dark, cool, quiet environment before bed. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/physical-activity-throughout-the-first-year-postpartum Mon, 08 Mar 2021 05:25:19 AM Signs that labor is near:   As pregnancy nears its end, many expectant mothers begin to notice bodily changes that may indicate labor is approaching. Knowing these signs helps pregnant women prepare and consult their doctor at the appropriate time.   Signs that labor is near: 1. Baby's head descends into the pelvis In the final weeks of pregnancy, the baby's head may descend into the pelvis, which can relieve pressure on the chest and make breathing easier. However, it may also increase pressure on the bladder, leading to frequent urination.   2. Increased uterine contractions The pregnant woman may begin to feel irregular uterine contractions known as Braxton Hicks contractions. These are a precursor to labor, but they do not necessarily mean that labor has begun.   3. Loss of the mucus plug The pregnant woman may notice the passage of a thick, mucus-like discharge, which may be clear or tinged with a little blood. This is known as the mucus plug and is a sign that the cervix is ​​preparing for labor.   4. Rupture of membranes (water breaking) A rupture of the amniotic sac can lead to a sudden or continuous leakage of amniotic fluid. In this case, you should seek immediate medical attention at the hospital.   5. Lower back pain and pelvic pressure As labor approaches, pregnant women may experience increased pelvic pressure and lower back pain due to the baby's descent.   The difference between true and false labor: Many pregnant women find it difficult to distinguish between true and false labor, so it is important to understand the differences between them.   False labor: Defined as irregular uterine contractions that occur in the last weeks of pregnancy.   Characteristics: - Irregular contractions - Mild to moderate intensity - Do not increase in intensity over time - May disappear with rest or changing position   True labor:  True labor is the beginning of actual childbirth, leading to cervical dilation and the start of delivery.   Characteristics:  - Regular contractions - Gradually increasing in intensity - The time between contractions decreases over time - They do not disappear with rest - They may be accompanied by light spotting or rupture of membranes   When should you go to the hospital?   - If contractions become regular and occur approximately every 5 minutes. - If your water breaks. - If there is noticeable vaginal bleeding. - If fetal movement decreases. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/signs-that-labor-is-near Mon, 08 Mar 2021 05:25:19 AM Constructing a delivery plan: A Guide for Expectant Mothers   Pregnancy is a beautiful journey and pregnant ladies should enjoy every bit of it. Preparing for birth is an essential part of antenatal care because labor and delivery can be unpredictable and putting such plans help ladies feel more confident about the process. A delivery plan is a written document that describes the woman’s preferences for labor and childbirth and helps expectant mothers communicate their preferences with healthcare providers. Medical circumstances require flexibility, but a healthcare provider should try to follow patients wishes as much as possible.   Elements of the plan: Basic information: Full name Due date Name of your doctor Name of your hospital Contact information of partner/spouse Medical conditions Pregnancy complications   Labor environment: Atmosphere like lighting or music Number and names of allowed visitors Freedom of movement Using some equipment such as: birthing ball, shower or tub   Options for pain management: Natural pain management like breathing and massage Medical pain relief like intramuscular narcotics or epidural anesthesia Combination of both A lady should be able to change the pain management method anytime during labor   Delivery preferences: Positions such as squatting or lying on your side Delayed cord clamping Use of vacuum or forceps Skin to skin contact with the baby When to initiate breastfeeding   Decisions about care of the newborn: Breastfeeding or formula feeding Timing of newborn bathing Vitamin K injection Rooming-in with the baby VS nursery care   When is delivery plan formulated? During the third trimester between 28-36 weeks of pregnancy   Who should be included in the plan? Healthcare providers (doctors, midwives) Partner Selected family members   Can the plan be changed? Yes, flexibility is needed as anything new can happen throughout pregnancy and changes of the plan might become essential   It is important to keep the plan simple and clear so that it can be easier for the healthcare providers to read and understand during labor.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/constructing-a-delivery-plan:-a-guide-for-expectant-mothers Mon, 08 Mar 2021 05:25:19 AM Dates... A Blessed Food and Support for Natural Childbirth   Dates are a favorite food due to their high nutritional value and are considered religiously blessed. Dates contain a rich array of vitamins, minerals, and natural energy sources such as potassium, magnesium, fiber, and natural sugars, which help the pregnant woman's body gain the necessary energy during labor and delivery. How do dates help facilitate childbirth? - Increase cervical softening - Improve uterine readiness for natural childbirth - Reduce the need for induced labor - Help regulate uterine contractions - Shorten the duration of labor - Contain compounds that support the function of natural birth hormones Are the benefits of dates limited to childbirth during pregnancy? No, they also include: - Providing energy due to their sugar content - Preventing constipation - Supporting digestive health - Helping to replenish certain minerals - Reducing feelings of fatigue and tiredness When is it advisable to eat dates? During the last weeks of pregnancy, especially after week 36, the quantity should be moderate according to the pregnant woman's health condition and the doctor's recommendations. Does eating dates guarantee an easier delivery? No, as its effect varies from woman to woman depending on her body. In which case is it not recommended to eat dates? - Diabetics - Those with a date allergy - Excessive weight gain - Digestive disorders such as bloating and irritable bowel syndrome - Allergies to certain preservatives Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/dates...-a-blessed-food-and-support-for-natural-childbirth Mon, 08 Mar 2021 05:25:19 AM ​Breast Care After Childbirth: Expected Changes and How to Manage Them ​The postpartum period is an incredible transitional phase for your body. Your breasts, in particular, undergo some of the most noticeable and rapid changes during this time, whether you plan to breastfeed or not. ​Here is a comprehensive guide to the most common breast changes after childbirth, along with practical tips on how to care for them and manage these changes comfortably. ​1. Expected Breast Changes After Childbirth ​A. Breast Engorgement (Fullness and Hardness) ​Between days 2 and 5 postpartum, your body transitions from producing small amounts of colostrum to producing mature milk in larger quantities. This shift can cause your breasts to feel heavy, warm, swollen, and hard—a condition known as engorgement. ​B. Nipple Changes (Leakage and Soreness) ​Milk Leakage: You might notice milk leaking spontaneously when you hear your baby cry, or even when you just think about them. ​Soreness and Cracking: It is common to feel some nipple tenderness when starting to breastfeed. However, severe pain, cracking, or bleeding usually indicates an incorrect latch. ​C. Plugged Milk Ducts ​You may feel a small, hard, and tender lump in a specific area of your breast. This happens when milk fails to drain completely from one of the milk ducts. ​D. Mastitis (Breast Infection) ​If a plugged duct is left untreated, it can develop into a bacterial infection. Symptoms resemble the flu and include a high fever, chills, and a red, hot, and very painful area on the breast. ​2. Postpartum Breast Care and Management ​How to Relieve Engorgement: ​Nurse Frequently: Breastfeed your baby regularly (every 2 to 3 hours) and ensure one breast is fully emptied before switching to the other. ​Use Compresses: Apply a warm compress or take a warm shower before nursing to help the milk flow. Apply a cold compress (or a bag of frozen vegetables wrapped in a cloth) after nursing to reduce swelling and pain. ​Gentle Massage: Gently massage the breast from the chest wall down toward the nipple while nursing to help expel the milk. ​How to Protect Nipples and Treat Cracks: ​Ensure a Proper Latch: Make sure your baby latches onto the entire areola (the dark circle), not just the nipple. A good latch is the number one secret to preventing pain. ​Natural Moisturizing: After nursing, express a few drops of your breastmilk, rub it onto your nipples, and let them air dry. Breastmilk contains natural antibacterial properties that promote healing. ​Lanolin Cream: Apply a pure, medical-grade lanolin cream designed for breastfeeding. It is completely safe for the baby and does not need to be washed off before the next feed. ​How to Handle Plugged Ducts and Mastitis: ​Change Nursing Positions: Position your baby so their chin points toward the hard lump; their suction is strongest in that direction, which helps clear the blockage. ​Rest and Hydrate: Overcoming mastitis requires plenty of rest and fluids. If you develop a fever or chills, consult your doctor immediately. You may need a course of antibiotics that are safe to take while breastfeeding. ​General Daily Care Tips: ​Wear the Right Bra: Choose supportive, cotton nursing bras without underwires, as underwires can compress milk ducts and cause blockages. ​Breast Pads: Use cotton breast pads to absorb leaking milk, and change them frequently to keep the area dry and prevent fungal infections. ​Gentle Hygiene: Wash your breasts with warm water only during your daily shower. Avoid using harsh soaps or perfumes on your nipples, as they cause dryness and cracking. ​When to Consult a Doctor ​Do not hesitate to seek medical advice or consult a lactation specialist if you experience: ​A fever rising above 38.5°C (101.3°F). ​Red streaks radiating from the painful area of the breast. ​Severe, persistent nipple pain that makes you dread nursing your baby. ​A breast lump that does not disappear or shrink after a few days of massage and frequent emptying. ​ Caring for your breasts after childbirth requires a little patience and awareness. Remember that your body is doing an amazing job, and most of these challenges are temporary. They will ease as your milk supply regulates and your body adapts to your baby's needs. Wishing you and your baby health and wellness! Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/childbirth-and-newborn/breast-care-after-childbirth Mon, 08 Mar 2021 05:25:19 AM Gynecological Disorders and Diseases   Gynecology is the medical practice dealing with the female reproduction health. Almost all gynecologists are obstetricians. To diagnose any gynecological problem, your doctor will start by clinical history and physical examination. Physical examination involve bimanual examination to palpate the uterus, cervix and ovaries; it also include speculum examination to check the cervix. Vaginal ultrasound or pelvic ultrasound can be done according to the complaint of the patient, and whether the hymen is intact or not Over the life time of the female she passes through several changes: hormones, breast growth, pregnancy, uterine bleeding, and menopause. So you should give special care and attention to every symptom you have because during this period a lot of health problems can happen. https://www.layyous.com/en/gynaecology Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/gynaecology Mon, 08 Mar 2021 05:25:19 AM Female genital tract   It is formed from external and internal organs:   A-External female genital organs: It is formed of organs around the vaginal opening: -Pubis: It is the groin folds covered with hair, in mature adult woman it is horizontal in shape, it is not present in childhood, and it gets smaller after menopause. Hair growth at this area is one of the signs for puberty. -Labia majora. -Labia minora. -Clitoris: It is equivalent to the penis in the male external genital organs, it about 2.5cm (1inch) in length and it is formed from tissues that are highly supplied with blood vessels that gets congested during orgasm at the time of intercourse. -Hymen: It has different shapes, usually its incomplete membrane with an opening that allows blood to come out through this opening, it could be torn during the first intercourse, but hymnal remnant may remain after several times of intercourse. -Bartholin’s gland: It lies at both sides of the vagina, and its function is to secret mucosal secretions that help in lubrication during intercourse. -Urethral orifice: It lies just below clitoris. Genital Area Hygiene   B-Internal Female Genital Organs: -Vagina: It starts from the hymen till the cervix, it is lined with folded skin, and it’s around 10cm in length, but it is stretchable and becomes longer during labor and intercourse. -Uterus: It’s like an inverted pear in shape, 7.5cm in length, 5cm in width, it starts from the cervix then uterine body and it’s lined by endometrium which is a special layer that lines the inside of the uterus, and gets thickened before each cycle in response to hormonal changes, then sheds out with cycle in the form of menstrual blood followed by formation of a new layer. -Fallopian tubes: Extend from uterine body to the ovary with an average length of 11cm, and ends with a finger like processes, it is lined with certain type of cells that helps in transporting the oocyte from the ovary to the uterus, fallopian tubes are the sites where fertilization and the early stages of fetal development happen. Cross Section of Female Pelvis Video of Female Reproductive System -Ovary: There are two ovaries at both sides of fallopian tubes they are formed from the external layer (cortex) that contain the follicles and inner layer (medulla) in between there are blood vessels and nerves, ovaries are equivalent to testis in the male, ovaries produce two hormones estrogen and progesterone . Internal female genital organs We will try to explain simply and as clear as we could what is the regular monthly cycle and what are the physiological changes that happen during each cycle, several hormones from different body organs control menstruation. The most important of which are: -At the base of the brain there is a gland called hypothalamus which secrets GNRH hormone. -Just beneath the hypothalamus there is the pituitary gland that secrets two hormones FSH and LH, their secretion is under the effect of GNRH hormone. -LH and FSH have a direct effect on the ovary to stimulate follicular growth and maturation, eventually ovulation at middle cycle and one oocyte is ready to be fertilized. The fertilized oocyte passes through fallopian tube to reach the endometrium, where the fetus grows, so if any blockage in one or both of fallopian tubes will affect pregnancy rate and any disturbance or decrease in the secretion of any previous hormone will affect fertilization. Let’s explain it in details: The hypothalamus starts secreting GNRH hormone in a pulsatile manner; this will induce the pituitary gland to secrete FSH and LH hormone, so its secretions differ during different stages of the cycle. During the first half of the cycle (before ovulation) GNRH is secreted every 1-1.5 hour, but after ovulation it is secreted much less frequent (every 4 hours).   Glandular Control of Menstrual Cycle During the first half of the cycle there are low levels of estrogen, this will stimulate GNRH secretion which will stimulate the pituitary gland to secret FSH and LH hormones, these hormones induce the ovary to start follicular production, when the oocyte forms it starts to secrete estrogen hormone so its level in blood will start to increase gradually during this time one of the follicles will be mature more than the other follicles and will grow faster and secret larger amounts of estrogen, rising level of estrogen causes a decrease in FSH and LH secretion, since the dominant follicle is capable of rapid growth, and fertilization it continue to grow despite high FSH level. Rising level of estrogen helps in more maturation of the follicle, and in building up the endometrium. Estrogen level continues to increase until it causes a sudden increase in LH level, which is important in the final maturation of the follicle. 36 hours after this sudden increase ovulation happens during normal cycle, LH increase at day 12 of cycle and ovulation at day 14, after ovulation the oocyte is released, the follicle shrink to form the corpus luteum at outer layer of the ovary and it continue to secret estrogen and progesterone. Menstrual cycle: Both estrogen and progesterone decrease pituitary gland secretion of FSH and LH. If there is fertilization corpus luteum continue to secret estrogen and progesterone to prepare the endometrium to be ready for the fertilized ovum, after the third month of pregnancy the placenta forms and start to secret estrogen and progesterone and corpus luteum disappears. If there is no fertilization (or pregnancy), corpus luteum disappears and shrink gradually 10 days after ovulation which result in drop in the level of estrogen and progesterone, two weeks later the endometrium sheds out in the form of menstrual bleeding, and the drop in hormonal level result in increase in GNRH, and initiation of new cycle. It should be mentioned here that each follicle is formed from the oocyte surrounded by fluid, at the first half of cycle it is small in size, but at time of ovulation it reaches 16-26mm; this increase in size is due to increase in amount of fluid around the oocyte, (this increase in size can be followed using ultrasound), 36 hour before ovulation it grows faster, once LH level increase, ovulation happens. Regarding endometrial changes; at the first half of cycle (proliferative phase) when estrogen level is high, the endometrium increase in thickness and in blood supply, and then the endometrial glands start to secret mucosal substances that nourish the endometrium to be ready for the fertilized ovum this phase is called secretory phase if there is no pregnancy, the corpus luteum dissolves, estrogen and progesterone level decrease which leads to shedding of the endometrium and menstruation.     Ovulatory Cycle Ovulatory and Endometrial changes during the Menstrual Cycle Dear readers: You may have some questions that cross your minds, we are glade to answer what we think is important for you?   How many oocytes does the woman have at birth?   At birth both ovaries contain around 2million oocyte; these remain dormant till puberty and most of them would have atresia, that is why at puberty their number decrease to 400.000 oocyte, the process of atresia continue, it is a lifelong process even during pregnancy, during each menstrual cycle about 20 follicle starts to grow, but only one follicle reaches maturation, and the rest of them disappear. There are many factors that affect the rate of atresia, some are genetic and hereditary factors, but some are related to the environment like irradiation, medication, and smoking; that’s why the age of menopause (the age when menstruation stops) differs from one woman to another, that’s when all the oocytes go into atresia. What is the follicle? It is some sort of a sac filled with fluid that contains the oocyte inside. How does ovulation happen? How could the oocyte come out of the follicle? LH hormone is secreted from the pituitary gland; when the level of this hormone increase, it leads to formation of something like a hole in the membrane of the follicle, the oocyte comes out to be catch by the fimbrial end of the fallopian tube (finger like processes mentioned before). Stages Of Oocyte Maturation   Video Stages Of Oocyte Maturation Video Oocyte Formation   Does ovulation happen in alternating manner between each ovary? Not exactly like that, ovulation whether from the right or left ovary is a random process, and you can never know which ovary will have the ovulation from till one or two days prior to ovulation and that can be done using ultrasound. This question is so important for women with only one fallopian tube, most of the time the tube catches the oocyte from the ipsilateral ovary, but there are reported cases of pregnancy in women with one tube (on the left for example) and one ovary on the other side (on the right side) which is an indirect evidence that the fallopian tube can catch the oocyte from the contralateral ovary. What is the regular menstrual cycle? It is the cycle that its duration is between 26-34 day starting from the first day cycle till the first day of the next one, and lasts from 3 to 5 days with average bleeding. Does having a regular cycle means necessarily that ovulation happened? Usually yes, but there are some exceptions in which the follicle grows incompletely, but still has the capability to secrete the hormones necessary for endometrial changes and menstruation. Generally irregular cycles mean that most likely there is no ovulation.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/female-reproductive-system Mon, 08 Mar 2021 05:25:19 AM Male Reproductive System   It is formed of penis, testicles, prostate and seminal vesicles. Video of Male Reproductive System   A-Testicle: It is the site where sperms are formed. And it secrets male hormones (testosterone), sperms are present in small tubules called seminiferous tubules, that are coiled together, these tubules unite to form larger ones that eventually unite to form one duct called epididymis, which is coiled also if we assumed that we open it, its length may reach 6 meters, sperms pass through the epididymis by the time it reaches its end they are mature and are capable of motility and fertilization. After the epididymis; it is connected to a thick tube that can be palpable in most men, it is called vas deference, it’s a transporting duct, that connect epididymis to the seminal vesicles (which has a role in semen production). After seminal vesicles there is the ejaculatory duct which passes through prostate gland and opens in the urethra. Spermatogenesis 1) Spermatogonial Phase (Mitosis): spermatogonia proliferate by mitotic divisions to provide stem cells and cells which will proceed through spermatogenesis (1º spermatocytes) 2) Spermatocyte Phase (Meiosis): 1º spermatocytes enter Meiosis I (reduction division) to form 2ry spermatocytes (diploid cells (2n) give rise to haploid cells (1n) ) which then enter Meiosis II (equatorial division) and result in spermatids 3) Spermatid Phase (Spermiogenesis): spermatid differentiation into spermatozoa Function of Sertoli cells 1)They prevent the antibody producing cells in Extra cellular fluid from reaching the tubular sperm factory, thus preventing the formation of antibodies against the highly differentiated spermatozoa. 2) They provide a mechanical support for seminiferous tubules. 3) They provide nutrition for the developing sperm 4) Sertoli cells have an important phagocytic function. They destroy defective germ cells that fail to successfully complete all stages of spermatogenesis. 5) Sertoli cells secrete fluid into the seminferous tubule which pushes and flushes the release of sperm from tubule into the epididymis for storage. 6)Sertoli cells secrete a protein that binds testosterone thus maintaining a very high level of this hormone which is essential for spermatogenesis. 7)Sertoli cells secrete inhibin to regulate FSH secretion. Also Mullerian inhibitory factor during fetal life to inhibit the formation of Fallopian tube from Mullerian duct. Cross Section of the Testicle Video Testicle   B-Penis: It is formed of a sponge like body that is responsible for erection, inside the penis there is a duct called urinary duct both sperms and urine pass through this duct. Pituitary hormones (LH and FSH) are secreted in men and women; their secretion is under the control of GNRH hormone secretion (a hormone that is secreted from the hypothalamus gland).     Male genital Organs In men FSH hormone has a role in stimulating seminiferous tubules to produce sperms. LH hormone stimulate certain cells in the testis (leydig cells) to produce testosterone hormone in the male, this hormone has a role in sperm production in addition to its role in secondary sexual characteristic of the male.   Sperm Formation Morphology of sperms   Dear readers: There are many questions that cross your minds and we are glade to answer what we think that is important for you. -What does a sperm look like? It is formed from head that contains the genetic material, and the middle part which is called (neck) that gives the energy needed for the sperm motility, the last part is the tail which helps the sperm to move forward inside the female genital tract, it should be noted here that the male starts sperm production only after puberty, unlike the female who is born with her ovaries already containing the follicles. -How much time is needed for sperm production? It takes around 60 days for production of sperms and 10-14 days to pass through the epididymis and vas deference. -What is the amount of semen during ejaculation? It is from 1-6 ml. At the time of ejaculation it is viscous but inside the female vagina it becomes less viscous (liquid) and that takes 20-30 minutes, the sperm needs 2 minutes to be able to pass through cervical mucus. -How much sperms are produced during intercourse? Around 100-300 million. A large number of sperms but only one sperm fertilize the oocyte, that is due to the large number of sperms that die during their passage in the female genital tract, beside that most of the semen comes out from the vagina, and only 1000 sperm reaches the oocyte, some may get through the outer membrane of the oocyte, but at the end only one sperm fertilize it. -How long does the sperm live inside the female genital tract? The definite answer is difficult, but sperms can be noticed in the vagina 16 hours after coitus and once it passes through the cervix, uterus and tube it can stay up to 3-4 days. -Does abstinence improves sperm count? In abstinence, sperms don’t live forever, with time it loses its ability to fertilize, also in cases of abstinence the large number of sperms present will result in increase the number of old sperms, in this case though large number of sperms, but bad quality; so abstinence doesn’t improve fertility.   Video of Male Reproductive System   -Does being ill affects sperm count? Any illness whatever it was simple, even tonsillitis may lead to decrease sperm count, and as said before 7-74 days are needed to produce sperms any illness will affect production, so it is wrong to judge on the semen to be abnormal from one seminal fluid analysis, and it should be repeated several times (2-3 times) in months to make sure that it is abnormal, and treat accordingly. -Does smoking and alcohol affect male fertility? Smoking leads to low sperm count and decrease motility, excess alcohol intake also leads to decrease sperm production indirectly by affecting male hormones and male sexual ability (impotence). Normal and Abnormal Sperm -Does taking certain medications affect sperm count? There are some medications that does, and it has to be stopped and other alternatives with the same medical effect used; that doesn’t affect sperms, all this should be decided by the treating physician, some medications that lead to addiction like morphine may affect fertility. -Can the woman get pregnant in any time of her cycle? Usually conception happens at the time of ovulation, which is usually the middle of the cycle, ovulation may happen in a different time, but this is the exception not the rule. -Does frequent intercourse decrease the rate of pregnancy? Not necessarily, the most important thing that is when the women are trying to get pregnant, it is advised to have regular intercourse every 2-3 days at the time of ovulation. -Does the feeling that most of the semen is coming out of the vagina during intercourse decrease pregnancy rate? No, because once the semen is liquefied, sperms are able to pass through the cervix. -Does pregnancy always happen when there is proper time of intercourse? No, because the chance to get pregnant in healthy couples with the right time of intercourse is only 15-25% during each cycle.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/male-reproductive-system Mon, 08 Mar 2021 05:25:19 AM Various Articles in Gynecology and Obstetrics   Uterine Abnormalities (Müllerian Ducts Abnormalities) Intra Uterine Contraceptive Device (IUD) 3D and 4D Ultrasound Scan Clinical Advantages Gestational Diabetes (During Pregnancy) Ectopic pregnancy Stress and Infertility Endometriosis Cerebral Palsy Treating IVF Failure Hysterectomy Essential Guide to Heartburn Relief Fertility, Natural Supplements and Treatments Causes and Cures for Loss of Female Libido Urinary Incontinence Smoking and Fertility Causes of Recurrent Miscarriage Diagnosis and Prevention of Cervical Cancer Breast Enlargement Methods Contraception Menopause Cloning Polycystic ovaries Epidural Analgesia Uterine Fibroids IMSI: Intracytoplasmic morphologically selected sperm Injection Cord blood Plastic Surgery of the Female Genital Organs Natural, Safe Weight Loss Supplements for Women Infertility: Pelvic Adhesions And Your Inability To Get Pregnant Ovarian Cysts: Useful Methods To Cope With Cysts On Ovaries Varicocele And Infertility Sex Selection Vulvar and Vaginal Hygiene Male Reproductive System   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/links-to-various-articles-in-gynaecology-and-obstetrics Mon, 08 Mar 2021 05:25:19 AM Urinary Incontinence   Few women consult gynecology clinics complaining of urinary incontinence (Inability to control urination ),and it’s considered to be strange, especially when it is known that this problem is the most common problem, mainly in those women who underwent vaginal delivery frequently or difficult deliveries or that who is post menopause. Those women are divided into three groups: A- Those who feel the problem and look for a solution. B- Those that feel the problem and are embarrassed from mentioning it. C- Those who think that urinary incontinence is a normal thing that happens to all women, and not consider it to be a medical problem that should be treated. Studies have proved that for 60% of women complaining of urinary incontinence, their daily life is affected and for the remaining 40%, their sexual life is affected. In (75%) this problem affects their mental health, while (20%) of those women have considered that life has become unbearable.   Types of Urinary Incontinence:   A- Stress incontinence: It is the loss of the ability to control urination unconsciously with any sudden stress like laughing, coughing, moving and sneezing. B- Urge incontinence: It is the loss of ability to control urination unconsciously after the sudden feeling of urge to urinate. C- As mentioned before the urinary incontinence can happen as a result of recurrent pregnancies and deliveries because they cause an additional load on the bladder and pelvic muscles affecting the sphincter that controls the passage of urine and the weakness of the detrusor muscle may happen. This is caused as a result of recurrent bladder infection, chronic cough or hormonal changes (that happen in post menopause).   Treatment of Urinary Incontinence:   The ways of treatment depend on the type of incontinence: Natural treatment For Urinary Incontinence: It’s done by teaching the patient physical exercises that aim to strengthen the pelvic muscles to support the bladder and different studies found that doing those exercises in a right way could help more than 50 % of ladies and their problem ended forever while others had significant improvement. Medical treatment For Urinary Incontinence. Surgical treatment For Urinary Incontinence: In difficult cases, different types of surgeries have been operated over the years and all these surgeries are done under General Anesthesia while some are done by laparotomy. Other surgeries are done vaginally by complex ways that need long recovery time to go back to daily life in addition to that it achieves low successful chance until it is developed to what’s called TVT (tension free vaginal tape) that had brilliant result, and considered the best treatment for urinary incontinence.   Definition of TVT It’s a special tape used to support the urinary passage and inhibit the leak of urine when the bladder is exposed to any pressure like coughing and laughing. This tape is inserted in a minor operation under spinal anesthesia because the patient needs to respond to the surgeon when he asks her to cough to make sure that urine will not leak and that the surgery is successful. This operation is done by doing a small opening in the upper vaginal wall to fix the tape, it takes around 30 minutes, and the patient can go home on the same day or the next day. The patient may feel mild pain for 24 to 48 hours after the operation which respond to simple analgesia, in addition to some difficulty in urination that can be easily overcame. The working lady needs two weeks leave from her work and she should not carry heavy things. She usually goes back to her usual daily physical activity after eight weeks from the date of operation, and she will be needing a follow up in the clinic six weeks after the operation. Complications of TVT operation: 1- Bleeding. 2- It might affect the organs near the bladder. 3- Urinary tract infection 4- Failing of operation. Success rate = 92 % This kind of operation done by Dr.Najeeb Layyous.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/urinary-incontinence Mon, 08 Mar 2021 05:25:19 AM Ovarian cysts Definition, Types, Signs and symptoms, Causes of Ovarian Cysts, Complications, Diagnoses, prevention and Treatment options   Definition of Ovarian Cyst - It is a fluid filled sac, within or outside of the ovary. - The ovaries are two small organs located on either side of the uterus. They produce hormones such as, estrogen which facilitates menstruation. - Every month, the ovary is programmed to produce an egg, which is important for fertilization. - Any follicle larger than 2 cm in diameter is called an ovarian cyst, which may vary in size from small to very large. - The majority of cysts are benign and harmless. - It can occur at any age, but mostly during child bearing age. - They may be: 1- Functional cyst (most common type), and they are short lived. 2- Pathological cyst, which may be harmless (benign) or malignant (cancerous).   Signs and symptoms of Ovarian Cyst - Symptoms: The patient feels pain. - Signs: The doctor must investigate and detect the cause. - In most cases of ovarian cyst, they will be small and benign with no symptoms or signs. - There are also other conditions that may have the same symptoms and signs of ovarian cyst like: pelvic inflammatory disease, ectopic pregnancy, ovarian cancer, appendicitis and diverticulitis. - These signs and symptoms are: 1- Irregular menstruation. 2- Pelvic pain either persistent or intermittent before menstruation begins or before it ends. 3- Pain during sex. 4- Pain during defecation. 5- Pressure on the bowel and bladder. 6- Pregnancy symptoms such as breast tenderness or nausea. 7- Bloating and swelling. 8- Problems during emptying your bladder. 9- Loss of appetite. 10- Hormonal abnormalities which may result in changes in the breasts and body hair growth. Symptoms that need immediate medical attention: 1- Sudden, severe abdominal pelvic pain, this may be due to torsion (the cyst is twisted on its pedicle and may be cutting the blood supply), or due to rupturing of the cyst. 2- Pain accompanied by fever and vomiting. 3- Cancer.   Causes of Ovarian Cysts: Functional ovarian cysts: Two types: 1- Follicular cyst: This is the most common type of ovarian cyst. Usually every month, the ovary will produce one egg which is formed in a follicle that contains fluid to protect the growing egg. Then, each month the follicle will burst and the egg is released into the tube, down to the uterus, in order to be fertilized. When the follicle does not shed the egg, it will accumulate fluid, and form a follicular cyst, which will evacuate on its own, without treatment.   2- Luteal ovarian cyst: When the egg is released, the tissue that is left behind is the corpus luteum, which will shrink over time, but if it accumulates blood, it will form hemorrhagic cuprous luteal cyst, that most of the time disappears on its own, over few months. However, sometimes it may rupture and cause severe pain or bleeding.   Pathological cysts: 1- Dermoid cyst (cystic teratoma): The most common pathological cyst in females under the age of 30, it is usually benign, arising from totipotent germ cell, these cysts contain teeth, hair, skin, bone and all other tissues, and need to be removed, surgically. 2- Cystadenomas: These cysts are formed from the outer layer of the ovary. They are filled either with thick mucus or a watery liquid. - They may grow inside the ovary or they may be attached to the ovary on a stalk. - They are rarely cancerous, but they need to be removed surgically. 3- Endometriosis: These affect patients with endometriosis, where the lining of the endometrium grows outside of the uterus. In this case. the ovary also needs surgical removal. 4- Polycystic ovary syndrome: These are small, harmless cysts caused by a hormonal imbalance, those patients are at a higher risk to develop ovarian cysts.   Complications of Ovarian Cysts: - Many cysts are asymptomatic and are discovered incidentally. - Cysts that develop after menopause may be cancerous. - Some cyst may: Rupture: Causes severe pain and may lead to bleeding. Get twisted: If the ovary is enlarged, it will move from its place and become twisted over its pedicle, cutting the blood supply and causing severe pain. What causes ovarian tumors? - If the tumor is non cancerous, it is benign. If it is cancerous, it is malignant and must be addressed. - Types of ovarian tumors: 1- Epithelial cell tumors which arise from the epithelium of the ovary. They are the most common ovarian tumor. 2- Germ cell tumors are mostly benign and arise from the cells that produce the oocyte. 3- Stromal tumors arise from the cells that produce ovarian hormones. Risk factors for cancer: 1- Age, especially after menopause. 2- Smoking. 3- Obesity. 4- Induction of ovulation drugs. 5- Hormone replacement therapy. 6- Nullipara or a female who has never breastfed. 7- Positive family history of ovarian, colorectal, breast cancer (those who have the BRCA gene). Oral contraceptives may reduce the risk of ovarian cancer.   Diagnoses of Ovarian Cysts - If an ovarian cyst is suspected, your doctor may need to do further testing to determine its type and the appropriate treatment: 1- Pregnancy test: A positive pregnancy test means that your cyst is a corpus Luteum cyst. 2- Pelvic ultrasound: It is a pain free procedure where a probe is introduced vaginally, and by this we can evaluate the uterus and both ovaries, so we can determine the size and consistency of any cyst, either fluid - containing cyst( mostly benign), cyst containing solid material, or mixed materials, which need further evaluation to rule out cancer. 3- Laparoscopy: It is a thin telescope inserted through your abdomen, and using it, we can visualize the uterus, both ovaries and tubes, and if a cyst is present, the doctor can remove it laparoscopically. 4- Ca125: This protein is increased in cases of ovarian cancer, but there are several benign conditions that may elevate this protein, such as, endometriosis, uterine fibroid, and pelvic inflammatory disease. 5- Computed tomography, magnetic resonance imaging and positron emission tomography will be ordered in cases of cancer, to determine the extent of spread of the tumors.   Treatment of Ovarian Cysts Mode of treatment depends on several factors: 1- The age of the patient. 2- If the patient is pre or post menopause. 3- Cyst appearance. 4- Cyst size. 5- Symptoms caused by the cyst. A- Observation: 1- Most of the cysts disappear on their own, over 8-12 weeks, especially if the patient is premenopausal, and if the cyst is functionally 2 - 5cm in diameter. 2- Follow up is recommended after 1 month. 3- In post-menopausal women, monitoring with ultrasound is recommended in addition to checking your Ca125 level. If there is a change in the size or texture, they need immediate intervention. After the cyst has disappeared, the patient needs to undergo a follow up scan, 4 months later. 4- During this time, avoid drinking a lot of caffeine or alcohol and drink a lot of water in order to decrease symptoms. B- Birth control pills: These drugs do not decrease the cyst size, but they do prevent formation of new cysts in patients with frequent cyst forming. C- Surgery for Ovarian Cysts: Is indicated under the following conditions: 1- Complex ovarian cysts that persist over months. 2- Persistent symptomatic cysts over 2 - 3 menstrual cycles. 3- Simple ovarian cysts larger than 5 - 10cm. 4- Cysts in perimenopause or postmenopausal female. 5- If the cyst is suspicious or may be cancerous. There are 2 types of surgery: Laparoscopy: - Where 2 - 3 small cuts in the abdominal skin are done, and a telescope is introduced through one of the ports and the cyst is removed, and sent for histopathology. - This method has a faster recovery rate and will not affect the woman's fertility. Laparotomy: - Is done if the cyst is cancerous. A cut through the top of pubic hair line is done and the cyst is removed. The doctor may need to remove the other ovary, and the uterus and adjacent organs, if the tumor is extended. - If it is cancerous, you may need additional intervention, according to the extent and type of tumor 1- Chemotherapy: Medications that are given intravenously, orally or directly into the abdomen in order to kill cancer cells, but they also kill normal cells. They may cause nausea, vomiting, hair loss, kidney damage and predispose to infection. 2- Radiotherapy: Is the use of high energy x-rays that kill cancer cells. It is delivered either externally or placed inside the body near the cancer. It also has side effects such as, skin redness, nausea, diarrhea and fatigue.   Prevention of Ovarian Cysts - There is no medication to prevent cyst formation but regular follow up helps in preventing complications from the cyst. - Oral contraceptives may prevent follicular cyst formation (only this type of cyst). Ovarian Cyst Ovarian Cyst   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/ovarian-cysts-definition-types-signs-and-symptoms-causes-of-ovarian-cysts-complications-diagnoses-prevention-and-treatment-options Mon, 08 Mar 2021 05:25:19 AM Causes for loss of female libido and ways to make it better   If sex is the core of all marital relationships, then it is sex drive or libido that affects or dictates all sexual relationships. A fall or decline of libido is commonly seen in women after a particular age. This leads to further loss of sexual desire. This problem is seldom found in men, however they have their own problems which center on erectile dysfunction. There are no accepted theories for the causes for the decline of female libido, but there are a few general circumstances that can lead to such a decline or loss. During any period of fluctuating hormones, including post partum, perimenopause phases, and menopause, most of women start to experience low sex drive, insomnia, digestive issues, mood changes, hot flashes, fatigue, and weight gain. These symptoms will make women feel bad. That is why their interest in sex will decline. Therefore, in most women, feeling better, physically, is the most important step in improving libido.   Causes of lack of libido in women: This can be either of physical or psychological in origin.   Physical causes for loss of female libido: • Anemia and the most common type is iron deficiency anemia, due to iron loss during menstrual periods. • Alcoholism: excess alcohol intake can cause a decrease in sex drive. It is important to moderate your alcohol intake to no more than 3 to 4 units a day, if you are a man and no more than 2 to 3 units if you are a woman. • Drug abuse. • Medications that decrease libido in men include antihypertensive drugs, medication for hyperprolactinaemia, anti-androgenic drugs such as cimitidine, finasteride, and cyproterone, and a low sex drive can be caused by SSRI type of antidepressants. This can happen in both men and women. • Post-baby coolness, this describes the loss of libido that happens after birth, and its caused by hormonal changes that occurs at that period. It can be caused by the general trauma of child birth. • Hormonal changes such as hyperprolactinaemia, abnormalities in production of luteinizing hormone (LH), lack of androgenic hormone and underactive thyroid. • Physical changes in the vagina that affect libido: As women near menopause, levels of estrogen begin to fall, which will cause thinning, tightening, dryness, and atrophy (a decrease in the muscle mass) in the vagina and the vulva that will lead to irritation, itching, and severe pain during sex, that will cause decreased libido.   Psychological Causes for loss of female libido: • Depression: This is a serious illness of feeling unhappy, or miserable, that may last for a long time and may become severe enough to interfere with your daily life, including your sex life. In this case, you may feel better if you take an antidepressant, prescribed by your GP. On the other hand, a type of antidepressant called selective serotonin reuptake inhibitors may cause low sex drive. If this has been prescribed for you, it will be better to switch to a different type of antidepressant. • Stress and exhaustion: If you feel stressed, you have to make some lifestyle changes as stress can have a major impact on your happiness by causing adrenal imbalance. This will cause a decrease in production of estrogen and testosterone that are important for desire and sexual response. • Relationship problems (problems with your sexual partner): Relationship problems are the most common causes of loss of libido, so if you are not happy in your relationship, or if you have any doubts or worries, this might be the main reason for your loss of sexual desire. Alternately, the problem might be a performance issue that makes sex difficult. For example, impotence, premature ejaculation in men and painful sex or vaginismus (the involuntarily tightening of the muscles around the vagina before penetration) in women. • Past sexual abuse or rape. • Difficult living conditions.   Solutions for low libido - Treatment for loss of female libido: • Treatment of the underlying causes of vaginal dryness and thinning: - Vitamin E vaginal suppositories twice weekly can be beneficial if the symptoms are new or mild, They act by hydrating the tissues and by increasing sensation. - Adding dietary soy that contains phytoestrogens that promote vaginal lubrication. - Restore adequate estrogen level: Your Doctor can help with this using regular blood analysis. - When ovarian estrogen production declines, the body starts to produce adequate estrogen from subcutaneous fat and adrenal glands, as long as raw materials are provided. Therefore, nutritional supplements and endocrine supports are the key to helping relieve vaginal dryness. - Some women have less estrogen than others, and they can benefit from using topical estrogen that can be placed directly into the vagina. It acts by soothing vaginal tissues and allowing the secretions necessary for comfortable sex. They are available as suppositories, creams or rings. • Testosterone: Testosterone is important in our sex drive because it stimulates interest, arousal, sexual response, orgasm and lubrication. After menopause, estrogen levels fall quickly in women, while testosterone levels decrease more slowly. Some women do not have normal testosterone levels, and testosterone level decreases under stress due to progesterone, the molecule precursor to testosterone. It is converted to stress hormone that will lead to a decrease in libido. In the Post Menopausal period, when ovarian testosterone production decreases, the adrenal glands will produce testosterone if adrenal reserves remain strong. On the other hand, adrenal reserve can be tapped down if the woman has experienced severe stress over a number of years. Therefore, good nutrition and a less stressful lifestyle can maintain better adrenal function that will keep good testosterone production throughout perimenopause and menopause. For all what mentioned above, testosterone can be suggested as a treatment of hypoactive sexual desire disorder. And it has been tried on women for more than 40 years, rarely with benefits and its associated by side effects include hair loss, deep voice and clitoris enlargement. In spite of that, there is some clinical evidence to support the use of testosterone as a treatment for low sexual desire. Intrinsa is a testosterone skin patch that became available in 2007 in the United Kingdom and it is licensed for women who have had a surgically-induced menopause, and who are already receiving estrogen therapy. Many compounding pharmacies (that make medicine from scratch) offer testosterone cream and gel that can be applied to the vagina and clitoris to increase sensation and orgasm. • Suction vibrators: This can increase female desire by applying suction to the clitoris, however, the ordinary non-suction vibrators have been used with good results, in the last decade. • Desire cream: This cream produces a tingly sensation in the clitoris, and it's made of wintergreen. It was introduced in the early part of this century. • Erection drugs (like Viagra): This can be beneficial by increasing blood flow to the vagina and clitoris, and by increasing lubrication. But those drugs have not been proven to help women who have low libido. They are not licensed for use in women. • Zestra: This is a genital massage oil that contains borage seed, evening primrose oils, Angelica root, and Vitamins C and E. and it provides a significant increase in arousal, genital stimulation and ability to orgasm. This worked in women with or without sexual desire problems, and it worked equally well in women using SSRI antidepressants. • Argimax: It has been found that this nutritional supplement increases sexual desire and satisfaction. This was published in 2001 in the journal of sex and marital therapy. Note: You should first have a discussion with your doctor before using any supplement to know about the side effects or interactions that may occur.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/causes-for-loss-of-female-libido-and-ways-to-make-it-better Mon, 08 Mar 2021 05:25:19 AM Endometriosis   It is a condition where pieces of the endometrium grow outside the uterus, most commonly in the ovaries, Fallopian tubes, bowel, and bladder, and rarely travel far from the pelvic region into the lung, skin, and other regions of the body, but it is a non-cancerous condition. This tissue continues to respond to hormonal signals, specifically estrogen from the ovaries each month which stimulate it to grow, and when the estrogen level drops, the tissue bleeds, after which an inflammatory process and adhesions occur. With each period, we expect blood to collect and form a chocolate cyst of the ovary. This disease affects 10-15% of premenopausal women, and it is a common cause of pelvic pain and infertility. About 35-50% of women with this disease have difficulty in getting pregnant due to adhesions, altered prolactin release, oocyte maturation defects, and anovulation.   Symptoms of Endometriosis: 1- The most common symptom is painful menstrual cycles. 2- Dyspareunia 3- Menorrhagia 4- Pelvic pain and backache 5-Dyschesia & rectal bleeding in cases of colonic endometriosis 6- Nausea & vomiting and abdominal cramps in endometriosis of the small intestine 7- Hematuria and frequency in endometriosis of the urinary bladder   Causes of Endometriosis: Causes of this disease are still unknown, but some researchers believe endometriosis is due to an immune system problem or hormonal imbalance. Others believe endometriosis is a genetic condition. Studies found an increased risk (5-7%) in women with family history of this disease. Theories of causation of Endometriosis include:- · Retrograde menstruation · Lymphatic and vascular dissemination · Coelomic metaplasia   Stages of endometriosis: We have four stages for this disease. 1-Microscopic endometriosis: In this stage, the peritoneum appears normal macroscopically, and lesions are identified using electron microscopy. The endometrial deposits contain endometrial gland and stroma. 2-Early active endometriosis: It appears as vesicles, papules; maybe solid or fluid-filled and highly vascular and non-fibrotic-containing glands in the proliferative or secretory phase. 3-Advanced active endometriosis: Present as pigmented hemorrhagic and fibrotic endometriotic deposits known as classic lesions. 4-Healed endometriosis: Appears as white nodules or flattened fibrotic scar-containing glands only.   Risk factors for Endometriosis: . Japanese race . Family history . Age 30 – 44 years . Alcohol – caffeine intake . Increased peripheral fat   Prevention of Endometriosis: There is no known way to prevent this disease, but some believe women having more than one child and having children early in life develop a certain level of protection against the disease and women with a long-term use of birth control pills are less likely to develop endometriosis. Complications of Endometriosis: 1- Infertility 2- Intestinal obstruction 3- Ureteric obstruction 4- Secondary infection of the endometriotic lesions 5- Rupture of endometrioma.   Investigations of Endometriosis: 1- Laparoscopy : - considered the gold standard when endometriosis is suspected. 50% of women with pelvic pain and dysmenorrhoea have endometriosis diagnosed at laparoscopy. 2- Ultrasonography : - have limited value in the diagnosis of endometriosis but is helpful when there is an endometrioma. 3- MRI: - detects endometrioma, ovarian adhesions, and extra peritoneal masses and detects invasion to bowel, bladder, and rectovaginal septum. 4- Blood test CA 125: This protein increases in patients with severe endometriosis but also increases in ovarian cancer and peritonitis. It is not a sensitive test since it cannot detect the disease in early stages, and it is not specific, but can be used for followup in treated patients to check their response to treatment.   Treatment of Endometriosis: There is no definite cure for this disease, but several options are available.   Medical Treatment of Endometriosis . (NSAIDS) non- steroidal anti- inflammatory drugs such as ibuprofen are helpful in reducing the severity of dysmenorrhoea. . Combined oral contraceptive pills Three packs of pills taken continuously are helpful in decreasing the number and frequency of the menstrual cycles, thus causing atrophy of the endometriotic spots. . Progestogen Such as medroxyprogesterone given continuously will produce pseudo-decidualization in endometriotic lesions, but has the side effects of weight gain and breakthrough bleeding along with the mood swings. . Danazol This drug has androgenic effect and is given in the dose 400-800 mg daily for three to six months, but it has the side effects of acne, weight gain, and hirsutism. . GnRH agonists Present as nasal spray, subcutaneous, or intramuscular injection. These drugs cause down-regulation of pituitary function, which suppresses ovarian steroid production and induces pseudo-menopause. Their side effects include hot flushes, atrophic vaginitis, and bone pain unless they are given with hormone replacement therapy as ADD-BACK THERAPY. Studies found that GnRH agonists given for endometriosis patients undergoing in-vitro fertilization cycles improve significantly their fertility and decreases preclinical abortions. Surgical Treatment of Endometriosis The surgery aims to palliate symptoms, increase fertility, remove endometriotic implants, and delay recurrence of the disease. Conservative surgery done with laparoscopy is a diagnostic as well as a therapeutic procedure used to remove endometriotic lesions by laser or diathermy and adhesolysis. This type of treatment reduces the need for open surgery in young women who seek future pregnancies. Radical surgery This is reserved for cases with severe symptoms and progressive disease or women who have completed their families. Such procedures include hysterectomy and bilateral salpingo – oophorectomy. Nearly 12% of all endometriosis patients require radical surgery. Endometriosis surgery is more effective in treating severe cases than a mild or minimal disease. Surgery in minimal or mild disease fails to restore normal fertility.   Endometriosis and Assisted reproduction techniques:-   Endometriosis patients with long-term infertility can benefit from assisted reproduction techniques in overcoming their infertility. Studies have shown that pretreatment with LH RH – analogues are associated with better fertilization and implantation results, especially in severe forms. Higher IVF pregnancy rates are found when there is a six-month pre-treatment using LH RH analogues and their effects seem to be more important for ovarian than endometrial level. In cases of mild and moderate endometriosis with normal findings at salpingoscopy, (GIFT) can be a useful option, but some studies have noted that the results are less encouraging after GIFT than after IVF or ICSI. In endometriosis, there is a risk for spontaneous abortion. Abortion rates are 11.7% in mild endometriosis and 13.6% in moderate forms of the disease regardless of the stimulation protocol used. Abortion rates of 60% in severe endometriosis cases were noted when there was no pretreatment using LH RH agonists.   Endometriosis in menopause Post-menopausal endometriosis is one of the most unusual facets of endometriosis. It is found in 5% of menopausal women, more often in the years immediately following the menopause. Clinical presentations:- -Metrorrhagia -If you find the enlarged uterus which may be fixed, it raises the suspicion of endometrial cancer. -Pelvic mass The association of post-menopausal endometriosis and neoplasia is possible. The transformation of an endometriotic lesion to malignancy occurs in 0.7-1% mostly on the ovary, but can also take place in the recto vaginal septum and colon. Causes:- Active endometriosis It indicates that estrogens are still being produced in the body or are supplied exogenously as in cases of: 1- Women on HRT. 2- Patients taking Tamoxifen. 3- Obese women in whom peripheral androgens are converted to estrogens. 4- Secretory ovarian tumors. Hormone-independent endometriotic lesions in which the receptor level is much lower in the lesion than in the endometrium and not influenced by hormonal variation as the endometrium, so it gives rise to severe and extensive clinical forms requiring hysterectomy with castration along with cyclic progestogen for six months, then estrogen – progestogen cyclic therapy.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/endometriosis-symptoms-causes-complications-treatments-and-prognosis Mon, 08 Mar 2021 05:25:19 AM Uterine Fibroids, types, clinical features, Causes, Diagnosis, treatment and management options   Fibroid is a condition affecting uterine smooth muscle termed leiomyoma, which is considered a benign tumor It is the most common tumor of the uterus affecting 20-30% of women.   Classification of Uterine Fibroids: depending on its location 1-Submucous fibroid :The tumor is protruding through the uterine cavity. 2-Intramural fibroid :The tumor is located within the myometrium. 3-Subserosal fibroid :The tumor is located at the outer border of the myometrium. 4-Pedunculated fibroid :The tumor is attached to the outer border of the uterus by a narrow pedicle containing blood vessels. 5-Fibroids can arise as a separate entity away from the uterus in the broad ligament mainly from the embryonic remnant   Pathology of Uterine Fibroids Macroscopic appearance Fibroids present as single or multiple circular or irregular masses. They have a false capsule consisting of compressed myometrial tissue by the tumor. On cross section, the tumor has characteristic whorled arrangement of tissue bundles, and its centre may show different types of degeneration.   Microscopic appearance Fibroids consist of smooth muscle fibers and fibrous connective tissue.   Types of fibroid degeneration   Fibroid Uterus 1-Red degeneration It follows an acute loss of blood supply to the fibroid during its active growth mainly seen during pregnancy. Patients present with the sudden onset of abdominal pain,and tenderness localized to the uterus associated with mild pyrexia and leukocytosis. The symptoms and signs resolve over a few days and surgical intervention is rarely required. 2-Hyaline degeneration This type of degeneration is caused by the gradual decrease in the blood supply to the fibroid. It is asymptomatic and can cause central necrosis leaving cystic spaces at the center termed cystic degeneration. Calcification of a fibroid This type of change in the fibroid is caused by deposition of calcium in the fibroid and can be detected on the abdominal x-ray in postmenopausal women. Malignant changes Submucous Fibroid Occurs in 0.1 -0 .5 % of fibroids known as sarcoma, which is characterized by rapidly increasing tumor size.   Clinical features of Uterine Fibroids The location of the fibroid and size affect the nature of symptoms of this disease.   1- Menstrual disturbance Fibroid is an important cause of uterine bleeding, mainly menorrhagia or intermenstrual bleeding, mainly in sub mucous type and as thus can present with symptoms of anemia. 2-Pressure symptoms, especially urinary frequency or constipation due to pressure of the growing fibroid on the adjacent structures like the urinary bladder and the rectum. 3-Pain is unusual except in red degeneration of a fibroid 4-Sub- fertility; Due to mechanical distortion or occlusion of the fallopian tubes and distortion of the endometrial cavity by a sub, mucous fibroid which can prevent implantation of the fertilized ova.   Cervical Fibroid 5-Obstetric complications In late pregnancy if the fibroid is located in the cervix or the lower uterine segment it can cause fetal abnormal lie or presentation and obstructed labor. After delivery, there is a risk of postpartum hemorrhage due to inefficient uterine contractions.   Signs of fibroids Abdominal examination may indicate the presence of a firm mass arising from the pelvis. On bimanual examination, the mass is felt to be a part of the uterus with some limited mobility.   Predisposing factors for Uterine Fibroids 1-Nulliparity 2-Obesity 3-Family history 4-African racial origin   Differential diagnosis of Uterine Fibroids 1- Ovarian tumor,whether benign or malignant. 2- Adenomyosis. 3- Leiomyosarcoma; patient presents with a history of rapidly enlarging abdominal-pelvic mass and decreased mobility of the uterus. In addition to general signs of cachexia.   Diagnosis of Uterine Fibroids .1-U/S Mainly vaginal U/S gives accurate information to distinguish a uterine fibroid from an ovarian mass. Fibroids appear as circular, well-demarcated lesions. 2-Hysteroscopy for diagnosing and treating sub mucous fibroids.   Treatment of Uterine Fibroids The choice of treatment will be influenced by many factors, e.g. the general health, the age, parity and the desire to have more children in addition to the size and location of the fibroid. Medical treatment of Uterine Fibroids Small and asymptomatic fibroids need to follow up by u/s every 6 months. When symptoms appear and treatment is required, medical therapy is ovarian suppression using GNRH agonist. This type of treatment is effective in shrinking the tumor. When treatment is stopped, ovarian function resumes and fibroids grow back to their previous size. Surgical treatment of Uterine Fibroids Cases of sub mucous and intrauterine fibroids can be removed by hysteroscopy. Other types of a fibroid are removed by abdominal myomectomy or hysterectomy. 1-Myomectomy Usually done for young women who want to preserve their reproductive function. It is done by Laparoscopy or Laparotomy, especially for large-size fibroids. 2-Hysterectomy; reserved for patients above 40 years who completed their families either by total or subtotal abdominal or vaginal hysterectomy. GNRH agonist pretreatment over a two-month period can facilitate hysterectomy or myomectomy to reduce the bulk and vascularity of a fibroid prior to surgery. Indications for surgery for Uterine Fibroids 1-Heavy or prolonged blood loss through the menses. 2-Large size fibroid. 3-Pressure symptoms like urine retention. 4-Possible malignant changes. Fibroid destruction 1-Myolysis; the idea of this treatment is to cut the blood supply to the fibroid laparoscopically and use laser to cauterize the blood vessels feeding the fibroid. Disadvantages of this method are that it may be associated with intra abdominal adhesions especially, between uterus and the intestines. 2-Embolization of the uterine artery This type includes selective block to the uterine artery. This is the most modern type of treatment done by percutaneous selective catheterization. It is associated with substantial reduction in fibroid size and improvement of menstrual symptoms over the following 6 months.   Fibroids in pregnancy What is the effect of fibroids on fertility and pregnancy?? The presence of fibroids in the female reproductive system negatively affects fertilization and pregnancy as follows: - Causing a distortion in the shape of the uterus, which affects the ability of sperm to enter the uterus or fallopian tubes, which reduces the chance of fertilization . - A change in the lining of the uterus in terms of size and the amount of blood that may reach the endometrium, which may cause difficulty in the implantation of the fertilized egg or the development of the fetus -May reduce the efficacy of infertility and fertility treatments Some expected complications in pregnancy: a. Repeated miscarriages and preterm birth B. bleeding in pregnancy c. Dystocia or obstructed labour D. Effect on the fetus Therefore, all women who are trying to conceive have to see their doctor to check whether there are fibroids in order to avoid complications before or during pregnancy . Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/uterine-fibroids-types-clinical-features-causes-diagnosis-treatment-and-management-options Mon, 08 Mar 2021 05:25:19 AM Intra-uterine contraceptive devices (IUD) types complications and contra indications of IUD use   One of the main contraceptive methods in use worldwide. It is the insertion of inert material inside the uterus in order not to allow pregnancy to happen. . . HISTORY In 1909_Ralph Richter from Germany showed the efficacy of mechanical contraception by inserting silk warm gut suture in the endometrial cavity. Between 1928_1930 Granfenberg from Berlin presented three reports on silk star devices, and he is known as the pioneer of the IUD. The Ohta ring was used by Ishehama from Japan. The ring was first made of gold and later from plastic. In early 1960s Lippes loop and Margolines spiral made of biologically inert polyethylene appeared. In 1970s hormone-releasing IUDs developed but their real use started in 1995.       TYPES OF Intra uterine contraceptive devices 1. Medicated IUD: Those IUDs that carry biologically active agents into the uterine cavity like levonorgestrel-releasing device [MIRENA]. It is an intrauterine system (LNG_IUS) that has sleeves of levenorgestril 52mg around its stem releasing 20 microgram/day and lasting for at least five years. The advantage of medicated IUDs is that the carrier part of the devices is smaller and less traumatic. 2. Non-medicated IUD: No drugs are added to the matrix or plate form of the IUD. It consists of plastic polyethylene and copper. There are so many types of this group. The most commonly used are copper T, TCU 380A, Multiload 375 and Nova T. Newer developments aim to reduce side effects and decrease expulsion rate by producing smaller and lighter IUDs. MECHANISM OF ACTION OF IUDs 1. Prevent implantation of the fertilized oocyte 2. Produce a local sterile inflammatory reaction in the endometrium as a result of the presence of a foreign body causing spermicidal effect, and the presence of copper increases this reaction and also increases  the local release of prostaglandins thus decreasing the rate of pregnancy. 3. They diminish sperm transport through the cervix to the oviduct by increasing the thickness of the cervical mucus (this happens with the hormonal IUD). 4. Steroid-releasing devices induce progestational changes that result in endometrial gland atrophy& Inhibit further development of the ova. TIME OF INSERTION OF Intra-uterine contraceptive device   The best time to insert IUD is during the menstrual cycle at any day of the week following menstruation, which indicates that the woman is not pregnant. After delivery either vaginally or by caesarian section; an eight-week delay seems to be adequate. IUDs specifically designed for immediate post partum insertion are now available. -Following spontaneous or therapeutic abortion, an IUD can be inserted immediately, but the risk of expulsion is increased in the second-trimester abortion. REMOVAL OF Intra uterine contraceptive devices IUD should be removed only in the late luteal phase of the cycle or the first seven days of the cycle, unless pregnancy is desired. If the woman reaches menopause, the IUD should be left in situ for one year after the last menstrual cycle. - IUD should be removed if the thread is not visible.Removal is done by a specially designed hook or a pair of artery forceps, preferably under ultra sound guidance. UNDESIRABLE EFFECTS OF IUD 1. MENSTRUAL DISTURBANCES: This includes both regularity and excessive blood loss, i.e. menstrual cycles become prolonged and heavier (menorrhagia) and also may cause dysmenorrhea. But-levenorgestril releasing IUDs decrease the monthly blood loss.   IUD Penetrating the wall of the uterus 2. PERFORATION This can occur at the time of insertion.The incidence is 1.3 of every 1000 cases. It may be best prevented by straightening the uterine axis through pulling the tenaculum which holds the cervix and by performing a bimanual examination to check if the uterus is anteverted or retroverted before attempting to insert the IUD. 3. EXPULSION OF Intra-uterine contraceptive device Rate of expulsion varies from 1_7/100 women in first year of use. Expulsion is commoner in the first three months of use so that every woman should be examined frequently and should be taught to feel the thread of the IUD vaginally frequently. 4. PELVIC INFECTION This is caused by bacteria carried into the uterus at the time of insertion. But having the pelvic inflammatory disease after insertion usually results from sexually transmitted bacteria . The consequences of these bacterial infections in the ovaries it may cause salpingitis, tubo- ovarian abscess, or pelvic peritonitis and tubal blockage. Symptomatic pelvic inflammatory disease is frequently treated with antibiotics without removing the IUD until the symptoms resolve, then a new IUD should be inserted under aseptic technique. 5. PREGNANCY ON TOP OF IUD Pregnancy with IUD   This doesn't happen unless the IUD is not in its proper place in the endometrial cavity (slightly low or tilted) so an intra uterine pregnancy may ensue.   ECTOPIC PREGNANCY IUD prevents intrauterine pregnancy but not ectopic pregnancy, so the relative incidence of ectopic could be higher in IUD users. SPONTANEOUS ABORTION A spontaneous abortion rate of up to 55% has been reported in women becoming pregnant on top of IUD, which is not removed after being pregnant. However, if the IUD appendage is visible it, should be removed or it might be expelled without any intervention, abortion rate diminished after that. If the thread is not seen, it is not advisable to perform uterine probing because of increased risk of perforation, abortion, and/or sepsis. PREMATURITY Reported cases of preterm deliveries have been found in patients with an IUD in situ. EFFICACY OF Intra-uterine contraceptive devices Throughout the years, pregnancy rate among IUD users has decreased steadily. Non medicated IUDs and copper IUDs (up to 200) had up to 3% pregnancy rates. CONTRA-INDICATIONS FOR THE USE OF IUD RELATIVE CONTRAINDICATIONS of Intra uterine contraceptive devices 1. Nulliparity 2. Valvular heart disease and cardiomyopathy 3. Previous ectopic pregnancy 4. Moderate to severe anemia 5. Hypermenorrhea or menorrhagia 6. Wilson's liver disease 7. Copper allergy 8. AIDS 9. High risk of STD ABSOLUTE CONTRAINDICATIONS of Intra uterine contraceptive devices 1.Cardiomyopathy 2.Recent acute pelvic inflammatory disease 3.Chronic or recurrent PID 4.Recent septic abortion 5.Acute cervical or vaginal infection 6.Congenital uterine anomalies 7.Uterine tumors 8.Undiagnosed uterine bleeding For whom Intrauterine Contraception is appropriate Women of any reproductive age willing for long-term, highly effective contraceptive CONCLUSION The benefit of IUD use surpasses its risks, and these are the risks of pregnancy on top of IUD. IUDs are strongly advised for most women seeking contraception in developing countries because it has the highest continuation rate and the lowest cost…….   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/intra-uterine-contraceptive-devices-iud Mon, 08 Mar 2021 05:25:19 AM Uterine Abnormalities - Müllerian Ducts Abnormalities   Female genital tract developed from three origins: 1. Ovaries from the germ cells that migrate from the yolk sac into the mesenchyme of the peritoneal cavity and developed into ova and supporting cells. 2. Lower third of a vagina developed from the ascending Sino vaginal bulb. 3. 3- Uterus, fallopian tubes & upper two-thirds of the vagina developed from the fusion of two Müllerian ducts & this is our subject for discussion. Complete formation of the genital tract depends on the completion of 3 stages. • Organogenesis If one of the tubes fails to develop, it results in the unicornuate uterus and if both failed then this will cause uterine agenesis or hypoplasia. • Fusion Two kinds of fusion 1. Lateral fusion process by which the two Müllerian ducts fuse together to form the uterus, tubes & cervix. Failure of this process cause bicornuate or didelphys uterus. 2. Vertical fusion: formation of the vagina completed by the fusion of the lower part of Müllerian duct that forms the upper two thirds and the ascending Sinovaginal bulb that forms the lower one third, incomplete vertical fusion lead to imperforate hymen. • Septal resorption Normally, the median part of the fused Müllerian ducts forms septum that resorpe to form single uterine cavity, failure of this resorption lead to septate uterus complete or partial. Frequency of Müllerian Ducts Abnormalities It occurs in 0.1_0.5%in healthy fertile population. Clinical presentation of Müllerian Ducts Abnormalities It differs in each patient according to the type of abnormality but nearly the most common presentations are. • Infertility • Recurrent abortion • Preterm labor • Intra uterine growth retardation • Primary amenorrhea in imperforated hymen & haematocolpus   Diagnosis of Müllerian Ducts Abnormalities Clinical history and physical examination cannot give much about the diagnosis, so the best way is by using imaging techniques: 1. Hysterosalpingography It has false-positive results of 38% and false-negative results of 28%. It also cannot assess the outer fundal contour making it impossible to differentiate between the septate and bicornuate uterus. Special criteria put in mind to confirm the diagnosis by H S G. a- Intercornual distance (distance between the distal ends of the horns): - Less than 2 cm means septate uterus. - More than 4 cm means bicornuate uterus - Between 2 and 4 cm means normal uterus. • Intercornual angle (formed by the most medial aspects of the two uterine hemi cavities) - Less than 60 means septate uterus - More than 60 means bicornuate uterus • T shaped uterus means DES exposure 2. MRI It allows imaging of the uterus in the coronal plane. It can assess the uterine cavity as well as the uterine contour, but it is coasty and requires referral to an imaging facility so the diagnosis will be delayed. 3. Three dimensional ultrasound It provides information that is the same or better than that obtained with MRI and it’s less expensive than MRI, and readily available in most centers which enable expedited diagnosis. When combined with saline infusion 3D ultrasound yield information similar to that obtained by HSG. When scanning a gynecology patient, especially if a uterine abnormality is imaged, the kidneys need to be assessed. Uterine Septum with early pregnancy Uterine Septum   Classification of Müllerian duct abnormalities. And its surgical treatment Anatomy: Müllerian duct anomalies are categorized most commonly according to the American Fertility Society (AFS) Classification Scheme (1988 into 7) as follows:   1- Class I (hypoplasia/agenesis): This class includes entities such as uterine/cervical agenesis or hypoplasia. The most common form is the Mayer-Rokitansky-Kuster-Hauser syndrome, which is combined agenesis of the uterus, cervix, and upper portion of the vagina. Patients have no reproductive potential aside from medical intervention in the form of in vitro fertilization of harvested ova and implantation in a host uterus occurs in 15 to 40% and also sometimes skeletal abnormalities. Diagnosis of vaginal agenesis - presented as primary amenorrhea - Normal secondary sex characteristics - Pelvic examination reveals patulous urethra - Vagina can be completely absent or shunt vaginal pouch can be present. - Uterus cannot be palpated on rectal examination - Ultrasound shows absent uterus and sometimes renal abnormalities - Laparoscopy is not indicated unless the diagnosis cannot be determined by the above findings - Treatment of vaginal agenesis 1. Non surgical treatment by using graduated dilators may take several months to few years before a functional vagina is formed so surgery remains the most effective method of treatment 2. Surgical treatment by vaginoplasty, the aim is to create a new vagina, surgical treatment should be considered only when the patient wishes to become sexually active and is highly motivated to use vaginal prosthesis for several months after surgery. there are various methods of vaginal reconstruction, some of these methods. - Full thickness skin graft - Transposition flaps. 2- Class II (unicornuate uterus): An unicornuate uterus is the result of complete, or almost complete, arrest of development of one Müllerian duct. If the arrest is incomplete, as in 90% of patients, a rudimentary horn with or without functioning endometrium is present. If the rudimentary horn is obstructed, it may come to surgical attention when presenting as an enlarging pelvic mass. If the contra lateral healthy horn is almost fully developed, a full-term pregnancy is believed to be possible (see didelphys uterus). - Surgical treatment Women with unicornuate uterus are not generally considered for reconstruction metroplasty. The only surgical indication is the presence of the endometrium in the accessory horn and this can be removed by laparoscopic hemi hysterectomy while the operation not indicated for rudimentary horn which lacks an endometrium. 3- Class III (didelphys uterus): This anomaly results from complete nonunion of both Müllerian ducts. The individual horns are fully developed and almost normal in size. Two cervices are inevitably present. A longitudinal or transverse vaginal septum may be noted as well. Didelphys uteri have the highest association with transverse vaginal septa but septa also may be observed in other anomalies. Metroplasty is Considered; however, since each horn, is almost a fully developed uterus, patients have been known to carry pregnancies to full-term; treatment is different according to the presentation. a- Uterine didelphys with obstructed unilateral vagina: full excision on marsuplization of the vaginal septum. Also laparoscopy preferred to be done intra operatively to treat associated endometriosis or adhesions if present. b- Uterus didelphys non obstructed: These patients are not candidates for surgical unification. Fortunately, they have had minimum associated problems and the fertility is good. 4- Class IV (bicornuate uterus): A bicornuate uterus results from partial nonunion of the Müllerian ducts. The central myometrium may extend to the level of the internal cervical os (bicornuate unicollis) or external cervical os (bicornuate bicollis). The latter is distinguished from didelphys uterus because it demonstrates some degree of fusion between the two horns, while in classic didelphys uterus, the two horns and cervices are separated completely. In addition, the horns of the bicornuate uteri are not fully developed; typically, they are smaller than those of didelphys uteri. Some patients are surgical candidates for metroplasty surgical treatment. Although numbers of metroplasty procedures are available, the strassmann procedure is the surgical treatment of choice for unifying the bicornuate and didelphys uteri. This is simply explained by fusing the fundi of the uteri. If two cervices are present their unification is not recommended. Hysteroscopy resection is contraindicated in this setting because it can result in uterine perforation. 5- Class V (septate uterus): A septate uterus results from failure of resorption of the septum between the two uterine horns. The septum can be partial or complete, in which case it extends to the internal cervical os histologically, and the septum may be composed of myometrium or fibrous tissue. The uterine fundus is typically conved but may be flat or slightly concave (<1-cm fundal cleft). Women with a septate uterus have the highest incidence of reproductive complications. Differentiation between a septate and a bicornuate uterus is important because septate uteri are treated using transvaginal hysteroscopic resection of the septum, while if surgery is possible and/or indicated for the bicornuate uterus, an abdominal approach is required to perform metroplasty. Surgical treatment of Uterine Septum The treatment of choice is transcervical lyses of the uterine septum combined with concurrent laparoscopy to reduce the risk of uterine perforation during septal incision. The operation done by hysteroscopy, which is introduced through the cervix and the septum is cut and IUD is inserted and left for at least 2 months to prevent intrauterine adhesions formation. Others found this is unnecessary and may provoke local inflammation with subsequent synechiae. Intrauterine septum as seen by hysteroscopy Hysteroscopic Septum Resection Video clips | Hysteroscopic Septum Photos 6- Class VI (arcuate uterus): An arcuate uterus has a single uterine cavity with a convex or flat uterine fundus, the endometrial cavity, which demonstrates a small fundal cleft or impression (>1.5 cm). The outer contour of the uterus is convex or flat. This form is often considered a normal variant since it is not significantly associated with the increased risks of pregnancy loss and the other complications found in other subtypes. This abnormality doesn't need any interference because researchers found that there is no difference in the reproductive outcome compared with normal. 7- Class VII (diethylstilbestrol-related anomaly): Several million women were treated with diethylstilbestrol (DES; an estrogen analog prescribed to prevent miscarriage) from 1945-1971. The drug was withdrawn once its teratogenic effects on the reproductive tracts of male and female fetuses were understood. The uterine anomaly is seen in the female offspring of as many as 15% of women exposed to DES during pregnancy. Female fetuses which are affected have a variety of abnormal findings that include uterine hypoplasia and a T-shaped uterine cavity. Patients also may have abnormal transverse ridges, hoods, stenoses of the cervix, and adenosis of the vagina with increased risk of vaginal clear cell carcinoma. Imaging findings are pathgnomonic for this anomaly). Conclusion Not all the types of uterine abnormalities can affect fertility and also not all the abnormalities correctable surgically. Uterine Abnormalities (Müllerian duct anomalies) are an uncommon but often treatable cause of infertility. Patients with Müllerian duct anomalies are known to have a higher incidence of infertility, repeated first trimester spontaneous abortions, fetal intrauterine growth retardation, fetal malposition, preterm labor, and retained placenta. The role of imaging is to help detect, diagnose, and distinguish surgically correctable forms of Müllerian duct anomalies from inoperable forms. In some correctable lesions, the surgical approach is altered based on imaging findings.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/mullerian-ducts-anomalies-uterine-abnormalities-congenital-abnormalities-of-female-genital-tract Mon, 08 Mar 2021 05:25:19 AM Menopause, causes, clinical features, and management modes of treatment   The term means the ending of menstrual cycles, which is the central external marker of human fertility and occurs after six months of secondary amenorrhea in women aged 45 years or older. It is a transitional phase from fertility to infertility state. What leads to menopause is the depletion of oocytes and primordial follicles from the ovaries and the subsequent cessation of estrogen production. The cessation of cyclic bleeding may take many forms; The menstrual cycle may cease abruptly or may stop after a stage of polymenorrhea followed by a stage of oligo menorrhea. Other causes of menopause :- 1- Surgical menopause :- Surgical removal of both ovaries for any reason, like ovarian cancer. Studies have indicated the median age of menopause in hysterectomized patients can be given at time of operation; indicating which patients may or may not be affected. 2- Premature ovarian failure (POF):- Secondary amenorrhea due to ovarian failure may occur at any age, and if below age, 45 years may be accounted as premature, these patients exhibit low plasma estrogen, increased level of follicle stimulating hormone (FSH) and (LH). (POF) is associated with other autoimmune endocrinopathies and in about half of the patients other antibodies are present. 3- Radiation and chemotherapy: Treatment of malignant disease in young women may provoke menopause in two ways; in women with breast cancer treated with radiotherapy, menopause may still be used to suppress estrogen output, and the use of chemotherapeutic agents in breast cancer or lymphomas may suppress and indeed arrest ovarian cyclic activity.   Symptoms of menopause 1- Vasomotor symptoms: The most noticeable consequences of the drop in estrogen levels are vasomotor symptoms in the form of hot flushes and night sweats. These are common and occur in at least 70-80% of women. Their frequency may vary between a few to several dozen attacks per day, and the duration may be from a few weeks to many years. 2- Insomnia Patient may experience repeated awakening from sleep with consequent loss of sleeping-hour quantity and quality. 3- Psychological symptoms, including: Mood swings, anxiety, lack of concentration, depression, and loss of short-term memory. 4- Vaginal dryness : Estrogen deficiency results in epithelial and connective tissue atrophy in the vaginal wall, causing vaginal dryness and dyspareunia. 5- Urinary symptoms:- Estrogen deficiency results in atrophy in the urethral wall, predisposing to stress incontinence and atrophy in the trigone area of the bladder, resulting in urgency and urge incontinence. 6- Osteoporosis :- In the early post-menopausal years the density of bone in women decreases at a faster rate than at any other time with greater bone resorption to the formation ratio. In many women, this process results in osteopenia which strongly predisposes to fractures. By the age of 70, 25% of women will have vertebral fractures, 15% will develop hip fractures, and 15% will develop fractures of the wrist.   Risk factor for osteoporosis: 1- Family history of osteoporosis 2- Smoking, alcohol abuse 3- Early menopause 4- History of prolonged immobilization 5- Treatment with corticosteroids or heparin 6- Medical conditions; hyperthyroidism, Cushing's disease, chronic renal failure, and hepatic insufficiency 7- Black women are less likely to develop osteoporosis than white or Asian women. Thin women are more prone to osteoporosis than fat women. Cardio vascular system: The function of the heart and great vessels is now known to be affected by the presence and absence of estradiol. - The incidence of myocardial infarction is much lower in pre-menopausal women than in men of the same age. The decline in plasma estrogen results in changes in lipid profile with promotion of both atherogenesis and vasoconstriction as estrogen exerts direct effects on the vessel wall.  Dietary changes and menopause Diet is thought to be one factor that helps in the explanation of the cultural differences in the menopausal symptoms. Asian women experience fewer menopausal symptoms and lower rates of hip fractures than Western women. This is related to their diets, which contain high levels of phytoestrogens (naturally-occurring estrogens), about 200 mg daily as compared to Western diet. Phytoestrogens are structurally similar to estradiol but much weaker than the body's natural estrogen and have a cumulative effect when taken in sufficient amounts. Soybeans are the richest source of this substance. In the USA, studies found that foods and drugs containing specific amounts of soya protein can lower cholesterol and improve arterial function, reduce atherosclerosis, then reduce cardiovascular disease. Studies have not shown any significant adverse effects due to phytoestrogens. They are well-tolerated and in spite of their cost, they are very popular supplements. Some studies have suggested that multivitamins and mineral supplements can reduce hot flushes, but their effect may be partly dependent on the quality of the woman's diet. Supplementation of vitamin E 440-1200 I.U. daily reduces vasomotor symptoms. Women in menopause and not on HRT (hormone- replacement therapy) are recommended to include 1500 mg of calcium daily. Some clinicians would recommend adding vitamin D 400 IU daily with calcium, which significantly reduces fracture risk.  Exercise in menopause : Exercise is effective in slowing the gradual, long-term aging-related bone loss and is important to cardiac health, helping to reduce weight, blood pressure, and cholesterol levels. Women who are exercising regularly are less prone to suffer severe hot flushes and depression and have less insomnia, together with providing a greater feeling of well-being. The safest exercise to recommend to women is walking. Women who walk for at least one hour per week experience about half the coronary heart disease risk than women who do not walk regularly.  Hormone replacement therapies (HRT) Hormone replacement therapies have been available for more than 25 years, and its use is growing rapidly. HRT can effectively reverse all the effects of the menopause but should be given under medical supervision. - Continuous estrogen- progestogen preparations: - This type of therapy is taken every day without interruption and prevents endometrial proliferation. Their use, therefore, does not cause withdrawal bleeding, and the majority of postmenopausal women prefer a bleeding-free hormone treatment. - Cyclic estrogen- progestogen preparations:- In this type of therapy estrogen is taken for 21 days and is combined with a progestogen for the last 10 days following, which there is a four- to seven day medication-free interval during which withdrawal bleeding occurs. This type relieves the symptoms effectively and regulates the cycle. - Tibolone (Livial):- This type of therapy is a synthetic steroid which exhibits estrogenic, progestogenic and androgenic activity, given in a dose of two to five mg daily to women at least one year after menopause and results in the suppression of symptoms and the prevention of bone loss. This preparation is well-tolerated, and the amenorrhea which is present in 80% of patients by six months of use is usually warmly welcomed. - Subcutaneous hormonal implants:- This mode of treatment is restricted in the UK to patients who have undergone hysterectomy with or without oophorectomy. The procedure involves the insertion of a pellet of estradiol in the subcutaneous tissue, usually of the lower abdomen, under sterile conditions and local anesthetic. This implant usually is reviewed at six monthly intervals. They are very well-tolerated and successfully treat menopausal symptoms and protect against bone loss. - Transdermal estrogen:- This type of therapy is particularly used in older women. Patches are available in varying strengths of 28 mg, 50, 75, or 100 mg of estradiol per day. Seven-day patches are now available. Skin reactions are minimal and such treatment is well-tolerated. - Local estrogen:- In this type of therapy estrogen is used in the form of cream, pessary, or vaginal ovules. It is suitable for those women with local symptoms and in whom systemic administration of estrogen is hazardous. Patients on HRT need a careful breast examination, pelvic examination, and blood pressure should be checked regularly along with a bone mineral density scan to check for osteoporosis. The patient must be reviewed every three months, then at six-month intervals thereafter, and then annually.  Contraindications to Hormone replacement therapies (HRT) use: . Absolute Contraindications to HRT 1- Breast cancer 2- Pregnancy 3- Endometrial cancer 4- Acute active liver disease 5- Uncontrolled hypertension 6- Confirmed venous thromboembolism . Relative Contraindications to HRT 1- Presence of uterine fibromyomata 2- Past history of benign breast disease 3- Unconfirmed venous thromboembolism 4- Chronic stable liver disease 5- Migraine Frequently asked questions : Does a woman lose her libido after the age of 40? It has been proven that women are two to three times more likely to experience a decrease in sexual drive and desire as they age. However, not all women experience a decline in libido after 40; it is a relative matter that varies from woman to woman. Some women experience a high sex drive even into their fifties. A decrease in libido can occur due to the cessation of female hormone production and the end of menstruation, causing a woman to feel less aroused than before.   Is it possible to get pregnant after menopause at age 50? A woman loses her ability to ovulate at menopause, and therefore cannot conceive naturally. However, if the uterus is healthy and capable of carrying and nourishing a child to term, a woman can become pregnant after menopause if she has previously frozen her eggs. What are the symptoms of menopause at age 40? Some women may experience no symptoms, yet they may be unable to conceive. Other women may experience the same symptoms associated with natural menopause, such as hot flashes, night sweats, or mood swings. Their periods may become lighter, irregular, or stop altogether. Is bloating a symptom of menopause? Before menopause, hormonal changes can lead to fluid retention, causing bloating that may persist into menopause. Furthermore, dietary changes, appetite disturbances, slowed digestion, and stress associated with menopause, along with smoking and lack of exercise, all contribute to weight gain after menopause.   When does a woman's fertility end?   A woman's fertility begins to decline after age 35, and by age 40, it is about half of what it was before she turned 30. This is because the ovarian reserve naturally and gradually decreases from the time a woman is born until she reaches menopause.   Is it possible to get pregnant at age 47? The chances of getting pregnant depend on each woman's ovarian reserve, but generally, the chances of pregnancy decrease significantly after age 40. Egg quality also begins to decline as a woman ages. Does menstruation return after a year of absence? If a woman's period has been absent for a year, she has likely reached menopause. If menstruation returns after a year of absence, she should consult her doctor. What are hot flashes in women? They are a sudden feeling of warmth in the upper body, often more intense in the face and neck, and may cause skin redness. Can early menopause be cured? It cannot be cured, but hormone replacement therapy can be used. What vitamins should be taken during menopause? There are many medications that contain natural herbs, vitamins, and antioxidants to improve menopausal symptoms. What are the benefits of hormone replacement therapy? - Effective treatment for hot flashes and mood swings. - Relieves vaginal dryness and improves libido. - Reduces the risk of osteoporosis. Can hormone therapy be taken if one has diabetes or high blood pressure? It usually doesn't affect it. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/menopause-hormone-replacement-therapy-hrt Mon, 08 Mar 2021 05:25:19 AM Cloning-Human Cloning   Imagine having a copy of yourself, such as having an identical twin, an exact replica of you that is created from your body cells. This idea created the door for cloning. WHAT IS CLONING generally speaking? It is done by replicating a certain type of cells or certain part of the cell/ DNA from a "parent" cell to propagate a certain desirable genetic trait. To understand this subject we have to differentiate between its different types: 1. DNA cloning 2. Therapeutic cloning 3. Reproductive cloning DNA CLONING This means transferring a fragment of DNA you are interested in from one organism to a self-replicating genetic element such as bacterial plasmid so the DNA of interest can then be propagated in foreign host cells. THERAPEUTIC CLONING Also called "embryo cloning", it is a production of human embryos for use in research, for example, extracting stem cells from these embryos for study & for producing tissues to treat diseases.     Reproductive cloning: A technology used to generate an animal that has the same nuclear DNA as another animal, so that every single gene is exactly the same between the two in a process called "Somatic Cell Nuclear Transfer", or (SCNT), and this type of cloning is our subject to discuss. HISTORICAL VIEW Scientists have been cloning animals for many years. The first trial of cloning done on animals was in 1952, a tadpole. That was earlier than the creation of Dolly the sheep in 1997 by a Scottish scientist at Rosaline Institute, the first cloning of an adult animal cell that resulted in a live mammal. Clones were created from embryonic cells. Since then researchers have cloned a number of large and small animals, including sheep, cows, mice, goats, pigs, cats, and a gaur, which makes it possible for human cloning. How is cloning done? How does one go about making an exact genetic copy of an organism? It can be done by different ways: somatic cell nuclear transfer and artificial embryo twinning. What is the difference between these processes? Artificial Embryo Twinning 1. Artificial embryo twinning is the relatively low-tech version of cloning. This technology is just like the natural process of creating identical twins.   Development of different organs In nature, twins occur just after fertilization of an egg, and rarely, if the fertilized egg "zygote", tries to divide into a two-celled embryo, then the two cells separate completely. Each one then continues to divide separately, finally developing into a separate individual inside the mother. Since they came from the same zygote, the developing individuals will be genetically identical twins. Artificial embryo twinning is produced in the same way, but instead of the mother's uterus, it occurs in a Petri dish. This is accomplished by manually separating a very early embryo into separate cells, then allowing each cell to divide on its own. The resulting embryos are placed into a surrogate mother, until term is complete and the baby is delivered. All the embryos came from the same zygote, so they are genetically identical.   2. Somatic Cell Nuclear Transfer Somatic cell nuclear transfer (SCNT) uses a different approach than artificial embryo twinning, with the same result: an exact clone of an individual. Dolly the sheep was created by this method. To make Dolly, researchers isolated a somatic cell from an adult female sheep. Then the nucleus is transferred from that cell to an egg cell after removing the nucleus. Followed by chemical reactions and interventions, the egg cell, with the new nucleus, behaves like a freshly fertilized zygote. An embryo then develops, is implanted into a surrogate mother, and carried to term. The lamb, Dolly, was an exact genetic replica of the adult female sheep who donated the somatic cell nucleus to the enucleated egg, resulting in the first mammal to be cloned from an adult somatic cell. What is the difference between the natural way of making an embryo and SCNT? An embryo is composed of cells containing two complete sets of chromosomes. From where the two sets of chromosomes originated lies the difference between fertilization and SCNT . In fertilization, the sperm and egg, both contain one set of chromosomes. After fertilization of the egg by a sperm, the resulting zygote ends up with two sets; one from the father (sperm) and one from the mother (egg).     In SCNT, the nucleus from a somatic cell is used to replace the egg nucleus. The egg contained the single set of chromosomes, but the somatic cell nucleus contains two complete sets of chromosomes. And the resulting embryo will have both sets of chromosomes from the somatic cell. What are the risks of cloning? Reproductive cloning is expensive and not highly efficient with a 90% failure rate of cloning attempts to produce a viable offspring. To produce one viable clone, more than 100 nuclear transfer procedures could be required. Cloned animals tend to have more compromised immune function and higher rates of infection, tumor growth, and other disorders in addition to low success rates. Studies done in Japan have shown that cloned mice live in poor health and die early. One-third of the cloned calves born alive have died young. Most of the others were large in an abnormal way. Most animals that were cloned have not lived long enough to generate good data about how clones age. Unfortunately, being healthy at a young age is not a good indicator of survival in the long term. Clones have been known to die without identifiable cause. For example, Australia's first cloned sheep was healthy on the day she died, and the autopsy failed to determine a cause of death. Should humans be cloned? Due to the inefficiency of animal cloning (only about one or two viable offspring for every 100 experiments) and the lack of understanding about reproductive cloning, scientists believe that it would be unethical to attempt human cloning. Most attempts to clone mammals fail. Also about 30% of clones born alive are affected by "large offspring syndrome" and other serious conditions. Most cloned animals have died early from infections and other complications. Human cloning will likely have the same problems. In addition, the impact of cloning on mental development is not known. Intellect and mood may not be as important for a cow or a mouse, but they are crucial for the development of humans. Many unknowns exist concerning reproductive cloning, so the attempt to clone humans at this time is considered potentially dangerous and ethically irresponsible. Reproductive semi-cloning respecting biparental embryo origin Embryos might result from syngamy between a gamete nucleus and a haploidized somatic cell nucleus, and the somatic cell may replace either the male or the female gamete, a potentially applicable technique in the treatment of both male and female infertility. There is a controversy about haploidization and it will require more research. Though sharing some features with conventional cloning, the technique is biologically closer to normal fertilization because the future individual results from the union of two parental genomes of which one is actually brought by a gamete. This would alleviate some of the ethical concerns raised against the use of conventional cloning in human assisted-reproduction.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/cloning-humans-myth-or-fact-options-and-applications Mon, 08 Mar 2021 05:25:19 AM Hysterectomy-Surgical Removal of the Uterus or womb   The uterus has two functions: It is the site where pregnancy occurs. The site from where bleeding occurs each month (menses). Therefore, if the women undergo a process of hysterectomy, she won’t become pregnant and won’t have menses.   Indications for hysterectomy-Removal of the Uterus: Generally, women who tried all conservative treatments that prevent pregnancy are advised to undergo Hysterectomy. But the followings make the process of Hysterectomy mandatory: Fibroid accounts for 30% of hysterectomy cases. Endometriosis and Adenomyosis accounts for 20% of cases. Uterine prolapsed. Uterine bleeding unresponsive to medical therapy nor balloon diathermy nor mirena accounts for 20% of cases. Uterine, ovarian and cervical cancer accounts for 10% of cases. Chronic pelvic pain. Uncontrollable post-partum hemorrhage.   Type of Hysterectomy-Removal of the Uterus: Hysterectomy could be done to remove the uterus alone or to remove the uterus, both ovaries and tubes according to the patient’s disease. There are three types of hysterectomy: Total Hysterectomy which includes removal of the cervix, this is the most common type of hysterectomy. Subtotal Hysterectomy which conserves the cervix mainly used in cases of uterine fibroids or to treat abnormal bleeding patterns. Radical Hysterectomy which includes removal of the cervix, upper part of vagina and parametrical tissue. This type of operation is done in cancer cases only. Although the number of hysterectomies had declined over the years, 55% of hysterectomies are done for women between 35-49.   Approaches for Hysterectomy: The best approach of Hysterectomy is determined by: The disease of the patient The experience of the surgeon The approaches For Removal of the Uterus include: Vaginal Hysterectomy: done through an incision in the vagina. This approach is associated with less pain, no visible scar, shorter stay in the hospital and less recovery time (4 weeks). Because it is more difficult for the surgeon to see the internal organs it is associated with more complications mainly for the urinary tract. This approach is chosen in obese patients, patients who has abdominal adhesions from previous surgery, in cases of uterine prolapse especially if other procedures are planned such as repair of a rectocele or enterocele and in early stage of cervical cancer. Abdominal Hysterectomy: done through an incision in the lower abdominal area, may reach 20 cm in length, it’s the best approach in cancer and huge fibroid cases. Laparoscopic Hysterectomy: A camera will be introduced into three small openings in the abdomen and the Hysterectomy is applied after the decomposition of the uterus to small parts that will be removed through these openings. Laparoscopic assisted vaginal Hysterectomy. Removing the uterus vaginally after releasing using the Laparoscope, the hospital stay is only one day and the recovery time is only two weeks -Before undergoing hysterectomy the patient should ask her doctor about: Risk of the operation Alternative treatment for the condition Undergoing these procedures to determine the best approach for the condition: Pap smear (to exclude cervical cancer). Dilatation and curettage (to exclude uterine cancer and hyperplasia). Pelvic u/s (to determine the size of fibroid, polyps, ovarian masses). Risks of uterus removal surgery: Hysterectomy is one the safest operation in gynecology, although every operation has complications that could occur during surgery or after it, but the advantages of Hysterectomy overcome the disadvantages. These complications include: Wound infection Internal bleeding Urological and bowel injuries Deep venous thrombosis and pulmonary embolism Anesthesia compilations Paralytic ileus   Preparations of surgery for Removal of the Uterus: Every patient, undergoing Hysterectomy, should be admitted to the hospital one day before the operation. Shaving the pubic area must be done and antibiotics should be given to decrease the risk of infection. The operation done under general anesthesia may last for 1 to 2 hours. After the patient is intubated, a Foleys catheter is inserted in the urinary bladder, cleaning and dropping done. Observation done in the recovery room, for few hours to check the vital signs, and the patient will receive painkillers (The degree of pain varies and its greatest after abdominal hysterectomy) and antibiotics as scheduled. The patient is advised to mobilize after six hours of the operation after removing the Foleys catheter, in order to decrease the risk of thrombosis. The admission period varies between 2days in LASH and 4 days in abdominal approach. There may be few spotting after surgery, which is normal if the amount wasn’t in the form of bleeding as menses (if this happens the patient should consult the doctor immediately). The patient may return to her daily activities 6 to 8 weeks after the operation and during this time, the patient is advised to do the followings: Avoid doing heavy works Avoid lifting heavy Weights Avoid the sexual intercourse and vaginal douches Avoid constipation Wound care with proper dressing and inform the doctor if redness or swelling develops. Follow the doctor’s instructions regarding her daily activities Counsel the patient about the need for hormonal replacement therapy if the ovaries were removed   Life after hysterectomy Amenorrhea Disappearance of bleeding and abdominal pain that the patient suffered from before surgery. No possibility of pregnancy at all. If the ovaries are removed with the uterus, the patient will suffer from menopausal symptoms like hot flushes, nervousness, vaginal dryness, sleep disturbances, osteoporosis. In these cases, the patient should receive hormonal therapy. Sexual life won’t be affected. However, some females feel excited during intercourse if she felt the uterine contraction, which will disappear after the operation. Others will feel excited during intercourse in absence of pain and bleeding after the operation. In case of subtotal Hysterectomy done, the patient should undergo Pap smear routinely to avoid ID cervical cancer. The patient starts to feel confident in absence of her past problems, but other patients will be depressed because they feel they lost their femininity. Urgency and urge incontinence which may need medical therapy.   Partial hysterectomy In partial hysterectomy only the body of the uterus is removed keeping the cervix and the ovaries behind, it can be performed abdominally, vaginally or laproscopically. If you choose this type of hysterectomy you have to do annual Pap smear to screen for cervical cancer.   Advantages Shorter operating time. More sexual enjoyment and healthier inner pelvic architecture. Avoiding vaginal vault prolapse, vaginal shortening and vaginal cuff granulation tissue formation.   Disadvantages Like any surgical procedure partial hysterectomy has some side effects Pain and wound infection Anesthesia complication Damage to internal organs, bladder, bowel or ureters Emotional issues Hormonal changes: removing the uterus decreases the blood supply to the ovaries, this will decrease circulating estrogen and testosterone resulting in osteopenia, osteoporosis cardiovascular issues and menopausal symptoms such as hot flushes, decrease sexual desire pain during intercourse and urinary incontinence. The risk of developing cervical cancer remains   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/hysterectomy-–-indications-procedures-and-complications-surgical-removal-of-the-uterus-or-womb Mon, 08 Mar 2021 05:25:19 AM Plastic Surgery of the Female Genitalia   Labiaplasty - Plastic Surgery of the vulva Candidates for Labiaplasty The candidates are patients complaining from elongation in the labia causing irritation and itching with redness and discomfort when using tight clothing or during sex.   Aims of the Vulva Plastic Surgery 1- Repair any marks or deformity due to previous delivery. 2- Repair the vaginal widening which mainly due to vaginal delivery. 3- Make symmetry of labia minora. 4- Decrease fat distribution in this area.   Procedure of Labiaplasty 1- Under GA. 2- Small incision and scar. 3- No change in sensation most of the time 4- Need no dressing, using absorbable stitches Labiaplasty post operation 1- You can leave the hospital on the same day of operation. 2- You can return to your daily activity and take shower the next day and make sex 30 days later.   Vaginal tightening surgery - The aim of this procedure is to increase strength of vaginal muscle and perineum, mainly after multiple vaginal deliveries, which gave satisfaction of both partners during sex. - Duration of the procedure is around one hour; most of the patient needs 24 hours for full recovery and return to their activity. - Follow up is done within two weeks, post op stitches need 7-12-day post op to be absorbed - If pregnancy occurred after operation delivery is advised to be by c/s.   Pelvic floor relaxation and prolapse repair. Pelvic floor is a group of muscle which gives support to the bladder, abdomen, uterus and vagina. When those muscles lose their strength, it causes the area to become relaxed which may lead to prolapse.   Causes of pelvic floor relaxation and prolapse 1- Recurrent vaginal delivery. 2- Menopause in which level of estrogen decreases and relaxation of the muscle happens. Types of prolapse There are many types of prolapse and sometimes there are two or more types presents at the same time: 1- Cystocele. 2- Cysto-urethrocele 3- Rectocele, Enterocele 4- Uterine prolapse.   Symptoms of pelvic floor relaxation and prolapse 1- Feeling of heaviness feeling or mass coming down through the vagina 2- Back pain 3- Stress incontinence, especially if the bladder neck weak 4- Obstructed defecation, especially if there is rectocele or enterocele 5- Wide vagina causing discomfort during intercourse. 6- Cervical erosion, infection and bleeding if the cervix is prolapsed through the vaginal opening.   Types of treatment of pelvic floor relaxation There are two types of treatment depending on the type and the degree of prolapse: 1- Conservative therapy in cases of mild prolapse including : a. Pelvic floor exercise. b. Ring pessary inserted by the doctor and replaced every 4-6 month. 2- Surgical treatment depending on the type and degree of prolapse, and if it is associated with stress incontinence or not: a. Anterior repair. b. Posterior repair. c. Vaginal hysterectomy + anterior and posterior repair. Done in cases where the uterus and cervix are outside the vaginal opening.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/labiaplasty-plastic-surgery-of-the-female-genital-organs-pelvic-repair Mon, 08 Mar 2021 05:25:19 AM Weight Loss Supplements for Women There are few natural supplements proven clinically that a person can consume to help you getting quicker results for weight loss objectives. You can eat reasonable portions and have some exercises to drop pounds, but you have to eat a right combination of food that will shift your body from fat storage made into fat melting mode. People tend to try faster ways to reduce fat like taking diet supplements, but many supplements lack credible result, and in some cases have side effects. Calcium Calcium consumption is helpful during weight loss. It is stored in fat cells and helps fat to be burned. Calcium also binds to fat in GI tract to prevent some of fat absorption. Research shows that women who take 1000 mg of calcium per day lose more weight than those women who take placebo. Vitamin D : Vitamin D helps decreasing Weight by many ways: A- It increases insulin sensitivity (insulin is a hormone secreted from pancreas to help glucose to get into body cells and burn it for energy) B- It maintains the normal level of (PTH), as the higher than normal level of PTH can lead to fat cells converting sugar into fat and when level of vit D are low PTH rises. C- Lack of vitamin D also interferes with leptin that signals your brain to stop eating Protein: It preserves muscle mass and helps to keep body composition (The amount of fat relative to muscle) in better proportion. Omega 3: It triggers, fat burning in cells and it boosts mood that will reduce emotional eating and it activates liptin that turn down appetite. Monounsaturated fatty acids (MUFAS). MUFA is a type of fat found in olive oil, nuts, seeds, avocado, peanut butter and chocolate and it improves a 24 hours caloric burning. Conjugated linoleic acid CLA. CLAs are potent fat burners created when bacteria ferments the food in stomach of cow, sheep and then makes its way into meat and milk of these animal and it helps blood glucose enter body cells so CLA can be burned for energy. Note: Research on CLA has showed some side effect. For example, blood tests that follow inflammation can be higher for those taking CL A, and it may adversely effects cholesterol levels and liver tests. Green tea It’s loaded with antioxidants (poly phenols) that have multiple benefits, it increases metabolic rate helping body to burn more fat, and that’s why when you drink green tea your body will heat up as your cells waste calories as heat. Green tea also reduces amount of belly fat linked to increase risk of death and it lowers blood pressure and LDL (The bad cholesterol) at the same time. Acaiberry: It’s rich in antioxidants, vitamins and minerals, fatty acid, and fibers, and so it makes an excellent diet supplement and there is evidence that it can help you to lose weight as part of balanced diet and regular exercise regimen. Fiber: Fiber like bran or psyllium can delay gastric empting and stay in stomach longer period of time. But be sure to add fiber to your diet slowly and drink plenty of fluid to avoid becoming constipated Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/weight-loss-supplements-for-women Mon, 08 Mar 2021 05:25:19 AM Genital Area Hygiene - Vulvar and Vaginal Hygiene – Hygienic considerations for sexual intercourse The Complete Medical Guide to Intimate Care and Vaginal & Vulvar Health   Caring for the intimate area (the vulva and vagina) is an essential part of a woman’s physical and emotional well-being. It is closely linked to daily comfort, self-confidence, femininity, and maintaining a healthy and comfortable intimate life free from irritation or pain.   Understanding the nature of this area is the first step toward proper care. It is completely normal for a woman to occasionally use a mirror to become familiar with the appearance of her intimate area and to better understand any natural changes that may occur.   ✨ It is important to emphasize that the appearance of the genital area varies naturally from one woman to another, including differences in skin color, labia size, hair distribution, and vaginal discharge. These variations are completely normal and should not cause concern.   The Natural Vaginal Balance: The Body’s Self-Protection System The vagina has a delicate natural defense system that relies on beneficial bacteria known as Lactobacillus. These bacteria produce lactic acid, which helps maintain the vagina’s natural acidic environment, with a normal pH ranging between 3.5 and 4.5.   This acidic environment helps to:   ✔️ Prevent the growth of harmful bacteria and fungi ✔️ Reduce unpleasant odors ✔️ Protect against infections ✔️ Maintain healthy vaginal tissues   💡 Therefore, clear or mild white vaginal discharge is considered normal as long as it is not accompanied by itching or an unpleasant odor.   Common Mistakes That Disrupt the Natural Balance Some of the most common harmful practices include:   ❌ Using regular or scented soaps ❌ Using strong antibacterial washes ❌ Excessive cleaning and scrubbing ❌ Vaginal douching ❌ Using vinegar or yogurt inside the vagina   These practices may lead to:   Destruction of beneficial bacteria   Disruption of the vaginal pH balance   Increased risk of fungal infections and irritation   Dryness, itching, and inflammation   ✨ The golden rule:   “Less is more.”   The Difference Between the Vulva and the Vagina 🔹 The Vagina: An internal organ that naturally cleans itself through normal secretions. It does not require internal washing or vaginal douching.   🔹 The Vulva: The external genital area, which only requires gentle cleansing to maintain hygiene and comfort.   The Correct Way to Clean the Intimate Area For proper daily care:   ✔️ Wash the external area with warm water only ✔️ Use your hand gently without scrubbing ✔️ Avoid harsh washcloths or loofahs ✔️ Pat the area dry gently instead of rubbing   If you prefer using an intimate wash:   ✔️ Choose a product that is:   Fragrance-free   Soap-free   pH-balanced   ⚠️ It should only be used a few times per week, not daily.   Bathing and Sensitive Skin Care The skin around the vulva is very delicate and sensitive. Harsh or scented products may cause significant irritation.   It is recommended to avoid:   ❌ Scented body soaps ❌ Bubble baths and bath salts ❌ Perfumed oils ❌ Aggressive scrubbing during washing   💡 For women with sensitive skin, warm water alone may be completely sufficient for daily cleansing.   Moisture and Underwear Constant moisture creates an ideal environment for fungal growth and infections.   For this reason, it is recommended to:   ✔️ Wear 100% cotton underwear ✔️ Change underwear when feeling dampness ✔️ Change clothes immediately after exercise or swimming ✔️ Allow the area to breathe during sleep   It is also preferable to avoid:   ❌ Tight clothing ❌ Synthetic fabrics ❌ Continuous use of panty liners ❌ Talcum powder or scented powders   Care During Menstruation To maintain intimate health during your period:   ✔️ Change sanitary pads or tampons every 4–6 hours ✔️ Avoid scented sanitary products ✔️ Keep the area dry   ⚠️ Leaving pads on for prolonged periods may lead to:   Infections   Unpleasant odors   Skin irritation   Safe Pubic Hair Removal Pubic hair is natural and healthy, and removing it is a personal choice that varies from one woman to another.   When removing hair:   ✔️ Test any new hair-removal method on a small area first ✔️ Use clean and sterilized tools ✔️ Choose a trusted clinic for laser hair removal   Avoid:   ❌ Shaving or waxing if there are active infections, pimples, or skin irritation   Itching and Irritation: When to Pay Attention If itching appears suddenly and is accompanied by thick white discharge, the cause is often a vaginal yeast infection.   To help relieve itching:   ✔️ Warm sitz baths ✔️ Cold compresses ✔️ Avoid scratching or rubbing ✔️ Use appropriate treatment after consulting a doctor   ⚠️ Persistent itching or the appearance of a skin rash requires medical evaluation.   Moisturizing the Vulvar Skin Some women experience dryness, especially after childbirth or after menopause.   Some of the best natural moisturizers include:   🌿 Sesame oil 🌿 Sunflower oil 🌿 Jojoba oil 🌿 Canola oil   Their benefits include:   ✔️ Moisturizing the skin ✔️ Reducing friction and discomfort ✔️ Protecting the skin from cracking   Important Tips During Intimacy Intimate relations should be comfortable and free from pain or burning sensations.   To reduce irritation and friction:   ✔️ Use appropriate lubricants ✔️ Urinate after intercourse ✔️ Maintain good hydration   Important notes:   ⚠️ Natural oils may weaken latex condoms ⚠️ Some women may have latex sensitivity ⚠️ It is preferable to avoid intercourse during active vaginal infections   When Should You See a Doctor? You should consult a doctor if you notice:   🚨 Yellow or green discharge 🚨 Strong or unpleasant odor 🚨 Persistent itching or burning 🚨 Pain during urination or intercourse 🚨 Rash, sores, blisters, or ulcers   Conclusion ✨ Proper intimate care is not about using many products; it is about preserving the area’s natural balance.   The golden trio for vaginal and vulvar health:   ✔️ Warm water ✔️ Gentle drying ✔️ Cotton underwear   💖 Always remember:   Natural differences between women are completely normal. Over-cleaning may cause harm. Normal vaginal discharge is not a disease. And any unusual symptoms deserve medical attention without embarrassment. Vaginal and genital area is a sensitive and important area; certainly, good hygiene gives more confidence, a strong sense of femininity and satisfying sexuality. In order for the woman to be able to examine the vulva she must crouch and use a mirror.   However, disturbances are often a source of concern such as: -A strange feeling of an abnormal form of her vulva. -An embarrassment during sex can cause denial of sexual intercourse. -A feeling of unpleasant smell. -Abnormally large or small labia (that maybe corrected surgical). Best hair removal method (laser, waxing or shaving)? -Each woman must be sure that she has a normal area just like any other woman but with minor differences that makes her unique and special. -It is strongly recommended to consult your doctor if you feel some itching, irritation or rash at vulvar area. -Vaginal discharge is very common and most often it is physiological and caused by hormonal changes. -The skin of the genital area is very sensitive and therefore requires a good daily hygiene to achieve maximum comfort and enjoyment during sex. -The use of vegetable oils to moisturize and soothe the vulva would be very beneficial providing more comfort and flexibility especially after menopause. Pubic Hair Removal: Naturally the pubic area contains hair, and there are different ways for taking care and removal of this hair which depends on the type of skin and what each woman prefer, she can remove all the hair from the whole area or she can remove it from certain parts only (upper area and the edges), or just trimming. Whatever the method chosen it is better to try it on a small area first to avoid allergic skin reaction or burn from hot wax or lacerations caused by shaving, in cases of active inflammation, herpes or blisters, shaving and waxing should be avoided, and it is recommended to trim the hair to prevent the spread of inflammation. If you prefer permanent hair removal; laser can be done. With this method there will be no irritation, or hair growing under the skin, but be careful in choosing the right place for that (specialized clinic or center). Laundry products: -Cleansers and products that do not contain dyes or enzymes and perfumes should be only used in cleaning underwear’s, sportswear, towels and sleepwear. -Use half or third the suggested amount of laundry products to minimize its concentration. -Avoid the use of soothing clothes. -If you use products to remove stains, rinse underwear in warm water before washing again. Choice of Underwear: -Choose a good quality cotton fabric that absorbs moisture and dries quickly. -If your skin is sensitive or you have rash use appropriate clothing and pants. -It is better to avoid wearing underwear and pants during the night, it is more appropriate to use pajamas or even sleep naked. -Underwear’s and cloths should be changed immediately when they get wet after exercise or swimming. Wet and dry vulval area: -Some women are suffering from chronic vulval dryness, a common mistake is to use powders such as talc, which is toxic and irritating, and therefore causing contact dermatitis, and since it is carcinogenic it has a correlation with ovarian cancer. -For women complaining of persistent wet vulva, the best prevention is by wearing cotton underwear that dry quickly and also using natural moisturizers and oils. -It is preferred to keep extra pair of underwear in a small bag or purse for regular change if the underwear, became wet at the work place or at school. -After exercise or making extra effort, immediate change of wet underwear is recommended. -It is advisable not to wear daily use pads. -Tampons are safe to use but their frequent use or when the amount of bleeding is not much, tampons become harmful, causing irritation of the vulva, increase in vaginal secretions and thereby releasing an unpleasant odor. Hygiene and shower: -Avoid using products that can cause irritation of the skin of the genital area such as liquid soap and scented lotions, though they have pleasant smell they can cause skin irritation. -Avoid douching which causes irritation by interfering with the bacteria naturally present at vulvar area and contribute in its protection. Among many other common mistakes include, the use of vinegar, milk and many other products in the douche. -If you have sensitive skin avoid direct contact with soap on the skin surrounding the vulva and avoid rubbing the area, cleaning the area with warm water and gentle rubbing with hand is enough to keep the area clean without causing irritation. -Try to change the type of soap used because you might be allergic to a particular type of soap, usually organic soap and natural products are preferred. -Avoid bath bubbles, bath salt and bath with scented oils if you have sensitive skin. -If you have irritation, wipe the area gently by pressing and avoid rubbing with the towel. Vulvar Itching: -If you suddenly started to complain from itching and it was associated with whitish vaginal discharge, then it is most likely due to fungal infection, local treatment with anti fungal cream and ovules would be sufficient. -If no improvement with local anti fungal or if it was associated with skin rash; the cause might be atypical fungus that needs specific treatment. Eczema and lichen scleroses are possible causes for that too. -Warm sitz bath can help to reduce the itching, 4-5 table spoon of baking soda can be added to the bath, 1-3 times daily for 10-15 minutes each time. -The use of wet bandages can relieve irritation. Cleaning the Genital Area: -After going to toilet, use smooth, white and unscented toilet paper. -Avoid wet napkins. -Wash the area with warm water after urination. -After defecation, it is important to wipe the genital area from front to back not the opposite. -If you are using daily pads, it is recommended to change every 6-8 hours. -Frequent use of tampons can increase your chance of having vaginal and vulvae infection. Moisturizers for the vulvar skin: -The best moisturizer is natural oils (sesame oil sunflower oil, canola oil or jojoba oil). -Natural vegetable oils are clean, cheap and free of chemicals. -Use only small amounts of these oils to avoid staining your underwear. -These oils are the best lubricant before intercourse. Considerations for Sex: It should be free of pain, and here are some instructions to avoid vulvar irritation, injury or having burning sensation: -Use natural oils as lubricant. -The use of vegetable oils during foreplay for more excitement and enjoyment and help lubricate the genital organs of both partners before initiating vaginal intercourse and it reduces friction and pain in the vagina, urethra and clitoris. -Avoid using latex condoms with natural oils, because it can be melted, but it is safe with the Avanti type. -If you are menopause; using sunflower oil is a must because it can give you a prolonged miniaturization and prevent cracks and laceration at the vagina. -Avoid synthetic lubricants containing water such as (K-y jelly), because it dries during intercourse and result in more dryness, it also contains chemicals and preservatives that can cause irritation. -Latex condoms can cause vulvar skin irritation and allergy; changing to a different type of condoms specific for sensitive skin; though the price is a little higher but you will be free from discomfort and irritation. -Avoid sex when there is vaginal infection. -The use of male condoms to prevent the spread infection.   Painful Sex: -It is strongly recommended to consult the doctor if you have pain during intercourse, including vulval vestibule, this may be due to vulvodynia a very common defect that can cause pain. -After the age of menopause and for better treatment, consult your doctor if you feel pain during intercourse. -It is advisable to urinate just after intercourse to prevent bladder inflammation.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/genital-area-hygiene-vulvar-and-vaginal-hygiene Mon, 08 Mar 2021 05:25:19 AM Diagnosis and Prevention of Cervical Cancer - Human Papillomavirus infection   Human Papillomavirus (HPV) is the main cause of most of the histological changes that affect the female reproductive tract that includes the vagina, cervix, external genitalia, and the anus. HPV is considered the most common cause of the cervical CA that’s why we are going to talk about it. Human Papillomavirus (HPV) This is a DNA virus that infects the skin and the mucosal membranes. And there are more than 100 types of HPV and some of these viruses cause skin polyps and that why its named a papillomavirus , and its transmitted by skin to skin contact and there is around 30 types that is transmitted sexually. Genital HPV is very common and it infects around 75% of women in west countries through out there entire life. General characteristics of Human Papillomavirus It's part of papillomaviridae family that can be fully integrated with the DNA of the host cell. Humans are the only known source of this virus. There is more than 100 types of HPV that have different DNA sequences and there specific group called genital HPV that are dangerous especially HPV 16, 18, 31, 45, 58 in addition to HPV 33, 35,39, 51, 52, 56, 59, 68, 73, 82 that are known as an important factor for development of cervical cancer.   Signs and symptoms of infection with Human Papillomavirus: Skin polyps: - Common warts - Planter warts - Flat warts, and this is found mainly on the arms, face, and forehead. - Nail warts Anogenital warts (condylomata acuminata): 90% of cases are caused by HPV 6 and 11, and usually the infection with this virus is resolved spontaneously without appearance of warts or any other signs or symptoms and its worth mentioning that the virus types that cause the genital warts don’t cause cervical cancer. Respiratory papillomatosis: HPV type 6 and 11 can cause a rare condition called recurrent respiratory papillomatosis in which the warts are formed in the larynx and other parts of the trachea and those warts can recur many times and it may need multiple surgeries and it can hinder the respiration and in extremely rare cases it might develop to cancer. Cancers that are related to HPV: There are 6 types of HPV that are classified as dangerous viruses such as HPV 16, 18, 31, 45, because they have high ability to cause cervical, anal, vaginal cancer in addition to head, neck, and penile cancer. And they have a genetic relation such as E6 and E7 that are known as carcinogens that encourage the growth of the tumor and the malignant transformation.   Methods of spread of Human Papillomavirus and prevention: Most of people can be infected with one of those cutaneous viruses during childhood period. The HPV has protein shell (strong, enable them to stay in the environment for long period of time), therefore avoidance of touching of metallic surfaces such as toilet floors may decrease the risk of cutaneous infections. The genital infection can spread quickly through the skin of the genitalia and the mucosal membranes and it can be asymptomatic. There are multiple strategies can be followed to decrease the risk of the diseases that can be developed from the genital HPV. HPV Tests: This test is done by detecting the genetic material (DNA) of the HPV. And like the Pap smear it's done on the cervical cells and it can be done at the same time as the Pap smear test. And it's done for the cases bellow: - Women who had atypical squamous cells that considered as abnormal cervical cells in the Pap smear to check for high-risk types of HPV. And if the test shows the presence of high risk types of HPV, then further approach like colposcopy or cervical biopsy should be considered. - In the women older than 30 years as part of abnormal cervical cells screening. Nucleic acid hybridization test is the most sensitive method for the detection of 18 types of HPV DNA in cervical samples. And it differentiate between tow HPV groups: the low risk group that includes types 6/11/42/43/44, and the high/intermediate-risk group that includes types 16/18/31/33/35/39/45/51/56/58/59/68, but it can't detect the specific type of HPV that present. HPV vaccine: - Two types of HPV vaccines are available, the Cervarix and the Gardasil, both protect against HPV-16 and HPV-18 that that cause 80% of anal cancers, 70% of cervical cancers, 60% of vaginal cancers and 40% of vulvar cancer. Gardasil also protects against HPV-6 and HPV-11 that cause 90% of genital warts. - Both vaccines are given in 3 shots over 6 months. - It's recommended for 11 and 12 years old girls and it can be given at age of 9 years, it can be given also for girls and women at age of 13 to 26 years who have not been vaccinated or completed the vaccine series yet. And it's not recommended for women at age of more than 26 years and the best way to screen for cervical CA at this age is by doing regular Pap tests. - It should be given for females before they become sexually active and before they are exposed to HPV, it can be given for women who are sexually active but they may get less benefit because they may have already been exposed to some HPV types targeted by the vaccine. - It's not recommended to be given during pregnancy, although studies found that it doesn’t harm the baby, but more researches is needed. Getting the vaccine during pregnancy is not an indication to end the pregnancy. - The vaccine can't protect against all types of cervical cancer ( about 30% of cervical cancers will not be prevented by the vaccine) , therefore it's important to continue to be screened for cervical cancer ( Pap smear regularly) even after getting all 3 shots of the vaccine. Other ways to prevent HPV: - Use condoms with every time of having sex from start to finish, but HPV can infect areas that are not covered with condoms, so it not fully protect against HPV. - To be in faithful relationship with one partner. - Choosing a partner who had few or no prior sex partners. - The only sure way of protection is to avoid all sexual activities. Avoid smoking as it increases the risk of cervical cancer. Pap smear The papanicolaou test (also called Pap smear) is a screening test that is used to detect the precancerous changes (cervical intraepithelial neuplasia CIN or cervical dysplasia) and the cancerous changes in the endocervical canal that are usually caused by sexually transmitted HPV, and it can also detect infections and abnormalities in the endocervix and the endometrium. Indications of Pap smear: - Screening starts in general at about the age of 20 to 25 and this vary from country to another and continues until the age of 50 or 60 and it's recommended every three to five years if the previous results were normal and more frequent Pap smear is needed after abnormal results. - It should not be done before the age of 21 and women should not do the screening until few years have passed after their first intercourse because if they had HPV after becoming sexually active, their immune system will take about 1 to 4 years to control this infection, so screening during this period may show mild abnormalities that are related to this immune reaction and not to the cervical cancer and this will cause stress to the woman and may lead to further investigation that are not necessary. And as the developing of cervical cancer usually take long time, so delaying the screening test for the reason mentioned above will carry a very little risk of missing a precancerous lesion. - Pap smear is indicated even for those women who had the HPV vaccine because it doesn’t cover all the HPV types that cause cervical cancer. - There is no need to screen: - Women who haven’t had sexual contact before. - Women aged 60 or over if there last 3 Pap smears were normal. - Women after complete hysterectomy for benign disease. Types of Pap smear: - Conventional Pap: after collecting the sample, it smeared directly on to microscopic slide. - Liquid based Pap: the collected sample is put in a liquid to be preserved until it transferred to the lab then it smeared on to the slide. Procedure for taking Pap smear: - It starts by inserting a speculum in to the vagina then open it to allow an access to the cervix, the sample of cells is collected from the outer opening of the cervix by a spatula. Then an endocervical brush is rotated inside the cervical opening and the collected cells are placed on a glass slide then it's taken to the lab. - It's advised not to do the Pap smear during menstruation because the blood and the endometrial cells may obscure cervical cells. - It's not painful procedure and using small amount of water-based gel lubricant does not interfere with the result. - The sample is stained using papanicolaou technique. Position for taking cervical smear Results: - Most Pap smear results are normal. - 2-5% are mildly abnormal and this includes: ASC-US: atypical squamous cells of undetermined significance. LSIL (CIN 1): low grade squamous intraepithelial lesion. - Both indicating HPV infection. - Although most of the low grade cervical dysplasia can regress spontaneously without causing cervical cancer, but precaution should be taken. - 0.5% of cases are high grade SIL (HSIL) (CIN2/3), High Grade Cervical Intraepithelial Lesion. - Less than 0.5 % indicate cancer ( squamous cell carcinoma) - 0.2%-0.8% indicates Atypical Glandular Cells of undetermined Significance (AGC-NOS). Normal PAP smear Abnormal PAP smear Cervical intraepithelial neoplasia: CIN is a premalignant transformation of cervical squamous cells and it's not a cancer, most of CIN cases remain stable or are cured by the immune system. Small percentage of cases might progress to cervical cancer if untreated. Most common cause of CIN is human papillomavirus (HPV) especially the types 16 and 18. And its diagnosed by the Pap smear screening test, and if it was abnormal , then colposcopy of cervix is recommended. Classification of Cervical intraepithelial neoplasia: Candidiasis in a pap smear - CIN 1(LSIL): - Mild dysplasia restricted to basal 1/3 of epithelium. - Its caused by HPV infection - Usually cleared by the immune system in a year or more. - CIN 2/3(HSIL): - CIN2: moderate dysplasia in basal 2/3 of epithelium - CIN3: severe dysplasia that involves more than 2/3 of epithelium an it may extends to involve the full thickness and this is called cervical carcinoma in situ Treatment of Cervical intraepithelial neoplasia: - CIN1 need no treatment if it last less than 2 years. - CIN of higher grade requires treatment that includes destruction of abnormal cells by cervical conization, laser cautery, loop electrical excision, electrocautery or cryocautery. Colposcopy: - It’s a diagnostic procedure that is used to examine magnified view of cervix to distinguish the normal from the abnormal tissues then direct biobsies will be taken from the abnormal areas for pathological examination. -Indications of Colposcopy: - Pap smear shows abnormality that indicates cervical dysplasia or cancer - Evidence of HPV - Pap smear shows repeated atypical squamous cells of undetermined significance (ASCUS). - If there is history of exposure to prenatal DES. - It is also done if the cervix looked abnormal during collection of the Pap smear. - It is a simple procedure and doesn’t require anesthesia and it takes about 10 minutes. -How is colposcopy done: - It starts first by examining the vulva and the vagina for the presence of warts or any abnormal growth. Then the speculum is inserted and the pap smear will be taken. - Then the cervix will be inspected , and the squamocolumner junction must be seen which is the area in which most cases of cervical cancer arise , and it’s the area between the squamous and columner cells the form the endocervical canal that connects the cervix to the uterus. After menopause this area tends to migrate inside the endocervical canal and therefore colcoscopy is usually not adequate after menopause and in those cases another procedures can be done to examine this squamocolumner junction such as cold knife and cold biopsy. - Tests done during colposcopy: - Acetic acid wash: this chemical used to wash the cervix which is diluted 3% to 5% that wash the mucus in the cervix and it will stain the abnormal areas white (acetowhite lesions), some times normal areas can be stained white but it will have faint borders while the abnormal areas will have clear borders. - Staining with lugol's solution: and this solution is a diluted iodine solution that can be used to distinguish the normal cells that will be stained brown when exposed to this solution from the abnormal areas that will not be stained. - Color filters: these filters , green or blue filtered light, can be used to distinguish the tiny blood vessels ( the abnormal capillaries) inside the acetowhite area which appear as red spots or in a pattern as hexagonal floor tiles, while the normal capillaries are slender with regular spaces. - Cervical biopsy: biopsies is taken from the abnormal areas and then the treatment will be decided according to the result of the biopsy. Treatment according the result of the colposcopy: - Treatment is recommended if the biopsy show pre-cancer (dysplasia) or cancer. - There are 2 types of treatment, ablation and resection and both types cure 90% of patients with mild dysplasia. - Ablation which is the destruction of the abnormal area is used in the mild dysplasia and it includes Carbone dioxide laser photo ablation and cryocautery. - Resection which is the removal of the abnormal areas is used in the more severe dysplasia and cancer and this includes loop electrosurgical excision procedure (LEEP), cold knife conization, and hysterectomy. - CO2 laser photo ablation: this laser will vaporize the abnormal area , in less than 1% complication can occur that includes cervical stenosis or delayed bleeding. - Cryocautery: this includes freezing the abnormal areas by using nitrous oxide and in less than 1% complication can occur that includes cervical stenosis or delayed bleeding. - Loop electrosurgical excision procedure (LEEP): this uses a radiofrequency current to remove the abnormal areas and complication occur in 1-2% and this includes cervical stenosis and bleeding. - Cone biopsy: it is used in the cases when the area cant be viewed during the colposcopy and also its used to obtain special sample in more advanced abnormalities and it associated with higher complication rate than other procedures, in around 5% of cases bleeding may occur post op and it may cause narrowing of the cervix. - Hysterectomy: this is a surgical removal of uterus and its done in all cases of invasive cervical cancer and also if dysplasia recurred after any other treatment procedure and sometimes its done to treat severe dysplasia. electro - surgical loop ( LLETZ ) - Cervical biopsy Cone biopsy PAP and Colposcope Cervical Changes   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/diagnosis-and-prevention-of-cervical-cancer Mon, 08 Mar 2021 05:25:19 AM The Vagina - Types of Vaginal Discharge - Vaginal infection   The vagina is a sex organ that is derivative of the embryonal Mullerian duct. It consists of fibromuscular tissue and it extends from the vulva to the uterus, its opening is protected by the labia. The vagina is lined with stratified squamous epithelium and its inner mould has a foldy texture that creates friction during intercourse. And there is a smooth muscle layer below the vaginal lining that contract during labor and also during sexual intercourse. The length of the vagina for a woman of childbearing age is 6.0 to 7.5 cm anteriorly and 9 cm posteriorly. During sex, the vagina expands in dimension. The membrane of the vaginal wall produces secretions although it doesn’t have glands. The bartholin glands also produce vaginal lubrication and it is located near the vaginal opening and the cervix. During ovulation, an alkaline environment is needed in the vagina for the survival of the sperm, and this is provided by the alkaline mucus that is produced by the cervix mucus glands. Normally, as a woman's age increases, the vaginal lubrication decrease,s and after menopause, a thinning occurs in the vaginal wall due to the decrease in the amount of estrogen in the body. The Hymen is a membrane that partially covers the opening of the external vagina. And the effect of sexual intercourse on it is variable. If its elasticity was sufficient, it may return to its original shape, or it may disappear completely after repeated penetration.   Functions of the vagina: It is a path for passage of uterine secretions such as menstrual blood, to exit the body. The vagina stretches during child birth due to its elasticity and this creates a channel for the passage of the newborn outside the uterus. That is why the vagina is called the birth canal. It receive the penis during sexual intercourse. - The lower third of the vagina, especially near the opening, contains nerve endings that cause the pleasure sensation during sexual intercourse. However, the other parts of the vagina have insufficient nerve endings to make the childbirth less painful. - When arousal sensations have been achieved, lubrication will be produced in the walls of the vagina that will reduce the friction that may happen during intercourse. And with arousal, the vagina expands especially its last 2/3rd in length and width, and the vagina will stretch to accommodate the size of the penis. This will stimulate the penis to result in orgasm and ejaculation which hopefully leads to fertilization. - G-spot (grafenberg spot) is located about 5 centimeters from the vaginal entrance in the anterior wall. And if it is stimulated, it will cause intense pleasure and may lead to female orgasm and ejaculation.  Erogenous Zones Video | Male reproductive system Video | Response To a Sexual Stimulus Video | Female reproductive system Video   Types of Vaginal Discharge: Normal Vaginal Discharge: These are usually related to menstrual cycle and to the ovulation, the cyclic discharge (that occurs at the beginning and end of cycle) is normal and it is usually thick, white and odorless. And a clear stretchy discharge occurs normally at the time of ovulation.   The vagina contains bacteria such L-acidophilus and L.doderlein that produce lactic acid from glycogen. This is responsible for the acidity of the vagina. The bartholin gland that is located in the vagina secretes mucus which lubricates the vagina.   Abnormal Vaginal Discharge Normal Vaginal Discharge Abnormal Vaginal Discharge: Thick, white and clumpy discharge is caused by fungal infection (candidiasis) and it is associated with itching, swelling, and pain. Bloody or brown discharge is associated with irregular menstrual cycle. Yellow or cloudy discharge is caused by Gonorrhea infection and it is usually associated with urinary incontinence. Trichomoniasis is associated with frothy, yellow and greenish discharge with a very bad smell and it is associated with itchiness and painful urination. Bacterial vaginosis Bacterial vaginosis is associated with yellow, gray, or white discharge with a fishy odor. It produces itching, burning, and redness of the vagina. Trichomoniasis fungal infection Cysto-vaginal fistula causes passage of urine from the vagina. Abnormal vaginal bleeding may be caused by: - Dysfunction of hypothalamus, pituitary gland, thyroid gland or the ovaries. - Postmenopausal bleeding that may result from endometrial hyperplasia or fibroids. - Bleeding disorders. - Chronic, severe inflammation. - Benign and malignant tumors. - Stress. - Vitamin deficiencies. - Puberty. - Vaginal injuries by chemicals or foreign bodies.   Factors which increase risk of Vaginal Infection: Cold exposure. Sexually transmitted diseases (trichomoniasis, syphilis, gonorrhea). Poor hygiene. Recurrent urinary tract infections. Prolonged use of antibiotics and exposure to chemotherapy.   Types of Vaginal Inflammation (Vaginitis): Vaginal and urinary tract infection. It is usually transmitted by sexual intercourse (gonorrhea, bacteria, trichomoniasis, etc) Atrophic vaginitis: Caused by the decrease of estrogen which happens in post menopausal women and will lead to thinning and atrophy of vaginal tissues, and to dryness. This will cause symptoms such as itching, burning, whitish discharge, and painful sexual intercourse. Fungal infection: This increases in pregnant women, in diabetics, in users of combined oral contraceptive pills and it increases after taking an antibiotic which will kill the vaginal bacteria that transform glycogen to acids. Vaginal diphtheria. Inflammation of vaginal erosions that may result from injuries by foreign bodies or chemicals or by ulcers that is associated with Behçet's disease.   Diagnoses of Vaginal Infection: The best way is to go to the doctor to take a sample from the discharge for culture. A Pap smear may be taken by collecting cervical cells.   Tips to avoid Vaginal Infections: Clean the infected area with water and medical soap three times daily and then dry the area and leave it exposed for 30 minutes. Use the cream that is prescribed by the doctor after washing the infected area and keep it exposed for 30 minutes. When using the vaginal ovules, you have to insert it as far as you can inside the vagina and it is preferred to be used before going to sleep. Avoid nylon underwear. Cotton underwear is preferred.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/the-vagina-vaginal-discharge-vaginal-infection Mon, 08 Mar 2021 05:25:19 AM Breast enlargement - Breast Augmentation   What is meant by breast enlargement? It is to increase the size of the breast naturally, or by implanting a prosthesis underneath the natural breast to help in shaping, increasing the tone, and promote growth of the breast and the area surrounding the breast, focusing on the goal of creating a pleasant, natural looking and natural feeling breast.   What is the aim of breast enlargement? The aim of breast enlargement is to enhance self-image. If you are bothered by the feeling that your breasts are too small, this can be addressed. Your breasts become smaller and loss their firmness after having children. If one breast is smaller than the other in a noticeable way, this can also be addressed. Keep in mind that bigger does not always mean better. What we strive for is tight, firm and flexible.   Methods of breast enlargement: Natural breast enlargement. Surgical Breast augmentation methods (mammoplasty).   1- Natural breast enlargements methods are: a) - Breast enlargement exercise b) - Yoga for breast enlargement c) - Breast enlargement food d) - Breast enlargement cream e) - Breast enlargement pills and cosmetic products   a) - Exercise Method for breast enlargement: Actually, this exercise does not enhance breast dimension, but the breast seems to be bigger as you build the chest muscles, and tone this muscle group. You effectively pull your breasts tighter.   Breast enlargement exercise:   1- After a shower, do a five minute breast massage by rubbing your hands together to generate heat before placing them on your breasts. Then massage by going clock wise on your left breast, and then counter-clock wise on your right side. Do 150 repetitions on each side twice daily, using high quality natural breast enhancement cream, to maximize your results. 2- Applying pressure to your chest region is a very good way to tone up the muscles that will help keep your breasts from hanging. To do that, you have to face a wall and stand with your back straight, extend your hands and press them against the wall as hard as possible repetition for ten times. You should feel the tensing of the pectoral muscles during this exercise. 3- Take your hands and join them in front of your chest. Press your palms against each other for up to five seconds and do this ten times. 4- Standup and rest your back against the wall. Squeeze the chest muscles and move your hands in an upward and outward motion, up 100 times. 5- The easiest thing to improve the breast appearance is to have good posture, check your stand and fix it, so that your shoulders held back and the back is straight. 6- Stretch your chest by bending your elbows and placing your hands on your hips. Using these exercises, you will keep your breasts firm and tight. The aim of exercises is not to enlarge the cup size, rather, build the pectoral muscles beneath the breast, making them appear bigger and firm. 7- Lie on your stomach, bend your knees with your ankles crossed. Place your hands slightly in front of shoulders, your elbows bent and tighten the abdominal muscles, slowly straighten your arms and body and push up. 8- Modified push up: - balance yourself on your palms and knees while keeping your body aligned with your knees. - Take your face to the floor with a straight spine. - Keep yourself parallel to the floor by bending your elbows. - Push up again, keeping your chest from touching the floor. 9- Butterfly press: Using 3 – 5 Ib weights, sit on the edge of a chair, your back straight your arms at your sides, then slowly begin to raise your arms to your shoulder level. Hold for four seconds then slowly lower your arms. Perform 5 – 7 times, three times a day. Breast massage is a natural method of breast enlargement as well as breast health, and stimulating healthy breast growth as well as promoting firmness. It is also a perfect method to ensure breast wellness by making you aware of any kind of fibrous or lumpy mass that you may find, early in its growth.   b) - Yoga for breast enhancement: Yoga, inhaling and exhaling is actually a complex strategy that exercises the body in three basic ways; energy-emotional, physical, as well as spiritual advantages of integration, so that you can assist people with a method of classic Hindu teaching, yoga. This can offer a strong impact in many ways to help enhance your breasts. Yoga asana can expand your own chest muscle tissue as well as the shoulder blade muscles and allow the upper body muscles to spread out.   c) - Breast enlargement foods (by modifying food intake): First thing in the morning, drink two full glasses of water to flush out toxins from your body It is important to note that food, by itself, cannot induce breast enlargement and growth. Some of the amino acids can help in enlarging the breasts without surgery. What are amino acids enhanced breast enlargement? The most important amino acids that are present in growth hormone are arginine, lysine, and glutamine. They have to be added into your daily supplements to speed up the breast growth rate, up to 300%. Those amino acids, when combined with chest exercise to build chest muscle, will certainly help create perkiness and firmness in your breasts, without any surgery. There are other benefits you can get from taking these amino acids as they slow the aging process and help you burn fat faster by increasing your body’s metabolism. Other foods that play a role are Green leaves and veggies like watery leaf, which are rich in Vitamin E, folic acid and Lucien. Vitamin E is an essential nutrient to help breast enlargement naturally. We can find these in: a- Palmetto berry oil, used to reverse atrophy of the mammary glands. b- Fennel seeds which offer extra mild estrogenic effects. c- Chick peas, black eyed peas, kidney beans, Lima lentils, all have a high level of estrogen.   d) - Breast enlargement cream: Do the products for natural breast enhancement really work? It is possible to acquire enlarged breasts without surgery, but it must be done on a regular basis. - Some herbal oils and supplements are powerful enough. Use them from 4 to 12 weeks and you will see a noticeable improvement in both firmness and cup size.   e) - Breast enlargement pills and cosmetic products: - Many cosmetic products accelerate estrogen receptors in the breast tissue and can permanently increase the breast size. - Some pills contain herbal additives with chemical substances called phytoestrogens, which play the same role as female sex hormones, the aim of the phytoestrogen is to give your body the same as if you are pregnant or just entering puberty. As a result, your body will start regenerating more breast volume, but it is not scientifically proved. Some studies show that most of us have not grown to our fullest potential during our puberty, due to many possible factors that cause hormonal nutrition deficiencies, high level of stress or lack of exercise. However, taking the herbal supplements alone you cannot be able to grow 2 or 3 cup sizes.   Some herbal breast enlargement methods:   1- Fresh onion juice mixed with honey and turmeric power is said to do the trick. The mixture is used in massaging the breasts, then wear a bra throughout the day and over night before bathing. 2- Fenugreek, wild yam and yarrow, soy are said to boost a woman's estrogen level, naturally. Constant sucking or caressing of the breasts, in African societies they believed that this may tend to help breasts grow larger, but it is not proven, scientifically. In summary, one has to be careful when using natural products, as there is no guarantee that they will work and some of them may even be dangerous to your health, if taken without the care of a Doctor. And, what works for one woman may not work for another. Keep in mind that they are not supported by medical science.   2- Surgical Breast augmentation: Which is known as augmentation mammoplasty is a surgical procedure to increase breast size in which implants are placed under the breast tissue or chest muscle, for some ladies, breast augmentation is a way to enhance self image and confidence for others its part of breast reconstruction after surgery for breast cancer.   Why is breast augmentation requested? It may help you for: 1- You may feel your breasts are too small in size so augmentation will enhance breast appearance. 2- Reconstruct the breast after having breast surgery for cancer or other condition.   What are the risks from Breast implantation? 1- Scar tissue can distort the shape of the breast implant. 2- Breast pain. 3- Infection. 4-sensation in nipple and breast will change. 5- Implant leakage or rupture. Correction of these complications, require additional surgery.   Breast Augmentation Surgical procedure: 1- Primary reconstruction: Replacement tissue damaged by trauma (blunt, penetrating), disease like, breast cancer, or failed anatomic development. 2- Revision and reconstruction: To correct the outcome of a previous breast reconstruction. 3- Primary augmentation: Increase the size, form, and the way the breasts feel.   Incision types for Breast Augmentation: 1- Infra mammary: Infra mammary fold incision, it is the preferred surgical technique for implanting silicone-gel implants, but it produces a thicker, slightly more visible surgical scar. 2- Border line incision in the periphery of the areola is difficult to place, but a less visible scar. 3- Trans auxiliary: Incision is made to the axilla without producing a visible scar, but is placed either bluntly or with an endoscope. 4- Trans umbilical: It is done from the umbilicus, more difficult for placement, but no visible scar will show on the breast.   Some important factors to consider before you decide to undergo surgery for breast augmentation: 1- Sagging breasts will not be improved by implants 2- Breast implants are not guaranteed to last a life time. 3- Mammograms may be more complicated, when you need to have this test done. 4- You may need routine MRI scans. 5- Breast implants may hamper breast feeding.   After the procedure for breast augmentation: - Soreness, pain and swelling for few weeks. - Follow the surgeon’s instructions about returning to regular activities. Avoid anything that could raise your heart rate or blood pressure for at least two weeks. - If drainage tubes were inserted, they must be removed at a follow up appointment. Keep your expectations realistic. Keep in mind that larger does not always mean better. What we want is tight, firm and flexible breasts.   Types of breast implants: 1- Saline implants which are filled with sterile saline solution. 2- Silicone implants. 3- Alternative composition implant with miscellaneous fillers (e.g. soy oil, polypropylene string).   Complications of breast implants: 1- Implant rupture: The suspected mechanisms: - Damage during implantation. - Damage during other surgical procedure. - Trauma. - Chemical degradation of the implant shell. - Mechanical pressure, mammographic breast examination. 2 -Platinum toxicity: In very rare cases, toxicity may occur due to accumulation of platinum at nerve endings or bone marrow and may lead to blindness deafness and nerve trauma.   Breast Implantation and breast feeding: Women with breast implants are able to breast feed, but difficulties could be faced, especially with mammoplasty that features a periareolar incision and sub glandular placement, surgery may damage the lactiferous ducts and nerves of the nipples and areola, making breast feeding difficult to impossible.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/breast-enlargement-breast-augmentation Mon, 08 Mar 2021 05:25:19 AM G spot – Amplification of the G spot   Described as a part of the female genital tract. It is thought to be located on the anterior vaginal wall, 5-7 cm from the vaginal opening. It’s a group of deep nerve fibers given the irregular texture similar to the area of the upper jaw. Some theories say that this area is an extension of the clitoris, or part of the female prostate and considered as one of the most stimulating areas in women which helps the woman to reach orgasm similar to the clitoris. 50 % of the studies indicated that women could reach orgasm through the G spot. G spot increases in size during excitement and become coarser due to increase blood flow to the area as what happens during erection in the male. This could lead to ejaculation in female.   What is the nature of female ejaculation, and does it happen at the same time for all women? It is the ejaculation of secretion from the urethra but not urine, during sexual arousal or orgasm. It can be described as white or transparent odorless fluid that contain fructose and glucose .usually it comes from network of small glands and Channels called skenes paraurethral glands which correspond to the prostate gland in men. Ejaculation dose not happen the same way in all women. Usually it is very small amount of secretion and a feeling of urgency to pass urine. Another function of the G spot is to minimize the labour pain. it’s more than one spot in the upper surface of the vagina.   Causes of G spot weakness? The most common cause is the weakness and relaxation of the vaginal tissue which lead to decreased response during sexual stimulation.   Augmentation of the G spot It’s to performed in order to increase sexual stimulation and pleasure, and is done by using a fine needle, as an outpatient procedure without using anesthesia or by using local anesthesia in multiple places in the anterior vaginal wall. The procedure needs from 10- to 30 minutes; you can return back to your normal life on the same day .and you can sense the difference in the same day.   Purpose of augmentation of G spot? It’s to enhance the enjoyment during sex and hopefully achieve orgasm. *this procedure is done by injecting collagen substance (hyaluronan) such as the that found in the skin. Re-injection can be done every 4-6 months, the same idea of removing facial wrinkles by collagen injections. * The operation is not specific to age and the results vary from one woman to another. One of wrong beliefs of men is that deep penetration into the vagina leads to orgasm and ejaculation in female. Thinking that G- spot is located deep inside the vagina is wrong. The sensory nerves are located in the first 5-7 cm from the vagina opening in the upper part of the vagina. What is the side effect of the procedure? It is simple procedure which is done in the clinic under local anesthesia. -sometime irritation of the area and allergic reaction occur. - Mild urinary tract infection. Risks from using such material? The material used does not contain any hormones or toxins and does not affect the reproductive capacity or have any harm on the overall health or any long term side effect. The aim is only to increase the size of G-spot and to increase the sensation in it. Preparing for the procedure: 1- Start by consulting your doctor and discussing details of the procedure. 2- You have to identify the map of your body well in order that you lead your physician to the most sensitive area. 3- You have to be comfortable with localization of the G-spot. 4- In the examination room you will be put in an appropriate position. Then by special speculum location of the G-spot is determined, then the collagen product will be injected, and after 4 hours you can return back to your normal life.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/amplification-of-the-g-spot-augmentation-of-g-spot Mon, 08 Mar 2021 05:25:19 AM Questions Related to sexual Topics   Q: Does frequent Masturbation reduces sperm count and affects its movement and activity? Is it related to premature ejaculation? A: Masturbation doesn’t affect sperm count and it’s not related to premature ejaculation, on the contrary it leads to a delay in ejaculation.   Q: Does low body weight and loss of appetite affect the production of active sperms? A: Yes, physical weakness and low body weight affect active sperm production.   Q: What is the difference between viscous and liquid semen, and is this difference related to the activity of the sperms and its future fertilization ability? I am a 29 year old, smoker, and not married. A: Regarding semen viscosity, you can’t differentiate it, only the lab technician can evaluate the viscosity. Viscosity affects sperm movement not sperm count.   Q: I’m recently married Guy (6months) till now no penetration for the hymen, although I have excellent testicular size, good erection of the penis but during intercourse there is rapid ejaculation. I took Viagra several times but without any benefit? A: I hope that it is not due to a psychological factor or your wife abstinence. understanding between the couple’s and the presence of passion and love all are important factors in the completion of intercourse, but we advise you to take Haldol 1mg two hours before intercourse in addition to Viagra and try another time, if you couldn’t, you have to take your wife to a gynecologist for consultation and possible surgical penetration for the hymen, which is an easy procedure with no complications and things will be better after that.   Q: I am 25year old and addicted to masturbation since I was 18years old: 1- Does masturbation affect fertilization when I get married? 2- Ejaculation happens rapidly, does this mean that I have sexual weakness, if the answer is yes how I can treat this condition and what is your advice for me? A: Masturbation has no effect on fertilization ability. Rapid ejaculation doesn’t indicate sexual weakness, and there is a treatment for this condition after examining you.   Q: Most of the times I feel that the head of the penis is not hard enough as I want, what is the cause of this laxity and is there a treatment to have a better erection, although sometimes I feel that it is hard enough, but within few seconds it becomes lax, in another words I feel that sex sucks, does this means that I have decrease libido (sexual desire)? A: Normally laxity follows sexual stimulation, only organic cause’s needs treatment but according to your description, your condition is not due to organic causes but mostly due to psychological causes, and what you feel doesn’t mean that you have decrease libido these are natural things that many guys might feel sometimes.   Q: I am married for three months, can you please answer my questions because your collogues at Tunis don’t want me to ask these questions especially that I am recently married, in each cycle of my wife’s cycles, my wife suffers from the same symptoms one week after the day of ovulation, she feels dizziness, nausea and mood disturbances especially that our sexual performance is frequent at the time of fertilization because we are trying to achieve pregnancy. And this continues for two weeks till her period comes, and we all feel frustrated after we have thought that she was pregnant, my wife didn’t have these symptoms before marriage. Dear doctor, is it possible that fertilization happened but implantation didn’t? Does frequent sexual intercourse at the time of possible implantation especially if my wife reaches orgasm several times? Can these cases be noticed directly or few days after fertilization? Dear doctor I desperately need accurate and conclusive answer, to enrich my humbled information which was nothing before reading your articles and books, with our appreciation for your great achievements? A: That is a possibility, sexual intercourse and reaching orgasm at the time of ovulation doesn’t affect implantation.My advice for you is to let things go through its natural process, no need to be so much worried and tense especially that you are recently married; usually pregnancy symptoms are felt after missing her period and not after ovulation.   Q: I would like to consult you about something that has been so much worrying for me since childhood, I am 36year old now, I will get married after one month sometimes I feel the scrotum empty and redundant, but this is occasional and not frequent and I don’t feel any pain or fatique, and erection is normal, but ejaculation is not much? A: You should be examined by urologist or infertility specialist to check your testicular size.   Q: I am married for three months and I have lost my sexual desire during the last three days, which was associated with failure to achieve erection when I tried to have intercourse with my wife, later on I found that I have sever congestion in the prostate please can you tell me what is the best way and what is your medical advice to treat this condition, and if possible can you give me the best antibiotic for this condition, because it is really affecting me and my wife psychologically? A: It is better for you to be examined first by urologist or a gynecologist and infertility specialist before any drug prescription.   Q: 10- I have a problem that I am so hesitant and afraid to tell anyone about, I feel that my penis is too short, during its normal status its front is embedded inside, during erection it elongates but still short, does this mean that I can’t have children when I get married? A: Penile length has no relation to fertility ability, and you can do seminal fluid analysis to be sure that you are fine.   Q: I am 18years old, I have whitish mucous discharge coming through the vaginal orifice continuously except during my cycle, which is regular every 28days and lasting for 7days, this discharge is odorless, and my vaginal orifice is so small, its diameter is like a lentil, please can you answer me quickly because I am in a really difficult psychological condition with all my appreciation? A: These are natural secretions as long as it is odorless and not associated with itching and regarding vaginal orifice this is normal.   Q: I’m suffering from my penis length it is around 11cm in length during erection with a small diameter I did some investigations in Al-Riad it showed normal sperm count and motility, I don’t have diabetes I only had a small increase in prolactin hormonal level and I took treatment for that the specialist who examined me offered two solutions for that, either surgical operation with a cost of 22000SR, this operation can increase the length by 3-5cm and its diameter by 2-3cm or to use a small device for 3months 2-4 hours/day, this can help to increase the length 1.5cm and the diameter 1cm I asked the doctor about the side effects for the surgery he said that it has no side effects, and thousands of surgeries done with a good success rate but I read an article at your web site that it has side effects because it is a sensitive area especially the nerves supplying the area are mostly affected and it is advised not to do the surgery I am so much confused, knowing that I’m overweight (I have around 35kg excess weight) with fat disposition at the genital area and obvious obesity at the thighs? A: My advice for you is to start physical exercises to decrease your weight, and not to do the surgery especially that you have a natural erection and normal seminal fluid analysis. There are several medical products, but for now there is no scientific proof and I can’t judge on these products before we get scientifically proved results.   Q: What are the consequences or harm that may result from sexual intercourse in the last day of cycle, this was unintentional, I thought that it was finished but after intercourse I discovered that it did not is there a possibility to have any disease from this? A: no need to be worried there is not any harm from this.   Q: Unfortunately I have been doing masturbation for awhile, I tried so many times to stop doing that I think I will eventually, but I have a question for you please, I am a21year old female and your answer will definitely help me to get rid from this habit, I did masturbation superficially i.e. on the clitoris and I didn’t come close to any orifice, can this affect my hymen knowing that I don’t use any objects or try to insert anything even my finger, no bleeding has ever happened except for some viscous secretions, but one time I thought that my period has finished (which is normally 3-6days) this time I noticed after 4days that bleeding stopped unfortunately I did masturbation, in the middle of the fifth day of cycle, it was completely superficial as usual, but 15-30minute after that I noticed some bleeding just as period. My question is, does masturbation in this way or during cycle harm the hymen, knowing that I never use any objects or even my finger, please help me and reassure me please? A: No, as long as masturbation is done superficially, no harm for your hymen and this blood is remnants from your period.   Q: When does the hymen form before puberty or after? Can it regenerate after being torn? How can the woman check on her virginity? A: The hymen is part of the female genital tract which starts formation during intrauterine fetal period, and it doesn’t regenerate after being torn, a specialist doctor can examine the patient just by having a look at the hymen and check on its condition.   Q: The size of my genitalia is a major problem for me resulting in a psychological distress and persistent concern, my penis length at erection is 13cm and its diameter is 10.5cm, after relaxation its length is 5cm and very small diameter? A: These measurements are considered less than normal, there are special exercises to elongate and enlarge the penis, you can see these exercises at my web site, you can also increase your intake from certain food supplements that can help, this length doesn’t mean weak sexual ability but you can do seminal fluid analysis to be sure.   Q: How can the strength of erection for normal sexual intercourse be checked, and if it is not enough what is the best treatment for that? Is there certain size for the penis in order to be able to enjoy sexual intercourse? If yes what is the best size (not length)? A: The size of the penis differs from one person to another and if there is weakness in erection, it will be obvious because mostly it is partial, and there are certain medications to improve erection such as some vitamins and Levitra.   Q: Most of the time the seminal fluid comes out from the vagina after intercourse, is this normal? Or it can reduce the chances of pregnancy? A: It is considered normal that some of the semen comes out; you can put your legs in apposition like a scissor after sexual intercourse and stay on your back for 10minutes after intercourse to increase the time for the semen inside the vagina if there is a delay in pregnancy you should be examined for other possible causes.   Q: Does sexual enjoyment for the women depends on the clitoris or the entrance of the penis to the vagina? And at what time the woman feels orgasm? A: Sexual enjoyment can happen by the stimulation of the clitoris or stimulation of certain point at the wall of the vagina which happen with the penetration of the penis.   Q: How can the girl know that she is a virgin, knowing that while doing masturbation I insert my finger inside the vagina but there is no bleeding? A: Sorry, we can’t know that unless by examining the hymen, and check its integrity by a specialist in forensic medicine.   Q: I am 18 years old, I saw A TV interview with a famous doctor, he talked about the penis and how to increase its size, he said that if the guy is 21 year old and the penis size is small, there is a hormone responsible for penile growth, and it can be prescribed to compensate its deficiency what is this hormone? A: There are certain exercises to enlarge the penis and improve its size you can see these exercises at my web site, and I don’t advice using any hormones because it may have a reverse effect resulting in a delay in fertility.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/questions-related-to-sexual-topics Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/pregnancy/contraception-different-birth-controls Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/infertility/polycystic-ovarian-syndrome-symptoms-causes-diagnosis-and-treatment-pcos Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/laparoscopy-&-hysteroscopy/what-you-should-do-before-and-after-surgery Mon, 08 Mar 2021 05:25:19 AM PMS (Premenstrual syndrome)   Premenstrual syndrome (PMS) is defined as physical, emotional and psychological symptoms that women may complain of after ovulation (luteal phase), typically ends with the onset of menses. A severe form of PMS occurs in a smaller number of women where they suffer severe symptoms like anxiety, irritability and anger that lead to inability to carry on with one’s daily activities and relationships. This disorder is known as premenstrual dysphoric disorder (PMDD).   Variants of Premenstrual syndrome Progestogen-induced PMDs’ are caused by exogenous progestogens present in hormone replacement therapy (HRT) and the combined oral contraceptive (COC) pill. Progestogen-induced PMDs’ are caused by exogenous progestogens present in hormone replacement therapy (HRT) and the combined oral contraceptive (COC) pill. Progestogen-induced, which caused by progestogens present in hormone replacement therapy (HRT) and the combined oral contraceptive pills. Premenstrual exacerbation of an underlying diso rder’, such as diabetes, depression, epilepsy, asthma and migraine. These patients will experience symp toms relevant to their disorder throughout the menstrual Wcycle. 2. Premenstrual symptoms exaggeration, because of an underlying illness, like depression, diabetes, epilepsy, asthma and migraine. The symptoms of these diseases will be exaggerated during menses. Menstrual cramps are not the same as PMS although they maybe experienced together and related to ovulation and passage of blood through the cervical passage and are treated by over the counter analgesia and NSAIDs.   Prevalence of Premenstrual syndrome About four of 10 women experience premenstrual symptoms during their lives. 5% of those have severe symptoms.   Causes of Premenstrual syndrome Due to the wide variety of symptoms, it is difficult to give a firm diagnosis. Theories have been speculated to explain the cause of PMS. However, none of them has been proven, and specific treatment for PMS is still not well know. There are two main theories that may explain PMS   First Some women are sensitive to progesterone more than others.   Second Neurotransmitters and brain receptors reactions to serotonin and GABA (Those neurotransmitters are related to mood changes).   Symptoms experienced in Premenstrual syndrome Psychological anger anxiety tension depression Crying Oversensitivity Mood swings Physical Fatigue, Bloating (due to fluid retention), Weight gain Breast tenderness Acne Sleep disturbances Appetite changes with food cravings.   Diagnosis of Premenstrual syndrome Usually the symptoms start on day of ovulation (mid cycle) and lasts from few to several days till menstrual blood flow begins then a relief period of time until ovulation of next cycle, and this can be the hallmark of diagnosis. It is difficult to diagnose PMS and it can be a diagnosis of exclusion after having blood tests for other conditions   Conditions that mimic PMS, idiopathic edema Depression Chronic fatigue Hypothyroidism Irritable bowel syndrome Another way to help make the diagnosis is to prescribe gonadotropin-releasing hormones (Decapeptyl) that stop all ovarian function. If these medications improve symptoms, then PMS is most likely the diagnosis.   Management of Premenstrual syndrome Treatment can be challenging that the exact cause is not well known. A healthy lifestyle: exercise emotional support salt restriction before the menstrual period; reducing caffeine intake before the menstrual period smoking cessation limiting alcohol intake Reducing sugar intake Some studies showed that B6, calcium and magnesium supplements might help. There is no solid evidence on using herbals and complementary medicine in relieving symptoms. In severe symptoms, cognitive behavioral treatment which is a type of psychotherapy which helps the patient balancing their thoughts and behaviors and relieving mental stress. Medical and hormonal treatments include Combined oral contraceptive pills, Yasmin specifically Antidepressants, specifically SSRI, either used continuously or starting mid cycle are of benefit in relieving symptoms.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/premenstrual-syndrome-pms Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/https://www.layyous.com/en/video-&-photos/video-clips/videos-about-the-reproductive-system Mon, 08 Mar 2021 05:25:19 AM Plasma injection for urinary incontinence & to increase sexual pleasure   Many women think that the loss of urine control is a big problem and it’s without solution. This problem usually happen as a result of childbirth and many think it can’t be solved without Surgery. If you are looking for a solution other than surgery that will help you to live your life without this problem then you are looking for PLASMA INJECTION.   What are the causes of urinary incontinence? Increase production of urine due to uncontrolled diabetes. Frequency urination due to urinary tract infection. Neurogenic bladder. Multiple sclerosis. Parkinson’s. Repeated births increase weight. Increase fluid intake mainly coffee tea. What is the relation between Orgasm & incontinence? Do you know that 10% of ladies with decrease libido & sexual desire also have leaking urine? & 20% with unexplained dysperunia have urinary incontinence & 30-50 % of women who can’t Reach the orgasms have urine incontinence. All of that can be solved with minimal procedure & that is by injecting a bulking agent which treats Dysfunctional urethra & increase libido at the same time is called PLASMA INJECTION. What is plasma injection and how does it work? Blood is drawn and the PRP (PLATELETS RICH PLASMA) taking by centre fusion which contain highly Active glycoprotein known as chemokines & cytokines injected into the vaginal wall which stimulate The unipotent stem cells which produce new cells in the adjacent tissue and enhance their migration to the site of injection and the production of fibroblast growth factors which direct the formation of new blood vessels and generate new tissue immediately in the place of injection in the vagina and the surrounding areas. Also injecting the clitoris lead to improve the sexual response .The natural build in the vagina l roof treats and improve urine control The success rate of plasma injection is 95%   What are the benefits from plasma injection? Urine control Grater arousal from clitoral stimulation Younger, smoother skin of the vulva. Stronger and more frequent orgasm. Increase natural lubrication. Questions you may ask? Dose plasma injection hurt? No, it causes minimal discomfort. What are the side effects? May be drops of blood from site of injection. When can I go back to my daily activity? In the same day. Do I need second shot? You may need after 8 weeks. Can I have this procedure when I’m pregnant? No, you can’t because of hormonal changes at that time.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/plasma-injection-for-urinary-incontinence Mon, 08 Mar 2021 05:25:19 AM Postmenopausal Bleeding   Menopause is when the menstrual cycle stops, and 12 months pass without having menstrual periods. And this usually happens in women in their 40s and 50s. The final cycles can be irregular or heavy and this may last for 5 years of which we call premenopause. Any vaginal bleeding, cycle like blood or spotting after menopause is called postmenopausal bleeding (PMB). Bleeding after menopause is usually a sign of a minor problem but can sometimes be an early sign of a serious disease, so it should be taken seriously as cancer until proven otherwise. When detected early, most conditions (including malignancies) can usually be successfully treated.   Causes of Postmenopausal Bleeding   Most of the time, postmenopausal bleeding is caused by: Inflammation and thinning of the vaginal tissue (called atrophic vaginitis) Thinning of the endometrium. Benign polyps in the cervix or the uterus. Thick endometrium (called endometrial hyperplasia) most of the time caused by hormone replacement therapy (HRT) In about 10 per cent of cases, post-menopausal bleeding is related to cancer of the cervix or uterus. Risk Factors of endometrial cancer It is very important to realize the causes that may put some women in danger of having endometrial cancer which is a serious cause of postmenopausal bleeding Diabetic patients Hypertension Null parity, having no children History of Polycystic ovary syndrome Obesity Taking unopposed estrogen hormone replacement therapy Receiving Tamoxifen as a treatment for breast cancer Family history of gastrointestinal and genitourinary cancers like ovarian and endometrial cancers and colon cancer especially at young ages Usually in women above 60 years of age Management of Postmenopausal Bleeding In women with Postmenopausal bleeding good history, examination and investigations must be done At first Referral to a Gynecologist History about any medical problems like diabetes, hypertension, polycystic ovaries, thrombosis renal diseases, endocrine or cardiac diseases. History of cancers in family and patient. History of marriage, sexual life, pregnancies and deliveries. History of taking any medications like anticoagulants or hormones. Examination of vital signs, breast masses, abdominal masses, cervical or vaginal masses or abnormalities through an internal examination using speculum. Investigations full blood count, thyroid function, Pap smear and vaginal ultrasound scanning. Treatment Options for Postmenopausal Bleeding   The kind of treatment depends on the cause of bleeding. Thinning of the endometrium or vagina is treated by estrogen hormone orally or cream. Polyps are usually removed by hysteroscopy and dilation and curettage under general anesthesia Thickening of the endometrium is usually treated with dilation and curettage and sending tissues for histopathology. After ruling out malignancies treatment can be by hormones like progesterone either orally or through an intra uterine device Mirena. Hysterectomy total or subtotal is a definite treatment.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/postmenopausal-bleeding Mon, 08 Mar 2021 05:25:19 AM Pelvic Inflammatory Disease (PID)   Pelvic inflammatory disease (PID) is an infection that affects the uterus, fallopian tubes, ovaries, surrounding tissues, the peritoneum lining them, and the pelvis.   It occurs due to an infection that spreads from the vagina and cervix to the uterus and pelvis. In severe cases, it can lead to the formation of pus in the pelvis. Often, the patient may not experience any symptoms. However, if symptoms and signs are present, they may include lower abdominal pain, vaginal discharge, fever, painful urination, painful intercourse, and irregular menstrual cycles. If left untreated, pelvic inflammatory disease (PID) can lead to complications such as infertility, ectopic pregnancy, and chronic pelvic inflammation.   Symptoms and Signs of Pelvic Inflammatory Disease (PID) If symptoms are present, they may include: *Lower abdominal and pelvic pain *Thick vaginal discharge with an unpleasant odor *Menstrual irregularities *Pain during intercourse *Lower back pain *Fever, fatigue, diarrhea, and nausea *Pain and difficulty urinating Other complications include endometritis, salpingitis, tubal and ovarian abscess, pelvic peritonitis, appendicitis, and perihepatitis.   Causes of Pelvic Inflammation: 1. Bacteria such as gonorrhea or chlamydia. 2. Unsafe sexual practices, which increase the likelihood of contracting sexually transmitted infections. 3. Certain types of contraceptives. 4. Bacteria may enter as a result of childbirth, abortion, or an endometrial biopsy.   5. It may be due to the spread of infection from a nearby area, such as appendicitis. 6. It may be due to the spread of infection via the bloodstream from other parts of the body. 7. Douching may disrupt the balance of naturally occurring microorganisms in the vagina.   Diagnosis of Pelvic Inflammatory Disease (PID): 1. Clinical examination and review of medical and sexual history. 2. Laparoscopy, including viral culture, intra-abdominal bacterial culture, and biopsy. Laparoscopy can reveal violin tendon adhesions, a characteristic feature of Fitz-Hugh-Curtis syndrome. 3. Blood tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. 4. Ultrasound, CT scan, and MRI. 5. Vaginal and cervical swabs. If the swab result is negative, it means you are unlikely to have an infection, but it does not mean you are completely free of infection.   The patient may be asked to undergo some additional tests such as: Urinalysis HIV testing Pregnancy hormone testing, as some pregnancy symptoms may resemble those of pelvic inflammatory disease.   Prevention of Pelvic Inflammatory Disease (PID): 1. Use condoms. 2. If symptoms of PID appear, seek medical advice immediately.   3. Using hormonal birth control pills reduces the likelihood of developing PID because they thicken the cervical mucus plug, thus preventing bacteria from ascending from the lower reproductive tract. 4. The patient should seek medical advice if their sexual partner has a sexually transmitted infection (STI) or if they themselves are infected. 5. Obtain a history of any STIs the patient's sexual partner has and seek treatment for them. 6- Avoid actions that increase vaginal inflammation, such as having sex with more than one sexual partner, as well as intentional abortion, spontaneous abortion, or certain procedures such as placing a stitch on the cervix during pregnancy.   Treatment of pelvic inflammatory disease 1- Antibiotics: We start by giving an antibiotic injection followed by two weeks of oral antibiotics. Antibiotics should be started immediately upon diagnosis, and it is not permissible to wait for the results of culture tests to start treatment for fear of the patient's condition deteriorating rapidly. The type of antibiotic is modified (if necessary) after the culture test results appear. 2- Painkillers to relieve pain and irritation caused by inflammation 3- Opening the abdomen to drain the abscess and take a sample of pus and secretions for culture and identification of the causative bacteria, and thus treat it accordingly. However, the procedure to open the tubes that were blocked by this inflammation is not performed except after treating the acute inflammation or the acute focus of a chronic inflammation. If you do not feel better or your condition worsens within 27 to 84 hours, you should see your doctor again. It is advised to avoid sexual contact during the treatment period. If the patient is pregnant, it is best to admit her to the hospital and prescribe an antibiotic that is safe for the fetus.   Complications of Pelvic Inflammatory Disease (PID): 1. PID causes scarring of the reproductive organs, leading to chronic pelvic pain, infertility, and ectopic pregnancy.   2. In some cases, the infection can spread to the peritoneal serosa, which can cause inflammation and scarring of the liver. This is known as Fitzhugh-Curtis syndrome.   When should a patient be hospitalized for pelvic inflammatory disease (PID)? **If the diagnosis is unclear **If the patient's condition is very serious **If the patient is pregnant **If there is no improvement within 27 to 84 hours of starting antibiotic treatment **If the patient is unable to take antibiotic tablets **If there is suspicion of pus or an abscess   How is a patient with pelvic inflammatory disease (PID) treated while having an intrauterine device (IUD)? The IUD is left in place. If there is no improvement within 48 hours of starting treatment, the IUD will need to be removed. Emergency contraception may be necessary after IUD removal if intercourse occurs within the seven days prior to removal.   Should the sexual partner be tested? If pelvic inflammatory disease is caused by a sexually transmitted infection, anyone the patient has had sexual relations with in the previous 6 months should be tested.   How is follow-up done after treatment for pelvic inflammatory disease?   **If there is no improvement, follow-up will be after 3 days. **If the patient feels better, follow-up will be at the clinic after two weeks. A cervical and vaginal swab may be taken after the treatment is completed to confirm the patient's response to the treatment.   What are the long-term effects of pelvic inflammatory disease (PID)? ** Ectopic pregnancy ** Infertility ** Abscess/pus in the fallopian tube or ovary ** Formation of adhesions leading to chronic lower abdominal pain   Dr. Najeeb Layyous F.R.C.O.G Consultant in Obstetrics, Gynecology, and Infertility   https://www.layyous.com/en/gynaecology/pelvic-inflammatory-disease-pid Mon, 08 Mar 2021 05:25:19 AM Sexual attraction and attractiveness to others   Sexual attraction and attractiveness to others is an exciting and complex field affecting factors, social with multiple, physical and anatomical factors all play a major role in this. We all know that human senses are all-important and play a role in sexual response of women: Tactile senses: play a major role by physical contact. visual stimuli: is well known to have avital role in sexual arousal Auditory stimuli: less effect such as listening to special kinds of music Olfactory stimuli: it is well known that unpleasant smells act as inhibitory factor but can smell act as an excitatory sexual input.   Pheromones: They are chemical substances that are secreted by an person and received by a second person of the same species, in which they stimulate a specific reaction It is an exciting area of research and many of its applications are still under research and had many controversial issues. But recently some of the pheromones are well characterized and found to have an important role in sexual response and sexual satisfaction. Whether in homo or heterosexuality, pheromones were found to play a role in these selections Simply we all notice that when we are attracted to someone we often love the natural scent emitted by our romantic partners or potential mates. In addition, most of women who live or work together usually will have synchronized periods. This was attributed to pheromones Pheromones are excreted in sweat, urine, saliva and skin, and received subconsciously by others resulting in altered mood, increased heart rate plus other physical changes. Pheromones do not only play a role in attractiveness but they are just as likely to repel someone or have no effect at all, these feelings are not mutual, sometimes you might be attracted to someone else’s pheromones but the other person might have no reaction to yours or even worse, that person may have a negative reaction. all these feelings are subconscious Though pheromones effectiveness and their exact role are still under research, so far scientist, classified them into four types Modulators: responsible for mood alterations and also affect emotions Signalers: helps identify someone by their scent, it is the one important between the newborns and mothers. Primers: Affect over time (hormone – altering pheromones) that influence menstrual cycle. puberty and sexual development. Releasers: the ones that are responsible for sexual attraction often elicit an immediate specific behavioral response Yet attraction is often subconscious but it is not inexplicable as we may think.   Hygiene for sexual attraction Personal hygiene is important for both partners, it allows you to feel fresh, attractive which reflects positively on your relationship Few tips that will help: Shower or bathe before bed Brush and floss, and refresh your breath Shave and remove body hair Perfumes and lotions Genital area appearance is important: By plastic surgeries to improve the whole appearance or to repair any congenital abnormality Such as labial reduction for large labia or augmentation of labia by fillers. Whiting for dark pigmented area.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/sexual-attraction-and-attractiveness-to-others Mon, 08 Mar 2021 05:25:19 AM Chronic pelvic pain   This is a very complex topic due to many conditions and diseases that can cause pelvic pain. WHAT DEFINES CHRONIC PELVIC PAIN? Chronic pelvic pain: pain of at least six months’ duration in lower abdomen and severe enough to affect quality of life or require treatment.   HOW COMMON IS CHRONIC PELVIC PAIN? 15 % of women report chronic pelvic pain, and 4% report the pain to be severe enough to miss work. Chronic pelvic pain leads to hysterectomy in 20% and laparoscopy in 40 %.   WHAT ARE THE GYNECOLOGIC CAUSES OF CHRONIC PELVIC PAIN? Gynecologic causes account for approximately 20% and include: Endometriosis: is the presence of endometrial tissues outside uterine cavity. This is the most common cause and is present in about 70 %of women with chronic pelvic pain. Pelvic Inflammatory Disease (PID): PID is infection of the upper genital tract (tubes, ovaries, and uterus) and is caused by an untreated sexually transmitted infection. 30% of women with PID will develop chronic pelvic pain due to the scar tissue caused by the infection. Pelvic adhesions: Dense adhesions, fibrous bands from infection, endometriosis, or prior surgery can cause chronic pelvic pain. Mild adhesions may not be the cause of the pain. Adhesions involving the bowel can cause abdominal bloating, constipation, and pain. Adhesions involving the uterus and the bladder are found in patients with multiple cesarean deliveries. Pelvic Congestion Syndrome: This condition is dilated uterine and ovarian veins found on a pelvic ultrasound or pelvic MRI. Dilated veins can be found in asymptomatic women. Adenomyosis: This condition is the presence of endometrial glands in myometrium due to increased parity that causes heavy bleeding and pain with menstruation. Pain is due to bleeding and enlargement of endometrial glands in the uterine muscle. Pelvic Mass: The pain can be caused by torsion or pressure of the mass on adjacent organs. Fibroids: Fibroids can cause pressure symptoms. Acute pain can occur due to degeneration, twisting, or expulsion of the fibroid through the cervix. WHAT ARE THE UROLOGIC CAUSES OF CHRONIC PELVIC PAIN? Interstitial cystitis painful bladder syndrome Recurrent urinary tract infection Urethral diverticulum Bladder cancer.   WHAT ARE THE GASTROINTESTINAL CAUSES OF CHRONIC PELVIC PAIN? Irritable Bowel Syndrome (IBS): This syndrome is characterized by chronic or intermittent abdominal pain that is associated with bowel function or dysfunction. About 10 % of the general population has symptoms compatible with IBS; women are diagnosed more than twice as often as men. Inflammatory Bowel Disease: Crohn’s disease and Ulcerative colitis cause fatigue, diarrhea, abdominal cramps, weight loss, fever, and rectal bleeding Diverticulitis Colon cancer Chronic constipation Celiac disease.   WHAT ARE THE MUSCULOSKELETAL CAUSES OF PELVIC PAIN? Fibromyalgia: This is a disorder in which the patient has at least 11 areas throughout the body that are tender to touch (knees, shoulders, elbows, neck). pelvic floor muscle spasms chronic abdominal wall pain inflammation of the pubic bone Hip joint and muscle tendon abnormalities.   WHAT ARE THE MENTAL HEALTH ISSUES THAT CAN CAUSE CHRONIC PELVIC PAIN? Drug seeking and opiate dependency Physical and sexual abuse experience Depression and somatization disorders.   SYMPTOMS of Chronic pelvic pain Nature of pelvic pain can be acute (sudden), chronic, intermittent, or cyclic Cyclical pain is usually associated with the period. Pain can also be associated with voiding, bowel motion, physical activity or intercourse.   DIAGNOSIS of Chronic pelvic pain Medical history Physical examination Psychological assessment and counseling.   RADIOLOGIC imagings ARE USED FOR DIAGNOSIS OF PELVIC PAIN? Pelvic ultrasound detects pelvic masses and fibroid. It is not used to distinguish between benign and malignant masses and diagnose adenomyosis. MRI is better to identify pelvic masses and for diagnosis of adenomyosis. CT scan can detect diverticular disease and pelvic masses.   LABORATORY STUDIES ARE USED FOR DIAGNOSIS OF PELVIC PAIN. Blood test Urine test Cervical swab to check Chlamydia and gonorrhea infection are necessary when infection is suspected Pregnancy test should be obtained if ectopic pregnancy is suspected.   WHY IS LAPAROSCOPIC SURGERY USED FOR PELVIC PAIN? To diagnosed pelvic adhesion and endometriosis. Laparoscopic evaluation of the pelvis is necessary to make the correct diagnosis and for treatment at the same time. One large study revealed the following findings during laparoscopy in women with chronic pelvic pain: 35 % had no visible abnormalities, 33 % had endometriosis, 24 % had adhesions, 5 % had PID, and 3 % had ovarian cysts.   WHEN WOULD ADDITIONAL SURGERY BE NECESSARY? There is recurrence in the cases of endometriosis, pelvic adhesions, ovarian cysts, and fibroids so patient may complain of recurrent pelvic pain, requiring a repeat laparoscopy for treatment.   WHAT IF LAPAROSCOPY DOES NOT SHOW ANY ABNORMALITIES? If no abnormality is detected by laparoscopy, it is necessary to perform cystoscopy and colonoscopy to rule out urologic and gastrointestinal causes of pain. Cystoscopy: This procedure to detect a bladder tumor and interstitial cystitis. Colonoscopy: This procedure to detect colon tumors and inflammatory bowel disease.   TREATMENT of Chronic pelvic pain IS TREATMENT BEFORE DIAGNOSIS (EMPIRIC TREATMENT) APPROPRIATE? Empiric treatment can be used in cases of suspected endometriosis, especially if the patient does not want to undergo a surgical procedure but the satisfactory response does not confirm the diagnosis Prolonged treatment may be necessary to evaluate improvement in symptoms. May not be effective in cases of moderate and severe endometriosis.   WHAT CONDITIONS ARE TREATED WITH MEDICATIONS? PID: This condition is treated with a combination of broad-spectrum antibiotics In some instances, admission to hospital is needed for IV antibiotics. UTI: Oral antibiotics. A simple cystitis can be treated with three to five days. Recurrent cystitis sometimes require daily antibiotic therapy for suppression. Hospitalization and IV antibiotic therapy are required in cases of complicated renal infections. Irritable Bowel Syndrome: Modifications in diet, behavioral changes, medications, and psychotherapy are used. Interstitial Cystitis/Painful Bladder Syndrome: No curative therapy. Ongoing physical and pharmacologic therapies are used to control the symptoms. Pelvic Congestion Syndrome: This diagnosis is controversial, progesterone injections have shown effectiveness   WHAT CONDITIONS ARE TREATED WITH SURGERY? Adhesions: Laparoscopic adhesiolysis is most effective in patients with dense adhesions and adhesions involving the bowel. Adenomyosis: Laparoscopic hysterectomy is the treatment of choice. Endometriosis: Laparoscopic resection of endometriosis implants. In cases of severe endometriosis and women who have, completed childbearing removal of the uterus and ovaries is an effective option. Pelvic/Ovarian Mass: This includes the removal of a mass with or without the removal of the ovary. The preservation of the ovary depends on several factors. Pelvic congestion syndrome: Surgical treatment options include the hysterectomy and oophorectomy, embolization of the ovarian veins, sclerotherapy, and surgical ligation of the ovarian veins. Fibroids: myomectomy or hysterectomy is surgical treatment option.   LAPAROSCOPIC UTEROSACRAL NERVE ABLATION (LUNA) LUNA is resection of about 2 cm segment of the uterosacral ligament to destroy the uterine nerve fibers located in the uterosacral ligament .Success rates of this procedure decline rapidly over several years.   LAPAROSCOPIC PRESACRALNEURECTOMY (LPSN) LPSN is resection of the sacral nerve plexus. This is risky because of the presence of large vessels and ureters near the area of dissection. This is effective for central pelvic pain and menstrual pain. Success rates decline over many years.   ALTERNATIVE TREATMENT OPTIONS FOR CHRONIC PELVIC PAIN Physical therapy Trigger-point injections Local anesthetic patches Acupuncture Psychotherapy Behavioral and relaxation feedback therapies Nerve stimulation   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/chronic-pelvic-pain Mon, 08 Mar 2021 05:25:19 AM Lightening Dark Skin around Pubic Area   Dark skin between the thighs and the pubic area is a cosmetic issue that bothers women and embarrasses them. Fortunately, it is usually not a medical illness but a cosmetic one except in women with insulin resistance and PCOS where it is called Acanthosis Nigricans, Hyperpigmentation of the pubic area can be be caused by several reasons, Most important is genetics. Sun exposure. Types of skin. Wearing non cotton (polyester underwear). Shaving. Frequent friction between the thighs because of tight clothes and obesity. Vaginal discharge and infections Sweating and dead skin.   The skin of the pubic area is very sensitive; that is why chemical products should be avoided as much as possible. And to use natural remedies instead, these remedies usually take long time and needs patience to get the wanted results. It should be kept in mind not to use remedies especially acids to skin if waxing was recently done, also avoid sun exposure for 2 to 3 days after applying the remedies that contain acids like lemon.   Those remedies include; Lemon Lemon juice works as an effective skin-lightening remedy. The vitamin C in helps get rid of dead skin and improves skin tone. You can use these remedies regularly. Rub dark area with the inner part of a half Cut lemon for a few of minutes. keep the juice on the skin for 10 to 15 minutes. Wash it off with warm water Aloe Vera It is a popular plant, which helps in healing skin conditions and an effective emollient. It is called as natural darkness corrector. Where gel is extracted from aloe Vera leaves. Applied to dark skin and left for 20-30 minutes, it Gel extracted from the aloe Vera leaves. Applied to dark areas. Leave it on for about 20 minutes, then wash it off with water. Use it once daily for quick results. Aloe Vera and Vitamin E Mix few drops of vitamin E oil with the aloe Vera gel. Apply the mixture to the dark area until dry Repeat this daily Coconut oil and lemon juice Take 3 teaspoon of coconut oil to the juice of half a lemon. Apply to the skin and massage the area for about 10- 15min. Wash the area with warm water and avoid using soap. Repeat this daily. Sugar, lemon and honey Sugar and honey exfoliates the skin and make skin healthy. Lemon is the bleaching agent. Mix 1 teaspoon of honey, the juice of half lemon and 1 teaspoon of sugar. Apply the mixture to dark areas and scrub until sugar residues are completely melted. Leave it for 5 minutes Wash with warm water Repeat this daily Sodium Bicarbonate (Baking Powder) Mix 3 teaspoons of sodium bicarbonate with water. Apply to dark area for 15 minute and massage the area regularly. Repeat this daily. Lemon, yogurt and honey Mix the juice from half a lemon with 1 tablespoon of yogurt and half teaspoon of honey. Apply it to the dark area. Leave it on skin for 10 minutes. Wash the area with water. Apply a moisturizer or coconut oil, to prevent dryness from lemon juice Cucumber Juice The vitamin A in cucumbers helps reduce skin darkness by controlling skin production of melanin. Plus, the high water content helps keep the skin hydrated and healthy. Extract the juice from half a cucumber Apply it all over the dark area. Leave it on for 10 to 15 minutes. Wash it with cool water. Repeat twice daily for quick results. Orange Peel The peels work as a natural bleach and help in lightening dark areas and spots, it can even lighten sun tans. Its content of vitamin C, which is even more in the peels than the orange bulb itself, works as antioxidant removes damaged skin and keeps the skin healthy and glowing. Put peels from orange in the sun to dry. Once dry, grind the peels into a fine paste. Mix 1 tablespoon of orange peel powder and 2 tablespoons of yogurt. Add a little honey to the mixture. Apply it over dark skin. Allow it to dry, and then scrub off the mixture with wet hands. Rinse the area with cool water. Repeat two times a week. Tomatoes Tomatoes have antioxidant contents; it helps protect skin against sun damage. It makes skin less sensitive to UV damage. And help get rid of dead skin. Rub a piece of tomato in circular motions on the dark skin for 5 minutes. Allow the juice to remain on the skin for 10 minutes. Rinse it with cool water. Repeat once daily. Almonds Almond and almond oil dark skin and dark spots, keep the skin healthy and well toned. The high vitamin E, vitamin A and essential fatty acids in almond oil help nourish and moisturize the skin. Whole almonds are beneficial for exfoliating and softening the skin. Soak 5 or 6 whole almonds overnight. The next morning, grind them into a smooth paste. Mix 1 tablespoon of milk into the paste. Apply it to skin for 10 to 15 minutes. Wash off gently while rubbing in circular motions the paste around. Repeat 2 or 3 times a week. Also, massage the area with warm almond oil for about 5 minutes daily before going to bed. Lemon, Baking Powder and powdered milk Mix one tablespoon of baking soda and 2 tablespoons of powdered milk. Add a little water to the mixture. Mix thoroughly. Add spoonful of lemon juice. Mix thoroughly. Apply to the area, wait for 15 minutes. Rinse the area with cool water. Repeat two to three times a week.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/lightening-dark-skin-around-pubic-area Mon, 08 Mar 2021 05:25:19 AM Wound Care After Surgery   Serious wounds do not heal overnight; it takes the body weeks for the body to regenerate new tissue.So after you leave the hospital, good home care is important to prevent infection and minimize scarring. ** The doctor will give you instructions on how to take care of wounds after you go. Patient should do the following steps: Keep the wound covered with a clean dressing until there is no more fluid draining from it.A doctor will give you instructions on how to change your dressing. Wait an average of 2-4 days after surgery before showering. Because each case is different, ask your doctor what to do before you can shower again Avoid soaking in the bathtub or swimming until your next doctor visit. Dirt in the water could penetrate the wound and contaminate it, and there is a risk that a wound might pull apart if it gets too wet. Do not let pets near wounds. Avoid picking or scratching scabs, may itch as the skin underneath heals, but picking or scratching can rip the new skin underneath.   Our bodies depend on vitamins and minerals to heal. Eat healthy foods, and drink a lot of water to avoid Constipation. The scars can take longer time to heal .to decrease the time of healing, try massaging the area with lotion.   Should I limit my activities? It is best to avoid movement that affects the area surrounding your wound. That way, you will lower your risk of pulling the cut apart. Stay away from lifting and do some exercises for about a month after surgery.   When will I get my stitches removed? If you have the dissolving type of stitches, you will not need to get them pulled out. They disappear on their own in 7 to 10 days. The stitches can be removed in 5 to 21 days, depending on the surgery you had.   When to Call a Doctor? Call your doctor immediately if any of these things happen: You develop a fever. You have increased pain even though you are using analgesia or the pain radiates out beyond the wound area. The area around the wound is getting more swollen. There is an expanding area of redness around the wound or red streaks on the skin around the wound. You see blood or pus draining from the wound. You have signs of dehydration, such as dark urine, dry mouth, or sunken eyes.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/wound-care-after-surgery Mon, 08 Mar 2021 05:25:19 AM 6 Wellness Things Women Over 40 Should be Wary of   Nearly 200 million women over 40 suffer from bone diseases today. 1 of 3 middle-aged women suffers from cardiovascular disease. Yet, women health remains the most underrated issue at the global level. Health still takes the backseat for most women. They visit a doctor only when things slip out of hand. Women usually experience menopause by mid 40s. This brings about several emotional and physical changes. Lack of communication around this biological phenomenon lets women to suffer in case of grave issues. Further complications are caused by factors like poor diet, stressful lifestyle, and lack of physical activity and self-care habits. This is the time when women are prone to depression the most. 40s bring about a host of changes. Dealing with new challenges in parenthood and relationships, besides physiological changes make it necessary for women to take care of themselves more than they did when in 20s & 30s. Here are six precautionary tips that women should essentially consider at this point of life -   1. Stress Management Thanks to balancing both work and family, women at the age of forty are prime contenders of excessive stress. Mid-life stress is a major contributor to depression, hypertension, and rapid ageing. It becomes all the more vital that women take precautions and a few steps to alleviate stress. The first step of dealing with stress is taking out some time for yourself. In a full day of serving others, it is important that you take out a few hours every week to unwind. You can start a book, get a de-stress massage, go out for movies and fun with your friends. Practice some proven stress-busting activities, like yoga and meditation. Another key aspect of stress management is getting adequate sleep. Sleeping for six-eight hours daily would ensure your body stays charged and ready to deal with the next day chores. You might read these tips on every second blog not because people like to copy but these ACTUALLY work.   2. Regular Doctor Visit & Checkup While forty is a great age to be, but like all other age groups, it comes with its own set of challenges. Stopping of menstrual cycle reduces the estrogen production. It is important to consult a gynecologist during this time. Even though it is an entirely natural process, the onset of menopause can combine with occurrence of depression, hot flashes, lowered sex drive and fatigue. Additionally, complications can spawn problems with breast and bone health. By keeping your doctor in loop, and regularly going for appointments, you will be better equipped to handle this period of transition.   Regular doctor visits and checkups can even help lowering genetic risks of some diseases.   3. Cutting Back on Processed Foods An important part of physiological wellness involves making age-appropriate dietary adjustments. Until you are middle-aged, your body can break down sugars and sodium present in processed foods. This means that occasionally you can consume foods like energy drinks, instant noodles, and processed meat. However, after 40, it is difficult for body to properly digest these foods. Due to hormonal changes and ageing, your digestive system slows down and it takes time to convert food to energy. Additionally, reduced oestrogen production make you more likely to put on weight. Since processed foods are highly calorific and unhealthy, consuming them regularly can put you at serious risk of obesity, which is fast a growing lifestyle issue among people of all ages. Nearly 38% of adults are suffering from Obesity in the US today. By switching to low-calorie, nutritious and healthy diet, you will be better equipped to deal with age related ailments.   4. The Right Vitamin Intake The primary reason poor bone health affects millions of women over the age of 40 is due to poor nutrition practices. After menopause, the calcium production in the body slows down. When combined by poor dietary habits, the bones and teeth of women can weaken greatly. Here, ‘poor dietary habits’ does not mean eating a lot of junk food. Even women, who eat healthy, home-cooked meals, are at a risk of vitamin deficiencies. Unfortunately, most meals do not contain adequate amounts of Calcium, Vitamin D, Iron, Omega 3, B12—the nutrients that women need the most at this time. One option is to consult a doctor and include right additives that you need. Refrain from picking cheap supplements that do more harm than good. Other option is to have whole foods like papaya, fish, almonds, kale, pomegranate, and spinach. These foods are naturally high in Vitamins B12 and D, and fish contains Omega 3. Taking these vitamins will ward deficiencies and diseases too.   5. Regular and Correct Exercise Intuitively, exercising is key to maintaining good health at any age. This means that regular exercise is a key part of good health, as you grow old. There are a number of proven benefits of exercise. It can help you maintain the right weight, cope with stress, help in pain management and even improve mental health. Yet, exercising at forty is slightly different. Some aspects need a bit of caution. The ideal work out should be 20-25 minutes long and include both cardio and strength training. Do not go beyond that. At this time, the body’s regenerative capacity decreases. This means that after the workout, you will take more time to heal. Over time, this can actually be negative than positive so you must not stress while exercising. Instead, take up light to moderate exercises such as swimming and walking. These low-intensity workouts do not put too much pressure on your joints and muscles, while still offering all the benefits of exercise.   6. Keeping Your Friends and Family Close A mid-life crisis is most debilitating when you suffer through it alone. As you transit to this stage of your life, the changes in your appearance and body can intimidate you and affect personal wellness. For women, it is more important than ever to maintain constructive relationships in their life. Be it their partners, children, friends or all of these. Find ways to maintain social relationships. By spending quality time with them, you can forge meaningful and supportive relationships. These small acts will go a long way in increasing your overall happiness, which is the most important wellness element at any age.   Final Words - For a woman, growing older is often stigmatized through different cultures. Yet, as with all ages, there is magic and adventure as you turn 40. To enjoy these years to the fullest, take these wellness precautions. Leave the rest to shape on its own. I am sure it will be pleasant through the rest of your life. Jenny Travens - Jenny is a creative blog writer who has many passions and interests. Health and wellness is one area where she likes to contribute as much as she can.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/6-wellness-things-women-over-40-should-be-wary-of Mon, 08 Mar 2021 05:25:19 AM Focal adenomyosis with leiomyomatous changes Let's talk about one of the rare cases that visited us in the clinic. The honorable lady, who is 42 years old, came to our clinic because she is suffering from Heavy menstrual cycle . This bleeding resulted in the frequent need for blood transfusions and intravenous iron administration . Several Treatments were used aiming at decreasing the amount of menstrual flow, such as: aminor (progesterone) pills, combined hormonal pills (OCPs), pills Non-steroidal anti-inflammatory drugs such as mefanimic acid, but without any improvement in her condition, there were many Other options that were not considered in her case (such as hysterectomy) as she was still single and wanted to keep the uterus and the reproductive capacity for the future. When the patient came to the clinic, she was clinically examined and the uterus was evaluated on ultrasound, she was found to have a large fibroid protruding from the posterior wall of the uterus, 7 cm in size, affecting the uterine cavity and encroaching on the endometrium, thus affecting the stability of the endometrium. The clinical findings were discussed with the patient, and a decision to perform myomectomy was taken. During the operation, it was found that the fibroid was firmly attached to the wall of the uterus (and this is something unusual in the case of uterine fibroids that are easily peeled off) and There was difficulty in peeling it away from the wall and the cavity of the uterus, but the operation was completed successfully with complete preservation of the uterus and uterine. The sample was sent for histopathology , and it was found to be (focal adenomyosis with leiomyomatous changes). Focal adenomyosis with leomyomatous changes is a benign lump, but facing such a rare condition does not happen on a daily basis. Thanks to God and the efforts of Dr. Najeeb layyous, the operation was performed successfully. https://www.layyous.com/en/gynaecology/rare-cases-in-gynecology-|-dr-najeeb-layyous Mon, 08 Mar 2021 05:25:19 AM Girls puberty Puberty is a period in which children acquire integral adult features, such as breasts , pubic hair, and become able to get pregnant. Puberty begins in girls at the age of about 8 to 10 years and lasts for 4 years. Puberty depends on several factors, the most important of which are: • Weight: It begins early in overweight girls • Nutrition: Most underweight girls who do not receive proper nutrition or cannot absorb nutrients begin the puberty late. • Genetics: If the mother reaches puberty early, her daughter usually reaches puberty early • Race: Dark-skinned girls begin puberty a year earlier than light-skinned girls How does the growth happen? Through hormones that act as chemical messengers that are made in certain parts of the body and are transmitted through the blood to send signals to other parts of the body. Puberty begins in girls when hormones released by the brain and cause the ovaries to grow, so the ovaries release estrogen, which leads to the growth of the reproductive system, including: • Breasts •the vagina • Ovaries •the uterus The order of pubertal changes is as follows: • First, the breast. This happens between the ages of 8 and 13 years • Shortly after that , hair begins to grow in the armpits and genital area • Then a growth spurt occurs in height, and growth slows when the menstrual cycle begins • Menstruation begins about 2 to 3 years after breast development begins **Menstruation occurs in girls about two years after breasts begin to form. The first period occurs at the age of about 12 or 13 years. For some girls, the first menstruation occurs at the age of 8 or 9 years. It can occur anytime between the ages of 10 and 16 while others may not get it until after their mid-teens. It is usually not regular. It may take up to five years to become regular. ** Growth in height usually stops in girls between the ages of 14 and 16 years As girls reach puberty, their body shape changes, their hips and thighs increase in size, and their body fat increases. This is a normal part of puberty for girls. There are many different hormonal problems, such as delayed puberty or early puberty Frequently Asked Questions : Q: What happens when a girl reaches puberty? Puberty goes through several stages, beginning with physical changes such as increased body fat, breast growth, increased height and weight, and sometimes the appearance of acne. One or two years after the first signs of puberty appear, the first menstrual cycle begins. Q:Do girls grow taller after puberty? About one to two years after puberty, the girl's height only increases from an additional 2.5 to 5 centimeters. After that, the height stops for most girls when they reach the age of 14 or 15 years, and this age can be younger depending on the time of the girl's first menstrual period. It should be noted that a girl's height is linked to the genes inherited from both of her parents, and that the final height is usually the average height of the mother. Q:What are the harms of early puberty for girls? Its most important complication is short stature. At first, children with precocious puberty may grow quickly and be taller than others their age, but their bone growth reaches maturity prematurely. Therefore, these children stop growing earlier than usual Q:Does a girl's height increase after menstruation? Some girls can increase their height by 2-5 cm after menstruation within a year or two Age and  Average height in cm At the age of 17 years, height ranges between (150-175) cm At the age of 18 years, height ranges between (151-175) cm At the age of 19 years, height ranges between (151-175) cm Q:When does a girl reach puberty after pubic hair appears ? Within one to two years Q:When does the period come after the breast appears? Within two to three years Q:When does puberty begin in girls? Usually from 10-16 years Q:When does armpit hair begin to appear in girls? Pubic and armpit hair appears in 8-year-old girls. Puberty occurs approximately two years after pubic hair appears Q:Does vitamin D increase height after puberty? There are no studies that have proven this Q:When does puberty end? Approximately at the age of 16-17 years . Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/girls-puberty Mon, 08 Mar 2021 05:25:19 AM Infantile/hypoplastic uterus Infantile uterus is a form of uterine malformation where the size of the uterus is smaller than normal. There are two subtypes of infantile uterus: 1- The fetal uterus: where growth is interrupted “immediately at birth” and the dimensions of the uterus do not reach more than 3 centimeters (almost no uterine chamber exists at all), which leads to the absence of the menstrual cycle and infertility. 2- Childhood uterus: where the growth of the uterus stops during childhood and the size of the uterus does not reach more than 3-5.5 centimeters. This condition is better than the condition of the fetal uterus as the chances of pregnancy are higher, but the woman is more vulnerable to recurrent miscarriages and premature births. What is the normal size of an adult female's uterus? 55-70 mm (5.5-7 cm) What are the causes of infantile uterus? - Malnutrition in infancy or in childhood. - Genetic factors. - An infection affecting the fetus or an infection affecting the female during childhood, such as recurrent respiratory infections and influenza. - Excessive vigorous exercise during childhood. - Family history of infantile uterus syndrome. - Use of certain medications and exposure to nicotine or narcotic substances. - Hormone deficiency due to hypogonadism. - Continuous severe psychological stress that affects the function of the hypothalamus in the brain. - Severe vitamin deficiency in childhood. - Performing surgeries on female ovaries during childhood. - Viral infections that affect the female ovaries in childhood, such as mumps, measles or rubella. What are the signs of infantile uterus? - At puberty, the female reproductive system develops, which leads to external physical manifestations that reflect that the development of the reproductive system is healthy, such as (the first menstrual period, the armpit and pubic hair, breast development) ... In the case of an infantile uterus, the menstrual cycle is absent (the first menstrual period does not occur). In some cases of the infantile uterus, a menstrual cycle may occur after the age of 16 years, but it is very light and irregular, and is accompanied by very severe pain during the period. The patient’s first visit may be due to fertility problems, lack of sexual desire, and difficulty in reaching orgasm. How is infantile uterus diagnosed? - The medical history, which in most cases shows the absence of the menstrual cycle (amenorrhea) since puberty. - The patient's first visit may be due to fertility problems. - Ultrasound examination (abdominal or transvaginal) with measurement of the size and dimensions of the uterus, which appears to be smaller than normal. - In some cases, we may resort to a hysteroscopy or a hysterosalpingography to evaluate the size of the uterine chamber and the severity of the problem. - In some cases, we may resort to hormonal tests to determine whether the cause of the infantile uterus is hypogonadism. What is the external appearance of women who suffer from an infantile uterus? The following signs may be present: - Short stature - Skinny women - Breast size is small - The pelvis is small - The amount of pubic hair is light - Underdeveloped labia. Is pregnancy possible in cases of infantile uterus? Yes, it is possible, but this depends on the size of the uterus. The pregnancy may be normal and without any problems in cases of mild infantile uterus, or the woman may suffer from repeated miscarriages and premature births in severe cases. Is there a treatment for infantile uterus? - There are experimental surgical treatments aimed at increasing the size of the uterine chamber, but their effectiveness has not been proven for everyone, and they differ from one case to another (depending on the degree of uterine growth deficiency). - Hormonal treatments can be given (especially in cases of infantile uterus due to hypogonadism). These hormonal treatments are represented by the hormones estrogen and progesterone, which are given over a period of 3-6 months with the aim of increasing the size of the uterus under their influence. - In vitro fertilization for the purposes of infertility and pregnancy. In severe cases (lack of a uterine chamber), we may have to implant the embryos in the surrogate mother. Note: Surrogate mothers are prohibited in some countries for religious/social/cultural reasons, but are permitted in other regions of the world. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/infantile-hypoplastic-uterus Mon, 08 Mar 2021 05:25:19 AM Dysmenorrhea. Causes and ways of treatment What are the causes of menstrual pain? Hormonal changes in the body after ovulation, which lead to the release of substances called prostaglandins, which are responsible for causing contractions in the uterus. During contractions in the uterine muscles, there is a momentary decrease in blood flow, which causes pain Does menstrual pain indicate ovulation? Yes, as there is no pain in menstrual cycles that do not have ovulation. Is menstrual pain severe? Not necessarily, menstrual pain ranges from bearable and responds to simple painkillers to severe and requires intramuscular or intravenous painkillers. What is the classification of menstrual pain? - Primary: Due to prostaglandins that are secreted physiologically - Secondary: Due to diseases in the female reproductive system such as: ** Endometriosis ** Uterine fibroids ** Ovarian cysts ** Uterine wall hypertrophy (Adenomyosis) ** Pelvic vascular congestion ** Severe pelvic infections How can menstrual pain be relieved? - Using simple or strong painkillers (intramuscularly or intravenously) - Using hormonal pills (such as birth control pills) that reduce the production of prostaglandins that cause menstrual pain - Using a hormonal IUD - Treating the secondary cause such as: ** Fibroid removal ** Cauterization or removal of endometriosis ** Treating infections ** Using treatments to relieve pelvic congestion and sometimes performing a catheterization of the blood vessels in the pelvis ** Removal of ovarian cysts Does menstrual pain decrease with age? Yes in some cases, and in other cases it may increase Does menstrual pain decrease with pregnancy and childbirth? Yes in some cases   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/dysmenorrhea.-causes-and-ways-of-treatment Mon, 08 Mar 2021 05:25:19 AM Increased Endometrial Thickness What is meant by endometrial thickening? The endometrial thickness appears thicker than expected on an ultrasound (vaginal or abdominal) (i.e., thicker than expected at a certain time of the menstrual cycle). What are the causes of a thick endometrial lining on an ultrasound? ** Endometrial hyperplasia ** Polyps in the endometrium ** Early pregnancy ** Placental tissue remains after childbirth ** Endometrial cancer What is endometrial hyperplasia? It is an irregular proliferation of endometrial glands, resulting in an increased proportion of glandular cells compared to normal endometrial cells. Is there a risk associated with endometrial hyperplasia? It has the potential to develop into endometrial cancer if left untreated, with a 5 percent risk over 20 years. What are the causes of endometrial hyperplasia or endometrial cancer? Risk factors: **Obesity **Estrogen therapy or estrogen receptor agonists **Polycystic ovary syndrome **Family history **Age over 35 **Never having a baby **Starting menstruation at a young age **Delayed menopause **Smoking How do endometrial polyps appear? They appear as localized thickening of the endometrium (i.e., the thickening occurs on one side, while the surrounding endometrium is thin or normal). How can we identify endometrial thickening resulting from early pregnancy? By performing a pregnancy hormone test (in blood or urine) When should we suspect placental remnants in the uterus? A recent birth followed by intermittent vaginal bleeding that does not stop despite the expected end of the postpartum period, in addition to the presence of thickening on an ultrasound consistent with placental remnants. What are the symptoms that women experience due to thickening of the uterine lining? **Irregular vaginal bleeding **Abdominal pain **Fever in cases of tumors or placental remnants How is endometrial hyperplasia suspected? By measuring the thickness on a vaginal ultrasound with cystic appearance of endometrium How is endometrial hyperplasia treated? Depending on age, symptoms, and reproductive desire, treatment may include: **Hormonal therapy (progesterone) for 6 months and a repeat endometrial biopsy to confirm that the changes have reversed. **Hysterectomy and oophorectomy What are the available progesterone forms for treatment of endometrial hyperplasia? **Pill form **Liquid form **Hormonal IUD (Mirena) How are endometrial polyps treated? By removing them under anesthesia via a uterine curettage or hysteroscopy, and confirming the diagnosis by sending the sample to a histopathology lab. Can endometrial polyps recur? Yes. Can polyps transform into tumors? Yes, with a probability not exceeding 1 percent How is retained placental tissues managed? **Giving antibiotics **Performing a surgical evacuation procedure under anesthesia How is endometrial thickening managed in the presence of a positive pregnancy hormone test? Repeat a transvaginal ultrasound after 7-10 days to see the gestational sac. If the gestational sac is not detected, repeat the pregnancy hormone test (either the level has decreased, indicating a chemical pregnancy, or the level of the pregnancy hormone has increased, indicating an ectopic pregnancy). How is endometrial cancer treated? Hysterectomy, followed by additional radiation/chemotherapy. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/increased-endometrial-thickness Mon, 08 Mar 2021 05:25:19 AM Combating Weight Gain During Menopause   One of the problems women face after menopause is weight gain and difficulty maintaining a normal weight.   What causes weight gain after menopause? A combination of factors such as hormonal changes, a sedentary lifestyle, and poor diet.   What causes body shape changes (fat distribution) during menopause? This is due to declining levels of estrogen, the hormone responsible for controlling appetite and fat distribution in the body. When estrogen levels decline, fat accumulates in the hips and abdomen. Declining estrogen levels also increase insulin resistance and reduce the body's ability to burn calories.   Does insomnia contribute to weight gain after menopause? Yes, as lack of sleep increases appetite hormones and leads to fatigue, which reduces physical activity.   Do mood swings contribute to weight gain after menopause? Yes, as depression and stress increase the consumption of foods containing sugars and starches and also raise the hormone cortisol, which is responsible for fat accumulation in the abdominal area. How can we avoid weight gain during menopause? ** Follow a balanced diet rich in fiber, vegetables, and fruits, and avoid starches, carbohydrates, and sugars. ** Exercise regularly. ** Focus on protein in your diet. **Getting enough sleep **Trying to reduce stress to lower cortisol levels **Hormonal replacement therapy is used by some women Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/combating-weight-gain-during-menopause Mon, 08 Mar 2021 05:25:19 AM Natural Ways to Treat Hormone Deficiency Symptoms During Menopause   The decline in estrogen during menopause leads to a number of symptoms that negatively impact women's lives and their relationships with others.   What are the symptoms of estrogen depletion during menopause? ** Hot flashes ** Vaginal dryness ** Decreased libido ** Chronic anxiety and stress **Difficulty sleeping and insomnia **High blood lipids **Osteoporosis **Depression   Many women are looking for natural ways to reduce the risks associated with menopause without resorting to hormonal treatments. This is due to some women's fears about the risks associated with hormonal therapy for certain tumors (cervical cancer, breast cancer, endometrial cancer).   What natural remedies can be used to alleviate the symptoms of estrogen deficiency during menopause? **Use some herbs and foods that mimic the way estrogen works in the body: Soy products Chickpeas Lentils Red clover Legumes These primarily help with hot flashes and vaginal dryness.   Black cohosh, which primarily helps with night sweats. Maca root, which helps with mood swings and libido. Evening primrose oil, which helps with hot flashes, breast pain, and mood swings.   **Regular exercise **Use magnesium, vitamin D, calcium, and B12 supplements **Practice calming exercises such as yoga Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/natural-ways-to-treat-hormone-deficiency-symptoms-during-menopause Mon, 08 Mar 2021 05:25:19 AM Recurrent Urinary Tract Infections Recurrent urinary tract infections (UTIs) are a common problem for women, impacting their daily lives on a daily basis.   What is the definition of recurrent urinary tract infections (UTIs)? A urinary tract infection occurs twice within a period of 6 months or three times within a period of 12 month. What are the causes of recurrent urinary tract infections? **Urinary tract abnormalities (bladder and ureters) **Foreign bodies in the urinary tract (such as stones, tumors, catheters, etc.) **Diabetes **Weakened immunity **Estrogen deficiency during menopause **Urinary retention (inability to completely empty the bladder) **Personal hygiene problems **Sexual relationships with multiple partners   How is a urinary tract infection diagnosed? **Based on symptoms (burning urination, blood in the urine, frequent urination, lower abdominal pain, fever, urinary tract discharge) **Laboratory tests (urinalysis, urine culture, white blood cell count, blood inflammatory markers)   How are recurrent urinary tract infections treated? ** Identify the causes ** Prescribe an antibiotic appropriate for the type of bacteria present **Drink adequate amounts of water **Wipe the genital area from front to back, not the other way around. **Use antibiotics during intercourse if the infection is found to be related to intercourse. **Chronic, low-dose antibiotic use to prevent recurrence of the infection **Topical estrogen use during menopause **Cranberry extract use to adjust urine acidity   When is a cystoscopy performed? If there is a suspicion of a foreign body in the bladder or a bladder tumor.   What happens if urinary tract infections are left untreated? Bacteria may spread and cause pyelonephritis , affecting kidney function or leading to sepsis. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/recurrent-urinary-tract-infections Mon, 08 Mar 2021 05:25:19 AM Vaginal pH and its relationship to reproductive health   **The vagina is characterized by an acidic environment, with a pH ranging from 3.8 to 4.5. **What causes vaginal acidity? It's due to the presence of a beneficial bacteria, Lactobacillus, which secretes lactic acid. **What are the benefits of an acidic vaginal environment? It prevents the growth of harmful bacteria, fungi, and other germs. ** Are there factors that alter vaginal pH? Yes, such as: - Menstruation, as blood is alkaline - Sexual intercourse, as semen is alkaline - Antibiotics, which kill beneficial bacteria - Using alkaline vaginal douches - Menopause, which leads to a decrease in estrogen, making the vagina alkaline **What happens if the vaginal environment shifts from acidic to alkaline? This creates a favorable environment for the growth of harmful fungi and bacteria, causing vaginal infections. **How ​​can I maintain vaginal pH? - Avoid using vaginal douches - Use feminine products that don't alter vaginal pH - Use cotton underwear and ventilate the area regularly - Use condoms, which prevents the alkaline semen from reaching into the vagina **How ​​can I tell if I have a vaginal infection? If I have a foul-smelling discharge or a colored discharge such as white, yellow, or green **Can I measure my vaginal pH? Yes, by using pH test strips available at pharmacies. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist   https://www.layyous.com/en/gynaecology/vaginal-ph-and-its-relationship-to-reproductive-health Mon, 08 Mar 2021 05:25:19 AM Sclerosing therapy for Endometriomas ** Endometriosis is a common gynecological disorder; it is the implantation of endometrial tissue outside of the uterine cavity.   ** the most common site for endometriosis is pelvic organs especially the ovaries.   ** endometrial implants on the ovary can encyst and form chocolate cysts (endometriomas).   ** endometriomas are usually adherent to the ovaries and any attempt to remove them surgically will result in the loss of significant part of the ovaries hence decreasing the ovarian reserve.   ** the scientific community has been looking for methods to treat these endometriomas without surgical interventions in order to prevent the decline in ovarian reserve.   ** using the sclerosing agent ethanol is one of these methods.   What is the mechanism of action of ethanol? Protein denaturation and fibrosis of cyst wall.   How is the procedure performed? Aspiration of cyst content Installation of ethanol 95% Retain the ethanol for 10 minutes and then aspirate it   Why is ethanol the preferred agent? Better outcome and availability   What are the patient criteria for endometrioma sclerosing treatment? - women who want to preserve fertility with symptomatic endometriomas - surgery is contraindicated - recurrence after surgery   What are contraindications for this mode of treatment? Suspected malignancy Pelvic infection Pregnancy What is the success rate of this procedure? 88% Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/sclerosing-therapy-for-endometriomas Mon, 08 Mar 2021 05:25:19 AM Beneficial Vaginal Bacteria   The vagina contains beneficial bacteria that naturally live and maintain a healthy vaginal environment. What is the importance of beneficial vaginal bacteria? ** Maintaining the natural vaginal pH between 3.8-4.5 ** Preventing the proliferation of harmful bacteria and germs Does the presence of beneficial bacteria prevent vaginal infections? Yes What is the most common type of beneficial bacteria found in the vagina? Lactobacillus What substances do Lactobacillus bacteria secrete to maintain a healthy vaginal environment? ** Lactic acid ** Hydrogen peroxide ** Bacteriocins (substances that help kill harmful bacteria) What is meant by bacterial imbalance in the vagina? This occurs when the concentration of Lactobacillus bacteria decreases and the concentration of anaerobic bacteria increases. What are the common causes of bacterial imbalance in the vagina? ** Frequent use of antibiotics ** Hormonal changes in the blood due to menstruation or menopause ** Sexual intercourse ** Use of certain non-medical vaginal douches ** Some types of contraception, such as IUDs or spermicides Does an imbalance of vaginal bacteria affect fertility or pregnancy? Yes: **Premature birth **Miscarriages **Infertility **Repeated IVF failures **Severe pelvic inflammatory disease **Increased risk of sexually transmitted infections such as HPV and HIV What is the effect of pregnancy on the concentration of lactobacillus bacteria? It increases their concentration. What treatments are used to modify the concentration of beneficial bacteria in the vagina? **Probiotics **Treating the sexual partner in some cases **Some hormonal treatments, such as topical estrogen. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/beneficial-vaginal-bacteria Mon, 08 Mar 2021 05:25:19 AM When to see a gynecologist   Many women visit the gynecologist when something has gone seriously wrong but regular visits are crucial for maintaining reproductive, sexual and overall health.  How often should I visit a gynecologist? It is recommended to visit a gynecologist once per year for a routine checkup. Visits can become more frequent if the medical condition of the lady needs so. Does the role of the gynecologist only revolve around pregnancy and menstrual cycle regulation? No, your gynecologist plays an important role in the following aspects: ** early cancer detection and prevention ** hormonal balance ** sexual well-being Why is it important for me to do routine gynecological checkups? To detect abnormalities before they start showing symptoms What are the parts of routine gynecological checkups? ** pelvic examination ** pap smear and HPV test ** breast examination ** talking about contraception ** discussing healthy lifestyle ** managing fertility issues ** talking about sexual life and addressing sexual dysfunction Are there specific vaccines that my gynecologist might offer? Yes: ** HPV vaccination What are the conditions the require immediate visit to the gynecologist? ** menstrual irregularities ** pelvic pain or discomfort especially if it was sharp or associated with fever ** abnormal vaginal discharge or odor ** pain or bleeding after sex ** concerns about fertility **menopause and hormonal changes What blood/radiological tests that my gynecologist might ask for? ** complete blood count to check for anemia ** thyroid function tests ** prolactin level ** osteoporosis screening ** breast ultrasound or mammogram Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/when-to-see-a-gynecologist Mon, 08 Mar 2021 05:25:19 AM Myths and facts about vaginal hygiene   From my experience I have noticed that the topic of vaginal hygiene is misunderstood worldwide. Many factors lead to this misunderstanding, such as: ** advertisements on social media that might be misleading ** cultural beliefs As a result, women practice many behaviors that might be harmful. Myth number one: use soap to wash the inside of your vagina ** the vagina self-cleans itself through bacteria and PH, using soap will cause irritation, infection and dryness. What should I do? Only clean the outside area (skin surrounding vaginal introitus) using soap. Myth number two: any vaginal discharge means that you have infection ** it is normal to have physiologic vaginal discharge which is odorless and has no color or whitish color. ** the discharge is only considered a sign of infection if it is foul-smelling or is causing symptoms like itching. Myth number three: you should use deodorants for the perineal area to smell fresh ** this causes skin irritation with superimposed bacterial infection ** having mild natural odor of the vagina is normal Myth number four: tight underwear is okay ** tight clothing trap moisture and heat leading to bacteria/yeast growth ** you should avoid synthetic underwear and choose loose cotton clothing Myth number five: you won’t get vaginal infection if you are not sexually active ** not all infections are sexually transmitted, many bacterial and yeast infections are the result of hormonal changes, diabetes, tight clothes, poor hygiene and many other causes. Myth number six: vaginal steaming prevents infection ** it can lead to skin irritation or burns Myth number seven: don’t bath during your period ** daily bathing and washing the external area help maintain hygiene and prevents infection. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/myths-and-facts-about-vaginal-hygiene Mon, 08 Mar 2021 05:25:19 AM Aging in females and sexual desire Libido decline in aging women is natural, multifactorial and highly individual. it is not just hormones, it is also about how a woman feels in her body, her mind and her relationships. Aging in women often leads to decrease in libido and sexual desire; this happens due to multiple factors such as hormonal, physical , emotional and social . Hormonal shifts (the core driver): Estrogen: its decline is the most significant factor; that leads to vaginal dryness and thinning tissues which make intercourse uncomfortable, it leads also to reduce blood flow to the genitals which dampens arousal and sensitivity . Testosterone: as with women aging its level decrease gradually and that reduces sexual desire in those women. Mental and emotional health: Stress, anxiety and depression increase cortisol level and that suppress libido. Body image issues and low self-esteem often triggered by physical changes like weight gain or skin aging can make women feel less desirable Sleep disturbances due to night sweats and insomnia lead to fatigue and no interest in intercourse. à medications and health conditions (such as antidepressants, diabetes, hypertension and arthritis). Some women feel liberated after menopause (no fear of pregnancy, more self-confidence) but others may feel loss of femininity which can affect sexual desire. Many of these factors are modifiable with support, communication and medical interventions.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/aging-in-females-and-sexual-desire Mon, 08 Mar 2021 05:25:19 AM Sexually transmitted diseases and warts Sexually transmitted diseases (STDs) are diseases that are transmitted through sexual contact. Sexual contact can be: **vaginal **oral **anal Some STIs (sexually transmitted infections) are transmitted through: ** skin contact ** blood ** vertical transmission from mother to baby What are the causatives of STDs? ** bacteria (chlamydia, gonorrhea and syphilis) ** viruses (HIV, herpes, HPV, hepatitis) ** parasites (trichomoniasis, lice and scabies) Symptoms of STDs: ** abnormal discharge ** discomfort during urination ** visible lesions (like blisters or warts) ** itching ** rash ** pelvic pain ** fever Diagnosis: ** History ** physical exam which reveals: -    Fever, tachycardia -    Lower abdominal tenderness -    Sometimes rash -    Abnormal discharge -    Adnexal mass or tenderness on bimanual examination -    Skin lesions ** laboratory tests: -    Elevated WBCs, CRP -    Urine analysis and culture -    Blood tests for antibodies, antigens or viral loads -    Swabs taken from vagina, cervix Treatment of STDs: ** bacterial: antibiotics ** viral: manage symptoms and give medications to reduce viral load and transmission ** parasitic: medication specific for the parasite It is important to treat early in order to prevent permanent organ damage or infertility. Prevention of STDs: ** avoid multiple sexual partners ** get vaccines (HPV and hepatitis) ** use condoms Genital warts: Are caused by human papilloma virus (6 &11) The virus can’t be eradicated, but the treatment focuses on removing lesions, reducing transmission and managing symptoms. It stays dormant and flares occur in cases or immunocompromise or illness. How to treat warts: ** externally applied creams and ointments (antimitotic and immunomodulators) ** liquid nitrogen ** electrocautery ** laser ** surgical excision If a woman develops warts, it is better to do routine pap smear due to increased risk of cervical cancer Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/sexually-transmitted-diseases-and-warts Mon, 08 Mar 2021 05:25:19 AM Having Daughters: When Females Excel in the Balance of Giving   Society has long viewed women with condescension, as the idea of having children in our communities has been linked to a preference for sons. With the passage of time and the honest experiences of life, these ideas have begun to lose their appeal in the face of more truthful and realistic notions: that having daughters is not a lack of luck, but rather a blessing and a divine gift worthy of gratitude. A woman carries in her heart double the love and inexhaustible giving, and for this reason, giving birth to daughters is more beautiful and has a deeper impact than giving birth to sons. Women play a vital social role: - Promoting values of compassion and cooperation - Reducing violence and social disintegration - Strengthening family ties - When women are given their right to education, they elevate society morally and intellectually. As the poet said: “The mother is a school; if you prepare her well, you prepare a nation of noble character.” Women also play a vital religious role: - They are the first school to teach their children values and morals. - The mother is the first school where a child learns the meaning of faith. - The wife helps her husband obey the Creator. - A daughter raises her parents' status in Paradise. - Raising and nurturing daughters earns their parents Paradise.  Thus, women are essential partners in upholding, preserving, and transmitting the faith across generations. But what is the reason for the inferior view of females and the preference for having sons? - Masculinity is seen as an extension of strength. - Some view masculinity as a symbol of physical strength and the ability to earn a living and provide protection. - There is a misconception that males do not represent a financial burden. - The male is seen as the continuation of the family and the bearer of the family name. The preference for males is a social legacy passed down through generations without knowledge of the fair truth. Society is not based on one gender, but rather it needs both males and females, each complementing the other. The relationship between the two parties must be based on mutual respect and recognition of shared roles. When we raise both well and give them an equal amount of love and opportunities, we contribute to building a cohesive and stable society and elevate our societies towards a more beautiful future. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/having-daughters:-when-females-excel-in-the-balance-of-giving Mon, 08 Mar 2021 05:25:19 AM Heavy menstrual bleeding heavy menstrual bleeding (HMB) has a major impact on a woman's quality of life; any intervention aims to improve this rather than focusing on blood loss. The term "normally heavy menstrual bleeding" refers to menstrual bleeding that is excessive in duration or intensity, affecting a woman's physical or psychological health, or her daily activities. It is generally defined as bleeding that lasts more than 7 days or requires frequent sanitary pad changes, as every one to two hours. There are many causes of heavy menstrual bleeding, including organic causes such as uterine fibroids, polyps, clotting disorders, and intrauterine devices (IUDs).  Hormonal causes are also common, especially before menopause. In some cases, the hormonal imbalance may be unexplained. The patient may experience accompanying symptoms such as fatigue, dizziness, and iron-deficiency anemia, which can negatively impact her quality of life. Diagnosis is based on medical history, physical examination, laboratory tests, and ultrasound. Treatment depends on the underlying cause and ranges from medication to surgery. Consider an LNG-IUS as the first treatment for HMB in women with:  • no identified pathology or  • fibroids less than 3 cm in diameter, which are not causing distortion of the uterine cavity or  • suspected or diagnosed adenomyosis If a woman with HMB declines an LNG-IUS or it is not suitable, consider the following pharmacological treatments:  • non-hormonal:  － tranexamic acid  － NSAIDs (non-steroidal anti-inflammatory drugs)  • hormonal:  － combined hormonal contraception  － cyclical oral progestogens.  If treatment is unsuccessful, the woman declines pharmacological treatment, or symptoms are severe, she can be offered  surgical options:  - second-generation endometrial ablation  - hysterectomy -For women with submucosal fibroids or polyps, consider hysteroscopic removal Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/heavy-menstrual-bleeding Mon, 08 Mar 2021 05:25:19 AM Ovarian cancer Ovarian cancer is one of the worst gynecological cancers as it is usually discovered late. The symptoms are very vague and that’s why the disease is usually discovered late with advanced stages. Symptoms: -    Bloating -    Abdominal distention -    Pain -    Early satiety -    Urinary frequency -    Change in bowel habits -    Weight loss -    Loss of appetite Risk factors: -    Nulliparity -    Advanced age -    Genetic mutations -    Endometriosis -    Using hormone replacement therapy How is it diagnosed? -    History taking -    Physical examination that involves pelvic examination -    Ultrasound scan -    Complementary MRI or CT scan -    Blood tests like tumor markers -    Definitive diagnosis with histopathology after surgical resection or biopsy How is it treated? -    Surgical resection -    Chemotherapy -    Hormonal therapy What about the prognosis? Usually, it is poor as the diseases is usually caught late Does using ovulation induction medications increase the risk of ovarian cancer? Evidence is mixed and overall reassuring If it was caused by gene mutations, what other types of cancers might accompany it? Gene positive breast cancer Is pregnancy protective from ovarian cancer? Yes, also breastfeeding is protective, as both inhibit monthly ovulation preventing repeated trauma to ovarian cortex Can fertility be preserved when treating ovarian cancer? Yes, through egg freezing and trying to preserve the uterus if the disease is early in its course and not invading adjacent organs Can we screen for the disease? Unfortunately, no, there is no screening test thus it can’t be prevented Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist   https://www.layyous.com/en/gynaecology/ovarian-cancer Mon, 08 Mar 2021 05:25:19 AM Endometrial Cancer It is considered the best gynecological cancer as it shows signs early in the course leading to early detection and earlier treatment with better outcomes and prognosis. Risk factors: -    Obesity -    Diabetes -    Hypertension -    Nulliparity -    Early menarche -    Late menopause -    Polycystic ovary syndrome -    Estrogen supplementation without progesterone -    Family history Symptoms: -    Abnormal vaginal bleeding -    Heavy cycles -    Irregular cycles -    Intermenstrual bleeding -    Postmenopausal bleeding -    Pelvic pain -    Pain during sex Diagnosis: -    Thickened endometrium on transvaginal ultrasound -    Tissue biopsy -    Using MRI imaging to determine disease stage Stages of the disease: Stage one: confined to uterus Stage two: reaches cervix Stage three: spreads outside uterus but confined to pelvis Stage four: spreading to bowel, bladder or distant organs Most of the cases are revealed at stage one and that is why it is the most curable gynecological malignancy. Treatment depends on: -    Fertility desires -    Stage of disease Treatment options: -    Surgery with uterine resection -    Radiation therapy -    Hormonal therapy for fertility preservation -    Chemotherapy in advanced stages Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/endometrial-cancer Mon, 08 Mar 2021 05:25:19 AM Estrogen: The leader of the hormonal orchestra in a woman's body It is known that the hormone responsible for female characteristics in a woman's body is estrogen, and women often ask us about the possibility of using this hormone as a treatment to enhance female characteristics. Functions of estrogen:  - Breast development  - Growth of the uterus and fallopian tubes  - Building the uterine lining during the menstrual cycle  - Regulating ovulation  - Increasing the level of good cholesterol in the blood  - Maintaining the elasticity of blood vessels  - Regulating sleep - Enhances cognitive abilities - Maintains skin thickness and elasticity - Reduces hair thinning - Maintains bone density - Prevents mood swings - Maintains vaginal lubrication - Prevents urinary incontinence Sources of estrogen production: - Ovaries - Placenta during pregnancy - Body fat - Adrenal glands Types of estrogen:  - Type 1: The primary type during menopause - Type 2: The most potent and dominant type during the reproductive years - Type 3: The primary type during pregnancy What happens when estrogen levels in the body are abnormal? High estrogen levels in the blood can lead to: - Heavy menstrual bleeding - Breast tenderness and swelling - Increased risk of uterine fibroids - Increased risk of endometrial and breast cancer Low estrogen levels in the blood can lead to: - Hot flashes - Vaginal dryness - Osteoporosis - Mood swings - Irregular or absent menstrual cycles - Heart problems Are there any medical uses for estrogen? Yes:  - Hormone replacement therapy for menopause - It is present in birth control pills - Treatment of amenorrhea (absence of menstruation) - Prevention of osteoporosis It should be noted that estrogen is not used alone and must always be used in conjunction with progesterone to prevent the development of endometrial cancer. What are the contraindications for using estrogen as a treatment? - Breast cancer - Cancers with estrogen receptor-sensitive cells - Blood clots and positive clotting factors - Unexplained vaginal bleeding - Liver and gallbladder disease In what conditions does a woman's body lose estrogen? - Premature ovarian failure - Menopause - Surgical removal of the ovaries What forms of estrogen are available in pharmacies? - Pills - Transdermal patches - Vaginal rings, creams, or suppositories It is not recommended to use estrogen without consulting a doctor due to potential risks in some cases. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/estrogen:-the-leader-of-the-hormonal-orchestra-in-a-woman-s-body Mon, 08 Mar 2021 05:25:19 AM Pain During Intercourse: Learn the Causes and Regain Comfort   Pain during intercourse is a common problem affecting women, with physical, psychological, and social dimensions, and it negatively impacts the relationship between partners.   Causes of pain during intercourse: - Physiological causes: ** Vaginal dryness: due to estrogen deficiency after menopause, during breastfeeding, or due to certain medications ** Vaginal infections ** Urinary tract infections ** Cervical or pelvic infections ** Internal scarring and adhesions due to previous surgeries ** Endometriosis ** Uterine fibroids   - Psychological reasons: **Anxiety or tension about sexual relations **Previous sexual trauma **Weak attraction or communication with partner   How is it treated? First, the underlying cause must be identified, and treatments will be prescribed accordingly. 1- If the cause is estrogen deficiency, it can be replaced topically or orally. 2- Appropriate treatments for vaginal infections: antibiotics, antifungals. 3- Appropriate treatment for urinary tract infections (antibiotics). 4- Prescribing antibiotics to treat pelvic inflammatory disease, which may require hospitalization and intravenous antibiotics. 5- Performing a laparoscopic procedure to release adhesions. 6- Treating endometriosis with hormonal pills or surgically removing endometriomas. 7- Removing uterine fibroids.   **Moisturizers and lubricants can be used during sexual intercourse to relieve dryness and painful friction.   **A topical anesthetic gel can be applied to the vaginal opening half an hour before intercourse to relieve pain caused by penile penetration, especially for newlyweds.   How can pain during intercourse caused by psychological factors be treated? **Consult a psychologist or sex therapist **Relaxation exercises **Enhancing sexual communication techniques **Adjustments to the relationship, such as:   - Gradually increasing foreplay and arousal before penetration - Using comfortable positions to reduce pain   If the pain is accompanied by bleeding or abnormal discharge, this requires immediate medical attention. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/pain-during-intercourse:-learn-the-causes-and-regain-comfort Mon, 08 Mar 2021 05:25:19 AM Stress and Ovulation: A Hidden Dialogue Between the Brain and the Ovaries   Psychological stress is not just a fleeting feeling; it triggers a full-blown hormonal response throughout the body, affecting all bodily systems, including the ovaries, which can lead to menstrual irregularities. The body interprets stress as a threat and postpones non-essential functions for survival, such as reproduction.   How does the body respond to stress? The body releases the hormone cortisol from the adrenal glands.   What is the effect of cortisol on the functions of other hormones? - It inhibits the release of GnRH from the hypothalamus.  - It decreases the levels of LH and FSH. - It negatively affects egg maturation.  - It disrupts or prevents ovulation.   How does stress affect the menstrual cycle? - Delayed or absent periods - Lack of ovulation - Menstrual bleeding or light flow - Spotting or irregular vaginal bleeding - Increased severity of premenstrual symptoms - Difficulty conceiving   In cases of extreme stress, such as wars and natural disasters, the menstrual cycle can be completely absent due to the total suppression of hypothalamic function.   What types of stress affect ovulation and the menstrual cycle? - Strict diets  - Professional athletes  - Chronic anxiety or severe life stressors   Who are the women most affected? Those who are underweight   Does normal daily stress affect ovulation? No, but chronic, severe stress can prevent ovulation.   What interventions are recommended to reduce stress levels and help regulate ovulation? - Regulating sleep - Reducing caffeine intake - Breathing exercises - Meditation - Moderate exercise - Seeking psychological help when needed   This shows us that taking care of mental health is not a luxury, but an essential part of women's reproductive health. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/stress-and-ovulation:-a-hidden-dialogue-between-the-brain-and-the-ovaries Mon, 08 Mar 2021 05:25:19 AM Acne from gynecological perspective   Many think that acne is only treated by dermatologists, in this article we will reveal the role of a gynecologist in the treatment of acne. Hormonal acne is usually linked to fluctuations or imbalances in female sex hormones (especially androgens which are male-type hormones that a woman’s body also produce).   Causes of hormonal acne: Increase in androgens Estrogen fluctuations Progesterone fluctuations Oil glands overstimulation Pores clogging   At what stages of life does hormonal acne appear or worsen? Puberty Premenstrual Pregnancy Postpartum Perimenopause Right after stopping birth control pills   What are the body parts that are most affected by hormonal acne? Chin Jawline Lower cheeks Neck   Characteristics of hormonal acne: Deep Painful Cystic Occurs in the same spot Worsens before menstruation   Gynecological causes of hormonal acne: Polycystic ovary syndrome: ** irregular cycles **hirsutism **weight gain **hair thinning **infertility In this syndrome the production of androgens is increased leading to more oil and cystic acne.   High androgen levels: These women are more sensitive to androgens   Changes by birth control pills: ** starting or stopping them ** some OCPs treat acne (anti-androgenic characteristics) ** some OCPs have androgenic progesterone components leading to worsening of acne   Stress: ** it increases cortisol levels which leads to increased adrenal production of androgens   When should a lady with acne be referred to a gynecologist? When she has: Irregular cycles Severe premenstrual syndrome symptoms Infertility Sudden severe acne Hirsutism Deepening of the voice   Assessment conducted by the gynecologist: ** total and free testosterone **hormone produced by adrenal gland **LH/FSH ratio ** prolactin level ** thyroid function tests ** pelvic ultrasound   How is hormonal acne treated? Lifestyle changes: ** low sugar diet **weight loss **get good sleep **stress management Hormonal medications: ** combined oral contraceptive pills **spironolactone **metformin especially in insulin resistance   Treating hormonal acne is not only about cosmetic outcomes, it also means that the body is once again in equilibrium. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/acne-from-gynecological-perspective Mon, 08 Mar 2021 05:25:19 AM Sex education: building knowledge, confidence and healthy societies   Sex education is learning about: The body Human reproduction Relationships Importance of consent Sexual health and hygene   The pillars of good sex education are: It has to be appropriate for the age group targeted Scientifically and medically accurate Culturally sensitive   What does sexual education encompass: Learning about anatomy and puberty: **male reproductive system **female reproductive system **body changes during puberty **the menstrual cycle **sperm production **different hormonal changes   Fertility and reproduction: **how pregnancy happens **ovulation and fertile window   Contraception: **condoms **birth control hormonal pills **intrauterine contraceptive devices **emergency contraception Ladies should also be taught about the proper use of each method and the effectiveness.   Sexually transmitted infections: ** method of spread **how to prevent it **testing for STIs **treatment **role of vaccines   Consent in healthy sexual relationships: **the importance of consent during any sexual encounter **respecting boundaries **definition of rape **communication skills **identifying abusive behavior **that consent must be freely given and is reversible   Why is sex education important? Reduces unwanted pregnancy rates Prevents STIs transmission Encourages adolescent to delay early sexual activity Improves relationships between couples Encourages safer behavior   Knowledge is power, sex education not only protects individuals, but also contributes to building generations with better understanding of healthy relationships and healthy body image. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/sex-education:-building-knowledge-confidence-and-healthy-societies Mon, 08 Mar 2021 05:25:19 AM Frequently Asked Questions about Menstruation   Menstruation is a natural physiological process that reflects the healthy balance of hormones between the hypothalamus, pituitary gland, and ovaries. Despite its prevalence, many questions and misconceptions still exist about it. Here are some of the most common questions about menstruation: 1- What is the normal length of a menstrual cycle? - Between 21 and 35 days for adults, calculated from the first day of bleeding to the first day of the next period. - Normal bleeding lasts from 3 to 7 days. - The amount of blood is approximately 30-50 ml per cycle. - Slight irregularity, meaning a difference of 2-3 days between periods, is considered normal. 2- Is it normal for periods to be irregular? - Yes, in some cases, such as (during the first two years after puberty, after childbirth, while breastfeeding, during perimenopause, in cases of psychological stress or significant weight loss).  However, persistent irregularity may be related to disorders such as: - Polycystic ovary syndrome (PCOS). - Thyroid disorders. - High prolactin levels. 3. Is pain during menstruation normal? Mild to moderate pain is called primary dysmenorrhea and results from increased prostaglandin production. However, severe pain that interferes with daily activities or worsens over time may indicate: - Endometriosis. - Pelvic inflammatory disease. - Uterine fibroids. 4. Is passing blood clots normal? Small clots may appear on heavy days, and this is normal. However, frequent large clots with heavy bleeding may indicate: - Hormonal imbalances. - Uterine polyps. - Fibroids. 5. Does stress affect the menstrual cycle? Yes: Stress can lead to: - Delayed menstruation - Temporary amenorrhea (absence of menstruation) - Ovulation disorders 6. If my period becomes lighter, does this mean I'm approaching menopause? Not necessarily. Lighter periods can occur for several reasons, including: - Transient hormonal changes - Psychological stress - Weight loss - Use of hormonal contraceptives - Thyroid disorders - Polycystic ovary syndrome (PCOS) 7. Does menstrual pain indicate strong ovulation? No, menstrual pain does not reflect strong ovulation. However, some women experience mild pain midway through their menstrual cycle called ovulation pain. This is a temporary pain that occurs when an egg is released from the ovary, but it: - Does not indicate egg quality - Does not mean stronger ovulation.  The intensity of menstrual pain is related to uterine contractions and prostaglandin levels and is not directly related to the strength or quality of ovulation. 8. Does the absence of pain during menstruation mean there is no ovulation? No. - Many women have regular ovulatory cycles without pain. - Conversely, pelvic pain may occur in non-ovulatory cycles. 9. When should you see a doctor? If you experience: - Bleeding lasting more than 7 days - Bleeding between periods - Severe pain that doesn't respond to painkillers - Amenorrhea (absence of menstruation) for more than 3 months without pregnancy - Bleeding after menopause   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/frequently-asked-questions-about-menstruation Mon, 08 Mar 2021 05:25:19 AM Use of hormonal pills to delay periods in Ramadan   Women delay periods during Ramadan so they can fast the entire month. It can be done medically but should be done under the direct supervision of a gynecologist. Hormonal pills are used for this purpose; the safest option is chosen based on patient assessment.   Why are women not allowed to fast during menstruation? During the menstrual cycle the body experiences hormonal changes and blood loss which result in: Fatigue Pain Headache Dizziness Low energy levels And that’s why they are not allowed to fast, in order not to put more physical strain on their body.   **norethisterone pills: Sold under the name primulot nor or aminor It is a progesterone Started 5-7 days before the expected cycle time Taken 2-3 times per day The period starts 5-7 days after stopping the pills It is not a contraception, it only works on the endometrium   **combined birth control pills: They contain both hormones estrogen and progesterone They also prevent ovulation and hence pregnancy The pills are taken daily and continuously (skip the placebo week and start the next pack immediately) Period starts 5-7 days after stopping the active pills Examples are: Yasmin, yaz, microgynon, marvelon   **side effects include: Breast tenderness Bloating Mild headache that responds to simple analgesia Mood swings Irregular spotting     Who shouldn’t take these pills? Tendency for clot formation Migraine with aura Liver disease Breast cancer Uncontrolled high blood pressure   From Islamic point of view, is it okay to delay periods in order to fast the whole month of Ramadan? Yes, it is halal as long as it doesn’t impose any harm on health.   What if the woman can’t take hormonal pills, are there any alternatives? There are no reliable alternatives but the can try taking tranexamic acid which decreases the amount of menstrual blood hence shortening the duration of the cycle and the number of days during which she doesn’t fast.   It is out of God’s mercy to His servants that He allows women to break their fast during the blessed month of Ramadan on the days of menstruation, because menstruation itself exhausts a woman’s body and she needs all her energy to be able to care for and feed her fasting family members, and she is rewarded for providing this care. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/use-of-hormonal-pills-to-delay-periods-in-ramadan Mon, 08 Mar 2021 05:25:19 AM Emergency contraception   Emergency contraception refers to the methods used to prevent pregnancy after unprotected sexual intercourse. unprotected sexual intercourse can happen after: missing birth control pills or by a broken condom sexual assault: Sometimes emergency contraception is needed in cases where the woman has been raped to prevent an unwanted pregnancy. no contraception used intentionally incorrect use of contraception Methods are usually referred to by (morning-after method).   **Emergency contraceptive methods: Levonorgestrel pills: Should be taken within 72 hours after intercourse Can be taken up to 5 days but are less effective It is over the counter in some countries but in others it needs a prescription It works by delaying ovulation or preventing fertilization Side effects: **nausea **breast pain **fatigue **menstrual changes   Ulipristal acetate pill: Can be used up to 5 days after intercourse More effective closer to ovulation Can’t be taken without prescription Delays ovulation even if it was about to occur   Copper intrauterine device: The most effective of all methods It has to be inserted within 5 days of intercourse More than 99% effective Provides long term contraception up to 10 years Copper is toxic to sperms and also it prevents fertilization and embryo implantation   Does emergency contraception terminate an existing pregnancy? No   Does emergency contraception protect against sexually transmitted diseases? No   What is the success rate of different emergency contraception methods? Levonorgestrel pills: 75-95%, the earlier the better Ulipristal acetate pill: 95-98% Copper intrauterine device: more than 99% effective   The following factors affect how well emergency contraception work: Time since intercourse Timing of ovulation BMI (levonorgestrel is less effective in high BMI) Drug interactions like enzyme inducing drugs Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/emergency-contraception Mon, 08 Mar 2021 05:25:19 AM Precocious puberty   Precocious puberty is the early onset of puberty, before the age of 8 years in females and before the age of 9 in males. In puberty a number of hormonal and physical changes lead to sexual maturity.   Why is precocious puberty worrisome? Because it leads to: Shorter adult height Psychological effects due to low self-esteem   There are two types of precocious puberty: ** central precocious puberty ** peripheral precocious puberty   central precocious puberty: Early activation of the hypothalamic-pituitary-gonadal access The brain sends signals leading to early stimulation of ovaries Can be caused by: **brain injury **infection **tumors **genetic causes **head trauma **idiopathic   peripheral precocious puberty: Early production of sex hormones from other places outside the central nervous system Causes: ** gonadal tumors or adrenal tumors **hormonal imbalance **genetic disorders   Signs of precocious puberty: Early development of secondary sexual characteristics like the breasts Accelerated growth followed by early closure of bones leading to subsequent short stature Armpit or pubic hair Menstruation before the age of 8 years in females   Diagnosis: Physical exam revealing early sexual development Blood tests to measure pituitary and ovarian hormones MRI to check for structural abnormalities in the brain or organs X-rays of the wrist to check on bone maturity   Treatment: central precocious puberty: suppression of hormones releases from the brain peripheral precocious puberty: surgery for tumors, medications to block hormonal production in cases of genetic diseases, it is better to have genetic counselling   it is important to address the condition as early as possible due to the possible detrimental effects on the emotional and psychological health of children and their families.   Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/precocious-puberty Mon, 08 Mar 2021 05:25:19 AM Herbs and Women's Health   Herbs play a vital role in supporting women's health, but it's best to use them responsibly and under the supervision of a qualified professional. There are certain situations where caution is advised before using herbs, such as: - Pregnancy - Breastfeeding - Chronic illnesses Some herbs contain phytoestrogens, which are structurally similar to the female hormone estrogen.  Herbs affect a woman's body in the following ways:  - Supporting hormones like estrogen and progesterone - Reducing inflammation - Calming the nervous system - Improving blood circulation - Improving digestion Herbs beneficial for menstruation: - Chamomile calms nerves and relieves uterine cramps during menstruation. - Ginger relieves menstrual pain and reduces inflammation. - Cinnamon helps regulate the menstrual cycle and improve blood flow. - Peppermint relieves bloating. Herbs that support hormonal balance: - Chasteberry relieves symptoms of premenstrual syndrome. - Sage relieves menopausal symptoms such as hot flashes. - Marjoram helps balance hormones. - Fenugreek improves insulin response. - Flaxseed relieves menopausal symptoms. Herbs that promote reproductive health: - Fenugreek promotes milk production - Cumin relieves bloating associated with menstruation Methods of using herbs: - Immersion in hot water - Decoction - Capsules - Essential oils It is worth noting that some herbs interact with certain medications, so they should be used with caution. Avoid consuming large amounts of cinnamon during pregnancy. Do not resort to herbal remedies before consulting a doctor to diagnose any hormonal imbalances. Avoid mixing several herbs randomly to prevent unwanted interactions. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/herbs-and-women-s-health Mon, 08 Mar 2021 05:25:19 AM Recovery After Gynecological Surgery   Gynecological surgeries (such as hysterectomy and endometriosis treatment) are common procedures aimed at improving a woman's quality of life. Recovery after these surgeries plays a crucial role in preventing complications and restoring health. What procedures are performed after surgery? - Inpatient monitoring  - Monitoring vital signs  - Pain management  - Blood clot prevention What are the main stages of recovery after gynecological surgery? - First few days: Rest with light movement to prevent blood clots, as movement improves blood circulation. - Day 7 to Day 21 after surgery: Activity can be gradually increased. - After 1 to 6 weeks: Return to normal activities. How can I speed up my recovery after surgery? - Follow the doctor's instructions precisely. - Take medications as prescribed. - Keep the wound clean. - Avoid lifting heavy objects. - Follow a diet rich in protein and vitamins. - Drink plenty of water. What symptoms warrant an urgent doctor's visit after surgery? - Fever - Bleeding - Increasing pain that doesn't respond to painkillers - Foul-smelling discharge The psychological aspect after surgery: Recovery isn't limited to the physical aspect; it also includes the psychological one. It's normal for a woman to experience anxiety or mood swings, especially after major surgeries like a hysterectomy. Women should be encouraged to talk to a specialist and seek family support. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/recovery-after-gynecological-surgery Mon, 08 Mar 2021 05:25:19 AM Importance of annual gynecological exams   Annual gynecological exams play vital roles in overall woman’s health. These exams are important for maintaining reproductive health and detecting gynecological diseases early in their course which lead to better outcomes. Annual exams also give healthcare providers the chance to provide education about healthy lifestyle choices. These visits should be done to all age groups and regardless of the marital status. Early detection of healthcare problems: ** cervical cancer through pap smears ** fibroids through pelvic examination and transvaginal ultrasound ** sexually transmitted infections by speculum exam ** ovarian cysts by ultrasound examination ** breast diseases by clinical examination Monitoring reproductive health: ** irregular periods ** painful menstruation ** fertility issues ** contraception use ** symptoms of menopause ** effects of hormonal changes Regular visits provide the opportunity to detect and evaluate conditions such as: -    Polycystic ovary syndrome -    Endometriosis -    Pelvic congestion Preventive care and screening: ** pap smear ** HPV vaccine ** breast exam, ultrasound and mammography ** STIs screening ** bone health assessment ** blood pressure and blood sugar monitoring ** thyroid diseases follow up ** weight monitoring Education: ** birth control options ** sex education ** how to plan pregnancy ** nutrition ** exercise ** mental health ** managing symptoms of menopause Annual gynecological assessment helps in building a trusted relationship with healthcare providers which improves healthcare experience and encourage women to seek medical help when needed without feeling embarrassed. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/importance-of-annual-gynecological-exams Mon, 08 Mar 2021 05:25:19 AM Intimate Hygiene and Care with Aging: Navigating Hormonal and Physical Changes   ​As women age, their bodies undergo natural hormonal and physiological transitions that directly impact the health and hygiene of the intimate area (the vulva and vagina). These changes, particularly during perimenopause and postmenopause, require a shift in daily care routines to maintain comfort, prevent infections, and preserve overall well-being. ​Here is a comprehensive guide to how aging affects the intimate area and how to care for it safely and effectively. ​1. How Aging Affects the Intimate Area ​The primary driver behind most of these physical changes is the decline in estrogen levels, the hormone responsible for keeping vaginal tissues healthy, elastic, and well-lubricated. This decline leads to several noticeable shifts: ​A. Vaginal Atrophy and Dryness ​The walls of the vagina and the external tissues of the vulva become thinner, less elastic, and lose their natural ability to self-lubricate. This dryness is not just an inconvenience; it can cause chronic discomfort, persistent itching, or a burning sensation during daily activities. ​B. Shifts in pH Levels ​During reproductive years, the vaginal environment is highly acidic to ward off infections. With lower estrogen, the pH level rises, becoming less acidic and closer to alkaline. This shift weakens the population of beneficial bacteria (Lactobacillus), leaving the area highly vulnerable to bacterial or yeast infections, as well as recurrent Urinary Tract Infections (UTIs). ​C. Thinning of External Skin ​The skin surrounding the vulva becomes delicate and fragile. Consequently, it can easily become irritated, chafed, or torn from minimal friction caused by clothing or daily movement. ​2. Daily Hygiene and Care Guide for Mature Years ​Because of these physiological changes, aggressive or traditional cleaning routines become highly damaging. The golden rule for mature intimate care is "Gentleness and Continuous Moisture." ​A. Ditch Foaming Washes and Harsh Soaps Entirely ​Thin, dry skin cannot tolerate regular bar soaps, perfumed body washes, or heavily lathering cleansers; these products worsen dryness and destroy what remains of your natural bacterial shield. ​Washing the external area with warm water only remains the safest and most medically recommended choice for daily hygiene. ​If you prefer using a cleanser, opt for a soap-free, non-foaming cleansing cream or oil designed specifically for mature or severely dry skin. Ensure it is entirely fragrance-free. ​B. Prioritize Moisture (The Key to Comfort) ​To counteract vaginal atrophy and chronic dryness, incorporating non-hormonal moisture barriers into your routine is highly beneficial: ​Vaginal Moisturizers: These are over-the-counter, hormone-free creams or gels designed for internal and external use. Unlike temporary solutions, they are used regularly (2 to 3 times a week) to bind moisture to the tissues, relieving chronic itching and irritation. ​Medical Lubricants: Keep water-based or silicone-based lubricants on hand to use during intimacy. This prevents painful friction, micro-tears, and subsequent irritation. ​C. Pat Dry, Never Rub ​After washing, avoid rubbing the delicate skin with a towel. Instead, use a soft, clean cotton towel and gently pat the area dry. ​Always adhere to the rule of wiping and drying from front to back. Because localized immunity decreases with age, preventing the migration of intestinal bacteria to the urethra and vagina is more critical than ever. ​D. Choose Breathable Fabrics ​Wear loose-fitting underwear made of 100% natural cotton to allow adequate airflow and prevent moisture buildup. ​Limit the use of tight pants or synthetic fabrics, which trap heat and cause friction against the easily irritated skin. ​3. When to Consult Your Gynecologist ​While adjusting your hygiene routine can provide massive relief, severe hormonal symptoms may require targeted medical therapy. You should schedule a visit with your doctor if you experience: ​Severe, painful dryness that disrupts your quality of life or makes intimacy distressing. (Your doctor can prescribe highly localized, low-dose topical estrogen creams that safely restore tissue thickness and moisture). ​Abnormal discharge that is yellow, green, or gray, or accompanied by a strong, foul odor. ​A persistent burning sensation during urination or a sudden, frequent urge to urinate (classic signs of a UTI). ​Any new sores, blisters, persistent lumps, or noticeably discolored skin patches on the external vulva. ​ Intimate care as you age is not about cleaning more; it is about protecting and hydrating more. Understanding these physiological changes and treating your body with gentle, specialized care ensures long-term comfort, health, and confidence. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/gynaecology/intimate-hygiene-and-care-with-aging Mon, 08 Mar 2021 05:25:19 AM Laparoscopy Hysteroscopy https://www.layyous.com/en/laparoscopy-&-hysteroscopy Mon, 08 Mar 2021 05:25:19 AM Laparoscopy Surgery - Gynecological Laparoscopy What is Laparoscopy (Key Hole Surgery)? Laparoscopy is usually done under general anesthesia although it could be done using local anesthesia. The laparoscopy is a procedure done for diagnostic or operative purposes, and in many cases is done as a combined diagnostic and operative procedure where the cause is found and dealt with at the same time . It is done by inserting a small telescope which has a light source and is attached to a camera, and a monitor used to visualize the internal organs. The laparoscopy ( key hole surgery ) has an advantage over conventional operations in that the operation is less painful and with a shorter hospital stay for the patient in addition to better cosmetic results and ability to resume normal activities in a shorter time after the operation. A small cut is made under or through the navel where a thin needle is inserted into the abdominal cavity and is used to insert gas (CO2). The abdomen is insufflated to a certain degree of pressure, and then a trocar is introduced through the small cut, and the telescope inserted through it. The camera is then attached to the telescope to enable the internal organs to be viewed on a monitor. Smaller-sized trocars are then inserted into the lower part of the abdomen & on either side (could be three in total). Instruments could then be introduced into the abdomen through the trocars, enabling the operator to perform his procedure. Recovery after Laparoscopy In the recovery room, the attending nurse will observe the patient until she is conscious, and then the patient will be returned to her room, if she is discharged on the same day, she is not allowed to drive. As a result of the anesthetic the patient might feel tired and dizzy, which is normal. Some feel shoulder pain for the first 24 hours after the operation. Minor complications could result from the operation manifesting as redness at the incisions sites or leakage of fluid from the cut sites or a small degree of fever. All of these complications are rare and easily controlled by the attending doctor. Indications and Uses of Gynecological Laparoscopy Gynecologists use laparoscopy to treat a variety of female health problems. General surgeons also now use laparoscopy to perform surgeries such as appendectomies and removal of the gall bladder (cholecystectomy). Indications for gynecological laparoscopy include the following: Ovarian cysts and tumours. An enlarged ovary could be due to the cystic area within the ovary or due to solid mass. The surgeon could differentiate between them and remove any cyst or tumour through the laparoscope or take a biopsy if cancer is suspected, or remove the whole ovary if needed. Removal of fibroids (Myomectomy).or destroying them (Myolysis ) Fibroids are benign tumours (growth) which arise from the wall of the uterus. Around 20% or more of women over 35 years old have fibroids. Women might suffer from painful periods or heavier periods. In pregnancy, it could lead to complications e.g. premature labour. Fibroids Infertility, Lysis of adhesions. Adhesions are a major cause of infertility. This usually happens as a result of previous surgery or pelvic infection. By operative laparoscopy, the adhesions are cut and there is a fewer chance of them recurring than if the same operation is done by opening the abdomen in the conventional technique. Infertility, checking the condition and patency of the Fallopian tubes The Fallopian tubes are checked at the time of laparoscopy, their condition and patency are noted, die is injected through the neck of the uterus, and if the tubes are patent, free spill is noted. Reproductive or tubal surgery Repairing damaged Fallopian tubes. Endometriosis. In this condition part of the lining of the uterus (endometrium) implants outside of the uterus in the pelvis and abdomen, e.g. on the ovary, and the intestine. On the ovary it could form a collection of blood in a cystic cavity where it is called a chocolate cyst. This condition leads to adhesions, cause pain during and before periods, painful intercourse (dyspareunia), painful defecation, or painful urination. This condition could lead to infertility, and diagnosis is usually by laparoscopy and if adhesions are found they are dealt with promptly. Intraperitoneal Hemorrhage. In cases of intraperitoneal hemorrhage where the cause is unknown, laparoscopy is used to find the source. Once found it can be dealt with. In some cases this could be the result of pregnancy in the Fallopian tube [ectopic pregnancy], and it is dealt with using the laparoscopy equipment. Polycystic Ovaries. This condition affects one in five women as a result of disorder in the function of the ovary where many follicles are formed (much more than normal), but they stay small and don’t mature. It is usually diagnosed by ultrasound and treated by medicines. Surgery is only resorted to in resistant cases where multiple ovarian drilling is done using the laparoscope. Pelvic infection (Pelvic Inflammatory disease ): This is diagnosed using the laparoscopy, especially in chronic cases where the cause of pelvic pain is unknown, A sample is taken and sent for bacteriological culture, and the appropriate antibiotics are given. Egg collection for assisted reproduction: This is done in some case, e.g gamete intrafallopian transfer, or in some cases of in vitro fertilization where the ovaries are high up in the abdomen, and the eggs could not be collected using the vaginal ultrasound. Sterilization ( laparoscopic sterilization) Couples who don’t want to have any more children could have this procedure done where the women undergo laparoscopic sterilization (the tubes are closed using clips or rings or cauterized). Severe period pain Diagnosis and treatment of some uterine anomalies. Pelvic floor and vaginal prolapse Urinary incontinence Some reproductive cancer Evaluation and removal of pelvic lymph nodes. Hysterectomy: Where it is indicated to remove the uterus, this procedure is done either completely using the laparoscopy or through the vagina (Laparoscopic assisted vaginal hysterectomy). Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/laparoscopy-&-hysteroscopy/laparoscopy-surgery-gynecological-laparoscopy-indications-and-uses-procedure-details Mon, 08 Mar 2021 05:25:19 AM Laparoscopy Photos https://www.layyous.com/en/laparoscopy-&-hysteroscopy/laparoscopy-photos Mon, 08 Mar 2021 05:25:19 AM Video clips of different Laparoscopy operations video clips hysterectomy removal of ectopic pregnancy Laparoscopic adhesolysis https://www.layyous.com/en/laparoscopy-&-hysteroscopy/laparoscopy-operations-videos Mon, 08 Mar 2021 05:25:19 AM Hysteroscopy   What is hysteroscopy?   A procedure in which the surgeon uses the hysteroscope (telescope) and introduces it through the cervix (neck of the uterus) to the uterine cavity, and by using a fluid (or gas) to distend the uterine cavity, the cavity is visualized using a light source for illumination, and instruments are used for operating.   Some instruments used in hysteroscopy   Indications of hysteroscopy Abnormal Menstrual Loss: Using the hysteroscopy, the cause of bleeding from the uterus can be found and dealt with. It could be due to benign tumors or malignant ones. Large tumours within the cavity could lead to abortion. Intrauterine Adhesions: Which might be caused by uterine infections or previous curettage operations or operations on the uterine cavity. The walls of the uterus get stuck together from these adhesions. Symptoms include abortion, infertility, or menstrual abnormalities. The role of hysteroscopy is diagnostic and can help in dealing with them. Sub-mucous Fibroids and Endometrial Polyps Uterine Septum: This could cause infertility and recurrent abortion or premature labour. The septum is cut or cauterized using the hysteroscope. Hysteroscopic uterine septum resection for recurrent miscarriage Missed IUD: This is rare, especially these days but the thread of the intra uterine contraceptive device could be cut and lost, and the IUD could be localized using the hysteroscopy and removed. Endometrial Resection: This is done in cases of abnormal menstrual bleeding (heavy, irregular periods). The patient either has very light periods afterwards or stops having periods in most cases. After the hysteroscopy operation the patient may feel: Slight pain in the lower part of the abdomen and may lose some blood coming from the vagina. One-day rest or you may check with your doctor if you are worried.   Dr Najeeb Layyous F.R.C.O.G   Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/laparoscopy-&-hysteroscopy/hysteroscopy-hysteroscopy-for-infertility Mon, 08 Mar 2021 05:25:19 AM Video clips of different operations carried out by using the Hysteroscope https://www.layyous.com/en/laparoscopy-&-hysteroscopy/hysteroscopy-videos Mon, 08 Mar 2021 05:25:19 AM Hysteroscopy Photos endometrial polyp intrauterine adhesions fibroid septum resection myomectomy https://www.layyous.com/en/laparoscopy-&-hysteroscopy/hysteroscopy-photos Mon, 08 Mar 2021 05:25:19 AM What you should do before and after surgeryInstructions for patients who are scheduled for surgery -Please do not eat, and drink from midnight before the operation. -If you are taking any medications like Aspirin, you should stop it at least five days prior to operation. -Anti- hypertensive medications should be taken early morning at same day of operation with sips of water. -Shave the genital area one day before operation. -Please come to the hospital two hours before operation, so you can prepare admission papers, and nursing staff could prepare you well, and take off jewelry, your hand watch, and remove nail polish before leaving home. -If the surgery includes abdominal incision, the nursing staff will catheterize your bladder. -Nursing staff will give you Antibiotics to minimize the risk for infection, and pain killers will be given as needed. -Please inform the nursing staff, if you have an allergy to any type of medication. -After surgery you should do the following: 1- Try to drink a lot of water daily. 2- Avoid setting in hot tubs; you can only take showers all time, water to contact with the incision area. 3- Don’t take Aspirin or vitamin E for five days after operation. 4- Commit to take all drugs that the doctor has described. 5- Avoid heavy lifting and standing for long time, and avoid squat position. 6- Avoid exercises through the whole month after operation, you're not allowed to have intercourse after the operation for a period of time decided according to the type of the operation. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/laparoscopy-&-hysteroscopy/what-you-should-do-before-and-after-surgery Mon, 08 Mar 2021 05:25:19 AM Hysteroscopic uterine septum resection for recurrent miscarriage   A uterine septum is a congenital anomaly which is a muscular or fibrous wall that divides the uterus, creating 2 cavities. The septum may be complete or incomplete. It is more common in women with primary infertility and who have had recurrent miscarriages. Hysteroscopic uterine septum resection Videos Surgical removal of the septum (metroplasty) is usually considered for women who have a septate uterus in association with repeated miscarriages (usually defined as 3 or more miscarriages in a row) and preterm deliveries.  A hysteroscopic approach aims to reduce morbidity and shorten the recovery period. it aims to create a normal uterine cavity by removing the septum, and consequently reduce the risk of miscarriage. The procedure may be done using ultrasound or laparoscopic guidance. After a miscarriage, an interval of at least 6 weeks is left before doing a hysteroscopic metroplasty. hysteroscopy-videos  Unlike transabdominal metroplasty, caesarean section is not mandatory for patients who get pregnant after hysteroscopic metroplasty. Hysteroscopic uterine septum Photos Complications : Uterine perforation during hysteroscopic metroplasty (1% ) Uterine synechiae after hysteroscopic metroplasty ( 2%) Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/laparoscopy-&-hysteroscopy/hysteroscopic-uterine-septum-resection-for-recurrent-miscarriage Mon, 08 Mar 2021 05:25:19 AM Endometrial ablation Endometrial ablation is the intentional destruction of uterine lining to reduce the amount of heavy menstrual bleeding. It might lead to one of the following: **decrease menstrual flow **some stop having menstrual flow at all The procedure doesn’t need abdominal incisions and that’s why some women might prefer it as a first line to treat their heavy cycles. What are the indications of endometrial ablation? ** heavy/prolonged cycles that don’t respond to other modalities of treatment ** heavy cycles that affect quality of life **heavy cycles causing anemia **bleeding between the cycles Usually, it is performed for patients who need a hysterectomy but are not suitable candidates for the surgery or don’t want to remove their uterus. What are the methods of endometrial ablation? ** heated fluid balloon ** radiofrequency energy ** microwave energy ** ablation using very cold temperature ** burning using electrical probe (electrosurgery) Does endometrial ablation preserve fertility? No, it should only be done in patients who don’t want future pregnancies Pregnancy after ablation is very rare and if it happens it might end with bad outcomes such as morbidly adherent placenta What should be excluded before endometrial ablation? **Endometrial pathology, as it shouldn’t be done in cases of uterine cancer **active pelvic infection **some uterine congenital anomalies And of course, it shouldn’t be done after menopause as it would be of little value. What are the possible complications after the procedure? ** pain and cramping ** discharge ** infection ** bleeding ** uterine perforation ** fluid overload with certain methods Can heavy bleeding return after ablation? Yes, and it might need further treatment Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/laparoscopy-&-hysteroscopy/endometrial-ablation Mon, 08 Mar 2021 05:25:19 AM Robotic gynecological surgery   Robotic surgeries have been spreading worldwide and in many surgical fields. It allows doctors to perform complex procedures with more precision and higher level of control. It also allows surgeons to perform surgeries on patients in other countries or thousands of kilometers away. In gynecology, it helps perform procedures on uterus, ovaries, fallopian tubes and other pelvic organs through a minimally invasive surgical technique.   What is the most widely used platform for Robotic gynecological surgery? Da Vinci surgical system.   How is robotic surgery applied? Very small incisions (5-12 mm), so cosmetically it is better. 3D high-definition camera inserted Using robotic arms holding tiny surgical equipment The surgeon controlling everything from a console   People might think that a robot might perform the operation but that is not true, a qualified surgeon performs everything through a highly precise controlled system.   What are the gynecological surgeries that are done robotically? Removal of uterus Removal of fibroids Endometriosis surgery Removal of ovary or ovarian cysts Ligation of fallopian tubes Pelvic organ prolapse surgery All types of gynecological cancers   What are the advantages of performing robotic surgery? Smaller incisions (smaller scars) Lower blood loss Less pain after surgeries Hospital stay is shortened (maximum one day) Less time needed for recovery Better accuracy in complex cases   What are the disadvantages of robotic surgery? Long operation time Expensive Not all surgeons are qualified to do it (needs special training)   In which cases do we prefer robotic surgery? Obese patients Very severe endometriosis Early-stage cancers   What is the recovery timeline after robotic surgery? Hospital stay for one day Can start walking after 6 hours Light activity after 1 week Full recovery after 3 weeks   What are the cases that are not ideal for robotic surgery? Severe adhesions Cardiopulmonary disease (can tolerate insufflation of abdomen) Advanced cancer stages that need open incisions Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/laparoscopy-&-hysteroscopy/robotic-gynecological-surgery Mon, 08 Mar 2021 05:25:19 AM Ultrasound Scan https://www.layyous.com/en/ultrasound-scan Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/ultrasound-scan/3d-4d-ultrasound-scans-photos Mon, 08 Mar 2021 05:25:19 AM 3D Gynaecology Ultrasound photos https://www.layyous.com/en/ultrasound-scan/gynecology-ultrasound-photos Mon, 08 Mar 2021 05:25:19 AM Abdominal and General Ultrasound Photos https://www.layyous.com/en/ultrasound-scan/abdominal-and-general-ultrasound-photos Mon, 08 Mar 2021 05:25:19 AM 4D Ultrasound Scan Fetal Video Clips https://www.layyous.com/en/ultrasound-scan/4d-ultrasound-scan-fetal-video-clips Mon, 08 Mar 2021 05:25:19 AM 3D Ultrasound Scan Pictures https://www.layyous.com/en/ultrasound-scan/3d-ultrasound-scan-photos Mon, 08 Mar 2021 05:25:19 AM Links to Scan Photos Slide Show https://www.layyous.com/en/ultrasound-scan/links-to-ultrasound-photos-slide-show Mon, 08 Mar 2021 05:25:19 AM 3D and 4D Ultrasound Scan Clinical Advantages   3D and 4D Advantages In General Simplified 3D acquisition Reduce study time, decrease patient waiting times Faster examination procedure The C-plane obtained, not possible in 2D Complete examination through increased perspective from volume data, … better qualitative and quantitative information to diagnose effectively All planes of view reproducible: virtual patient Anatomical views not possible with 2D scanning Simplify orientation for referring physician patient Obstetrics Morphology, malformation, agenesis (3D, easier in 4D) Bone shape abnormalities: spina bifida, dwarfism, club feet on one image, cleft palate vs. cleft lip. Skeletal. dysplasia, abnormalities in dynamic (4D): investigation of spine Fetal heart (4D): better correlation between valves, chambers and vessels; volume calculation of heart cavities; atrial and ventricular communication; assessment of valvular function. Variety of fetal volume evaluation: urinary bladder, stomach, cyst Fetal biopsy (4D): umbilical blood sampling puncture with precision, amniocentesis, kidney dilatation,uropathy Fetal well-being (4D): normal vs. abnormal fetal gestures; evaluation of fetal sleep vs. awakening. Motion:deglutition, respiratory motion, eyelid, limbs and mouth motion, fetal digestive peristaltic motion. Fetal neuro-myopathy genetic diseases (4D): fetal reactivity / tonicity Cord insertion using power-Dopper and 3D Frontal bones, spatial view of fusion or not STIC and Fetal Cardio Fast, efficient assessment Information acquired can be accessed offline, allowing processing of reproducible views. Simultaneous visualization of 2-3 planes: easier for obstetrician to learn spatial orientation of fetal heart. Better correlation between valves, chambers and vessels. Volume calculation of heart cavities Better access: Left ventricular and right ventricular outflow tracts easier to see with the 3D volume; opening and closing of the foramen ovale difficult to see in 2D, new views now seen with 3D. Atrial and ventricular communication: Ventricular wall can be seen in relation to the chambers" or cutaway the top of the atria and look down into the ventricles using Magicut tool. Cut away heart walls and analyze septum alone in rotation. 90-degree crossing of Roman">DORV; using 3D rotation view how VSD is related to pulmonary artery. Diagnose fetal heart defects in utero, prepare pathologic conditions for treatment at birth. Gynecology Exact volume measurement of endometrial hyperplasia (3/4D) Equivalent hystersonography realization (3D/4D) Virtual hysteroscopy (3D/4D), using slicing technique Exact volume measurement of cysts (post-menopausal), polyps, myoma or fibroma. Exact localization and measurement of ovarian and endometrial tumors Gynecological tumor monitoring after treatment (chemotherapy): effectiveness Contrast media use to check tumor vascularization and blood supply Gynecological contrast media for tumor follow-up (4D) Contrast media to better evaluate the fallopian tubes (tubal permeability, sterility) 3D placental abnormalities (placenta previa) 3D placenta exact insertion vs inferior segment IVD and exact positioning Breast and Small Parts Accurate 4D biopsy in all 3planes, exact placement of the needle Breast tumor volume evaluation Breast tumor treatment monitoring (chemotherapy) Skin tumor infiltration evaluation Contrast media use on breast tumors (4D) 3 planes to define margins, i.e., microlobulation, papillomas; and extra information seen in B, C planes that would otherwise be missed in 2D (A plane). C plane to view compression vs. retraction patterns of tumors Urology Accurate 4D biopsy Needle visualization in all 3 planes allow exact seed implantation (Brachi therapy) Evaluation of the prostate parenchyma due to addition of coronal plane Accurate prostate/urinary bladder volume measurement or/and prostatic/bladder tumors (adenofibroma, neoplasm, papilloma) Correct positioning of urinary catheter Exact assessment of the post-micturitional residue Internal Medicine Precise evaluation of acute abdominal syndrome (3D, C-plane): appendix torsion, ileum sigmoidal fistula, Crohn's disease, endometriosis, recto-sigmoidal fistula, rectitis, oroctitis Accurate 4D biopsy (liver, kidney) Appendicitis with aberrant location (top of the finger-like projection in the pelvic area or in the meso-colic positioning. 3D, C-plane) Excellent evaluation of parenchyma/tumor volumes colic polyps (>to 11 mm) localization in the recto-sigmoidal section (3D, C-plane), colic tumor infiltration within the wall Excellent lithiasis localization in the urethra during renal colic (3D, C-plane) Contrast media use in abdominal tumor (kidney, liver) Virtual colonoscopy Excellent evaluation in3D of cholecystitis (Wall thickness evaluation. Lithiasis is better seen in 3D than in2D) Abdominal tumor volume follow-up and monitoring in 3D Tumor location versus vascularization before chemo-embolism (3D/4D) Obstruction determination in icterus mechanism (3D/4D) Pediatrics Neonatal brain, 3-plane view of chamber symmetry; volume measurements Color or power-angio vessel correlation Hip measurement Orthop edics/Musculoskeletal Musculoskeletal biopsy guidance (4D) Musculoskeletal dynamic examination (4D): rotator-cuff, knee (meniscus positioning), hip measurement Intervertebral disc (nucleus) evaluation, degenerative disc desease (3D) Bone microsplit evaluation (3D) Broken or fractured patella Partial tendon separation evaluation (3D) Tendinitis diagnosis and follow-up (breaking-point risk evaI;1;iation) Fetal bone-shape abnormalities Degenerative arthritis (joint disease) Check-up of bone screw placement Opthalmology Excellent volume measurement of the normal structures (lens, eyes) Tumor findings (retinal melanoma) Retinal detachment evaluation (3D) Foreign particle detection within the vitreous humor (3D) Vitreous proliferative retinopathy evaluation (3D) (Ref :VISUS Education)   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/ultrasound-scan/the-clinical-advantages-of-3d-and-4d-ultrasound Mon, 08 Mar 2021 05:25:19 AM Questions Related To Four Dimensional Ultrasound 1- Is there special arrangements before the examination? No special arrangements expect for taking an appointment, sometimes she may need to have full bladder, in this case she is asked to drink 4cups of water or juice and wait for a while before the examination. 2- Is it a safe procedure? How long does it take? Yes, it is a safe procedure; the ideal examination takes 20-40 minute. 3- In which cases of pregnancy it is considered very important? Old maternal age. Previous baby with congenital anomalies. Negative laboratory result. Family history of congenital anomalies. Maternal exposure to affecting factors such as, taking certain medications or poisonous substances. 4- What is the appropriate time for this procedure? The ideal thing is to do this three times during pregnancy: In the first trimester: To check if there are certain congenital anomalies such as, anencephaly, neural tube defects or anomalies related to abdominal wall and limbs. In the second trimester: To have an idea with more details for the fetus and check his internal organs and their functions, and the most important of which is the heart. In the third and last trimester: To have more clear idea and observe some problems that may appear during this period such as, growth and development, muscle coordination, fetal movement and if there is any growth retardation. If the pregnant wants only to have this examination one time only, she is advised to do it during the fifth month of pregnancy in which the doctor can check most of the details at this time, in addition, the pregnant can recognize some details of the fetus. It should be mentioned here that the most beautiful photos for the baby is between 26-30 weeks but there is no guarantee to have beautiful ones especially for the face. 5- What is the main goal from this examination? It is to check on fetal wellbeing, by examining most of fetal organs like: heart, kidneys, liver, stomach and other details that the mother may not understand its importance. It has a role also in social relationship and bonding between the mother and the fetus, but taking photos for his face is something that you can’t control because it depends completely on fetal position which can’t be controlled. 6- Is the 4-D scan an alternative for amniocentesis? No, it is not an alternative. 7- Is there a guarantee to have fetal photos exactly like the ones on our web site? Fetal photos depend on many factors: First: Fetal position inside the uterus. Second: Fetal age. Third: The amounts of liquor around the fetus, good amounts are required to have clear photos. Fourth: The skills for who is using the ultrasound. All these factors together affect the quality of the photos, all we can’t guarantee except the fourth one (the skill). 8- When I can have the photos and C.D? Just before leaving our center. https://www.layyous.com/en/ultrasound-scan/questions-related-to-four-dimensional-ultrasound Mon, 08 Mar 2021 05:25:19 AM Four Dimensional Ultrasound, Definition and Features   What are the three dimensions? What is the fourth one? When we say three dimensions we mean length, width and height (depth), and that is what forms a holograph. The fourth dimension is time, which gives life for the three dimensions. With three dimensional ultrasound, the doctor needs effort in rotating the pictures to take the third dimension which takes time, but the fourth dimensional ultrasound gives the third dimension at the exact time when needed. For that reason, it is called, “live three dimensional ultrasound.”   This device can take photos in three different ways: 1 - Surface Imaging: When taking photos of the fetus, with this process, it shows the body surface without penetrating the internal organs. With this, the treating physician can check on fetal wellbeing and check for multiple potential anomalies in the body, such as a cleft lip. It can also give a close and clear photo of the features of the fetus. These can be clear, just like photographic photos, and it can diagnose external organ anomalies like ear, nose, hand, foot issues. It can also help in accurate diagnosis of Down syndrome. As identifying the surface can be done by this method, it can differentiate malignant from benign tumors as well.   2- Penetrating tissues: This is like the two dimensional ultrasound. It shows the integrity of internal fetal organs like the heart, kidneys, liver, stomach and the rest of the internal organs in three dimensions. It can show accurate size, and irregular shape.   3- Transparent imaging: This gives photos of the skeleton of the fetus, just like X-ray pictures. Any anomalies of the skeleton will be obvious in addition to being able to observe jaw development. The breast can be examined also which can show obvious tubers in addition to the Doppler which shows blood flow and its direction. We can study heart function for the patient or the fetus inside the uterus or study blood circulation in the tissues, in general. It can also be used in the diagnosis of cancerous tumors, breast masses and unknown masses in the human body.   These previously mentioned ways provide the four dimensioned scan advantages like: Enables the treating physician to have general comprehensive stereoscopic images which helps in accurate diagnosis and following live movements inside the human body in its three dimensions, and it plays a major role in taking biopsies or inserting catheters inside the body. The possibility of storing photos through the computer and studying their sections later. This has saved much time in examination and makes a second opinion very easy, if the treating physician needs to consult another physician or if he needs to study sections in more detail. The accurate diagnoses that can be achieved by these devices has made diagnosis easier and it minimizes the associated psychological stress on the patient as well as the effort and financial cost by minimizing assumptions and contradictions. Accurate measurement for internal organs if they have an irregular shapes. All these advantages have forced the world to push and rush development, and to make scientific revolutions in two dimensional ultrasound. It can achieve good results in diagnosis, but it needs this kind of revolution to give it the best results and finest details.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/ultrasound-scan/definition-and-features-of-four-dimensional-ultrasound Mon, 08 Mar 2021 05:25:19 AM Uses of Four Dimensional Ultrasound scan   Four dimensional ultrasound has widespread applications in diagnosis, the most important ones are:   1- Follow up of pregnancy and fetal wellbeing throughout the different stages of pregnancy: First trimester: Check the number of embryos. Threatened abortion. Dating of pregnancy. Fetal heart. If there is ectopic pregnancy (pregnancy outside the uterus). Completion of skull bones. Completion of vertebral columns and if there is any problem like neural tube defects or meningocele. Diagnosis of Down syndrome. Identify the sex of the baby. Check upper and lower limbs and facial features. Second and third trimester: Examine the head and brain in a detailed manner. Check if there are associated anomalies of the internal organs like, heart, brain, lungs, kidneys, stomach, esophagus, bladder and liver. Check the chest, thoracic cage and abdomen. Identify if there is chromosomal or congenital anomalies. Fetal growth, development and synchronization of its movement. Check placental location and associated problems such as, infarctions, insufficiency, identify umbilical cord insertion, thrombosis and coherence in the case of multiple pregnancies, if we use Doppler ultrasound. To study the amount of amniotic fluid around the fetus, blood supply to fetal organs and blood flow in the umbilical cord. To have a clear idea of fetal features, attitude and surrounding environment. Identify risk factors for preterm labor. Fourth dimensional ultrasound: Has achieved the greatest applications in fetal wellbeing, diagnosis of congenital and chromosomal anomalies, whether related to fetal surface, internal organs or fetal skeleton. In addition to the joyful feeling the parents would have by looking at their baby, which has a major role in strengthening the child - parent relationship. It will also help them to accept and handle anomalies (if present). This will minimize post partum psychological stress. This test needs only 20 - 40 minutes. It is safe and does not need any preparation, except for setting an appointment.   2- Diagnosis of women's infertility and gynecological problems: A- Ovaries: Accurate estimation of ovarian size. Follicular measurements (number and accurate size). Diagnosis of PCOs. Follicular tracing and to identify ovarian hyperstimulation. Cyst aspiration and oocyte retrieval, which is done by monitoring needle insertion and piercing through the ultrasound screen. Diagnosis of ovarian cancer. B- Fallopian tube: Differentiate between hydrosalpinx (fluid accumulation inside the tube), and ovarian cysts. Evaluate tubal function. C- Uterine status diagnosis: Positive evaluation of endometrial shape, thickness and accurate size. Diagnose uterine anomalies by taking complete sections of the uterus. Identifying uterine factors interfering with pregnancy like endometrial polyps, fibroids or tumors. Achieve the purpose of HSG and checking fallopian tubes by (Hycosy), using saline, injecting it into the uterus and following its path. This procedure will avoid the patient being exposed to X-ray, allergic reactions to the dye and anesthesia. It is done at the clinic, a quick and painless procedure.   3- In family planning: Check the position of IUD. Check if the woman’s body is suitable for IUD or not, if there is, (pregnancy, uterine anomaly, tumors, internal infections, history of ectopic pregnancy or recurrent abortions), the woman cannot use IUD for contraception. 4- Diagnose cancerous tumors: Four dimensional ultrasound can accurately visualize internal organs and understand the complicated relation between anatomical organs, measuring their accurate size and area, especially if there are irregularities. All this enables the doctor to diagnose tumors and differentiate benign from malignant lesions, especially in the breast, testes, uterus, ovary and cervix. Using Doppler ultrasound can clarify the degree of blood supply.   5- Breast examination and diagnosing masses or tubers.   6- Treatment of male infertility: Examining the testes and check if there is varicocele or hydrocele. Check the prostate gland. This device is also helpful in other medical fields such as, urinary tract, kidneys, internal medicine, heart, respiratory system, brain, neurological system and even in ophthalmology.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/ultrasound-scan/uses-of-4d-ultrasound-scan Mon, 08 Mar 2021 05:25:19 AM A Short History of Sonography in Obstetrics and Gynaecology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987368/ S. Campbell Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/ultrasound-scan/a-short-history-of-the-development-of-ultrasound-in-obstetrics-and-gynecology-dr.-joseph-woo Mon, 08 Mar 2021 05:25:19 AM Fetal behavior during pregnancy   Fetus ….. World of secrets that can be discovered by four dimensional ultrasound Fetal life starts by the fertilization of ova by sperm followed by division of the cells that will increase in number and the organs start to be formed and start functioning forming in that way a human being that is modest in size and complicated in development and behavior that use the uterus as a place of residence until it's time for him to meet the outside world!!! The four dimensional ultrasound has opened a window in to the woman's uterus to discover the secrets of that human being and to answer a lot of questions that surround him and that stunned the scientists for long period of time and that stimulated the curiosity of parents such as: when the fetus start moving? What are that movements? And when does the mother feel them? And does the fetus have senses? Does he feel pain? Does he sleep? Does he dream? Does he have the ability to learn and does he have memory? Is stimulating the fetus is a healthy phenomenon? A lot of questions that were impossible to be answered without the massive development that has occurred on the ultrasound devices. The first fetal movement-that doctors can observe- starts between the seventh week and the middle of the eighth week and it can't be felt by the mother. And it’s a sudden movement that continues for one to two seconds as if the whole body of the fetus that is around 2 cm in length in that period of time is moving and this movement is preceded by his heart beats that can be monitored during the 6th week. And from that moment the practical fetal life starts inside the uterus of his mother and every day the fetus grows up is associated with an increase in complexity of his movements and his organs start functioning gradually. Those movements take different shapes and the scientists thought for long period of time that those movements start as a reaction but it was found later on that they are spontaneous and unplanned movements that develop gradually with time until the fetus start to flex and extend his arm then flex and extend his limps and moving his whole body without the appearance of the movements of limps. And that overall body movement increase in strength from the 8th week- when it starts- until the 12th week so it ranges between strength and weakness. But the greatest thing which distinguishes it is that it gives this little creature an intimation of high confidence that he keeps for himself always. And one of the funny movements that can be monitored and that start in the 9th week is the hiccup which is associated with a contraction in the diaphragm and it can be monitored by the doctors in the abdominal and chest movements, and the hiccup usually is repeated in a short and fixed periods of time and it rarely happen for one time only. On the other hand the mouth movements are various and start by opening and closing the jaw and by chewing like movements since the 10th week and then yawning in the middle of the 11th week that start by opening his mouth and relaxing the tongue and staying in that situation for 1 to 8 seconds and it might be asked by some people what make the fetus to yawn?! The reason that causes the adults and the children to yawn is the same that cause this little creature of a few centimeters length to yawn too, and it’s the lake of oxygen that nourishes the brain in cases of sleepiness, boredom, and rarely is associated with tiredness. So the body starts involuntary mouth movement to prepare the chance to inhale the largest proportion of oxygen. And the yawning is a phenomenon that might be related to some medical conditions like anemia, and so it's a common character between the healthy fetuses. Sucking and swallowing can be noticed in the middle of the 12th week and at that time the fetus can be seen sucking his finger or putting his hand on his face, opening and closing his fingers, putting one hand over the other and moving his feet, making acrobatic movements trying to attract the attention of his parents and to deliver a message from his little surrounding that he is he is a human being with an individual personality and special needs, even if it was before the 1st trimester of the pregnancy. And as the fetus is approaching the expected date of delivery, his behavior becomes as close as possible to the behavior of the newly born baby. And in spite of all those movements that start early in pregnancy, the mother doesn’t feel them until the 16th to 20th week of pregnancy. And the proportion of movements that are felt by the mother is negligible when compared to the overall movements of the fetus that sleeps and wakes up and moves on a rate of 50 movements per hour. And he goes through the same sleep stages of us, he feels sleepy and goes in a deep sleep and he has dreams during his sleep that can make him smile or annoyed and in many times he might feel angry and frown his eyebrows, and this can be seen during sleep and wakefulness. Sleep stages change and take its final shape with the fetal brain development until it becomes the same as in the new born when approaching the time of delivery. And it's worth mentioning that the fetus in the 32 weeks sleeps in 85-90% of his day. It remains to say that the movements of the eye lids appear between the 18th and the 20th weeks but it can't be distinguished easily by the doctors. The most complicated question is that does the fetus have the same senses that we have?! After the researches that was done by the scientists the answer was yes. And the first sense that appears in the fetus is the sense of touch that starts in the face in the 7th week and then it moves gradually to the rest of the body. In the 14th week of pregnancy the sense of taste starts so we find the fetus sucking and swallowing and the strangest thing is that the speed of swallowing of the amniotic fluid depends on the taste of this fluid that change according to the type of the mother nutrition. And it was found by the scientists that the swallowing becomes faster when the taste is sweeter!! The sense of hearing in the fetus starts sooner than everybody thinks, it starts in the 16th week in spite that the ears take its final shape in the 24th week. It can be concluded that when it comes the time of birth, the fetus will have the same hearing ability of the adults… that he gained from his 6 months experience in hearing his mother heart beats and the blood flow and what reach to him through the abdominal wall and the uterus, in addition to the stomach and intestines sounds. And the fetus can be monitored by the ultrasound vibrate strongly in response to the powerful acoustic stimuli. He even born preferring the voice of his mother and there are many cases recorded when the fetal heart beats became slower by hearing the voice of his mother or a story by a familiar voice to him as he doesn’t only hear the voices, he distinguishes them too and this is a proof that the ability to learn and the memory are formed in the human before he meets the outside world. And those conclusions by the scientists came out by the prolonged observation of the fetuses within the researches, in addition to the monitoring of the fetus behavior, as a reflex to the voice was seen in the 24 weeks fetus. The vision is the last sense formed in the fetus and this sense was discovered by the Japanese scientists by shedding a strong light to the abdomen of the mother and they registered a response from the fetus. However, most scientists advised not to do such experiences on the fetuses before he becomes ready to receive such stimulants. Even the damage that happens to the retina in the preterm babies that was explained by the doctors for long period of time to the high concentrated oxygen that he receives was attributed to the exposure of the infant to the high degrees of the light that he is not actually ready to receive during that stage. For example, the brain of the fetus during the 6 months of pregnancy is not ready to receive or translate the signals of the eyes which affect the fetal brain development. In general, the scientists are against the external influences that are over expected in all its types the audio, the visual or the sensual effects, that exceeds the limits of the short, quiet conversation and the story telling for short periods of time. Because all those influences have an effect on the fetal life in terms of sleep and alertness which affects the brain and nerves development and thus will give an adverse results to that expected by the parents like the increase in the mental development of the fetus in the future. And the best way to achieve this goal is by providing a uterine environment that is free from toxic materials for a mother without any psychological pressures and to have a healthy nutrition. And it was proved by the scientists that level of intelligence of the children is affected by the uterine environment more than it's affected by the genetic factor. On the other hand the feeling of pain – unexpectedly- will be formed in the fetus at an early age and the doctors notice that in the procedure of the amniocentesis in which a needle is inserted through the uterus and if the fetus was accidently pricked by the needle he will withdraw quickly trying to escape and he will attack the needle again to defends himself and there was found a 6 times increase in the hormone B endorphins that is responsible of the body reaction to the stress in addition to the increasing in the breathing rate when the enfant is exposed to a sharp object. And this is the result of experiments that done by scientists in London to prove that the enfant can feel pain after this fact has been denied by the embryos surgeon for long period of time. It remains to say that a case of crying infant in 23 weeks was recorded. After all what mentioned above, everything we see by a 4 dimensional ultrasound can be explained, so this tiny creature has an independent personality that has its special hallmark that gives an inspiration of what he will be in the distant future. And the most beautiful thing that can be seen by a 4 dimensional ultrasound is twin playing or awakens one another or even hitting each other… it is a world full of secrets. Images displayed are for infants of varying ages that was captured by a 4 dimensional ultrasound in Doctor Najeeb Layyous centre which is located in Amman- Jabal Al-Hussein- Next to Amal Hospital.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/ultrasound-scan/fetal-behavior-during-pregnancy Mon, 08 Mar 2021 05:25:19 AM Start Your Baby's Photo Album   3D/4D Pregnancy Ultrasound Scan and recording it on Video and/or CD Start Your Baby's Photo Album   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/ultrasound-scan/start-your-baby-s-photo-album Mon, 08 Mar 2021 05:25:19 AM The importance of 4D ultrasound imaging in pregnancy 4D ultrasound is a technological development of 2D and 3D imaging, as it adds the element of time to the 3D image, allowing for the display of a moving stereoscopic image of the fetus in real time. Technical Principle: 4D ultrasound relies on high-frequency ultrasound waves. Multiple 2D images are collected and digitally reconstructed to produce a 3D moving image. The physical principle is the same as traditional sonar, but the image processing mechanism and quality differ. Clinical Importance: Although the common use of 4D ultrasound is for interactive purposes and to reinforce maternal-fetal bonding, it has important clinical applications, including: 1- Evaluation of superficial malformations (cleft lip, facial deformities, and limb defects) 2- Evaluation of fetal behavior and movement (as fine limb movements, facial expressions, mouth movements, and swallowing can be observed) 3-Supporting diagnosis in some specific cases (for example, if there is suspicion of abdominal wall defects, and evaluating the spine at certain angles) Optimal timing for the scan: The best time for an anomaly scan is between weeks 18 and 22. Image clarity depends on several factors, including: - Abdominal wall thickness - Fetal position - Amniotic fluid volume 4D ultrasound is considered safe when used according to medical guidelines and is a helpful tool in assessing some surface abnormalities and fetal movement, but it remains a supplementary examination and does not replace the basic examinations used in monitoring pregnancy. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/ultrasound-scan/the-importance-of-4d-ultrasound-imaging-in-pregnancy Mon, 08 Mar 2021 05:25:19 AM Video & Photos https://www.layyous.com/en/video-&-photos Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/video-&-photos/video-clips Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/video-&-photos/photos Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/latest-news Mon, 08 Mar 2021 05:25:19 AM Corona Virus Prophylaxis - COVID-19 Prophylaxis There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). The best way to prevent illness is to avoid being exposed to this virus. The virus is thought to spread mainly from person-to-person. Between people who are in close contact with one another (within about 6 feet). Through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. What to do ?? Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry. Avoid touching your eyes, nose, and mouth with unwashed hands. Avoid close contact with people who are sick Put distance between yourself and other people if COVID-19 is spreading in your community. This is especially important for people who are at higher risk of getting very sick. Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow. Throw used tissues in the trash. Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol. If you are sick: You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers. Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks. If surfaces are dirty, clean them: Use detergent or soap and water prior to disinfection. https://www.layyous.com/en/latest-news/corona-virus-prophylaxis Mon, 08 Mar 2021 05:25:19 AM Corona Viruses Disease - CoronaVirus (COVID 19) Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China. The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). Cases of COVID-19 have been reported in a growing number of countries, including the U.S. Public health groups, such as the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC), are monitoring the situation and posting updates on their websites. WHO declared a global pandemic in March 2020. These groups have also issued recommendations for preventing and treating the illness. Symptoms Signs and symptoms of COVID-19 may appear two to 14 days after exposure and can include: Fever Cough Shortness of breath or difficulty breathing Other symptoms can include: Tiredness Aches Runny nose Sore throat The severity of COVID-19 symptoms can range from very mild to severe. Some people have no symptoms. People who are older or have existing chronic medical conditions, such as heart or lung disease or diabetes, may be at higher risk of serious illness. This is similar to what is seen with other respiratory illnesses, such as influenza. When to see a doctor Contact your doctor or clinic right away if you have COVID-19 symptoms, you've been exposed to someone with COVID-19, or you live in or have traveled from an area with ongoing community spread of COVID-19 as determined by CDC and WHO. Call your doctor ahead to tell him or her about your symptoms and recent travels and possible exposure before you go to your appointment. Anyone with respiratory symptoms who hasn't been in an area with ongoing community spread can contact his or her doctor or clinic for further recommendations and guidance. Let your doctor know if you have other chronic medical conditions. As the pandemic progresses, it's important to make sure health care is available for those in greatest need. Causes It's unclear exactly how contagious the new coronavirus is. It appears to spread from person to person among those in close contact. It may be spread by respiratory droplets released when someone with the virus coughs or sneezes. It may also be spread if a person touches a surface with the virus on it and then touches his or her mouth, nose or eyes. Risk factors Risk factors for COVID-19 appear to include: Recent travel from or residence in an area with ongoing community spread of COVID-19 as determined by CDC or WHO Close contact with someone who has COVID-19 — such as when a family member or health care worker takes care of an infected person Complications Complications can include: Pneumonia in both lungs Organ failure in several organs Death Diagnosis If you develop symptoms of coronavirus disease 2019 (COVID-19) and you've been exposed to the virus, contact your doctor. Tell him or her if you've traveled to any areas with ongoing community spread of COVID-19 according to CDC and WHO. Also let your doctor know if you've had close contact with anyone who has been diagnosed with COVID-19. Your doctor may determine whether to conduct tests for COVID-19 based on your signs and symptoms. To decide whether to conduct tests for COVID-19, he or she may also consider whether you have had close contact with someone diagnosed with COVID-19 or traveled to or lived in any areas with ongoing community spread of COVID-19 in the last 14 days. To test for COVID-19, your doctor may take samples, including a sample of saliva (sputum), a nasal swab and a throat swab, to send to a lab for testing. Treatment Currently, no antiviral medication is recommended to treatCOVID-19. Treatment is directed at relieving symptoms and may include: Pain relievers (ibuprofen or acetaminophen) Cough syrup or medication Rest Fluid intake If your doctor thinks you can be treated at home, he or she may give you special instructions, such as to isolate yourself as much as possible from family and pets while you're sick and to stay home for a period of time. If you're very ill, you may need to be treated in the hospital. https://www.layyous.com/en/latest-news/corona-viruses-disease Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/about-jordan Mon, 08 Mar 2021 05:25:19 AM Universities in Jordan University Location Tel. Fax. Al al-Bayt University Mafraq +962 (2) 629 7000 +962 (2) 487 1232 Al-Ahliyya Amman University Amman +962 (6) 533 3315 +962 (6) 533 5169 Al-Balqa Applied University Al-Salt +962 (5) 349 1111 +962 (5) 353 2312 Al-Hussein Bin Talal University Ma'an +962 (3) 217 9000 +962 (3) 217 9050 Al-Zaytoonah University of Jordan Amman +962 (6) 429 1511 +962 (6) 429 1432 Amman Arab University Amman +962 (6) 551 6124 +962 (6) 551 61103 Applied Science Private University Amman +962 (6) 560 9999 +962 (6) 523 2899 Arab Academy for Banking and Financial Sciences Amman +962 (6) 550 2900 +962 (6) 523 7834 German Jordanian University Amman +962 (6) 530 0666 +962 (6) 534 1573 Irbid National University Irbid +962 (2) 705 6680 +962 (2) 705 6681 Isra University Amman +962 (6) 471 1710 +962 (6) 471 1505 Jadara University Irbid +962 (2) 720 1222 +962 (2) 720 1210 Jerash Private University Jerash +962 (2) 635 0521 +962 (2) 635 0520 Jordan Applied University College of Hospitality and Tourism Education Amman +962 (6) 562 9232 +962 (6) 567 1133 Jordan University of Science and Technology Irbid +962 (2) 720 1000 +962 (2) 709 5123 Middle East University Amman +962 (6) 479 0222 +962 (6) 412 9613 Mutah university Al Karak +962 (3) 237 2380 +962 (3) 237 5540 New York Institute of Technology Amman +962 (6) 553 7861 +962 (6) 553 7862 Philadelphia University Amman +962 (6) 47 99000 +962 (6) 47 99040 Princess Sumaya University for Technology Al Jubaiha +962 (6) 534 8441 +962 (6) 534 7295 Tafila Technical University Tafilah +962 (3) 225 0326 +962 (3) 225 0002 The Hashemite University Zarqa +962 (5) 390 3333 +962 (5) 382 6613 The World Islamic Sciences & Education University Amman +962 (6) 506 2895 +962 (6) 506 3042 University of Jordan Amman +962 (6) 535 5000 +962 (6) 535 5511 University of Petra Amman +962 (6) 5799555 +962 (6) 571 5570 Yarmouk University Irbid +962 (2) 721 1111 +962 (2) 727 4725 Zarqa University Zarqa +962 (5) 382 1100 +962 (5) 382 1120 https://www.layyous.com/en/about-jordan/jordan-university Mon, 08 Mar 2021 05:25:19 AM Jordan Hospitals Hospital Location Tel. Fax. Specialty Hospital Amman +962-6-5001111 +962-6-5697425 Istishari Hospital Amman +962-6-5001000 +962-6-5698833 Afia Radiotherapy and Nuclear Medicine Centre Amman +962-6-4622280 +962-6-4622281 Palestine Hospital Amman +962-6-5607071 +962-6-5686406 Abdulhadi Eye Hospital Amman +962-6-4627628 +962-6-4659534 Al Amal Hospital Amman +962-6-5607155 +962-6-5673155 Al Essra Hospital Amman +962-6-5300300 +962-6-5347888 Al Mowasah Hospital Amman +962-6-4896842 +962-6-4896806 Al Rashid Hospital Amman +962-6-4722248 +962-6-4722248 Al Khalidi Medical Center Amman +962-6-4644281 +962-6-4616801 Amman Surgical Hospital Amman +962-6-4641261 +962-6-4641260 Arab Medical Centre Amman +962-6-5921199 +962-6-5921282 Bashir Hospital Amman +962-6-4702966 +962-6-4772189 Eye Specialty Hospital Amman +962-6-4884899 +962-6-4884898 Farah Hospital Amman +962-6-4603555 +962-6-4644440 Ibn Al Haytham Hospital Amman +962-6-4391111 +962-6-4383111 Ibn AL Nafis Hospital Irbid +962-02-710210 +962-02-710210 International Hospital Amman +962-6-5852040 +962-6-5853031 Islamic Hospital Amman +962-6-5680127 +962-6-5661773 Islamic Hospital Aqaba Aqaba +962-3-2018444 +962-32018844 Istiklal Hospital Amman +962-6-5652600 +962-6-5652710 Jordan Hospital Amman +962-6-5608080 +962-6-5607575 Jordan University Hospital Amman +962-6-5353444 +962-6-5353388 King Abdullah University Hospital Irbid +962-2-7200600 +962-2-7095777 King Hussein Cancer Center Amman +962-6-5300460 +962-6-5353001 Prince Hamza Hospital Amman +962-6-5053846 +962-6-5053792 Shmaisani Hospital Amman +962-6-5607431 +962-6-5669310 https://www.layyous.com/en/about-jordan/jordan-hospitals Mon, 08 Mar 2021 05:25:19 AM Tourist places in Jordan Amman Amman, the capital of Jordan, is a fascinating city of contrasts – a unique blend of old and new, ideally situated on a hilly area between the desert and the fertile Jordan Valley. In the commercial heart of the city, ultra-modern buildings, hotels, smart restaurants, art galleriesand boutiques rub shoulders comfortably with traditional coffee shops and tiny artisans' workshops. Everywhere there is evidence of the city’s much older past. Due to the city’s modern-day prosperity and temperate climate, almost half of Jordan’s population is concentrated in the Amman area. The residential suburbs consist of mainly tree-lined streets and avenues flanked by elegant, almost uniformly white houses in accordance with a municipal law, which states that all buildings must be faced with local stone. The downtown area is much older and more traditional with smaller businesses producing and selling everything from fabulous jewellery to everyday household items. The people of Amman are multi-cultural, multi-denominational, well-educated and extremely hospitable. They welcome visitors and take pride in showing them around their fascinating and vibrant city. Petra The giant red mountains and vast mausoleums of a departed race have nothing in common with modern civilization, and ask nothing of it except to be appreciated at their true value - as one of the greatest wonders ever wrought by Nature and Man. Although much has been written about Petra, nothing really prepares you for this amazing place. It has to be seen to be believed. Petra, the world wonder, is without a doubt Jordan’s most valuable treasure and greatest tourist attraction. It is a vast, unique city, carved into the sheer rock face by the Nabataeans, an industrious Arab people who settled here more than 2000 years ago, turning it into an important junction for the silk, spice and other trade routes that linked China, India and southern Arabia with Egypt, Syria, Greece and Rome. Entrance to the city is through the Siq, a narrow gorge, over 1km in length, which is flanked on either side by soaring, 80m high cliffs. Just walking through the Siq is an experience in itself. The colours and formations of the rocks are dazzling. As you reach the end of the Siq you will catch your first glimpse of Al-Khazneh (Treasury). This is an awe-inspiring experience. A massive façade, 30m wide and 43m high, carved out of the sheer, dusky pink rock-face and dwarfing everything around it. It was carved in the early 1st century as the tomb of an important Nabataean king and represents the engineering genius of these ancient people. Jerash A close second to Petra on the list of favourite destinations in Jordan is the ancient city of Jerash, which boasts an unbroken chain of human occupation dating back more than 6,500 years. Jerash lies on a plain surrounded by hilly wooded areas and fertile basins. Conquered by General Pompey in 63 BC, it came under Roman rule and was one of the ten great Roman cities of the Decapolis League. The city's golden age came under Roman rule, during which time it was known as Gerasa, and the site is now generally acknowledged to be one of the best-preserved Roman provincial towns in the world. Hidden for centuries in sand before being excavated and restored over the past 70 years, Jerash reveals a fine example of the grand, formal provincial Roman urbanism that is found throughout the Middle East, comprising paved and colonnaded streets, soaring hilltop temples, handsome theatres, spacious public squares and plazas, baths, fountains and city walls pierced by towers and gates. Beneath its external Graeco - Roman veneer, Jerash also preserves a subtle blend of east and west. Its architecture, religion and languages reflect a process by which two powerful cultures meshed and coexisted - The Graeco-Roman world of the Mediterranean basin and the traditions of the Arab Orient. The modern city of Jerash can be found to the east of the ruins. While the old and new share a city wall, careful preservation and planning has seen the city itself develop well away from the ruins so there is no encroachment on the sites of old. Dead Sea Without a doubt the world’s most amazing place, the Jordan Rift Valley is a dramatic, beautiful landscape, which at the Dead Sea, is over 400m (1,312 ft.) below sea level. The lowest point on the face of the earth, this vast stretch of water receives a number of incoming rivers, including the River Jordan. Once the waters reach the Dead Sea they are land-locked and have nowhere to go, so they evaporate, leaving behind a dense, rich, cocktail of salts and minerals that supply industry, agriculture and medicine with some of its finest products. The Dead Sea is flanked by mountains to the east and the rolling hills of Jerusalem to the west, giving it an almost other-worldly beauty. Although sparsely populated and serenely quiet now, the area is believed to have been home to five Biblical cities: Sodom, Gomorrah, Adman, Zebouin and Zoar (Bela). One of the most spectacular natural and spiritual landscapes in the world, the Jordanian east coast of the Dead Sea has evolved into a major hub of both religious and health & wellness tourism in the region. A series of good roads, excellent hotels with spa and fitness facilities, as well as archaeological and spiritual discoveries make this region as enticing to today’s international visitors as it was to kings, emperors, traders, prophets and pilgrims in antiquity. The leading attraction at the Dead Sea is the warm, soothing, super salty water itself – some ten times saltier than sea water, and rich in chloride salts of magnesium, sodium, potassium, bromine and several others. The unusually warm, incredibly buoyant and mineral-rich waters have attracted visitors since ancient times, including King Herod the Great and the beautiful Egyptian Queen, Cleopatra. All of whom have luxuriated in the Dead Sea’s rich, black, stimulating mud and floated effortlessly on their backs while soaking up the water's healthy minerals along with the gently diffused rays of the Jordanian sun. Amman Touristic Beach Situated on the Dead Sea main road, two kilometres after the hotels area . Amman Touristic Beach offers swimming pools and changing rooms for low budget travelers and locals for minimal fees. Amman Touristic Beach is an ideal location for beach parties and events. Aqaba With its wealth of other attractions, Jordan’s splendid Red Sea resort is often overlooked by modern-day visitors. But apart from being a delightful place for discerning holidaymakers, this is actually a great base from which to explore various places of interest in southern Jordan. Aqaba is a fun place. It is a microcosm of all the good things Jordan has to offer, including a fascinating historywith some outstanding sites, excellent hotelsand activities, superb visitor facilities, good shopping, and welcoming, friendly people, who enjoy nothing more than making sure their visitors have a good time. But perhaps Aqaba’s greatest asset is the Red Sea itself. Here you can experience some of the best snorkelling and divingin the world. The temperate climate and gentle water currents have created a perfect environment for the growth of corals and a teeming plethora of marine life. Here you can swim with friendly sea turtles and dolphins as they dart amongst the schools of multi-coloured fish. Night dives reveal the nocturnal sea creatures, crabs, lobsters and shrimp, as they search for a midnight snack. There are several dive centres in Aqaba. All offer well-maintained diving equipment, professional instructors, and transport by boat to a variety of dive sites. For those who prefer to keep their feet dry, all the deep sea wonders can be viewed through a glass-bottomed boat or by submarine, or you can just relax under the sun on the resort’s sandy beaches. Plus, of course, there are plenty of other water-sport activities available, as well as an extensive and interesting Marine Park. From as far back as five and a half thousand years ago Aqaba has played an important role in the economy of the region. It was a prime junction for land and sea routes from Asia, Africa and Europe, a role it still plays today. Because of this vital function, there are many historic sitesto be explored within the area, including what is believed to be the oldest purpose-built church in the world. Aqaba International Airport is situated just 20 minutes from the town centre and services regular flights from Ammanas well as from several European cities. From the town centre, the borders of Israel, Egypt’s Sinai and Saudi Arabia are no more than a 30-minute drive.   Source : Jordan Tourism Board https://www.layyous.com/en/about-jordan/tourist-places-in-jordan Mon, 08 Mar 2021 05:25:19 AM Travel Agencies   Travel Agencies Location Tel. Fax. Abercrombie and Kent Jordan Amman +962-6-5665465 +962-6-566476 Adviser Travel And Tourism Amman +962-6-5538325 +962-6-5523411 Amani Tours Amman +962-6-4636166 +962-6-4614400 Amin Kawar and Sons Travel and Tourism Amman +962-6-5604676 +962-6-5604649 Ashtar Tours International Amman +962-6-461641 +962-6-461642 Atlas Travel Tourist Agency Amman +962-6-4656647 +962-6-4610198 Dakkak Tours International Amman   +962-6-560107 Desert Horizon Travel Tourism Amman +962-6-569799 +962-6-569818 Green Arrow Tours Amman +962-6-5858478 +962-6-5857242 Green Meadows Travel Tourism Amman +962-6-5777170 +962-6-5777171 Hermes Arabia Amman +962-6-5411785 +962-6-541178 International Traders Amman +962-6-560701 +962-6-566990 Jordan Select Tours Amman +962-6-5930588 +962-6-5930811 Jordan Tours And Travel Petra +962-3-2154666 +962-3-2154600 Karma House Travel Tourism Amman +962-6-4631654 +962-6-4631183 Maltrans Travel Tourism Amman +962-6-5626141 +962-6-5626142 Nebo Tours Amman +962-6-5679950 +962-6-5679954 Pan Arabian Travel Company Limited Amman +962-6-5531014 +962-6-5512074 Petra Moon Tourism Services Petra +962-3-215-666 +962-3-215-666 Plaza Tours Amman +962-6-5651773 +962-6-5651774 Royal Tours Amman +962-6-58572 +962-6-58276 Rum Travel Amman +962-6-5697434 +962-6-5697437 Terhaal Travel Tourism Amman +962-6-581306 +962-6-581204 Travel One Amman +962-6-590200 +962-6-59377 Tropicana Tours Irbid +962-6-5623743 +962-6-5623745 Tyche Tours Amman +962-6-5663150 +962-6-5690150 United Travel Agency Amman +962-6-566049 +962-6-566026 Zaatarah Co. Tourist And Travel Agency Amman +962-6-4612003 +962-6-4655011   https://www.layyous.com/en/about-jordan/travel-agencies Mon, 08 Mar 2021 05:25:19 AM Jordan Facts & Figures History Jordan, a kingdom in the northwestern corner of the Arabian Peninsula, is bounded by Syria in the north, Saudi Arabia on the south, Iraq and Saudi Arabia on the east, and the Occupied West Bank and Israel in the west. The Nabateans, An arab people, were among the first to settle in Jordan, with their base in Petra. The southern city was situated on one of the main trade routes between eastern and western Asia. Caravans carrying gums, spices, and silks brought by sea to the Gulf of Aqaba went through Petra on their way to the lands of the eastern mediterranean. The Nabatean Kingdom lasted until 106 A.D., when it was conquered by the Romans. After the division of the Roman Empire in the late 4th century A.D., all of what is now Jordan came under the rule of the Byzantine, or eastern Roman, empire. In the 7th century A.D., the Byzantines were expelled by invading Muslim armies. In later centuries, the region was overran by tribes from central Asia, including Seljuk Turks, Mongols, and Tatars. In 1516, it was made part of the Ottoman Empire and incorporated into the Turkish province of Syria. During the Ottoman rule, Jordan was the subject of discrimination. An inevitable uprising took place as the consequence of Turkification, oppression, economic malaise, administrative corruption and the inability of the Ottoman Empire to provide a modicum of security or stability for the Arab countries as a whole. The late King Hussein's great-grandfather, Al-Hussein bin Ali, Sharif of Mecca and King of the Arabs (later he also became known as King of the Hijaz), led the liberation of Arab lands from their domination by the Ottoman Turks in the Great Arab Revolt of 1916. Countries of the Arab East were united into one Arab state embracing Iraq, the Hijaz, Greater Syria, Jordan and Palestine. On this basis, Prince Faisal,I announced the establishment of the first government in Damascus on October 5, 1918. But on October 22, Britain issued a statement dividing Greater Syria into three regions. This was not only pursuant to the 1916 Sykes-Picot agreement, but also to enable Britain to fulfill its promise to the Zionist Movement to establish a national homeland for the Jews in Palestine. The November 2, 1917 Balfour Declaration called for the establishment of a national homeland for the Jews in Palestine. In march 1920, the division of the Arab territory was rejected and the Arab's people's representatives meeting in Damascus declared the unity and independence of Syria proclaiming Sharif Hussein's son Faisal,I as King. King Faisal I later also assumed the throne in Iraq. But Britain and France agreed at the San Remo conference on April 25, 1920 to impose a French mandate on Syria and Lebanon, and a British mandate on Iraq, Palestine and Jordan. Several battles took place following the mandates' imposition, the last of which was at Maysalun on July 27, 1920. After freeing the lands of Jordan, Lebanon, Palestine, Iraq, Syria and the Hijaz, Sharif Hussein's son Abdullah assumed the throne of Transjordan. The Emirate of Transjordan was founded on April 11, 1921, and became the Hashemite Kingdom of Jordan upon formal independence from Britain on May 25, 1946. The name Hashemite Kingdom of Jordan is derived from Hashem, which was the name of the great- grandfather of the Prophet Mohammad. The Royal Family of Jordan is called Hashemite, which means descended from Hashem. King Abdullah successfully defended Arab East Jerusalem and the "West Bank" during the 1948 Arab-Israeli War when the Israeli state was created on three quarters of Palestine. The Jordanian Arab Legion, fighting alongside other Arab armies succeeded in holding on to those Palestinian territories, which later became known as the West Bank of the Kingdom. On July 20, 1951, King Abdullah, I was assassinated by a lone gunman while attending Friday prayers at al-Aqsa mosque in Jerusalem with his grandson Hussein, who was saved from a bullet by a medal his grandfather had recently awarded him. After King Abdullah's martyrdom, King Talal, his eldest son, ruled for a brief period. Due to king Talal's illness, his eldest son, Hussein, was proclaimed King of the Hashemite Kingdom of Jordan on August 11, 1952. He assumed his constitutional powers on May 2, 1953, after reaching the age of eighteen according to the Muslim calendar. His Majesty King Hussein's reign continued until February 7, 1999,when he lost his long battle with cancer at the age of 63, marking the end of an era in Jordan's history. The late king Hussein will be remembered for many achievements, most of all as a "king of peace" due to his vigorous efforts in bringing about peace in the Middle East. Shortly before his demise, King Hussein appointed his eldest son, Prince Abdullah as crown prince who was sworn in as regent and proclaimed king of Jordan. Jordanians look with optimism and pride to a future under the reign of King Abdullah, current bearer of the Hashemite torch. Located in the heart of the Middle East, strategically situated at the junction of Europe, Asia and Africa, Jordan has an amazingly historic, cultural and archaeological patrimony, and many natural wonders that are known worldwide. Due to its diverse geological nature, visitors can climb the proud mountains of Ajloun, hike at the Rose City of Petra, ride Arabian horses in Wadi Rum, sunbathe in the lowest point on earth - the Dead Sea and dive in the crystalline Red Sea waters of Aqaba. The major source of attraction lies in the hospitality of Jordan’s people. Visitors to Jordan are constantly greeted with a warm smile and a genuine welcome. Location Jordan is located in the heart of the Middle East, Northwest of Saudi Arabia, South of Syria, Southwest of Iraq, and East of Israel and the Palestenian National Authority. Jordan has access to the Red Sea via the port city of Aqaba, located at the northern end of the Gulf of Aqaba. Geographic co-ordinates: 29 - 34 00 N, 35 - 39 E Area total: 89,213 sq. km (34, 445 sq. miles) land: 88,884 sq. km (34, 318 sq. miles) water: 329 sq. km (127 sq. miles) Population 6,482,081 (July 2013 est.) Capital Amman (1.9 million / 38% of total population) Language Arabic is the official language. English is widely spoken. Currency and Exchange Rates Jordan's currency is the Jordanian Dinar, or JD. It is subdivided into 1000 fils, or 100 qirsh or piastres. It appears in paper notes of 50, 20, 10, 5, 1, and 0.5 JD denominations. Coins come in denominations of 1 JD, 0.5 JD, 0.25 JD, and 100, 50, 25, 10 and 5 fils. The daily exchange rate is published in local newspapers. United States Dollar 708/00 710/00 (As from June 28, 2001) You can change foreign cash or travelers’ checks at any bank in Jordan. Only traveler's checks will be charged a commission. Also, there are authorized money-changers in Amman, Aqaba and Irbid, and you will usually get a slightly better rate of exchange at money-changers than at banks. Hotels of three stars or above will also change money but at a less favorable rate. Foreigners are permitted to open accounts at Jordanian banks in either Jordanian Dinar or in foreign currencies. Currency exchange operates under the guidelines and regulations of the Central Bank of Jordan. The Central Bank also sets the minimum and maximum interest rates for financial institutions to follow. Climate and Geography Jordan can be divided into three physiographic regions, each with a distinct climate. 1. The highlands comprise mountainous and hilly regions that run through Jordan from north to south. The highlands are by no means uniform. Their altitude varies from 600 to 1600 meters (1969-5249 feet) above sea level. Generally wet and cool, also varies from one area to another. The average temperature in Amman ranges from 8.1 degrees Celsius (46.6 Fahrenheit) in January to 25.1 degrees (77.2 Fahrenheit) in July. 2. The Jordan Rift Valley which also runs along the entire length of Jordan. The Rift Valley plunges to over 400 meters below sea level at the Dead Sea, becoming the lowest spot on earth, and reaches a maximum width of 15 kilometers (9.3 miles). The Rift Valley ends in the south at Aqaba, a tropical resort surrounded by mountains. Aqaba also enjoys a warm, sunny climate throughout the year and is a tourist destination sporting some of the world's most spectacular underwater life. 3. The desert region in the east Jordan is an extension of the Arabian Desert, and forms nearly two-thirds of the country. There is an extreme variation in the climate of the desert between day and night, and between summer and winter. Summer temperatures can exceed 40 degrees Celsius (104 Fahrenheit), while winter nights can be bitterly cold, dry and windy. Business Hours Government offices:8.00 am to 15.00 pm (Sunday to Thursday) Ramadan:9.30 am to 14.00 pm (Sunday to Thursday) Commercial Offices:8.00 am to 13.00 pm & 15.30 pm to 19.30 pm all year round. Ramadan::9.00 am to 15.00 pm (Usually) Banks:8.30 am to 15.00 pm (Sunday to Thursday) Public Holidays January 1 - New Year January 30 - King Abdullah's Birthday Shawal 1st for 3 Days Eid Al Fitr The AL Hijeh 1st for 4 Days Eid Al Adha Muharram 1st Hijra New Year May 1 - Labor Day May 25 - Independence Day 12 Rabi' 1 Prophet's Birthday November 14 - King Hussein Remembrance Day November 16 - El Issra' Wall-Mi'raj December 25 - Christmas Time Time is GMT + 2 (in winter, +3 in summer), or 7 hours ahead of US Eastern Standard Time. Summer time is observed from April through September. Entry and Visa Requirements Any non-Arab visitor to Jordan, whether for business or tourism, needs an entry visa. The required fee for a visa in addition to the granted stay duration depends on the visitor’s nationality. Although entrance visas are obtainable for the airport for visitors arriving by airplane, those arriving by land must get a visa prior to arrival. These are obtainable from any Jordanian diplomatic mission abroad, where they generally take a day to be received. Visas cannot be obtained at Jordan's land border crossings. Visas obtained in Jordanian consulates are valid for 3-4 months from the date,of issue, and can be issued for multiple entries. Tourist visas allow a stay of up to one month initially. However, this period can easily be extended for up to another two months. After that date you must exit and re-enter the country, or undergo immigration procedures. If your visa has not been renewed properly by the time you leave Jordan you will have to pay a fine at the border. If you plan to stay for more than two weeks in Jordan, you will need to register at the nearest police station. Health Requirements and Recommendations Inoculations are not required unless you are travelling from an infected location. If you come from a country where diseases such as cholera and yellow fever are prevalent, you will have to show a certificate of inoculation at your point of entry into Jordan. Although not required, it is preferable to have preventative shots against polio, tetanus and typhoid. Jordan is one of the cleanest and safest countries, but it is,nonetheless advisable to take some precautions until your digestive system adjusts. Hotels rated four-star and up have their own filtering systems, and their tap water is safe to drink. In other places, bottled water is recommended. All fruit and vegetables should be washed thoroughly, and salads and cold meats,which have been sitting out for a long time should be avoided, especially during summer months. All Jordanian dairy products are pasteurised and safe. Medical services are well developed throughout Jordan, with a medical centre or clinic in every town and village. There are hospitals in Amman, Aqaba, Ma'an, Karak, Madaba, Zarqa, Irbid and Ramtha. In the larger towns and cities,many of the doctors have been trained overseas and speak English. Antibiotics and other drugs normally sold on prescription in the West are often available over-the-counter in Jordan. You should carry prescriptions of any medicaments you may need, making sure you have the generic name as your specific brand may not be available. If you wear glasses, bring a spare pair and a copy of the prescription as well. Transport Taxis are cheap and often the most convenient from of transport in Jordan even over such substantial distances as the run between Amman and Aqaba, though on this particular route there is an excellent Pullman coach service. Car Rental in Jordan A license valid in the holder's country of origin is usually acceptable if it has been held for at least one year. Industry Expanding very rapidly .The main ones include phosphates, iron, cigarettes and cement. Agriculture It involves half of the population. Three-quarters of the agricultural produce comes from the fertile Jordan Valley. Main items on the agricultural list include wheat, vegetables, citrus fruits, grapes and olives. Electricity 220 V 50 Hz AC The Government The Hashemite Kingdom of Jordan is a constitutional monarchy with representative government. The reigning monarch, His Majesty King Abdullah II, is the Head of State, the Chief Executive and the Commander-in-Chief of the Armed forces.The king exercises his executive authority through the Prime Minister and the Council of Ministers, or Cabinet. The cabinet is responsible before the elected House of Deputies who,along with the house of Notables (Senate), constitutes the legislative branch of the government. The judicial branch is an independent branch of the government. Since 1989, all elements of the Jordanian political spectrum have embarked together on a road to greater democracy, liberalization and consensus building. These reforms, which were guided by the late King Hussein, have placed Jordan on an irreversible road to democratization. The result has been greater empowerment and involvement of everyday citizens in Jordan's civic life, contributing to increased stability and institutionalization,which will benefit the country far into the future. The Economy Since His Majesty King Abdullah II,assumed the throne in 1999, Jordan has embarked on some broad economic reforms in a long-term effort to improve living standards. The Jordanian government has worked closely with the IMF, practiced careful monetary policy, and made significant progress with privatization. The government also has liberalized the trade regime sufficiently in order to guarantee Jordan's membership in the Word Trade Organization (2000), an association agreement with the European Union (2000), and a Free Trade Agreement with the United States (2000). Jordan has also signed a Bilateral Investment Treaty with the United States. International Transport Travelers can reach Jordan by air, sea or land. Jordan has three airports, a good network of international and national roads, and a port in Aqaba. Amman’s Queen Alia International Airport and Marka Airport, and Aqaba Airport are used for scheduled commercial travel. Queen Alia International Airport is located 40 kilometers (25 miles) south of Amman. Completed in 1983, it can handle up to three million passengers per year. The national carrier, Royal Jordanian, links Amman with major cities in Europe, the Middle East, the Far East, North Africa and North America. International airlines also link Jordan with their respective countries. Driving to Jordan is facilitated by a good network of roads linking Jordan and neighboring countries. Daily buses, taxis and "service" cabs link Jordan with Iraq, Saudi Arabia, Syria, Egypt, Lebanon, Israel and the West Bank and Gaza. Service cabs – pronounced "servees" – are taxis that follow a set of route and stop on demand to pick up and drop off passengers. Bus services also link Amman with Damascus, Cairo, Baghdad, Istanbul, and the crossing points into Israel and the territories under the Palestine National Authority (PNA). A passenger train service operates weekly between Jordan and Syria. A twice daily passenger and car ferry service links Jordan’s port of Aqaba with the Red Sea port of Nuweibe’ in Egypt. Domestic Transport Jordan is a small country that can be crossed by car in approximately four hours. A visitor with an international driver‘s license may rent a car in Jordan. Residents, are required to obtain a Jordanian license. Major international car rental companies and a number of local companies operate in Jordan. Car rental prices are controlled by the government. Taxis are available in the major cities, and can be called by telephone or simply waved down in the street. All taxis operate by meter, and can be hired for the day. An economical method of travel is the service taxi. Fares are set by the government, and tend to be higher than bus fares but lower than taxi fares. Service cabs operate within cities and also connect major cities and towns. Government and private buses operate within and between major cities. Private bus companies run luxury air-conditioned buses that offer day trips to the major tourist sites. Limousine service is also available for short distance as well as day trips. The national air carrier, Royal Jordanian, operates reasonably priced flights between Amman and Aqaba six times a week. Labor force 1.26 million GDP purchasing power parity - $22.8 billion (2002 est.) Real GDP growth 3.5% (2002 est.) Main Exports Phosphates, potash, fertilizers, chemicals & pharmaceuticals. Main Imports Crude oil, wheat, sugar, meat, machinery, transport equipment & spare parts. Source: Ministry Of Tourism/Ministry Of Foreign Affairs/Jordan Embassy Geography Jordan Location: Middle East, northwest of Saudi Arabia Geographic coordinates: 31 00 N, 36 00 E Map references: Middle East Area: total: 89,342 sq km land: 88,802 sq km water: 540 sq km Area - comparative: Slightly smaller than Indiana Land boundaries: Total: 1,635 km  border countries: Iraq 181 km, Israel 238 km, Saudi Arabia 744 km, Syria 375 km, West Bank 97 km Coastline: 26 km Maritime claims: Territorial sea: 3 nm Climate: Mostly arid desert; rainy season in west (November to April) Terrain: Mostly desert plateau in east, highland area in west; Great Rift Valley separates East and West Banks of the Jordan River Elevation extremes: Lowest point: Dead Sea -408 m  highest point: Jabal Umm ad Dami 1,854 m Natural resources: Phosphates, potash, shale oil Land use: Arable land: 3.32%  permanent crops: 1.18%  other: 95.5% (2005) Irrigated land: 820 sq km (2003) Natural hazards: Droughts; periodic earthquakes Environment - current issues: Limited natural fresh water resources; deforestation; overgrazing; soil erosion; desertification Environment - international agreements: Party to: Biodiversity, Climate Change, Climate Change-Kyoto Protocol, Desertification, Endangered Species, Hazardous Wastes, Law of the Sea, Marine Dumping, Ozone Layer Protection, Wetlands  signed, but not ratified: none of the selected agreements Geography - note: Strategic location at the head of the Gulf of Aqaba and as the Arab country that shares the longest border with Israel and the occupied West Bank ople Jordan Population: 6,482,081 (July 2013 est.) Age structure: 0-14 years: 34.9% (male 1,168,406/female 1,102,892) 15-24 years: 20.1% (male 673,794/female 636,925) 25-54 years: 35.8% (male 1,177,521/female 1,155,117) 55-64 years: 4.2% (male 131,416/female 140,680) 65 years and over: 4.9% (male 156,735/female 165,401) (2012 est.) Median age: total: 22.4 years male: 22 years female: 22.7 years (2012 est.) Population growth rate: -0.965% (2012 est.) Birth rate: 26.52 births/1,000 population (2012 est.) Death rate: 2.74 deaths/1,000 population (July 2012 est.) Net migration rate: -33.42 migrant(s)/1,000 population (2012 est.) Sex ratio: at birth: 1.06 male(s)/female under 15 years: 1.06 male(s)/female 15-64 years: 1.03 male(s)/female 65 years and over: 0.95 male(s)/female total population: 1.03 male(s)/female (2011 est.) Infant mortality rate: total: 15.83 deaths/1,000 live births male: 16.42 deaths/1,000 live births female: 15.2 deaths/1,000 live births (2012 est.) Life expectancy at birth: total population: 80.18 years male: 78.82 years female: 81.61 years (2012 est.) Total fertility rate: 3.32 children born/woman (2013 est.) HIV/AIDS - adult prevalence rate: Less than 0.1% (2001 est.) HIV/AIDS - people living with HIV/AIDS: 600 (2003 est.) HIV/AIDS - deaths: less than 500 (2003 est.) Nationality: Noun: Jordanian(s)  adjective: Jordanian Ethnic groups: Arab 98%, Circassian 1%, Armenian 1% Religions: Sunni Muslim 92% (official), Christian 6% (majority Greek Orthodox, but some Greek and Roman Catholics, Syrian Orthodox, Coptic Orthodox, Armenian Orthodox, and Protestant denominations), other 2% (several small Shia Muslim and Druze populations) (2001 est.) Languages: Arabic (official), English widely understood among upper and middle classes Literacy: definition: age 15 and over can read and write total population: 92.6% male: 95.8% female: 89.2% (2010 est.) ernment Jordan Country name: conventional long form: Hashemite Kingdom of Jordan  conventional short form: Jordan  local long form: Al Mamlakah al Urduniyah al Hashimiyah  local short form: Al Urdun  former: Transjordan Government type: Constitutional monarchy Capital: Name: Amman  geographic coordinates: 31 57 N, 35 56 E  time difference: UTC+2 (7 hours ahead of Washington, DC during Standard Time)  daylight saving time: +1hr, begins last Thursday in March; ends last Friday in September Administrative divisions: 12 governorates (muhafazat, singular - muhafazah); Ajlun, Al 'Aqabah, Al Balqa', Al Karak, Al Mafraq, 'Amman, At Tafilah, Az Zarqa', Irbid, Jarash, Ma'an, Madaba Independence: 25 May 1946 (from League of Nations mandate under British administration) National holiday: Independence Day, 25 May (1946) Constitution: 1 January 1952; amended 1954, 1955, 1958, 1960, 1965, 1973, 1974, 1976, 1984 Legal system: Based on Islamic law and French codes; judicial review of legislative acts in a specially provided High Tribunal; has not accepted compulsory ICJ jurisdiction Suffrage: 18 years of age; universal Executive branch: chief of state: King ABDALLAH II (since 7 February 1999); Crown Prince HUSSEIN (born 28 June 1994), eldest son of King ABDALLAH II head of government: Prime Minister Abdullah NSOUR (since 11 October 2012); Deputy Prime Minister Awad KHULAYFAT (since 11 October 2012) cabinet: Cabinet appointed by the prime minister in consultation with the monarch; note - following the legislative election held on 23 January 2013, the members of the Cabinet are serving in an acting capacity until a new government is formed elections: the monarchy is hereditary; prime minister appointed by the monarch Legislative branch: bicameral National Assembly or Majlis al-'Umma consists of the Senate, also called the House of Notables or Majlis al-Ayan (60 seats; members appointed by the monarch to serve four-year terms) and the Chamber of Deputies, also called the House of Representatives or Majlis al-Nuwaab (150 seats; 123 members elected using the single, non-transferable vote system in multi-member districts, and 27 seats elected using a closed national list system based on proportional representation; all legislators serve four-year terms); note - the new electoral law enacted in July 2012 allocated an additional 10 seats (6 seats added to the number reserved for women, bringing the total to 15; 2 additional seats for Amman; and 1 seat each for the cities of Zarqa and Irbid; unchanged are 9 seats reserved for Christian candidates, 9 for Bedouin candidates, and 3 for Jordanians of Chechen or Circassian descent elections: Chamber of Deputies - last held on 23 January 2013 (next election NA); note - the King dissolved the previous Chamber of Deputies in November 2012, midway through the parliamentary term election results: Chamber of Deputies - percent of vote by party - NA; seats by party - 27 elected on closed national list to include: Islamic Centrist Party 3, Nation 2, National Union 2, Stronger Jordan 2, Ahl al-Himma 1, Al-Bayyan 1, Citizenship 1, Construction 1, Cooperation 1, Dawn 1, Dignity 1, Free Voice 1, Labor and Trade 1, National Accord Youth Block 1, National Action 1, National Current 1 (member resigned in February 2013), National Unity 1, Nobel Jerusalem 1, Salvation 1, The People 1, Unified Front 1, Voice of Nation 1; other 123; note - the IAF boycotted the election Judicial branch: Court of Cassation; Supreme Court (court of final appeal) International organization participation: ABEDA, AFESD, AMF, CAEU, CD, CICA, EBRD, FAO, G-11, G-77, IAEA, IBRD, ICAO, ICC (national committees), ICRM, IDA, IDB, IFAD, IFC, IFRCS, ILO, IMF, IMO, Interpol, IOC, IOM, IPU, ISO, ITSO, ITU, ITUC (NGOs), LAS, MIGA, MINUSTAH, MONUSCO, NAM, OIC, OPCW, OSCE (partner), PCA, UN, UNAMID, UNCTAD, UNESCO, UNHCR, UNIDO, UNISFA, UNMIL, UNMISS, UNOCI, UNRWA, UNWTO, UPU, WCO, WFTU (NGOs), WHO, WIPO, WMO, WTO Flag description: Three equal horizontal bands of black (top), representing the Abbassid Caliphate, white, representing the Ummayyad Caliphate, and green, representing the Fatimid Caliphate; a red isosceles triangle on the hoist side, representing the Great Arab Revolt of 1916, and bearing a small white seven-pointed star symbolizing the seven verses of the opening Sura (Al-Fatiha) of the Holy Koran; the seven points on the star represent faith in One God, humanity, national spirit, humility, social justice, virtue, and aspirations; design is based on the Arab Revolt flag of World War I https://www.layyous.com/en/about-jordan/jordan-facts-&-figures Mon, 08 Mar 2021 05:25:19 AM Museums and Galleries in Jordan Jordan Archeological Museum Tel: 962-6 4638795 Fax: 962-6 4615848 Houses an excellent collection of the antiquities of Jordan dating from prehistoric times to the 15th Century. Museum working hours are 9:00-17:00 in winter, 9:00-19:00 in summer, except on Fridays and official holidays 10:00-6:00. Of the exhibited collection, three items are of particular importance: the Dead Sea Copper Scrolls, the Neolithic plaster statues of Ain Ghazal and the anthropomorphic pottery coffins, which give an insight into ancient burial practices. Jordan Folklore Museum Tel: 962-6 465 1742 Fax: 962-6 4615848 Located near the Roman Theater, presents the traditional Jordanian life, including costumes, home furnishings, musical instruments and handicrafts dating back to the 19th Century. Open 9:00-17:00. Jordan Museum of Popular Tradition Tel: 962-6 4651742 Fax: 962-6 4615848 Located near the Roman Theater, this museum displays the traditional costumes of Jordanians, including embroidery and antique jewelry, as well as domestic utensils. It also houses a collection of mosaics from some Byzantine churches in Jordan. Open 9:00-17:00. Martyr's Memorial at Sports City Tel: 962-6 5664240 Fax: 962-6 5664240 The monumental building houses a chronological display of military memorabilia dating from the Arab Revolt of 1916 to the present. Open 9:00-16:00. University of Jordan Museums Tel: 9626 5355000 ext. 3412 Fax: 962-6 4615848 The University of Jordan has several small museums of various subjects, including archaeology [antiquities from the Bronze Age to the Islamic period], anthropology, folklore and medicine/biology. Open Sun-Thur 8:00-17:00. Jordan National Gallery of Fine Arts Tel: 4630128 Fax: 4651119 Email: jng@go.com.jo http://www.nationalgallery.org Located at Al Muntazah, in Jabal Al-Weibdeh. A fine collection of paintings, sculptures and ceramics by contemporary Jordanian and Arab artists. Open 10:00-13:30 and 15:00-18:00, closed Tuesday. Jordan Crafts Center for exhibits and sales of traditional and authentic Jordanian crafts, including: embroidery, woodwork, glass, leather, woven rugs, sheepskins, ceramics, mother-of-pearl objects, jewelry, brass and silver) located on a small side street off the Second Circle of Jabal Amman, behind the Lebanese Embassy. Haya Center [for children] Tel: 962-6 5665195 Fax 962-6 5665196 In Shmeisani. A heritage and science museum geared to children, with lots of hands-on exhibits to try. Working hours 8:30-13:30 and 15:30-17:30, closed Fridays. Muncipality of Greater Amman - City Hall Tel: 4635111 ext. 2540 Fax: 4649420 Shoman Foundation - Darat Al-funun Location: Jabal luweibdeh Tel: 4643252 Fax: 4643253 Email: daratalfunun@nets.com.jo http://www.daratalfunun.org This Museum consists of three buildings in Amman. According to the museum's website "its programs maintains a constant focus on the visual arts, the Darat al Funun strives to be a haven for all the arts"; Darat al-Funun views itself as a home for all the artist of the Arab world. It offers features such as concert, lectures, and a summer academy. Currently featured at the Dar al Funun is the work of Dr. Hisham Khatib in an en exhibit tittled Palestine and Jordan 1500 -1900. Dar al-Landa Created in 1998 as a gallery of the arts, its main goals are to protect the creative rights of the artist and to make contact with Arab and International art and culture groups. With a mission of being a positive force in the community the museum is currently offering services to children in the community. For example its facilities are turned into a public library for a couple hours a day and its new program 'Project Human' will focus on providing free classes to children in drawing, sculpture, pottery, and music. 4 Walls http://www.4walls.org The 4 Walls is located in the Sheraton Hotel Amman. Its atmosphere is inviting to people of all ages, and it serves as a culture center to promote the history and culture of Jordan. Throughout the month of March the museum will run its 'New Vision" Exhibit. Madaba Museum (for archaeology and folklore). Closed Tuesday. Kerak Museum (for archaeology and folklore), Kerak Castle. Closed Tuesday. Petra Museum, actually two museums, at the lower end of the road through the basin. Yarmouk University of Archaeology and Anthropology, beautiful presentation of small collection. Yarmouk University campus, Irbid. Closed Fridays. Tel: 02 271-100 ext 3741. Salt Museum (for archaeology). Museum of School Books, Salt, Jordan. Art Galleries in Jordan Al Mashreq Gallery Tel:  5681303 Baladna Gallery Tel:  5537598 Darat Al Funun - Jabal Luweibdeh Tel:  4643252 The Gallery - Jordan Intercontinental Tel:  4641361 Orfali Gallery Tel:  5526932 Dar Al Anda Tel:  5519122 Riwaq Al Balqa'a Tel:  4720677 Rodin Gallery Tel:  5920334 Zara Gallery - Grand Hyatt Amman Tel:  4651433 Jordan Design and Trade Center of the Noor Al Hussein Foundation] Tel:  5699141 Source: Ministry Of Foreign Affairs/Jordan Embassy https://www.layyous.com/en/about-jordan/museums-and-galleries-in-jordan Mon, 08 Mar 2021 05:25:19 AM Emergency Calls in Jordan   Emergencies Tel. Amman Fire Brigade 4622090/93 Amman Municipality 5339970/1 Blood Bank 4749121 Civil Defense H.Q 4617101-6/19 Civil Defense/ Irbid 02/271292 Electricity Emergency 4750981/2/3 First Aid & Ambulance 193 Highway Police 5343401 Police 192 - 191 Traffic Police 4896390/1 Traffic Accidents 4896391 Tel.Directory Enquiries 1212/4640444 Int.Tel.Enquiries 0133 Int.Switch-Board 0132-0134 R.J.Flight Information 4453200     Repairs, Complaints & Others in Jordan     Repairs, Complaints & Others Tel. Electric Power Co. 4636381/4 Hotel Complaints 4605800 Jordan Television 773111/19 Jordan & Middle East Calls 10 Jordan Hotel Association 4616846-465895 Ministry of Tourism 4642311 Post Office Information 121 Price Complaints 4661176 Public Transport Complaints 4656400 Radio Jordan 774111/19 Sewerage Complaints 891892/3 Telephone Repairs 139 Water Complaints 4777131   Source: Ministry Of Foreign Affairs/Jordan Embassy https://www.layyous.com/en/about-jordan/emergency-calls-in-jordan Mon, 08 Mar 2021 05:25:19 AM Airlines Offices in Jordan   Airline Telephone +962 (06) The Royal Jordanian AirlinesHead Office 5202000 Royal Jordanian Reservation 5100000 Royal Jordanian Sales Office 5100000 Aeroflot 4641510 Air Algeria 5688301/5695876 Air Canada 4630879 Air France (Reservation) 5666055/5667824 Air India 5695876/5688301 Air Ukraine 5535610 Airlanka 5682140/4628596 Alitalia 4625203 American Airlines (Passengers) 5669068/5668069 Austrian Airlines 5694604/5693845 Azerbaijan Airlines (AZAL) 4646155 Balkan Airlines 4611740/5682146 Belgian Airlines 5675888/5683674 British Airways (GSA) 5828801/5862288 British Midland 5694801/5694802 Cathay Pacific 4653691/2 Czechoslovakian Airlines 4630956/5682140 China Airlines 5670449/4613680 Continental Airlines 5682140/4628598 Cyprus Airways 5670267/5670493 Delta Airlines 4643661 Egypt Air 4630011 Emirates Airlines 4643341/4643353 Ethiopian Airlines 5688301/5695876 Gulf Air 4653613/4653621 Iberia 4637827/4644036 Iran Air 4630879 Iraqi Airways 4638600 Japan Airlines 4630879 Jet Airways 4646190/4653613 Kenya Airways 5688301/5695876 K. L. M. 4655267 Korean Airlines 5662236/5676624 Kuwait Airways 5690144/5690145 Libyan Arab Airlines 4643831/2 Lufthansa 5601744 Malaysia Airlines 4639575/4653446 Malev Hungarian 4640200/1 center East Airlines (M. E. A.) 4636104 Olympic Airways 5682140/4630125 Oman Air 4646190/4653621 Pakistan International Airlines 4625981 Philippine Airlines 4640200/1 Polish Airlines 4625981 Qantas Airways 5862288/5828801 Qatar Airways 5684526/5684576 Saudia 4639333 Scandinavian Airlines 5699701/2/3 Singapore Airlines 5676177/5676186 Sudan Airways 5667100/1/2 Swiss Air (G. S. A.) 4642943/4641906 Syria Airways 4622147/8 Tarom (Romanian Air transport) 4630380/4613670 Thai Airways 5699701/2/3 Trans Mediterranean Airways 5699701/2/3 Turkish Airlines 4659102/4659112 TWA 4623430/4622684 US Airlines 5694801 Uzbekistan Airways 5691768 Varig Brazilian Airlines 4630011 Yemen Airways 5514165 Yugoslav Airlines 5604911 Aeroflot (cargo) 5681951 Air France (Cargo) 4621775 Air France (Sales) 5698317/8 Airlines of CUBA 4641391/2 American Airlines (Cargo) 4621775 American West Airlines 5694802 Austrian Airlines (GSA) 5684526/5694604 British 5866151 Eva Air 5684775 Palestinian Airlines 5688301/5695876 Swiss Air 4659791 Transaero Airlines 5665269/5665688 TWA (Cargo) 5688301/2 Air Bosna 5698128/5698129 Garuda Indonesia 5680801/5680944   Source: Ministry Of Tourism https://www.layyous.com/en/about-jordan/airlines-offices-in-jordan Mon, 08 Mar 2021 05:25:19 AM Jordan Diplomatic Missions-Different Embassies in Jordan Embassy Telephone Location Algeria 4641271 4th Circle Indonesia 5528912 Telaa Al Ali Australia 5807000 Abdoun Austria 4601101 Amman Brunei 5928021 Abdoun Bahrain 5664148 Amman Belgium 5931859 Abdoun Brazil 4642169 Amman Canada 5666124 Shemeisani Chili 5925740 Abdoun China 5515151 Rabueh Czech Republic 4927051 Abdoun Egypt 5605175 4th Circle Yugoslavia 4647593 Amman France 4641273 Amman Germany 5930367 Abdoun Greece 5672331 Abdali Holland 5930525 4th Circle Hungaria 5934056 Abdoun India 4637262 JAbal Amman Iran 4641281 Jabal Amman Iraq 4623178 1st circle Italia 4636413 Jabal Al Weibdeh Japan 5932005 Abdoun Korea 5930746 Abdali Kuwait 5675135 4th Circle Lebanon 5929111 Abdoun Libya 5693101 Shemeisani Malaysia 5696540 Amman Morocco 5921771 Abdoun Oman 5686155 Amman Pakistan 4624080 Jabal Amman Palestine State 5677510 4th Circle Philippines 5518448 Abdoun Poland 5512593 Telaa Al Ali Bulgaria 5539392 Telaa Al Ali Qatar 5607311 4th Circle Romania 5813460 Abdali Russia 4641229 3rd Circle Saudi Arabia 5920155 Abdoun Sri lanka 5820611 Down Town South Africa 5921194 Abdoun Spain 4614166 4th Circle Sudan 4644252 Bayader Sweden 5930178 Abdoun Switzerland 5930417 Abdoun Syria 4641076 Amman Tunisia 5674308 4th Circle Turkey 4641251 Amman United King Dom 5923100 Abdoun USA 5906000 Abdoun Bosnia 5856921 Bayader Yemen 5923771 Amman Consulate Telephone Location Denmark 5603703 Abdali Ecuador 4625495 Amman Peru 5151715 Dahyet Rasheed Ukraine 5514122 Telaa Al Ali Ireland 4625632 Amman Portugal 5531203 Tela Al Ali Thailand 4622344 Amman Croatia 4875490 Amman Cyprus 5677559 Abdali Finland 5824676 Bayader https://www.layyous.com/en/about-jordan/diplomatic-missions-in-jordan Mon, 08 Mar 2021 05:25:19 AM International Dialing Codes   Country Code Capital Code Afghanistan 93 Kabul - Albania 355 Tirana 4 Algeria 213 Algiers 21 Argentina 54 Buenos Aires 1 Armenia 374 Yerevan 2 Australia 61 Sydney 2 Austria 43 Vienna 1 Bahrain 973 Manama - Bangladesh 880 Dhaka 2 Belgium 32 Brussels 2 Bolivia 591 La Paz 612 Bosnia Herzegovina 387 Sarajevo 71 Brazil 55 Brasilia 61 Brunei 673 Bandar Seri Begawan 2 Bulgaria 359 Sofia 2 Cameroon 237 Yaounde - Canada 1 Ottawa 613 Chad 235 Ndjmena 51 Chile 56 Santiago 2 China 86 Bejing 10 Colombia 57 Bogota 1 Costa Rica 506 San Jose - Croatia 385 Zagreb 1 Cuba 53 Havana 7 Cyprus 357 Nicosia 2 Czech 420 Prague 2 Denmark 45 Copenhagen - Djibouti 253 Djibouti - Egypt 20 Cairo 2 Finland 358 Helsinki 9 France 33 Paris 1 Germany 49 Berlin 30 Greece 30 Athens 1 Hungary 36 Budapest 1 India 91 New Delhi 11 Indonesia 62 Jakarta 21 Iran 98 Tehran 21 Iraq 964 Baghdad 1 Ireland 353 Dublin 1 Italy 39 Rome 6 Japan 81 Tokyo 3 Jordan 962 Amman 6 Kenya 254 Nairobi 2 Korea 82 Seoul 2 Kuwait 965 Kuwait - Lativia 371 Riga 34 Lebanon 961 Beirut 1 Libya 218 Tripoli 21 Luxembourg 352 Luxembourg - Malaysia 60 Kuala Lumpur 3 Malta 356 Valletta - Mauritania 222 Nouakchott - Mexico 52 Mexico 55 Morroco 212 Rabat 7 Netherlands 31 Amsterdam 20 New Zealand 64 Wellington 4 Nigeria 234 Lagos 1 Norway 47 Oslo 22 Oman 968 Muscat - Pakistan 92 Islamabad 51 Paraguay 595 Asuncion 21 Peru 51 Lima 1 Philippines 63 Manila 2 Poland 48 Warsaw 22 Portugal 351 Lisbon 21 Qatar 974 Doha - Romania 40 Bucharest 21 Russia 7 Moscow 95 Saudi Arabia 966 Riyadh 1 Senegal 221 Dkkar - Singapore 65 Singapore - South Africa 27 Johannesburg 11 Spain 34 Madrid 1 Sri Lanka 94 Colombo 1 Sudan 249 Khartoum 11 Sweden 46 Stockholm 8 Switzerland 41 Berne 31 Swaziland 268 - - Syria 963 Damascus 11 Taiwan 886 Taipei 2 Thailand 66 Bangkok 2 Tunisia 216 Tunis 1 Turkey 90 Ankara 312 Ukraine 380 Kiev 44 United Arab Emirates 971 Abu Dhabi 2 United Kingdom 44 London 207/208 United States 1 Washington 202 Uruguay 598 Montevideo 2 Venezuela 58 Caracas 212 Yemen 967 Sana'a 1 Zambia 260 Lusaka 1   https://www.layyous.com/en/about-jordan/international-dialing-codes Mon, 08 Mar 2021 05:25:19 AM Ministries of Jordan   Prime Ministry 4641211 Ministry of Highly Education & Scientific Research 5347671 Ministry of Administrative Development 5664111 Ministry of Agriculture 5686151 Ministry of Awqaf and Islamic Affairs and Holy Places 5666141 Ministry of Culture 5697359 Ministry of Education 5685081 Ministry of Finance 4636321 Ministry of Energy & Mineral Resources 5863326 Ministry of Water & Irrigation 5680100 Ministry of Foreign Affairs 5735150 Ministry of Industry & Trade 5629030 Ministry of Information 4641460 Ministry of Interior / Domestic Affairs 5691141 Ministry of Justice 4653533 Ministry of Labor 5629130 Ministry of Municipals & Rural Affairs 4641393 Ministry of Planning 4644466 Ministry of Public Works & Housing 5850470 Ministry of Social Development 5931391 Ministry of Tourism & Antiquities 4603360 Ministry of Transport 5518111 Ministry of Environment 5350149 Ministry of Health 5607531 Ministry of communication and Information Technology 5859001 Ministry of Post & Communications    Ministry of Youth 5604701   https://www.layyous.com/en/about-jordan/ministries-of-jordan Mon, 08 Mar 2021 05:25:19 AM Real Estate Agencies in Jordan   Abdoun Real Estate http://www.abdoun.com.jo 5920605 Zalloum Real Estate http://www.zalloum.com/ 5850440 Viviun Real Estate http://www.viviun.com/Real_Estate/Jordan/   SALMAN ABU S'AUD Int. Est http://www.1stjordan.net/salmanabusoud/index.html 5605080 AL NASER Housing http://www.al-naser.com/ 5538182 Al-Amal   5517309 Alkhadrh   5510400 Amra   5514456 Al-Fairoz   5688775 Alternative   5921793 Al-Sanabel   5864230 Byblos   5652400 Mashura   5821549 Nahhas   5865336 Senator   5859981 Zeina   5696955 https://www.layyous.com/en/about-jordan/real-estate-agencies-in-jordan Mon, 08 Mar 2021 05:25:19 AM Banks in Jordan A.Commercial Banks . Name P.O.Box Postal Code Telephone Fax. E-mail Arab Bank PLC. 950545 11195 Amman 5607231 5606793 corpcomm@arabbank.com.jo Arab Banking Corporation (Jordan) 926691 11190 Amman 5664183 56146291 info@arabbanking.com.jo Arab Jordan Investment Bank 8797 11121 Amman 5607146 5681482 info@ajib.com Bank of Jordan PLC 2140 1981 Amman 5696277 5696291 boj@bankofjordan.com.jo Cairo Amman Bank 950661 11195 Amman 4616910 4642890 info@cab.jo Capital Bank of Jordan 941283 11194 Amman 5694250 5692062 info@efbank.com.jo Jordan Commercial Bank 9989 11191 Amman 5603931 5664110 jcb@jcbank.com.jo Jordan Investment and Finance Bank 950601 11195 Amman 5665145 5681410 investment@jifbank.com Jordan Kuwait Bank 9776 11191 Amman 5688814 5695604 webmaster@jkbank.com.jo Jordan Ahli Bank JAB 3103 1981 Amman 5622282 5622281 Info@ahlibank.com.jo Societe Generale de Banque / Jordanie 560 1198 Amman 5600300 5693410 sgbj@sgbj.com.jo The Housing Bank for Trade & Finance 7693 1198 Amman 5607315 5678121 info@hbtf.com.jo Union Bank for Saving & Investment 35104 1980 Amman 5607011 5666149 retail@unionbankjo.com B.Islamic Banks Name P.O.Box Postal Code Telephone Fax. E-mail Islamic International Arab Bank PLC 925802 11190 Amman 5694901 5694914 info@iiabank.com.jo Jordan Islamic Bank for Finance and Investment 926225 11190 Amman 5666325 5666326 jib@islamicbank.com C.Foreign Branches Name P.O.Box Postal Code Telephone Fax. E-mail Standard Chartered 9997 11191 Amman 5607201 5623171 norsan.akkawi@jo.standardchartered.com Egyptian Arab Land Bank 6729 1198 Amman 5150181 5650061 ealb@arakari.com.jo Citi Bank 5055 1983 Amman 5675100 5674888 n / a Rafidain Bank 1194 1198 Amman 4624367 46514698 rafbank@go.com.jo National Bank of Kuwait 941297 11194 Amman 5608800 5608811 joroper@nbk.com Banque Audi / sardar Audi Group 840006 1984 Amman 4604000 4680015 info@BanqueAudi.com Blom Bank 930321 11193 Amman 5654380 5677177 blommail@blom.com.jo Source: Central Bank of Jordan https://www.layyous.com/en/about-jordan/banks-in-jordan Mon, 08 Mar 2021 05:25:19 AM Selected Restaurants in Jordan   ARABIC FRENCH INDIAN ITALIAN Patisserie & Coffee Shops CHINESE SPANISH MEXICAN GREEK Casual Restaurants FAST FOOD     * ARABIC* Restaurant Name Telephone Location Abu Ahmad 4641879 Jabal Amman Al-Bustan 5661555 Al-Jamea'ah St Al Baydar 4127556 Off airport road Al-Kalha 5864242 Sw eifieh/Jabal Al-Hussein/Gardens St. Al Quds 4630168 Amman, King Hussein St. Al Dewan 4618181 Middle EastHotel Al Mansaf 5607607 Marriott Hotel, Shmeisani Al Zawadeh 079-32413 Al-Fuheis Ana Amman 787833 Near Roman Amphitheater Al Waha 5343734 Gardens St Haret Al Amar 5607670 Amman Marriott Hotel Ata Ali 5668682 (Eastern Desserts) Shmeisani Darotel 5607193 Shmeisani Faisal Al Qadi 5605881 Jabal Al Hussein Jabri 5681700 Shmeisani Kan Zaman 4128393 Al Yadoudeh Okaz Terrace 4641361 Inter Con. Hotel Reem Al Bawadi 5607193 Tla' Al Ali Mays Al-Reem 5536990   Seven Hills 4122077 Al Yadoudeh Al-Huwara 5354210   Alargeelah 4659520 Jabal Amman Qaser Al Sounobar 5713113 Airport Road Tonnoureen 5515987 Souq Um Utheina Fakhr El-Din 4652399 Jabal Amman - First Circle Sawani 4651234 Grand Hayyat Amman Al Afandi 5934794 Abdoun Al Firdous 711113 Marj Al Hamam Diwan Al Sultan Ibrahim 5517383 Um Utheina Tarabeesh 4641361 Hotel Inter- Continental Jordan * FRENCH* Restaurant Name Telephone Location La Coquette 5680093 Shmeisani La Maison Verte 5685746 Shmeisani L'entrecote 4642401 Jabal Amman L'olivier 5929564 Abdoun La Tarasse 5601675   * INDIAN* Restaurant Name Telephone Location Bukhara 4641361 Hotel Intercontinental Indian Restaurant 5819829 8th Circle Kashmir 4659520 Jabal Amman India Chicken Tikka Inn 4642437   * ITALIAN* Restaurant Name Telephone Location Alferedo 5821705 Mecca St. La Cucina 5933355 Abdoun La Dolce Vita 4659520 Near 3rd Circle Romero 4644227 3rd Circle Royal Club 5607200 Radisson SAS Hotel La Casa Rosa 5816521   Leonardo Davinci 5662441   Mamamia 5682122 Shemeisani Turino 5818637   Cazar 5934773 Abdoun Garaba 4638212 3rd Circle RYCJ 322404 Aqaba *PATISSERIE & COFFEE SHOPS* Restaurant Name Telephone Location Adam's 4645229 1st. Circle Rainbow St. Al Farouki 5678580 Shmeisani Arabisk 5698005   Al Mawardi 5692010 Al Rabia Housing Al-Noumani Cafe 07940566 Mecca St. Al Sanabel 5825112 Abdoun Al Wadees 5660664 Shemisani Babiche 5928613 Abdoun Arabesque 5698005 Shmeisani Bambo Cafe 5693628 Shmeisani Babiche 5661322 Shmeisani Café Boulevard 4641361 Hotel Intercontinental Café De Paris 593 4765 Abdoun Café Mokka 5926285 Abdoun Cake Boutique 5526726 Um Utheina Chez Hilda 5824808 Sweifieh Dar Al Anda (Tea House) 5519122 Um Utheina Demitasse 5866066 Sweifieh Deli Cafe 4641361 Hotel Intercontinental Jordan Frosti (Italian Ice Cream) 5864237 5661503 Um Uthaina Shmeisani Geneva 5669100 Shmeisani La Patisserie 4641361 Amman Marriott Hotel Strand 5660927 Shmeisani Layali Al Sultan 5601230 Shmeisani Zaltimo Brothers 5621133 Shmeisani Donee 5511031 Rabia Unita 5511031 Rabia *CHINESE* Restaurant Name Telephone Location Beyond Rangoon 5528822 Holiday Inn Amman Chen 5518214 Tla' Al Ali China House 5693004 Jabal Al-Hussein China Town 5696511 Forte Grand Hotel Indochine 5517383 Grand Haytt Amman Jengizghan 4658850 2nd Circle Peking 5660250 Shmeisani Restaurant China 4638968 Rainbow St. 1st Circle Szechwan Gardens 5861174 Um Uthaina Tokyo Gardens 5812997 Mecca St. Taiwan Tourismo 4641093 Jabal Amman *SPANISH* Restaurant Name Telephone Location La Bonita Café 4615061 Third circle of Jabal Amman Bonita Ajloun (Arabic) 04/462981 Overlooking Ajloun Castle Taiwan Tourismo 4641093 Jabal Amman *MEXICAN* Restaurant Name Telephone Location Humphrey's 53530640 University Commecial Complex Mama Juanita 4641361 Hotel Intercontinental *GREEK* Restaurant Name Telephone Location Corfu 5695308 5680185 Shmeisani *CASUAL RESTAURANTS* Restaurant Name Telephone Location 30 Something 5604620 Shmeisani Al Madafa 5607000 Regency Palace Amigo Nabeel 4638031 Jabal Amman Carrousel 5822425 Abdoun Chili 5337033 Shemeisani Blue Fig 5928800 Abdoun The Terrace 4641361 Hotel Intercontinental Forest 4642720   Fuddruckers 4652245   JJ’s 4651234 Jabal Amman La Bonita Café 4615061 Third circle of Jabal Amman Options 5825541   Casereccio 5934773 Abdoun Chicken Tikka (Indian Style) 5515491 Gardens St Champions (American) 5607607 Marriott Hotel French Quarter 5528822 Holiday Inn Amman Garfield's (Restaurant & Coffee Shop) 5691004 Al Rabeya Houston's 5620610 Adli Center, Shmeisani Little Caesar Pizza 5862135 Abdullah Ghousheh St. Mama Mia (Casual Italian) 5682122 Shmeisani Milano ( Italian) 5680670 Shmeisani Napoli Pizza 5698504 Al Rabiya Circle Nouroz (Continental) 4642830 3rd. Circle Papazzi 5821938 Mecca St. Pizza Hut 5681640 Shmeisani Planet Hollywood 5930972 Abdoun Rovers Return 5814844 Comfort Suites Salute (Beer Garden) 4651458 Secound Circle The Big Fellow (Irish Pub) 5934766 Abdoun Wings 5607100 Radisson Hotel Whispers 5827850 Between 5 th and 6 th Circle *FAST FOOD* Restaurant Name Telephone Location Boston Fried Chicken 783203 Medena St. Chilli House 5337033 5681707 5688778 Sweifieh Shmeisani Gardens St. China Inn 5861303 Sweifieh Funny Bunny 5825204 Medena St. Jolly Bee 5688006 Shmeisani Kentucky Fried Chicken 5359124 5671608 Al-Jamea'ah St. Shmeisani Mc Donald's 5865279 Sweifieh Mc Donald's 5859806 7th Circle Popeye's 5512617 5601721 4694650 Medena St. Shmeisani Jabal Al-Hussein Subway 5856165 Mecca St. https://www.layyous.com/en/about-jordan/selected-restaurants-in-jordan Mon, 08 Mar 2021 05:25:19 AM Jordan Rent A Car - Car rental in Jordan   Car Rental Telephone +962 (06) Abdo 5682427 Al Anan 5359639 Al Andalusiah 5606821 Al Arz 5671470 Al Fairouz 5359005 Al Farouk 5686546 Al Gardens 5602265 Al Jawad 5606125 Al Masy 5535644 Al Saad 5827180 Sallam 5683899 Alaqsa 5513554 Aldana 5863091 Alia 5157178 Al Amin 5827201 Assaraya 5684771/032016265 Atlas 5697469 Arabesque 5685884 Atlantic 5688453 Cruise 5530176 Dalia 5528528 Dallal 5359733 City 4648130/1 Camel 5359905 Diplomat 5510427 Dweik 5606699 Escort 5856384 Europcar Jordan 5655581 Faraneh International 5690310 Fadi 5535568 Golden Key 4652426/7 Firas 5602082/4617674 Gulf 5150902 Hanania 5856999 Heart 5686075 Jerusalem 5682016 Jumana 5683141 Macca 5689226 Kanan 5513532 Al Khaled 5358007 Lu'lua 5813529 Natour 4627455 Nebo 5858224 Al Mahaba 571622/1 Oryx - Aqaba 03-2013133 Al Manal 5523196 Monte Carlo 5347002 Raonsh 5699744 Rawan 5865996 Nascar 5510041 Al Noor 5536632 Rimal 4639861 Oscar 5531945 Al Qadi 079/28622 Quality 4655749 Safari 5605080 Ramallah 775149 Samer 5689645 Riviera 5532228 Shakhshir Hertz 5538958/032016206 Ruibes 5621480 Star 5154904 Tiger 5161931 Trans World 5519272 U Drive 5669376 Sheraton 5346381 Al Sho'la 4613005 Washah 5359650 Tell 5682016 Carriage 5525180 Hamdi 5863605 Alamo 4612927 Apollo 874869 Thrifty 5622232 Alwaha 5154105 Wheels 5623553 Vinice 5536186 Ya Hala 5618388 Yazor 568948 Zaher 5686102   Source: Ministry Of Tourism https://www.layyous.com/en/about-jordan/car-rental-in-jordan Mon, 08 Mar 2021 05:25:19 AM Cultural Centers in Jordan Cultural Centers Phone Phone Location Abdel Hamid Shoman Found 5602155 5672541 Jabal Amman 1st. Circle American Center 5602155 5841132 Abdoun The British Council 4612353 4639777 Jabal Amman 1st. Circle Darat al Funoun 4643252 Emirates cultural centre 4612658 4630061 Shmesani French Cultural Center 4612658 4630061 Jabal El-Webdeh Haya Arts Center 5665195 5665196 Shmesani Goethe Institute 4641993 4612383 Jabal Amman, 3rd Circle Italian Language Center 4638185 Abdali Royal Cultural Center 5669026 5669081 Shmesani Spanish Cultural Center 4630858 4624049  Jabal Amman, 3rd Circle Theatre and Arts Directorate 4639317 4664133 Turkish Cultural Center 4639777 4612353 Jabal Amman 1st. Circle Al-Hussein cultural center GAM established Al Hussein Cultural Center to be a cultural landmark for the City of Amman. The Center is located in the center of town, next to GAM main building.It includes several exhibition halls, which can be used by citizens free of charge, as well as theaters and public libraries. Queen Rania Park Queen Rania Park (QRP) is located in Um Nuwara neighborhood near the ‘Ten Bridges’,between Al Nuser and Quweismeh, and covers an area of 26 acres. QRP project aims at providing educational, health and physical care for children, and developing their mental capabilities, as well as providing opportunities for training and educating women. The project also seeks to provide an outlet for area residents to engage in recreational activities and other educational and cultural functions. Considering the great emphasis on bridging the digital gap, QRP facilities include a special computer room for children, which contains seven computers connected to the Internet. Zaha cultural center The Center is located in Khalda, in western Amman. It is dedicated to providing Amman's children with free social, cultural and athletic services. The Center has a computer lab,a library and several courts and playgrounds. The house of art The establishment of House of Arts came as a result of GAM wishes to dedicate one of Amman's ancient houses as a center for Jordanian arts. For that purpose, it purchased and restored a house that was built in 1926. In addition to staging musical and theatrical activities, the House showcases traditional costumes and handicrafts. The Public Library Amman Municipal Public Libraries are among the oldest and most visible cultural attractions in the city. The first public library was opened to the public in 1960. GAM Public Libraries Department works hard to provide cultural and educational services through public libraries in all Municipality regions, so that there will be a public library in each region. Today, the Municipality oversees 31 public libraries that a number of which cater exclusively to children. In total, these libraries, which welcome some 1000 visitors daily, house more than half a million books, 256 periodicals; have some 50,000 members, and serve the needs of around 130,000 borrowers a year. The House of Poetry It considered one of the major cultural attractions of Amman, and situated on Jabal al Qal'ah overlooking the Roman Amphitheatre, the House of Poetry occupies one of Amman’s oldest houses: the former residence of Prince Ali bin Nayif. Greater Amman Municipality purchased the house in 1994, and in August 1999 began the restoration and remodeling project of the place thus preserving its original architectural identity. The House was then dedicated as a meeting place for local and Arab poets and poetry enthusiasts from all over the country. Source: Ministry Of Tourism/Greater Amman Municipality https://www.layyous.com/en/about-jordan/cultural-centers-in-jordan Mon, 08 Mar 2021 05:25:19 AM Hotels in Jordan The Ministry of Tourism classifies hotels in Jordan using a one-to-five star system. Pensions (motels) are classified into three categories. Room prices are set by the ministry, but may be negotiated down during the low season. There are approximately 250 hotels in Jordan, of which around 150 are classified by the Ministry of Tourism. More than half are located in Amman. There is currently an investment boom in hotels and land speculation. Major investments have been made in new hotel construction, especially near Petra. Several new hotels on the Dead Sea Coast, and in Amman and Aqaba are being currently built or planned. 5 ***** 4 **** 3 *** 5 Five Stars Hotels Hotel Name Telephone City Name email 1 Amman Marriott +962 6 5607607 Amman jomariot@marriot.com.jo 2 Crown Plazza Amman +962 6 5510001 Amman ammhb@ichotelsgroup.com 3 Grand Hayyat Amman +962 6 4651234 Amman info@ammgh.com.jo 4 Holiday Inn +962 6 5528822 Amman holidayn@nol.com.jo 5 Jordan Inter-continental +962 6 4641361 Amman ammha@interconti.com 6 Kempinski +962 6 5200200 Amman rabyaco@nol.com.jo 7 Le Meridien Amman +962 6 5696511 Amman meridien@lemeridien-amman.com 8 Le Royal +962 6 4603000 Amman leroyalhotel@amman.com.jo 9 Radisson SAS Amman +962 6 5607100 Amman ammzh-bc@net.com.jo 10 Regency Palace +962 6 5607000 Amman regency@nets.com.jo 11 Sheraton Amman +962 6 5934111 Amman reservation@starwoodhotels.com 12 Four season +962 6 5505555 Amman www.fourseasons.com.jo 13 Aqaba Inter-continental +962 3 2092222 Aqaba 14 Movenpick/Aqaba +962 3 2034020 Aqaba resort.aqaba@moevempick.com 15 Grand View +962 3 2156871 Petra nazzalco@nets.com.jo 16 Nabatean Castle +962 3 2157201 Petra resortnabatean@movempick.com 17 Petra Marriott +962 3 2156407 Petra petra@marriot.com.jo 18 Petra Movenpick +962 3 2157111 Petra hotel.petra@movempick.ch 19 Taybet Zaman +962 3 2150111 Petra h2818@accor-hotels.com 20 Dead Sea Movenpick +962 5 3561111 Dead Sea resort.deadsea@movempick.com 21 Dead Sea Marriott +962 5 3560400 Dead Sea jordanvalley@marriotthotels.com 4 Four Stars Hotels Hotel Name Telephone City Name email 1 Days Inn +962 6 5519011 Amman daysinn@index.com.jo 2 Prestol Signature +962 6 5923400 Amman bristol@bristolhotel.com 3 Al-Qasr +962 6 5689671 Amman alqasr@nol.com.jo 4 Alia Gateway +962 6 4451000 Amman aliahotel@index.com.jo 5 Amman International +962 6 5341712 Amman aih@nets.com.jo 6 Amman west hotel +962 6 4657615 Amman ammwes@index.com.jo 7 Ammon +962 6 5680090 Amman achte@go.com.jo 8 Arwad +962 6 5672635 Amman arwad@firstnet.com.jo 9 Dana Plaza +962 6 5924455 Amman danapl@nol.com.jo 10 Grand Palace +962 6 5691131 Amman grandpalace@nets.com.jo 11 Amman Alsham Palace +962 6 5659270 Amman 12 Imperial Palace Jordan +962 6 5651333 Amman infc@iphj.com.jo 13 Jerusalem international +962 6 5151121 Amman alquds@jerusalem.com.jo 14 Arena Space +962 6 5515550 Amman arena@nets.com.jo 15 Aqaba Gulf +962 3 2016636 Aqaba aggulfhtl@index.com.jo 16 Radisson Sas Aqaba +962 3 2012426 Aqaba aqizh-fo@go.com.jo 17 DAYS INN Hotel and Suites +962 3 2031901 Aqaba daysinn@wanadoo.jo 18 Crown Plaza +962 3 2156266 Petra petra@interconti.com 19 Golden Tulip Kings' Way +962 3 2156799 Petra resrv@kingsway-petra.com 20 Petra Panorama +962 3 2157398 Petra panorama@index.com.jo 21 Dead Sea SPA +962 5 3561000 Dead Sea dssh@nets.com.jo 22 Mercure Ma'in spa +962 5 3245500 Ma'in SPA h2174@accor-hotels.com 3 Three Stars Hotels Hotel Name Telephone City Name email 1 Gardenia +962 6 5667790 Amman gardeniahotel@index.com.jo 2 Al-Waleed +962 6 5862464 Amman alwaleed@nets.com.jo 3 Abjar +962 6 4648883 Amman abjar@abjarhotel.com.jo 4 Ambassador +962 6 5605161 Amman ambashtl@go.com.jo 5 Amman Crown +962 6 4758180 Amman crownhtl@go.com.jo 6 Amman Orcida +962 6 5522111 Amman orchid@firstnet.com.jo 7 Arena International +962 6 5515550 Amman arena@nets.com.jo 8 Arwad +962 6 5672635 Amman arwad@firstnet.com.jo 9 Beirut International +962 6 5656010 Amman 10 Belle View +962 6 4616144 Amman info@bellevue.com.jo 11 Commodore +962 6 5607185 Amman comedest@go.com.jo 12 Carlton +962 6 4654200 Amman icarltont@jainnot.com.jo 13 Cordoba +962 6 5536166 Amman tth@go.com.jo 14 Darotel +962 6 5622200 Amman darotel@nets.com.jo 15 Feras Palace +962 6 4650404 Amman info@firaspalace.com 16 Geneva +962 6 5858100 Amman geneva@joinnet.com.jo 17 Hill Side +962 6 5359481 Amman hillside@index.com.jo 18 Hisham +962 6 4644028 Amman hishamhotel@nets.com.jo 19 Liwan +962 6 5858125 Amman liwanhotel@hotmail.com 20 Land of Dreams +962 6 4657778 Amman violet@jordanlandofdreams.com 21 center East +962 6 5517150 Amman comedest@go.com.jo 22 Ocean +962 6 5517280 Amman info@oceanhotel.com.jo 23 LARASA +962 3 5850955 Amman palmhotel@yahoo.com 24 Palmyra +962 6 5339939 Amman palmhotel@yahoo.com 25 Region +962 6 5159314 Amman regionht@joinnet.com.jo 26 San Rock +962 6 5513800 Amman info@sanrock-hotel.com 27 Sandy Palace +962 6 5621102 Amman 28 Shepherd +962 6 4639197 Amman petraplaza@nets.com.jo 29 Fanar Palace +962 6 5100400 Amman exe_mgr@al-fanarpalacehotel.com 30 Toledo +962 6 4657777 Amman hbarakat@toledohtel.com.jo 31 Aquamarina 1 +962 3 2016250 Aqaba aqumama@qo.com.jo 32 Aquamarina 2 +962 3 2015166 Aqaba aqama@qo.com.jo 33 Petra Int +962 3 2016255 Aqaba petrah@go.com.jo 34 Amra Palace International +962 3 2157070 Petra amrapalace@index.com.jo 35 Edoum +962 3 2156995 Petra edom@go.com.jo 36 Petra Palace +962 3 2156723 Petra ppwnwn@go.com.jo 37 Petra Rest House +962 3 2156266 Petra petra@interconti.com 38 Silk Road +962 3 2157222 Petra petresilkroad@hotmail.com 39 Sella +962 3 2157170 Petra 40 Candles +962 3 2155333 Petra candles@nets.com.jo 41 Al-Joud +962 2 7275515 Irbid joude@go.com.jo 42 Madaba Inn +962 5 3259003 Madaba Source: Ministry Of Tourism https://www.layyous.com/en/about-jordan/hotels-in-jordan Mon, 08 Mar 2021 05:25:19 AM Information about Jordan &Links Jordan Facts and Figures Museum & Galleries in Jordan Emergency Numbers to Call in Jordan Diplomatic Missions in Jordan International Dialing Codes Ministries of Jordan Real Estate Agencies in Jordan Banks in Jordan Selected Restaurants in Jordan Rent A Car in Jordan Jordan Cultural Centers Jordan Hotels Jordan Photos Jordan Video clips Jordan Maps Jordan Hospitals Airlines Offices in Jordan Universities in Jordan Tourist places in Jordan Travel Agencies The Country & People of Jordan Jordan Times BBC Country Profile: Jordan Library of Congress / Federal Research Division / Country Studies / Area Handbook Series / Jordan Jordan at AtlasTours.Net 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Please read the following before submitting an error: Layyous.com website uses Flash and Javascript and is meant to be viewed using the more recent browsers. We also have some sections of the website that opens in a new window which may be seen as 'Pop-up' windows by your browser/security software. If you are having problems accessing a page, please make sure your browser/security software settings: Do not suppress 'Pop-up' windows and/or use 'Pop-up window' suppression software for Layyous.com. Javascript is enabled Cookies are enabled (for good bye page) Is the most current version of browsers The most current Flash software has been downloaded Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist Name* Email* Text* Captcha Submit Reset https://www.layyous.com/en/website-related/website-feedback-form Mon, 08 Mar 2021 05:25:19 AM Privacy Statement for www.layyous.com Our Commitment to Privacy Dr Najeeb Layyous is committed to respecting and protecting your privacy as a visitor to his Web site at http://www.layyous.com. We take the issue of privacy very seriously and value the trust you place in us each time you use our services and access this Web site. This Privacy Statement describes the practices and policies we have put into place to safeguard your personal and health-related personal information that may be gathered and used as you visit our Web site. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULL. The policy may change from time to time so please check back periodically. If you have any questions about our privacy policies, we encourage you to contact us using any of the methods outlined at the end of our Privacy Statement. Who Is Collecting the Information? Dr Najeeb Layyous is collecting information on this Web site as outlined in this privacy statement. What Information Do We Collect? and how do we use it? Automatic Collection of Information: If you do nothing during your visit but browse through the web site or download information, our system will automatically gather and store certain information about your visit. This information does not identify you personally and is used in an aggregate way to help us improve our web site and tell us the number of visitors to our site each day. Permission-based Collection of Information: At different places on our site depending upon the feature you use, you may be asked to volunteer personal and health-related information such as your name, email, mailing address, telephone number, and health history. With Whom Will the Information Be Shared? The personally identifiable information gathered during your visit to this Web site is not shared with any organization for any purpose. Dr Najeeb Layyous has the right to reveal the personally, identifiable information for website visitors in cases which involves legal issues to defend himself and his website or a user of the website. Access and Correction of Personal Information Review of Personal Information Site visitors may not access information we have collected and maintain about them Use of our forum and other public places in our website. Dr Najeeb Layyous site contains infertility and endoscopey public forum. the information submitted in this forum is public and its privacy cannot be controlled . so any information that you submit in the forum is public and you are warned not to submit private information. Our Use of Cookies We do not use any cookies to store or collect information on our Web site. Registration for Access Visitors can use this entire Web site anonymously, without registration. Family safe site We are especially concerned about protecting children's privacy. We hope parents and teachers are involved in children's Internet explorations. It is particularly important for parents to guide their children when children are asked to provide personal information on line. Dr Najeeb Layyous site is an educational site containing information about infertility, male and female genital system's anatomy and information about pregnancy and delivery, which are within the limits put in any educational school program . however Dr Najeeb Layyous stresses that it is up to the parents to decide which age group from their family is allowed to visit his site, as concepts and beliefs vary amongst different families. Security of Communications We recognize that many people are concerned about the privacy and protection of information as it is transmitted over the Internet. You should keep in mind that the possibility exists for unauthorized individuals to intercept any email message you send over the Internet. We use e-mail forms and consultation forms to allow our visitors to ask questions about our services, available treatments and ask for free consultation. These are not hosted on a secure server. The possibility exists that unauthorized individuals may intercept email messages. E-commerce and On-line Donations Purchasing items or making donations over the Internet usually requires you to provide your personal identifying information and credit card information on a Web site. Many people have become accustomed to on-line commerce as a time-saving and useful convenience. There are a number of practices that can make providing your sensitive credit card information more secure and therefore make you feel more comfortable about doing so. At this time, we do not process credit card payments for donations, or advertising on our Web site. Advertising Servers On-line advertising, such as banner ads, has become commonplace on many Web sites. Certain Web sites have developed relationships with third-party advertising servers to display these advertisements on their sites. By clicking on one of these banner ads, you will be taken to another site with different privacy policies. These third party ad servers may also use cookies to collect non-personal information on your preferences and interests via the advertisement you decide to view. we encourage users to review the privacy policy of each advertising company as we cannot be responsible for the privacy practices of these sites. Links to Other Sites Web sites often provide a number of links that offer direct access to other useful or interesting web sites holding potential value to site visitors. Inclusion of the other sites by links does not imply any endorsement of the material or information on the other sites. Users are encouraged to review the privacy policy of each linked site before sharing personal and health-related information. This site includes links to non-affiliated external Web sites. We have the following practices: We encourage users to review the privacy policy of each linked site, as we cannot be responsible for the privacy practices of other sites. Changes in Our Privacy Policy From time to time, we may use customer information for new, unanticipated uses not previously disclosed in our privacy notice. If our information practices change at some time in the future, we will post the policy changes to our Web site to notify you of these changes and provide you with the ability to opt out of these new uses. If you are concerned about how your information is used, you should check back at our Web site periodically. Web Site Contact Information If you have questions about our privacy policy, or feel that this site is not following its stated information policy, please contact us. Contact: Dr Najeeb Layyous F.R.C.O.G Tel: clinic 96265656575 Fax: 96265655293 P.O.Box 830038,Amman 11183,Jordan e-mail: layyous@layyous.com www.layyous.com Modification Date This privacy statement was last modified on September 4, 2003. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/website-related/privacy-statement Mon, 08 Mar 2021 05:25:19 AM Advertising policy for www.layyous.com This site is funded by Dr Najeeb Layyous personally. All the material for the site have been contributed by Dr Najeeb Layyous personally. The advertising policy of layyous.com is as follows: Advertising policy and conditions for advertising on layyous.com www.Layyous.com cares in choosing its list of advertisers. We only consider advertisers with good reputation, or licensed medical centers that employ reputable competent specialists in their field .we have the right to accept or refuse any advertisement without having to give an explanation. www.Layyous.com does not endorse any product advertised on this site The advertisement should meet the following conditions:- Should be clear and not vague Banner ads must be supplied by the advertiser in the form of a gif or jpg file. Any animation may run for only 7 seconds and then stop, or may continue to run only if there is a 2 seconds pause between cycles. Maximum AD size is 468 pixels wide 60 pixels tall. Maximum file size is 24 k. When advertising products or services, www.Layyous.com condition that the advertiser supports his claims by clinical research. The advertiser presents balanced and objective information on the advertised products and services. The product advertised should be legal. The product advertised should be related to the topics discussed in the web site. The advertisement should not conflict with the morals and ethics of the society If www.Layyous.com receives complaints supported by enough evidence against any of the advertised services or products that the product does not fit the advertised claims, we will terminate the contract with the advertiser of this service or product. The advertiser takes full responsibility for the product advertised and the content of the advertisement .Obtaining copyright and publication rights is the responsibility of the advertiser. www.Layyous.com does not allow Posting advertisements or solicitations of business in the Public forum. www.Layyous.com may provide links to other Internet sites only for the convenience of World Wide Web users. www.Layyous.com does not endorse the content of any third-party website. www.Layyous.com is not responsible for the content of links; third-party sites, sites framed within www.Layyous.com or third-party advertisements, and do not make any representations regarding their content or accuracy. Your use of third-party websites is at your own risk. www.Layyous.com does not accept "advertorial" articles. In other words, our site does not display consumer health articles provided by companies who advertise on our site. Advertisers and sponsors may target their messages to specific health information categories within our site, but www.Layyous.com does not target advertisements to individual users on our site. In other words, we do not use personal information about you to determine which advertisements you will see when you visit our site. We do not receive commissions on purchases you may make when you leave www.Layyous.com to visit the site of a company advertising on www.Layyous.com, with the following exception: we may receive a commission under certain agreements, included with but not limited to, bookstores and publishers for the sale of books or other literary works through our web site. To date, these commissions have not been material in amount. Advertisers and sponsors also have no influence over the order of the listing of responses to a search request on our site. We do not allow advertisers or sponsors to purchase priority listings in our search engine. This advertising policy may be revised periodically .We recommend that you read our advertising policy whenever you visit our site. Why should you advertise with us www.Layyous.com is a huge Multilanguage site in English, French and Arabic. We had Over 44,000,000 hits in the last year which is huge for non commercial website and proves the popularity of our website amongst people seeking information. We have over 1,500,000 page views monthly. We have over 4,000,000 hits monthly. We have over 130,000 hits daily. Over 350,000 visitors visit the site monthly from all over the world. Over 13000 visitors visit the site daily from all over the world. Our visitors are from all sections of the society. We constantly update the content website which ensures return visits Our site is family safe site. Our site contains and discusses different topics. There is a professional section dedicated to doctors. Our site is a free site. That is all the information is provided to visitors for free An award winning site. Our site is placed amongst the top sites in search engines. we are amongst the top five in all the Arabic search engines. We are open 24 hours, 365 days a year, so the advertiser can reach the audiences always. Our rates are very competitive. Our advertising policy gives the advertiser and sponsors the ability to be involved on a month -to-month basis allowing testing marketing trial periods, special events and promotions before committing themselves for long term advertisement. Minimum Advert duration time Description Duration Banner 1 month Skyscraper 1 month If you agree with our conditions here are our prices and method of payment Description Price Banner on main page 468 x 60 300 US dollars monthly Skyscraper on main page 160 × 600 300 US dollars monthly Banner on internal page 468 x 60 225 US dollars monthly Skyscraper on internal page 160 × 600 225 US dollars monthly To run ad on all main pages throughout site Add $150 per month Page advertising Space to allow you to present your company on the www.layyous.com WebPages .this 'page advertising' is especially interesting for companies who don't have a website , but if you do have one of your own, links can be incorporated in the page(s). These 'presentations' are listed prominently in our classified section/site sponsors. You can buy any number of A4 pages. You deliver the file; A4-pages(s) in MS-Word format with a font size of minimum 10 points and we do the rest. Each page can contain any number of images with a maximum of 72 pixels/inch .price per A4 page= 1500 US dollar per year. -For three months and more of Banners or buttons advertising we give 10% discount. -Payment in advance and the period of advertisement is counted from the date it is published on the website. -Placing the advertisement on the website is done within a week after we receive payment. -The advertiser cannot change the advert except once in 45 days. -Advertisement rates are subject to revision at any time and orders are accepted on condition that the price bind us on the agreed time .In the event of rate increase , the advertiser will have the option to cancel the order affected without surcharging or continue with the order at the revised advertisement rates. Sponsorship of our site www.Layyous.com offers you the opportunity to sponsor certain sections of the site. This includes putting advertisements on the web pages of the section in addition to putting the sponsor logo. The cost for sponsoring a section is 1500 US dollars per month. For advertising please contact us Please specify the place you want your advertisement to appear and the duration .We will send you details of payment. Contact: Dr Najeeb Layyous Tel: clinic 96265656575 Fax: 96265655293 P.O.Box 830038,Amman 11183,Jordan e-mail: layyous@layyous.com www.layyous.com Modification Date This advertising policy was last modified on February 2, 2013. Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/website-related/advertising-policy Mon, 08 Mar 2021 05:25:19 AM Terms and Conditions of Usewww.layyous.com By using this site, you signify that you have read and assent to these Terms and Conditions of Use. If you do not agree to follow all the Terms and Conditions of Use, do not use this site. Dr Najeeb Layyous reserves the right to update these Terms and Conditions of Use at any time. Your continued use of my website means that you accept those changes. This site does not provide medical advice. The content of the site of Dr Najeeb Layyous, including text, graphics, images, and other material ("content") contained on site, are intended for informational and educational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay seeking it because of something you've read on this website. Articles are not intended as a substitute for consultation with a physician. If you have questions or concerns about specific items, please contact your personal physician. While Dr Najeeb Layyous uses his best efforts to provide the most up-to-date, accurate information, no guarantee of any kind is made, and he is not responsible for the results of any mistakes or misprints that are found in these pages, nor any consequential damages that may result from such mistakes or misprints and is not liable for any damage or loss related to the accuracy, completeness or timeliness of any information contained on this site. You should not assume that this site is error-free, or that it will be suitable for the particular purpose that you have in mind when using it. If you have a medical problem or concern, Dr Najeeb Layyous urge that you consult a qualified physician and not use any articles in these pages as a substitute for a qualified medical opinion or as justification for not seeking medical help or treatment, and he is not responsible for any decisions made by his readers regarding their medical decisions. Use of content Dr Najeeb Layyous authorizes you to view or download the material on the his website solely for your personal, noncommercial use. Any use of the content must carry the copyright notice as follows: "©2001, www.layyous.com, Inc. All rights reserved." The materials on this site are copyrighted, and any unauthorized use of any materials on this site may violate copyright, trademark, and other laws. You may download the information or software ("Materials") found on this site for your personal, noncommercial, internal use only, unless specifically licensed to do otherwise by Dr Najeeb Layyous in writing or as allowed by any license terms that accompany or are provided with individual Materials. 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When using Dr Najeeb Layyous's site, information is transmitted over a medium who is beyond the control and jurisdiction of Dr Najeeb Layyous. Accordingly, he assumes no liability for or relating to the delay, failure, interruption, or corruption of any data or other information transmitted in connection with use of this site. This site and the content are provided on an "as is" basis. Dr Najeeb Layyous and his licensors, to the fullest extent permitted by law, disclaim all warranties, either express or implied, statutory or otherwise, including but not limited to the implied warranties of merchantability, no infringement of third-party rights, and fitness for a particular purpose. Specifically, Dr Najeeb Layyous makes no representations or warranties about the following: The accuracy, reliability, completeness, currentness, or timeliness of the content, software, text, graphics, links, or communications provided on or through the use of a site. 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Links to Other Sites Layyous.com may provide links to other Internet sites only for the convenience of World Wide Web users. Layyous.com does not endorse the content of any third-party website. Layyous.com is not responsible for the content of links, third-party sites, sites framed within Layyous.com or third-party advertisements, and does not make any representations regarding their content or accuracy. Your use of third-party websites is at your own risk. Indemnity You agree to defend, indemnify, and hold Dr Najeeb Layyous, his employees, agents, licensers, and suppliers harmless to and against any claims, actions or demands, liabilities, and settlements, including without limitation reasonable legal and accounting fees resulting from or alleged to result from your violation of these terms and conditions. General Dr Najeeb Layyous is based in Amman, in Jordan. Dr Najeeb Layyous makes no claims that the content is appropriate or may be downloaded outside of Jordan. Access to the content may not be legal by certain persons or in certain countries. If you access this site from outside Jordan, you do so at your own risk, and you are solely responsible for compliance with the laws of your jurisdiction. All of the provisions of this agreement survive the expiration or termination of the Terms and Conditions for any reason whatsoever. Advertising Policy Privacy Policy Complete Agreement Except as Expressly Provided in a Particular "Legal Notice" on Dr Najeeb Layyous's Site These Terms and Conditions constitute the entire agreement between you and Dr Najeeb Layyous with respect to the use of his site and content. Your use of his site is also subject to Dr Najeeb Layyous disclaimers and policies posted herewith. September 14, 2003 Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/website-related/general-website-disclaimer Mon, 08 Mar 2021 05:25:19 AM Medical Search and Information Page   Search Layyous.com Medical Searches PubMed Search OMNI Search.obgyn.net WebMD Medical World Search Search-22 Medical Search Engines Search Syndromes(Multiple Congenital Anomaly Syndromes Database) NIH The Top Medical Resources Health on the Net National Institutes of Health (NIH) Medical Matrix Reuters Health World Health Organization Internet Mental Health Centers for Disease Control and Prevention Medical information UK Health Centre Carpenter Center Library Interactive learning CASO’s Internet University MRCP Part I Question Bank MCQs for medical students Drugs And Medicines Search The RxList Drug Database Medical Journals The Free Medical Journals Site Search any medical journal Free full medical articles Medical journals Medical Dictionary MedTerms Medical Dictionary Medical news From Layyous.com Arabic Health news from Layyous.com Fertility News Reuter's Health CNN Health Medical Images & Multimedia Medical Images Search Medical Images Search Engine by Foto Search Medical Databases CenterWatch Clinical Trials Alternative and Complementary Medicine Health World online Guidelines And Protocols The National Guideline Clearinghouse Medical Libraries Royal Society of Medicine Library Catalogue The British Library Medical textbooks Freebooks4doctors.com The Merck Manual of Diagnosis and Therapy Family Practice Handbook Gray’s Anatomy of the Human Body Directories Of Doctors And Hospitals CiteHealth Health Care Providers Check Up Search for Medical books, Videos or Software Books Videos Software Search by keywords: Search Health Information: Powered by:Healthopedia.com Medic8 Medical Search Engine Search the internet for medical resources with Health On the Net Foundation's MedHunt   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/website-related/medical-search-and-information-page Mon, 08 Mar 2021 05:25:19 AM Enable JavaScript   Instructions for enabling JavaScript in Various Browsers is provided below. 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If possible, Dr Najeeb Layyous will try to provide advance notice of any changes.   Web Site Contact Information If you have questions about our Link policy, or feel that this site is not following its stated policy, please contact us.   Contact: Dr Najeeb Layyous F.R.C.O.G Tel: clinic 96265656575 Fax: 96265655293 P.O.Box 830038,Amman 11183,Jordan e-mail: layyous@layyous.com   If you do not wish to create a link, or do not agree to the terms, return to home page.   Modification Date This Link Policy statement was last modified on October 28, 2004.   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/website-related/link-policy Mon, 08 Mar 2021 05:25:19 AM The construction of the Website Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/website-related/the-construction-of-the-website Mon, 08 Mar 2021 05:25:19 AM https://www.layyous.com/en/dr.-najeeb-layyous Mon, 08 Mar 2021 05:25:19 AM About Dr. Najeeb Layyous   Dr Najeeb is a highly progressive and well read gynecologist that believes in taking advantage of the latest technological advances available within his specialty. It is for this reason that he has perfected his skills in ultrasonography as well as all the endoscopic surgery and assisted reproductive techniques. The techniques of laparoscopy and hysteroscopy are far less invasive and therefore, offer the patient a safer procedure with a quick recovery. Dr Najeeb studied for his medical degree in Alexandria Egypt where he learned the necessity for economical practices. In Egypt, clinical diagnosis is of major importance unlike the affluent western societies where expensive laboratory and other investigative methods are relied upon. He then went on to study for his M.R.C.O.G in England where he received his post- graduate training. He had thorough training and developed wide experience in all aspects of routine, high-risk and operative obstetrics and gynecology. In 1983, Dr Najeeb returned with his British wife to Jordan where he obtained the Jordanian board of obstetrics and gynecology certificate and then set up in private practice in Zerka. His background of Egypt + England +Jordan had given him his individual outlook on medicine as a whole, and enabled him to offer his patients the latest advances available from the western world, as economically as possible. For 18 years, he worked in Zerka, building a very successful practice serving patients from all over Jordan and other Arab countries. Following this Dr, Najeeb held the position of Medical director and head of the I.V.F unit in Hiba hospital in Amman. He is currently practicing in IVF Center in Jordan next to Amal hospital in Amman, Jordan. Clinical experience Dr Najeeb has a wide experience in general obstetrics and gynecology both medically and surgically. He has daily work in obstetrics and gynecology in-and-out patients. In addition to performing general gynecological operations he is experienced in all aspects of reproductive medicine and surgery including infertility counseling, diagnosis, ovulation induction, invitro fertilization (IVF), intracystoplasmic sperm injection (ICSI), performing tubal reconstruction surgery, selective salpingo graphy and tubal catheterization. He has wide experience in performing diagnostic and operative hysteroscopy and laparoscopy. He has been doing laparoscopies since 1979 and has done a large number of different operations over the years. Dr Najeeb also has large experience in the investigation and treatment of male infertility, including performing percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA) and testicular sperm extraction (TESE) .His experience in ultrasonography started in 1980 and over 23, years developed vastly in both diagnostic and interventional ultrasound, to include the latest four-dimensional ultrasound scanning. Dr Najeeb constantly attends courses, work shops and lectures believing firmly that the best doctor is one who never stops learning. He has a wide range of publications ranging from his book on infertility to brochures and leaflets, which give his patients and the general public guidance and information. His patients come from all parts of Jordan, and the middle east. His patients include all aspects of the society. In summary, it is true to say that Dr Najeeb has dedicated his working life to helping the less fortunate people in his society believing that every person has the right for the best treatment regardless of color, race or creed or indeed economical background. This is the story of a doctor who is one of the most prominent medical figures in his field, as Dr. Najeeb Layyous has decades of experience in providing distinguished medical care and is considered a trusted reference for many patients and specialists alike. What distinguishes Dr. Najeeb is his deep commitment to providing the appropriate treatment for each patient, as he studies his medical cases with great care, relies on the latest therapeutic methods and medical techniques, and is always keen to provide solutions that guarantee the highest levels of recovery and comfort for patients. On the other hand, Dr. Najeeb Layyous continuously contributes to disseminating medical knowledge through informative scientific articles. These articles address various medical topics and aim to educate the community and introduce it to the latest medical developments. Visitors can view these articles through its website, which provides diverse and comprehensive medical content, covering multiple medical fields in a simplified and comprehensive manner. Dr. Najeeb Layyous's website has become one of the trusted sources of health information, as it provides readers with a deeper understanding of many diseases, their prevention, as well as various treatment options, thanks to his attention to detail and his keenness to provide accurate information. The website has gained a good reputation among those interested in health, and his articles have spread around the world, documenting his journey in helping thousands of couples who suffered from infertility achieve the dream of having children. This image embodies a long medical legacy distinguished by Dr. Najeeb Layyous, where the medicine stick and the snake symbolize He is not only a capable doctor, but he is also a mentor and source of inspiration for many new doctors, as he contributes to raising the level of medical awareness and contributing to improving health comprehensively. As for the Golden Lion, it represents his deep commitment to providing the appropriate treatment for each patient, as he studies his medical cases with great care, relies on the latest therapeutic methods and medical techniques, and is always keen to provide solutions that guarantee the highest levels of recovery and comfort for patients. The dove of peace, holding an olive branch, carries a clear message that his approach was and will remain based on peace and embracing his patients with care and responsibility, to help them overcome the challenges of infertility and give them life by giving birth to long-awaited children. Qualifications & Registration 1976 M.B.Ch.B Alexandria, Egypt 1978 Full registration with the Jordanian General Medical Council 1978 E.C.F.M.G US A 1982 M.R.C.O.G London, England (Member of the Royal College of Obstetricians & Gynecologists ) 1983 J.B.O.G Jordan ( Jordanian board of Obstetrics & Gynecology ) 1985 Full registration with the British General Medical Council 1995 F.R.C.O.G London, England ( Fellow of the Royal College of Obstetricians & Gynecologists ) Jordan Medical Council subspeciality Certificate in Infertility and IVF Membership of Medical Societies: - Member of the European society for Embryology and human Reproduction. - Member of the British society for Colposcopy and Cervical pathology. - Member of the British society for Gynecological Endoscopy. - Member of the Jordanian society for Obstetricians and Gynecologist. - Member of the Jordanian Fertility committee. - Member of the Jordanian society for Fertility and Genetics. - Member of the Cochrane Menstrual Disorders and Sub fertility Group - Member of the Cyber 3D-Ultrasound Society Awards and honors Dr Najeeb Layyous has received many awards and honors from different organizations, amongst these: - The awards he has achieved for his website. - Being awarded the " Jordan first Cup" for the distinguished. - Honoring of the Jordanian society for obstetricians and gynecologist . Some of the Publications in different Magazines, Textbooks and Newspapers   BRITISH MEDICAL JOURNAL:-9 APRIL 2005 Twins, coloured 3-D ultrasound scan colour, contents page GP:-28 OCTOBER 2005 Polycystic ovary, coloured 3-D ultrasound scan colour GP:-25 NOVEMBER 2005 Polycystic ovary, coloured 3-D ultrasound scan colour LIFECYCLE MARKETING LTD:-EMMA'S DIARY WEBSITE Twins, coloured 3-D ultrasound scan colour LIFECYCLE MARKETING LTD:-EMMA'S DIARY PREGNANCY Twins, coloured 3-D ultrasound scan colour BROWN REFERENCE GROUP PLC:-A-Z OF FAMILY HEALTH Polycystic ovary, coloured 3-D ultrasound scan, p.1248 INTERNATIONAL MASTERS PUBLISHERS:-INSIDE THE HUMAN BODY PACK FI : Multiple ovarian follicles, coloured 3D ultrasound WATTS PUBLISHING:-MAKING SENSE OF SCIENCE - SOUND : 25-week-old Foetus, coloured 3-D ultrasound scan, p.25 FOLENS PUBLISHERS:-LEAVING CERTIFICATE BIOLOGY : Foetus, coloured 3-D ultrasound scan NOW:-STAR DIET & FITNESS - WINTER 2005 : Polycystic ovary, coloured 3-D ultrasound scan, p.21 DORLING KINDERSLEY:-BABYCARE BEFORE BIRTH Triplets, coloured 3-D ultrasound scancolour DORLING KINDERSLEY:-BABYCARE BEFORE BIRTH Twins, coloured 3-D ultrasound scan colour GP - 10 FEBRUARY 2006 Fallopian tube operation , p.35 GP - 10 FEBRUARY 2006 Fallopian tube operation , front cover HARDLINES:-EXTEME MACHINES Foetus, coloured 3-D ultrasound scan colour GP - 3 MARCH 2006 Twins, 3-D ultrasound scan , p.8 PREGNANCY AND BIRTH:-MAY 2006 29-week-old foetus, coloured 3-D ultrasound scan colour ENDEMOL TV UK PLC:-SCIENCE OF SEX Kinked fallopian tube FRANCE FOR SEPTEMBER 2004 Foetus, coloured 3-D ultrasound scan SCIENCE ET VIE HAMLYN BOOKS - BABY MILESTONES Foetus, 3-D ultrasound scan, p.31 REAL MAGAZINE - ISSUE 6 Polycystic ovary syndrome INDEPENDENT NURSE - 24 APRIL 2006 IUD contraceptive, ultrasound scan Up to 1/16 page, p.25 PLUS WEB GP - 12 MAY 2006 IUD contraceptive, ultrasound scan, p.21 FUTURE PUBLISHING LTD:-JUNIOR PREGNANCY & BABY MAGAZINE - ISSUE 1 : 25-week-old foetus, coloured 3-D ultrasound scan INDEPENDENT NURSE:-14 FEBRUARY 2005 : Foetus, coloured 3-D ultrasound scan, p.18 INDEPENDENT NURSE:-11 JULY 2005 Ovarian endometriosis, coloured 3-D ultrasound colour, p.21 INDEPENDENT NURSE:-WEBSITE Ovarian endometriosis, coloured 3-D ultrasound colour GP:-22 APRIL 2005 Multiple ovarian follicles, coloured 3D ultrasound colour, p.60 THE TIMES EDUCATIONAL SUPPLEMENT:-X-RAY POSTER Foetus, coloured 3-D ultrasound scan colour HODDER EDUCATION:-SPORT & EXERCISE SCIENCE 14-week-old Foetus, coloured 3-D ultrasound scan colour CANADIAN MEDICAL ASSOCIATION:-CMAJ Small intestine, coloured 3-D ultrasound scan OCR:-EXAM PAPER: 2857/W/06 Foetus, coloured : 3-D ultrasound scan inside page USA Science Magazine JULY 2005, 8-week-old Foetus, coloured 3-D ultrasound scan PEOPLE NEWSPAPER:-TRIPLETS FEATURE - 12 JUNE 2005 Triplets, coloured 3-D ultrasound scan HAMLYN PUBLISHING:-PREGNANCY WEEK BY WEEK, Fetus's foot, coloured 3-D ultrasound scan, colour,  p.125 HAMLYN PUBLISHING:-PREGNANCY WEEK BY WEEK, 9-week-old Foetus, coloured 3-D ultrasound scan, colour p.153 HAMLYN PUBLISHING:-PREGNANCY WEEK BY WEEK 25-week-old Foetus, coloured 3-D ultrasound scan,p.179 HAMLYN PUBLISHING:-PREGNANCY WEEK BY WEEK 29-week-old Foetus, coloured 3-D ultrasound scan, p.187 SPG MEDIA LTD:-HOSPITAL MANAGEMENT INTERNATIONAL Foetus, coloured 3-D ultrasound scan, inside page USA AUGUST 2005 Magazine QUADRANT HEALTHCOM INC Triplets, coloured 3-D ultrasound scan PRACTICAL DIABETES INTERNATIONAL:-PDI - SEPTEMBER 2005 Polycystic ovary, coloured 3-D ultrasound scan, front cover PREGNANCY AND BIRTH:-NOVEMBER 2005 25-week-old Foetus, coloured 3-D ultrasound , p.22 PREGNANCY AND BIRTH:-NOVEMBER 2005 Foetus, coloured 3-D ultrasound scan , p.36 PREGNANCY AND BIRTH:-FETAL DEVELOPMENT - MARCH 2006 Foetus' head, coloured 3-D ultrasound scan p.32 PREGNANCY AND BIRTH:-FETAL DEVELOPMENT - MARCH 2006 Foetus, coloured 3-D ultrasound scan p.33 ITALY SEPTEMBER 2005 Editorial CORRIERE DELLA SERA 14-week-old Foetus, coloured 3-D ultrasound scan ITALY SEPTEMBER 2005 Editorial DOLCE ATTESA Foetus, coloured 3-D ultrasound scan ITALY FOR DECEMBER 2005 Foetus at 14 weeks, coloured 3-D ultrasound scan Editorial DONNA E MAMMA SWEDEN FOR JANUARY 2006 Foetus' face, coloured 3-D ultrasound scan Editorial Naturvetarefrbundet AUSTRALIA JUNE 2005 Female reproductive organs, coloured 3D ultrasound, Textbook AUSTRALIA 3Q JULY/AUGUST Fetus's foot, coloured 3-D ultrasound Textbook inside Schools BEST MAGAZINE:-ISSUE 40 Foetus, coloured 3-D ultrasound scan colour LITHOGRAPHICA:-AMAZING HUMAN BODY Foetus, coloured 3-D ultrasound scan USA FOR NOVEMBER 2005 14-week-old foetus, coloured 3-D ultrasound scan Magazine MACLEANS MAGAZINE DORLING KINDERSLEY:-PREGNANCY AND BIRTH WEEK BY WEEK Foetus's foot, coloured 3-D ultrasound scan GP:-28 JANUARY 2005 Pregnancy with IUD, coloured 3-D ultrasound scan colour, p.49 ITALY FOR JANUARY 2005 29 week old foetus, coloured 3-D ultrasound scan L'ESPRESSO Foetus, coloured 3-D ultrasound scan HEINEMANN:-FREESTYLE BODY TALK colour Foetus, 3-D ultrasound scan HART MCLEOD:-EDEXCEL ADDITIONAL SCIENCE Twins, 3-D ultrasound scan RODALE BOOKS:-PREGNANCY & ANSWER BOOK Twins, 3-D ultrasound scan COLLINS EDUCATION DIVISION:-GCSE SCIENCE PUPILS BOOK 2 Foetus, 3-D ultrasound scan COLLINS EDUCATION DIVISION:-GCSE SCIENCE PUPILS BOOK 2 Ovarian cyst GP - 19 MAY 2006 p.39 Female reproductive organs, ultrasound GP - 19 MAY 2006, p.40 Polycystic ovary syndrome treatment HODDER EDUCATION - AROMATHERAPY IN ESSENCE Foetus, 3-D ultrasound scan PREGNANCY AND BIRTH - AUGUST 2006 Foetus, 3-D ultrasound scan MOTHER AND BABY MAGAZINE - JULY 2006, p.69 Foetus, coloured 3-D ultrasound scan GERMANY FOR NOVEMBER 2005 Editorial TAGESZEITUNG Foetus, coloured 3-D ultrasound scan USA FOR MAY 2006 WADSWORTH PUBLISHING/THOMSON Foetus, coloured 3-D ultrasound scan GERMANY FOR DECEMBER 2005 Editorial GEO WISSEN Fallopian tube operation HARRIS COOK TURNER - 2518D_SONY_LMD_MAILER Foetus' face, 3-D ultrasound scan PRIMA BABY - AUGUST 2006 14-week-old foetus, coloured 3-D ultrasound scan PORTUGAL FOR MAY 05 Editorial CONSTANCIA EDITORES Umbilical cord blood flow, coloured ultrasound ITALY FOR JUNE 2006 DONNA E MAMMA 29-week-old foetus, coloured 3-D ultrasound scan ROMANIA FOR Q2 2006 COPILUL MEU/VINE BARZA NR.1 Foetus with crossed arms, coloured 3-D ultrasound SWEDEN FOR JUNE 2006 Bok & Webb Uterus, ultrasound scan INDEPENDENT NURSE - 140806, p.19 Foetal genitalia, coloured 3-D ultrasound scan FRANCE FOR JUNE 2006 Editorial Twins, coloured 3-D ultrasound scan CAMBRIDGE UNIVERSITY PRESS:-CAMBRIDGE GATEWAY ADDITIONAL SCIENCE Polycystic ovary, ultrasound scan BRITISH MEDICAL JOURNAL - 22 JUNE 2006 Foetus, 3-D ultrasound scan PREGNANCY AND BIRTH:-OCTOBER 2006 Foetus' face, 3-D ultrasound scan PICK ME UP - ISSUE 36 p.40 Foetus, 3-D ultrasound scan KINGFISHER PUBLICATIONS PLC:-KFYK LIGHT & SOUND GIUNTI EDITORE IN ITALY FOR JULY 2006 29-week-old foetus, coloured 3-D ultrasound scan Editorial ELTERN IN GERMANY FOR MARCH 2006 Umbilical cord blood flow, coloured ultrasound BRITISH MEDICAL JOURNAL:-26 AUGUST 2006 Enlarged kidney, ultrasound scan EDITORIAL FRANCE IN JULY 06 Pregnancy with IUD, coloured 3-D ultrasound scan MONKEY PUZZLE MEDIA - SCIENCE IN FOCUS: HUMAN BODY Foetus, 3-D ultrasound scan Pelvic adhesions INDEPENDENT NURSE:-9 OCTOBER 2006 p.34 Editorial IN USA FOR SEPTEMBER 2006 Ovarian endometriosis, coloured 3-D ultrasound HAYMARKET PUBLISHING:-MIMS WOMAN'S HEALTH - SEPTEMBER 2006 Removal of a displaced IUD contraceptive p.20 CIRCULATION: EUROPEAN PERSPECTIVES:-31 OCTOBER 2006 Polycystic ovary, ultrasound scan HAYMARKET PUBLISHING:-MIMS WOMAN'S HEALTH - SEPTEMBER 2006 IUD contraceptive, ultrasound scan p.41 PREGNANCY AND BIRTH - NOVEMBER 2006 p.30 Foetus, 3-D ultrasound scan HEINEMANN PUBLISHERS (PTY) LTD - SA - LIFE SCIENCES FOR THE CLASS Foetus, 3-D ultrasound scan JUNIOR PREGNANCY & BABY MAGAZINE - WINTER ISSUE WALL CHART: ISSUE Foetus, 3-D ultrasound scan BIOMEDICAL SCIENTIST - JANUARY 2007 Polycystic ovary, ultrasound scan, p.18 GP:-12 JANUARY 2007 Polycystic ovary syndrome treatment, p.10 PREGNANCY AND BIRTH - FEBRUARY 2007 Foetus' face, 3-D ultrasound scan, p.33 FOCUS - FEBRUARY 2007 Foetus, 3-D ultrasound scan, p.48/49 Uterine adhesions PEARSON EDUCATION LTD:-CXC HUMAN & SOCIAL BIOLOBY Endometrial polyp, ultrasound scan BEST MAGAZINE - ISSUE 4 - 30 JANUARY 2007 Foetus, 3-D ultrasound scan BRITISH MEDICAL JOURNAL - 3 FEBRUARY 2007 Ovarian adhesions ECOSSE TV PRODUCTIONS:-CAPE WRATH Foetus, 3-D ultrasound scan BBC ACTIVE - WHITEBOARD ACTIVE: HUMAN BODY 9-11 Ectopic pregnancy GP - 16 FEBRUARY 2007, p.41 Polycystic ovary syndrome GP - 23 FEBRUARY 2007, p.28 Polycystic ovary syndrome GP - 11th MAY ISSUE Quadruplets, 3-D ultrasound scan CHAT - WEEK 18, p.8 FLIPSIDE MAGAZINE:-ISSUE 23 SUPER SENSES FEATURE Foetus' face, 3-D ultrasound scan p.11 GP - 08 JUNE 2007 Ovarian adhesions to the uterus p.26 Double uterus BELLA MAGAZINE - ISSUE22-29 MAY 2007 Foetus, 3 D ultrasound scan MOTHER AND BABY MAGAZINE - AUGUST 2007 GP - 22 JUNE 2007 Ectopic pregnancy p.37 GP - 29 JUNE 2007 Uterine fibroid surgery p.22 Foetus, coloured 3-D ultrasound scan SPAIN MARCH 2007 PUBLISHING/BOOKS Foetus' face, 3-D ultrasound scan ARCTURUS PUBLISHING - CUTTING EDGE MEDICINE: SEEING INSIDE THE BODY Removal of an ovarian cyst DORLING KINDERSLEY:-DK: EARTH: A VISITOR'S GUIDE Twins, 3-D ultrasound scan BEST MAGAZINE - ISSUE 29 - 24 JULY 2007 Foetus, 3-D ultrasound scan OCTOPUS PUBLISHING GROUP:-PREGNANCY: ALL YOUR QUESTIONS ANSWERED, p.74 Twin foetuses, 3-D ultrasound scan OCTOPUS PUBLISHING GROUP:-PREGNANCY: ALL YOUR QUESTIONS ANSWERED, p.198 Foetus, 3-D ultrasound scan PREGNANCY AND BIRTH - 01 SEPTEMBER 2007, p.34 Polycystic ovary syndrome THE LANCET:-25 AUGUST 2007 29-week-old foetus, coloured 3-D ultrasound scan POLAND JUNE 2007 EDITORIAL Liver blood vessels, ultrasound scan INDEPENDENT NURSE - 17/09/07 Polycystic ovary, ultrasound scan GP - GP MAGAZINE 5th OCT Polycystic ovary, ultrasound scan BRITISH MEDICAL JOURNAL - 29 SEPTEMBER 2007 Polycystic ovary, ultrasound scan PULSE - SEPTEMBER 2007, p.22 Uterine fibroid GP - 9TH NOVEMBER 2007, p.31 Endometriosis PULSE - 23 AUGUST 2007, p.26 Uterine fibroid surgery PULSE:-20 SEPTEMBER 2007, p.46 Foetus, 3-D ultrasound scan SCIENCE MUSEUM - HEALTH MATTERS GALLERY Ovarian adhesions to the uterus MINNS WOMEN'S HEALTH - N04. 2007, front cover Foetus, 3-D ultrasound scan PREGNANCY AND BIRTH - JANUARY 2008, p.34 Foetus, 3-D ultrasound scan BBC TV NEWS - TRANSMISSION IN OCTOBER 2007 Polycystic ovary, ultrasound scan DORLING KINDERSLEY - DK - PLAN TO GET PREGNANT Endometriosis DORLING KINDERSLEY - DK - PLAN TO GET PREGNANT Abdominal adhesion treatment, endoscope view NORWAY FOR SEPTEMBER 2007 Editorial Triplet foetuses, 3-D ultrasound scan CAMBRIDGE UNIVERSITY PRESS:-COAS PHYSICS 1 Triplet foetuses, 3-D ultrasound scan CAMBRIDGE UNIVERSITY PRESS:-COAS PHYSICS 1 TEACHER RESOURCES Double uterus THIS MORNING - 11 SEPTEMBER 2007 Twins, 3-D ultrasound scan CAMBRIDGE UNIVERSITY PRESS - CES8 TEACHER RESOURCE CD-ROM KEY STA Twins, 3-D ultrasound scan CAMBRIDGE UNIVERSITY PRESS - ESSENTIALS SCIENCE 8 CORE TEXT BOOKS Twins, 3-D ultrasound scan CAMBRIDGE UNIVERSITY PRESS - EXTENSION TEXTBOOKS & CD-ROMS KEY ST Ovarian cyst FIRST - ISSUE 20 Foetus, 3-D ultrasound scan MIMMS WOMEN'S HEALTH - VOLUME 3 NUMBER 1, p.30 Polycystic ovary, ultrasound scan DORLING KINDERSLEY - ASK A MIDWIFE Endometriosis DORLING KINDERSLEY - ASK A MIDWIFE Foetus, 3-D ultrasound scan DORLING KINDERSLEY - ASK A MIDWIFE Foetus' face, 3-D ultrasound scan DORLING KINDERSLEY - ASK A MIDWIFE Triplet foetuses, 3-D ultrasound scan BBC TV NEWS - TRANSMISSION IN FEBRUARY 2008 Endometriosis MAVERICK TELEVISION - EMBARRASSING BODIES PROGRAMME Polycystic ovary syndrome treatment MAVERICK TELEVISION - EMBARRASSING BODIES PROGRAMME IUD contraceptive, ultrasound scan GP - 30th MAY ISSUE Ovarian cyst HALESWAY LTD - BANNER STAND Polycystic ovary, ultrasound scan BRITISH MEDICAL JOURNAL - BMJ CAREERS - 14 JUNE 2008 Foetus, 3-D ultrasound scan BBC TV NEWS - TRANSMISSION IN APRIL 2008 Uterine fibroid GP - 20th JUNE ISSUE Polycystic ovary, ultrasound scan MARK ALLEN GROUP - PRACTICE NURSING 19 (8) Foetus' face, 3-D ultrasound scan ,MCGRAW HILL EDUCATION - THE SCIENCE OF MIND AND BEHAVIOUR Tubal pregnancy ,PULSE - 23 Polycystic ovary, ultrasound scan ,DR FOSTER INTELLIGENCE - NHS CHOICES - AUGUST 2008 Foetus, 3-D ultrasound scan,DORLING KINDERSLEY - NEW PREGNANCY AND BIRTH (2009 REVISE) Twins, 3-D ultrasound scan ,DORLING KINDERSLEY - WOMEN'S HEALTH FOR LIFE Foetus, 3-D ultrasound scan ,BRITISH MEDICAL JOURNAL - 27 SEPTEMBER 2008 Umbilical cord blood flow, ultrasound ,WEARSET:-OCR PHYSICS Endometriosis ,HAYMARKET MEDICAL - OCTOBER Polycystic ovary syndrome treatment MAVERICK TELEVISION - EMBARRASSING BODIES PROGRAMME Endometriosis MAVERICK TELEVISION - EMBARRASSING BODIES PROGRAMME Foetus, 3-D ultrasound scan REDWOOD PUBLISHING - BOOTS PARENTING CLUB Ovarian cyst PEARSON EDUCATION NORTH ASIA LTD. - NEW SENIOR SECONDARY PHYSICS Foetus, 3-D ultrasound scan DORLING KINDERSLEY - EYEWITNESS HUMAN BODY Foetus, 3-D ultrasound scan FLIPSIDE MAGAZINE - FLIPSIDE ISSUE 35 Twin foetuses, ultrasound scan QUINTESSENCE - 1001 INVENTIONTIONS THAT CHANCED THE WORLD. Twins, ultrasound scan WOMBTWIN SURVIVORS - WOMBTWIN SURVIVORS WEBSITE Foetus, 3-D ultrasound scan PREGNANCY AND BIRTH - JANUARY 2009, p.100 Abdominal adhesion treatment DORLING KINDERSLEY!-BODY SCIENCE Pelvic adhesions HAYMARKET MEDICAL — JANUARY 2009 Endometriosis HAYMARKET MEDICAL — JANUARY 2009 Ovarian endometriosis, coloured 3-D ultrasound USA (PHOTORESEARCHERS) FOR DECEMBER 2008 EDITORIAL Triplet foetuses, 4D ultrasound - SPL MOTION Foetus' face, 3-D ultrasound scan Q2AMEDIA - OUP: KS3 SCIENCE WORK STUDENT BOOK 2 Triplet foetuses, 3-D ultrasound scan HACHETTE CHILDREN'S BOOKS - MAKING NEW LIFE Quadruplets, 3-D ultrasound scan BBC TV NEWS:-TRANSMISSION IN JANUARY 2009 Ovarian cyst HAYMARKET MEDICAL:-FEBRUARY 2009 Endometriosis COMPANY MAGAZINE - APRIL 2009 Foetal genitalia, 3-D ultrasound scan PREGNANCY AND BIRTH - MAY 2009 Ovarian cyst HAYMARKET MEDICAL - MARCH 2009 IMAGES Ovarian cyst USA (PHOTORESEARCHERS) FOR MARCH 2009 Editorial Foetus, coloured 3-D ultrasound scan USA (PHOTORESEARCHERS) FOR MARCH 2009 Editorial Triplet foetuses, coloured 3-D ultrasound scan USA (PHOTORESEARCHERS) FOR MARCH 2009 Editorial Foetus at 9 weeks, 3D ultrasound DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Foetus at 10 weeks, 3D ultrasound DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Foetus in the womb 3D ultrasound DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK 29-week-old foetus, coloured 3-D ultrasound scan DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Foetus' face, coloured 3-D ultrasound scan DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Foetus at 18 weeks, coloured 3-D ultrasound scan DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Foetus with crossed arms, coloured 3-D ultrasound DORLING KINDERSLEY,-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Twins, coloured 3-D ultrasound scan DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Embryo and yolk sac, coloured 3-D ultrasound scan DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK 14-week-old foetus, coloured 3-D ultrasound scan DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Foetus' back, coloured 3-D ultrasound scan DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Foetus skeleton, coloured 3-D ultrasound DORLING KINDERSLEY:-DK BOOK: THE DAY-BY-DAY PREGNANCY BOOK Quadruplets, 4-D ultrasound scan BBC TV NEWS - BBC Web Nov 2007 - Mar 2009 Foetus, 3-D ultrasound scan BBC TV NEWS - BBC Web Nov 2007 - Mar 2009 Triplet foetuses, 3-D ultrasound scan BBC TV NEWS - BBC Web Nov 2007 - Mar 2009 Foetus' face, coloured 3-D ultrasound scan USA (PHOTORESEARCHERS) FOR APRIL 2009 EDITORIAL 29-week-old foetus, coloured 3-D ultrasound scan USA (PHOTORESEARCHERS) FOR APRIL 2009 EDITORIAL 25-week-old foetus, coloured 3-D ultrasound scan USA (PHOTORESEARCHERS) FOR APRIL 2009 EDITORIAL Twin foetuses, coloured 3-D ultrasound scan USA (PHOTORESEARCHERS) FOR APRIL 2009 EDITORIAL 9-week-old foetus, coloured 3-D ultrasound scan USA (PHOTORESEARCHERS) FOR APRIL 2009 EDITORIAL Embryo at five weeks, coloured 3-D ultrasound scan USA (PHOTORESEARCHERS) FOR APRIL 2009 EDITORIAL Ovarian cyst -HAYMARKET MEDICAL Foetus, 3-D ultrasound scan DORLING KINDERSLEY! NEW CHILDREN'S ENCYCLOPEDIA Polycystic ovary syndrome HAYMARKET MEDICAL - JULY 2009 Polycystic ovary syndrome, endoscope view SWEDEN FOR JUNE 2009 Foetus in the womb 3D ultrasound PEARSON: CHRISTIAN PHILOSOPHY AND APPLIED ETHICS Foetus' face, 3-D ultrasound scan PEARSON EDUCATION LTD:-TB PHYSICS HIGHER LEARNING Pelvic adhesions HAYMARKET MEDICAL MEDIA - OCTOBER IMAGES Testicular tumour, 3-D ultrasound scan HAYMARKET MEDICAL MEDIA - OCTOBER IMAGES Umbilical cord blood flow, ultrasound HEINEMANN - A2 PHYSICS FOR OCR ACTIVE TEACH Twins, 3-D ultrasound scan PEARSON CANADA INC - PSYCHOLOGY - FROM ENQUIRY TO UNDERSTANDING Abdominal adhesion treatment QUERCUS PUBLISHING PLC - ILLUSTRATED SURGERY GUIDE Endometriosis HAYMARKET MEDICAL MEDIA Foetus with cleft palate, ultrasound scan HAYMARKET MEDICAL MEDIA - HAYMARKET Uterine fibroid HAYMARKET MEDICAL MEDIA Foetus` face, S-D ultrasound scan MOTHER AND BABY MAGAZINE - APRIL 2010 Twins, 3-D ultrasound scan EMMA'S DIARY PREGNANCY GUIDE Ovarian cyst PRIMARY CARE WOMEN'S HEALTH JOURNAL - PCWHJ 1(2) JUL/AUG/SEP 09 Foetus, 3-D ultrasound scan HAYMARKET MEDICAL MEDIA - MAY 2010 Foetus, 3-D ultrasound scan HEINEMANN PUBLISHERS - Classroom Life Sciences Revised Grade 12 Foetus, 3-D ultrasound scan WELLCOME WING TEAM - wai exhibition display books Endometriosis HAYMARKET MEDICAL MEDIA - GP MAGAZINE JUNE 18th Foetus, 3-D ultrasound scan DORLING KINDERSLEY - WOW HUMAN BODY! Foetus, 3-D ultrasound scan  DAILY MAIL - 20 JUNE 2010 Foetus, 3-D ultrasound scan MAGAZINE QUEBEC SCIENCE - AUG-SEPT 2010 Caesarean section delivery, THE EYES PRODUCTION COMPANY - Untold Stories of the ER 2010 Triplet foetuses, 3-D ultrasound scan, HODDER EDUCATION - SCIENCE FOR EXCELLENCE L3 BIOLOGICAL SCIENCE Triplet foetuses, 3-D ultrasound scan, DORLING KINDERSLEY - PREGNANCY AND BIRTH: EVERYTHING YOU NEED TO KNOW Ovarian adhesions to a Fallopian tube, ROYAL COLLEGE OF OBSTETRICIANS AND - STRATOG.NET Endometriosis, ROYAL COLLEGE OF OBSTETRICIANS AND - STRATOG.NET Foetus, coloured 3-D ultrasound scan,CHINA FOR JUNE 2010,TEXTBOOK Foetus at 12 weeks, ultrasound ,ROYAL COLLEGE OF OBSTETRICIANS AND - STRATOG.NET 40 Seconds Or Greater, Assistance, Beginnings, Biolog USA DECEMBER 2010 MOTHER AND BABY MAGAZINE - DECEMBER 2010 Polycystic ovary syndrome BRITISH MEDICAL JOURNAL - OCTOBER-NOVEMBER 2010 Uterine adhesions PULSE - 8 DECEMBER 2010 Foetus with duodenal atresia, ultrasound HAYMARKET MEDICAL MEDIA:-HAYMARKET MEDICAL 2010 to 2011 Endometriosis HAYMARKET MEDICAL MEDIA:-HAYMARKET MEDICAL 2010 to 2011 WAPASKWA VIRTUAL COLLEGIATE - DIGITAL LEARNING VIDEO PACK 2-cell embryos, MEDIA SERVICES PVT LTD - OUP: GCSE GATEWAY CORE SCIENCE STUDENT BOOK Uterus and ovaries ENDEMOL UK PLC - SEX EDUCATION SHOW 1 2011 Twin foetuses, 3-D ultrasound scan PHILIP ALLAN UPDATES - AQA GCSE PHYSICS STUDENTS BOOK Foetus' face, 3-D ultrasound scan REM PUBLISHING LTD - awaken the world Twins, 3-D ultrasound scan HAYMARKET MEDICAL MEDIA - Q 1 2011 22 week foetus, 3-D ultrasound scan PREGNANCY AND BIRTH - October Issue 2011 Foetus, 4D ultrasound scan BBC CLIP ACQUISITION - HORIZON - THE NINE MONTHS THAT MADE YOU Foetus, 3-D ultrasound scan MCGRAW HILL EDUCATION - PSYCHOLOGY: THE SCIENCE OF MIND AND BEHAVIOR Triplet foetuses, 3-D ultrasound scan BBC TV NEWS - APRIL - JUNE 2011 Uterine fibroid, ultrasound scan UBM INFORMATION LTD - PULSE MAGAZINE 22ND JUNE 2011 Foetal genitalia, 3-D ultrasound scan CANADIAN MEDICAL ASSOCIATION JOURNAL - SEPTEMBER 6TH 2011 Uterus and ovaries ENDEMOL UK PLC - SEX EDUCATION SHOW 2011 Foetus, 3-D ultrasound scan PREGNANCY AND BIRTH - WEEK BY WEEK 18th August 2011 22 week foetus, 3-D ultrasound scan HACHETTE UK LTD - SCIENCE FOR EXCELLENCE LEVEL: 4 PHYSICS Endometriosis CHANNEL 4 TELEVISION - EMBARRASSING BODIES 1 Polycystic ovary syndrome treatment CHANNEL 4 TELEVISION - EMBARRASSING BODIES 1 Ectopic pregnancy, ultrasound scan HAYMARKET MEDICAL MEDIA . Haymarket Images Q 1-2011 Foetus at 14 weeks, 3-D ultrasound scan HAYMARKET MEDICAL MEDIA - Haymarket Images Q 1- 2011 Triplet foetuses, 3-D ultrasound scan HAYMARKET MEDICAL MEDIA - Haymarket Images Q 1- 2011 MATTHEW SANGER - CLEARSTORY C4 SEX, DEATH & THE MEANING OF LIFE DORLING KINDERSLEY - MY PREGNANCY ROYAL COLLEGE OF RADIOLOGISTS - RADIOLOGY REFERRAL GUIDELINES 7 BOOK, front cover, Enlarged kidney, ultrasound scan ROYAL COLLEGE OF RADIOLOGISTS - RADIOLOGY REFERRAL GUIDELINES 7 WEBSITE HOME PAGE Enlarged kidney, ultrasound scan ROYAL COLLEGE OF RADIOLOGISTS - RADIOLOGY REFERRAL GUIDELINES 7 Mobile Application Enlarged kidney, ultrasound scan UBM INFORMATION LTD - PULSE MAGAZINE 9TH NOVEMBER  Kidney, ultrasound scan REM PUBLISHING LTD - awaken the world DESIGN & ARTISTS COPYRIGHT SOCIETY- 2011 PREGNANCY AND BIRTH - P&B WEEK BY WEEK Removal of an ovarian cyst SHERBORNE GIBBS LIMITED - JAN/FEB/MARCH ISSUE OF PCWHJ Endometriosis UBM INFORMATION LTD - PULSE LEARNING WEBSITE. 9TH FEBRUARY uterine fibroid surgery HAYMARKET MEDlCAL MEDIA Ovarian adhesions to a Fallopian tube HAYMARKET MEDICAL MEDIA Polycystic ovary, ultrasound scan MEDICINE TODAY PTY LTD - MEDICINE ODAY, MAY 2012 Ovarian follicles, ultrasound scan CHENELIERE EDUCATION - ADN: SECONDAIRE 3 29 week foetus, 3-D ultrasound scan DORLING KINDERSLEY - TWINS Foetus at 9 weeks, ultrasound redwood publishing - boots parenting club magazine Foetus at 12 weeks, ultrasound the times - 6th October 2012- news Ovarian cyst human and health sciences - gynae development group e-learning Uterine fibroid Uterine Fibroid human and health sciences - gynae development group e-learning Female reproductive organs Dorling Kindersley - October 2012 Foetus face, 3-d ultrasound scan, nhs choices November 2012 Foetus with cleft palate, ultrasound scan , british association of plastic reconstructive and aesthetic surgeons - bapras e-learning 20-week-old foetus, 3d ultrasound scan  the science museum - medicine gallery - science museum london, September 2019 endometriosis_in_pelvic_wall.medicine today - medicine today - july 2021 issue Cancer of the chorion, ultrasound scan, the lancet - september 2021 Endometriosis_in_pelvic_wall, heedo health training limited - diploma in womens health 2022 Uterine fibroid, ultrasound scan, heedo health training limited - diploma in womens health 2022 Endometriotic Spots6, heedo health training limited - diploma in womens health 2022 Triplet foetuses, 3-d ultrasound scan, the random house group ltd - the body – illustrated 2022 Universal images group ltd - image quest, q4 2021 - education foetus with cleft palate, ultrasound scan, bbc news, tv and online - child - bbc web august- 2022 foetus at 15 weeks, ultrasound, bbc news, tv and online - child - bbc web august- 2022 Uterus and fallopian tubes, endoscope, Oxford university press canada - biology of disease, 1st edition by andrew blann, p.14.12 , 03-Mar-23 Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/dr.-najeeb-layyous/about-dr.-najeeb-layyous Mon, 08 Mar 2021 05:25:19 AM Location Of Dr. Najeeb Layyous Clinic   The Clinic is located in Amman-Jordan IVF Clinic in Jordan, around 30 minutes from Alia International Airport and is situated in the most lively areas in Jabal Al Hussein -Amman next to Amal Maternity Hospital. View Larger Map Tel: 00962-6-5656575 Fax: 00962-6-5655293 Address: P.O Box 830038; Zahran Post Office ;11183 ;Amman-Jordan Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/dr.-najeeb-layyous/location-of-dr.-najeeb-layyous-clinic Mon, 08 Mar 2021 05:25:19 AM Visit Dr. Najeeb Layyous Clinic - IVF Clinic in Jordan   Available treatments at the Clinic Dr Najeeb Layyous provides the following services in his practice in Amman, Jordan in IVF Clinic in Jordan. Infertility treatment Female medical and surgical infertility treatment In office ultrasound Male infertility treatment Intra Uterine Insemination( IUI ) Conventional In vitro Fertilization ( IVF ) Intracytoplasmic Sperm Injection ( ICSI ) Intracytoplasmic morphologically selected sperm Injection ( IMSI ) Percutaneous Epididymal Sperm Aspiration or Extraction and ICSI (PESA ,MESA) Testicular Sperm Aspiration or Extraction and ICSI (TESA,TESE) Assisted Hatching Blastocyst culture Embryo Glue Embryo freezing Freezing seminal fluid and testicular tissue PGD- preimplantation genetic diagnosis for genetic diseases and preconception sex selection Laparoscopic surgery Ovarian cysts and tumours. Removal of fibroids (Myomectomy). or destroying them (Myolysis ) Infertility, lysis of adhesions. Infertility, checking the condition and patency of the fallopian tubes. Reproductive or tubal surgery Endometriosis. Intraperitonal Haemorrhage. Polycystic Ovaries. Pelvic infection (Pelvic Inflammatory disease ). Egg collection for assisted reproduction. Sterilization (laparoscopic Sterilization) Severe period pain Diagnosis and treatment of some uterine anomalies. Hysterectomy. Hysteroscopic surgery Intrauterine Adhesions Endometrial Resection Uterine Septum Resection Removal of Endometrial polyps Removal of sub mucous fibroids (Myomectomy) 2D/3D/4D Ultrasound Scan Breast Ultrasound Evaluation of Masses Routine Screening Gynecologic Ultrasound Diagnosing Gynecological Problems Diagnosing Pelvic Cancers Pre-menopausal Post-menopausal Early Ovarian Cancer Detection Doppler Evaluations Obstetric Ultrasound Pregnancy Ultrasound Scan Early Obstetrical Examinations Ectopic Pregnancy Biophysical Profile Testing Cervical/cerclage Evaluation Doppler Evaluations IUGR Examinations Infertility Ultrasound Female Infertility Evaluation And Follow-up Male Infertility Evaluation Pre-treatment Evaluations Sonohysterosalpingography Sonohysterography Sonosalpingography Uterine Biophysical Profile Testing Follicle Monitoring Uterine Blood Flow Evaluation Endometrial Blood Flow Evaluation Timing of Insemination Follicle Aspiration Guidance Embryo Transfer Monitoring Procedures Guided Amniocentesis Chorionic Villus Sampling Sonohysterosalpingography Sonohysterography Sonosalpingography Cyst Aspiration Biopsies Investigation and Treatment Of Recurrent Miscarriage T.V.T Operations For stress Incontinence Call us on +96265656575 Amman, Jordan Photos of the Center and The Staff https://www.layyous.com/en/dr.-najeeb-layyous/visit-our-clinic-and-available-treatments Mon, 08 Mar 2021 05:25:19 AM Online Consultation, Form for Gynecological, Infertility consultation   Dr Najeeb Layyous IVF Clinic in Jordan would be happy to provide a free online consultation to your problem. He will do his best to answer all queries. Please refer to Frequently Asked Questions before submitting your query. Consultation In Facebook Page IN CASE YOU HAVE PRIVATE PROBLEMS Please email your details in the following format, so that he can guide you more effectively. The better the question you ask, the better his answer will be ! Copy and paste the form, fill in the details, and them email it to layyous@layyous.com Date__________________ Name _____________________________________Occupation____________ Partner Name_______________________________ Home Phone ____________________ Business phone ________________Fax No____________ Address ________________________________________________________ E-Mail _____________________________________________ City _______________________ State _________________ Postal Code _________________ GENERAL HISTORY How long have you been married?_____________ How long have you been trying to get pregnant? ________________ How long have you been trying to get pregnant with a doctor's help?___________ Was it a General Gynecologist or a Reproductive Endocrinology and Infertility Specialist? _________ About how many times a month do you have intercourse? _____ Does either partner smoke? _____________ How much? ___________ Does either partner use recreational drugs? ________ Which ones? _____________________ FEMALE HISTORY Age_____ Birth date ________ Height_________ Weight_________ Blood group ______________________Allergies to medicines _________ Menstrual periods occur every ________ days. Are they regular? __________Amount of bleeding ____ For how many days do you bleed? _________ Do you have endometriosis? ______ Do you have any medical problems? ______ If yes, please give details, including any medications _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Have you ever had pelvic inflammatory disease (PID)? ______________________ What pelvic surgeries have you had? ____________________________________ What were the findings? _____________________________________________ ________________________________________________________________ Number of pregnancies with this partner _______ Number of pregnancies with a previous partner _______ Number of miscarriages _______ Number of abortions __________ Number of tubal pregnancies ________ Number of live births _________ TREATMENT HISTORY Have you had: Test Yes/No Result Hysterosalpingogram     Laparoscopy     Hysteroscopy       Procedure Yes/No How many Any success? Clomiphene stimulation with intercourse       Clomiphene stimulation with insemination       Injectable FSH stimulation (Metrodin, Humegon, etc.) with intercourse       Injectable FSH stimulation with insemination       Inseminations without any stimulation       In vitro fertilization       In vitro fertilization with ICSI         OTHER What else should we know about your case? Are there other pertinent test results, procedures or problems that have been identified? Give details of IVF results, if applicable: -Stimulation Protocol _______________________________________ -No. of follicles ___________________________________________ -No. of eggs _____________________________________________ -No. of embryos transferred _________________________________ -No. of frozen embryos ____________________________________ -Out come ______________________________________________ MALE HISTORY Age______________ Birth date ________________ Height ____________ Weight ________ Occupation ___________________ Allergies to medicines ______________ Blood group___ - Prior marriage __________________________________________________ - Number of pregnancies with a previous partner _________________________ - Do you have problems with evection or ejaculation ?_____________________ ______________________________________________________________ - Male medical problem ___________________________________________ - Current medications _____________________________________________ - Hormonal blood test _____________________________________________ - Previous surgeries _______________________________________________ - Family history of infertility _________________________________________ - Previous treatment for infertility _____________________________________ - Semen analysis : Volume ________________ PH _______________Date of test_____________ Liquefaction ________________ Count _____________________ Motility ________________ Type 1 ____________ Type 2 ___________ Type 3 ___________ Type 4 ___________ Normal forms __________________ WBCs _________________________ RBCs _________________________ If you had Azoospermia : Have you ever had testicular biopsy ? _________________________________ Date __________________________ Result ________________________________________________________ _____________________________________________________________ Ask specific questions that you would like addressed. _____________________________________________________________ _____________________________________________________________ E- mail or Fax us this form along with copies of your relevant medical records Dr. Layyous will then review the material and make a written report (including recommendations). Alternatively, he will speak with you on the phone regarding your case - if you prefer.     Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/dr.-najeeb-layyous/gynaecological-infertility-consultation Mon, 08 Mar 2021 05:25:19 AM Contact Dr Najeeb Layyous Clinic or book appointment   Dr. Najeeb Layyous, OB GYN, is an infertility specialist practicing in a medical Clinic located in Amman, Jordan. There is more than one way to contact him! E-Mail layyous@layyous.com For general questions website@layyous.com For comments about the website ( constructive comments encouraged ) IVF@layyous.com For questions about assisted reproduction , IVF and infertility problems endo@layyous.com For questions about laparoscopy and hysteroscopy Consultation In Facebook Page For Consultation       Tel: 00962777588861 00962-6-5656575 Fax: 00962-6-5655293 Address: P.O Box 830038 Zahran Post Office 11183 Amman-Jordan   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/dr.-najeeb-layyous/contact-dr-najeeb-layyous-clinic-or-book-appointment Mon, 08 Mar 2021 05:25:19 AM Awards Page for www.layyous.com   Welcome to my Awards Page. Thank you everyone for these wonderful awards they make me so proud. I do not take getting an award lightly, I worked so hard over these web pages and wanted so for people to visit. So thank you all from the bottom of my heart. MedRocket's Award for Health Web Site Excellence. Your Site has been awarded MedRocket's Award for Health Web Site Excellence. Your site now joins a select group of health Web sites. It identifies your site as one that adheres to the highest standards of health information quality, ethical behavior, and respect for consumer privacy. Approved By Medic8 Medic8 seal of approval. I am pleased to inform you that after our medical team reviewed your infertility and reproduction website we found the information on it to be informative, easy to navigate and user friendly. Your website is a great source of information, and in a variety of languages, for various people interested in topics related to pregnancy and reproduction. The fact that your website contains videos and pictures make the whole learning process much easier. Not only is the medical information contained on your site of a high standard, but its helpfulness is multiplied by the manner in which it is translated into various languages. We have therefore selected your website from the 1000s we review each year to award you with the Medic8 seal of approval that you can proudly display on your website. This is certified by medical professionals and will demonstrate the high level of advice and information that your website contains. Keep up the good work! The med411.com "Medical Award". Congratulations. We like your web site so much that we've added it to the med411.com directory. Criteria for selection include: Content of interest to healthcare professionals. Tone and presentation maintained at a professional level. Site structure, navigation and graphic design executed at a professional level. A high level of integrity and credibility. Health links Select Site We like your site so much that we've added it to the Healthlinks.net directory. Criteria include content of interest to health care professionals; tone and presentation maintained at a professional level; site structure, navigation and graphic design executed at a professional level; and a high level of integrity and credibility. 2003-2004 Golden Web Award The coveted Golden Web Awards are presented to outstanding websites by the International Association of WebMasters and Designers. The World Wide Web Award The World Wide Web Awards are primarily designed to supply formal recognition to webmasters and designers who have shown outstanding achievement in web design content and creativity. Great Site, with nice graphics, layout, design, navigation and appearance Your site is a wonderful contribution to the internet community Diamond Web Award 2003-2004 The Diamond Web Awards is presented to those sites whose web design, originality and content have achieved levels of excellence deserving of recognition. The American Association Of Webmasters, "Gold" Award. We see all the hard work and dedication that you have put into constructing your web site and your efforts are well deserved. Your site displays: Excellent Design and Layout of Website, with quality content and informative information for your visitors. Canada Graphics Gold Award (Excellence of Design) Your site qualifies for Canada Graphics (excellence of design) Gold Award 2003. Congratulations on a job well done. Award of Awael The sites are judged on content, functionality, graphics and usefulness to the general public. Comments: First we wanted to congratulate you on the nice site you have designed. It is really a pleasure looking at it. You have done a very good job, keep up the hard work. WM8C's Ham Links award! Thank you for inviting me to your home on the web and it is a compliment to the WWW. I enjoyed my visit! It's clear you have put a lot of hard work into your website! Good luck with your clinic. Again congratulations! Resource Site Award from Canada We thank you for inviting us to visit your home on the Internet. We applaud your site's ease of navigation, obvious hard work, and informative content. Considering the nature of your site, it is with great pleasure that we give you the Resource Site Award. World Website Award from Canada This award is given to sites that express exemplary degrees in graphics, applications, technology, resource material, and/or creativity. Gigi's Dream Catcher Gold Award Infertility, assisted reproduction and Endoscopy has won the Gigi's Dream Catcher Gold Award. I found your site to be a well designed, easy to navigate, and very informative. Your site scored a 185 out of 200 I enjoyed my visit and I offer the above comments in good faith. webthrower.com Award You have won a "webthrower.com Silver Award"...Congratulations!!! We can see the hard work you put into your site We are glad to give you the recognition that you deserve. We wish you much success in your endeavors. Thanks for helping make the Web a more interesting and attractive place to visit. Our compliments on a job well done! BTDesign Awards! your website has been thoroughly evaluated and I'm glad to announce it was selected to win one of the most coveted awards in the world, the BTDesign APPROVED Award, a sign of recognition for websites which make surfing a different experience. Gold Compass Award After evaluating your website and finding it to be such an exceptional contribution to the Internet business community, we would like to bestow upon you our Gold Compass Award for commercial websites. Your website provided extensive content and graphical detail pertaining to the medical information and services that you provide to potential and current clientele. We would like you to be assured that you have one of the best commercial websites on the Internet. Once again, congratulations on winning our award and maintaining a superb website that promotes exceptional Internet marketing and technological skill. Seasons Of Change Award I enjoyed my visit to your site. Thanks for making the web a better place. It is evident that you have put a lot of hard work into your web space. Texas Precancel Club Award I am pleased to present my silver award. Pages are fast loading. I especially want to recognize extensive content about an intimate subject, some of which is in a choice of 9 languages. The site says that it is best in IE5+, but it was found to be usable in NS4. Artsy Awards Is one of the toughest and most prestigious on the web Alcazaren Award. It has been a pleasure to get in touch with your website and I am very happy to offer you the mentioned award. The information you provide about the infertility is exhaustive as well as the different methods and practices to fight against it, the information about Jordan has also been very interesting to read and see. The bronze award you have earned is the only one presently given by Villa de Alcazarén Award Winners JerryD's Award, Rated AS! 4.0. We were impressed with your site as a great contribution to the internet. Your site has nice graphics and wonderful navigation. Our awards are not easy to win so keep up the great work. A Lady's View Award Hello and Congratulations Dr Layyous! We have visited your site "Dr Najeeb Layyous" and found it to be very nice! We are proud to present you with our Bronze Award. Your site is of great importance and the content is very informative. Thank you for making such a positive contribution to the internet. Best of the web Award You site has everything I look for in a web site. It really is one of the Best of the Web.   Juggling Balls Award You've rated 5 out of 5 juggling balls! - Designed exceptionally well - Easy to navigate - Inoffensive - Contains no illegal stuff - Looks good in any web browser - Loads quickly Top site award You really have talent. I wish more of the sites that apply for my award were as good as yours. Web 1000 Award Your site impressed me very much . Best Of America-Award You run an outstanding web site, one which you can be very proud of. I applaud you. Enetwire Award we're very impressed. Your site is certainly news worthy Five hearts award Your site scored excellent in every category I rate sites under I was quite taken with your site.It was more than qualified to win my award,the Elite Site Award. Best Site Award Your site really exceeded our high standards. I was impressed.! The American Indian Health Council Award AwardWorld.com Directory   Dr Najeeb Layyous F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist We subscribe to the HONcode principles. Verify here. https://www.layyous.com/en/dr.-najeeb-layyous/website-awards Mon, 08 Mar 2021 05:25:19 AM A Comprehensive History of Najeeb Layyous's Contributions to Gynecology, Obstetrics, and Infertility Treatment Dr. Najeeb Layyous is a distinguished Gynecologist and Obstetrician based in Amman, Jordan, with a notable specialization in infertility.1 His expertise encompasses a wide array of critical areas within reproductive medicine, including advanced laparoscopic techniques and sophisticated fertility treatments such as In Vitro Fertilization (IVF).1 The consistent association of Dr. Layyous with both general gynecology and obstetrics alongside specialized infertility treatments from the beginning of his career suggests a deliberate and robust foundation upon which he built his expertise.1 This dual focus likely provided him with a comprehensive understanding of reproductive health, enabling him to become a recognized authority in the more focused domain of infertility. Furthermore, the recurring geographical emphasis on Jordan across numerous sources 2 indicates that his primary influence and contributions have been within the Jordanian healthcare system and community. This localized impact underscores his significance as a pioneer in the development of reproductive medicine within that nation.2 This report aims to provide a thorough historical account of his professional trajectory, significant contributions, and the recognition he has garnered within the field. While specific details regarding his early life remain limited within the provided materials, information from his official website offers crucial insights into Dr. Layyous's academic background.5 He obtained a Bachelor's degree in Medicine and General Surgery from the University of Alexandria in Egypt in 1976. This foundational medical education equipped him with the essential medical knowledge and surgical skills necessary to embark on his medical career. Demonstrating an early pursuit of international medical standards, he received the E.C.F.M.G. certification in the United States in 1978, a significant step for international medical graduates seeking to practice or pursue further training in the US. His dedication to specializing in Obstetrics and Gynecology became apparent through his acquisition of the Membership (M.R.C.O.G.) from the Royal British College in 1982.5 This achievement signifies specialized training and a recognized level of competence in the field based on rigorous British standards. Further solidifying his expertise within his home country, he obtained the Jordanian Board in Obstetrics and Gynecology Surgery (J.B.O.G) in 1983 5, demonstrating his adherence to national medical standards and his commitment to practicing within Jordan. His continuous pursuit of professional excellence and the highest level of recognition in his chosen specialty is evident in his elevation to Fellowship (F.R.C.O.G.) of the Royal British College in 1995.5 This prestigious fellowship signifies extensive experience, advanced expertise, and a substantial contribution to the field of obstetrics and gynecology, as recognized by a leading international professional body. Dr. Layyous's educational journey, spanning institutions in Egypt, the United States, and the United Kingdom before his practice in Jordan, reflects a deep commitment to acquiring a comprehensive and diverse base of medical knowledge and specialized skills from reputable global centers of medical education.5 This international exposure likely played a crucial role in shaping his medical approach and enabling him to introduce international best practices into his work in Jordan. The sequential attainment of the MRCOG and FRCOG qualifications from the Royal British College illustrates a structured and progressive development of his expertise in Obstetrics and Gynecology, aligning with the well-established standards of a prominent international professional organization.5 This progression demonstrates a long-term dedication to his chosen specialty and an unwavering pursuit of excellence. Furthermore, obtaining the Jordanian Board certification alongside these international qualifications underscores his commitment to serving the healthcare needs of his home country while simultaneously upholding internationally recognized standards of medical practice.5 This dual certification would have been paramount in establishing his credibility and fostering trust within the local medical community, ensuring that his practice met all national regulatory requirements. Qualification Institution / Location Year Bachelor of Medicine and General Surgery (MB ChB equivalent) University of Alexandria, Egypt 1976 E.C.F.M.G. Certification United States 1978 Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) Royal British College 1982 Jordanian Board in Obstetrics and Gynecology Surgery (J.B.O.G) Jordan 1983 Fellowship of the Royal College of Obstetricians and Gynaecologists (FRCOG) Royal British College 1995 Dr. Layyous has established a prominent professional career as a Gynecologist and Obstetrician, with a well-documented specialization in infertility.1 This area of focus appears to be a central and enduring aspect of his medical practice. He has founded a clinic in Amman, Jordan, located in the Jabal Al Hussein area.7 The consistent mention of this specific location across various sources confirms it as the primary site of his practice. Notably, his clinic is also identified as being within the outpatient clinics building of Al Amal Hospital in Amman 9, suggesting a significant affiliation or operational integration with a larger medical institution. This connection likely provides him with access to a broader range of medical resources and facilitates collaborative opportunities with other specialists. Dr. Layyous is widely recognized as "one of the pioneer doctors in Jordan specialized in Infertility".2 This distinguished title implies that he was among the first medical professionals in Jordan to dedicate his expertise to the specialized field of infertility treatment, playing a crucial role in its development and advancement within the country. Information from Kinz.jo 11 indicates his job title as "Doctor," though specific details about the company are subscription-based. This suggests he holds a significant position, most likely within his established clinic or the affiliated Al Amal Hospital. The establishment of his clinic in the Jabal Al Hussein area of Amman and its connection with Al Amal Hospital indicates a sustained commitment to serving the local community and integrating his practice within the existing healthcare framework of the city.7 This physical presence and institutional link have likely been instrumental in building trust with patients and ensuring the consistent delivery of care. Furthermore, the repeated designation of Dr. Layyous as a "pioneer" in infertility treatment in Jordan strongly suggests that he played a fundamental role in introducing and developing specialized techniques and approaches for addressing infertility within the nation.2 This could involve being among the first to offer advanced treatments like IVF or IUI, as well as establishing specialized protocols and standards of care in this rapidly evolving field of reproductive medicine. Dr. Layyous has made substantial contributions to the field of infertility treatment through his extensive involvement in Assisted Reproductive Technologies (ART), with a primary focus on In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI).3 The sheer volume of sources referencing these procedures in association with his name highlights his significant activity and expertise in this area. He has actively engaged in both patient and professional education by creating comprehensive materials about IVF, including detailed SlideShare presentations.3 These presentations meticulously outline the various stages of the IVF process, from the initial evaluation of the patient to ovarian stimulation aimed at producing multiple follicles, the critical step of egg retrieval, the preparation of sperm and subsequent fertilization in a laboratory setting, the delicate process of embryo culture, and the final stage of embryo transfer back into the uterus. These educational resources also cover the underlying causes of infertility that may necessitate IVF treatment and provide crucial information regarding potential side effects and realistic success rates, demonstrating a strong commitment to ensuring informed consent and effectively managing patient expectations. Dr. Layyous's expertise also extends to Intracytoplasmic Sperm Injection (ICSI) 3, a specialized IVF technique that is particularly relevant in cases of male factor infertility. His presentations on ICSI further illustrate his comprehensive understanding of the various modalities within ART. Moreover, Dr. Layyous has provided valuable educational resources on Intrauterine Insemination (IUI) 12, another significant ART procedure. His materials on IUI detail the procedural steps and discuss the key factors that influence its success, such as the quality of the sperm sample and the precise timing of the insemination relative to the woman's ovulation cycle. Notably, one source 21 specifically mentions his development of "advanced techniques for sperm selection prior to IVF procedures." This is a significant indication that Dr. Layyous has not only implemented established ART techniques but has also been actively involved in innovation and refinement, with the aim of improving the overall outcomes of IVF treatments. His collaboration with a researcher specializing in stem cell therapies, on a publication related to infertility 4 suggests a potential exploration of cutting-edge treatment approaches. This collaboration could involve investigating the integration of stem cell therapies with conventional ART methods to address complex and challenging cases of infertility, representing a significant contribution to the evolving landscape of reproductive medicine. Dr. Layyous's dedication to creating and disseminating detailed educational content on IVF, ICSI, and IUI through platforms like SlideShare demonstrates a strong commitment to empowering both patients and fellow medical professionals with comprehensive knowledge about infertility treatments.3 This proactive approach to education likely played a vital role in increasing awareness, understanding, and acceptance of ART within his community and potentially on a broader scale. By making intricate medical information more accessible, Dr. Layyous likely helped to reduce the stigma often associated with infertility, enabled patients to make more informed decisions regarding their treatment options, and contributed to raising the overall standard of care by sharing his expertise with other practitioners in the field. His active engagement in both standard IVF procedures and the more specialized ICSI technique showcases a comprehensive and adaptable approach to addressing the diverse range of infertility challenges encountered by couples.3 This versatility suggests a deep understanding of the underlying causes of infertility and the ability to tailor treatment strategies to the specific needs of individual patients, potentially leading to improved success rates for a wider population seeking fertility assistance. The mention of his development of advanced sperm selection techniques for IVF 21 highlights an innovative aspect of his professional practice. This suggests that Dr. Layyous is not simply applying established protocols but is actively seeking to enhance the efficacy of IVF by focusing on critical factors such as sperm quality. Such innovations can have a direct and positive impact on fertilization rates and the overall success of IVF, potentially making a significant difference in the lives of couples struggling with infertility. Furthermore, his collaboration with a stem cell researcher strongly indicates his interest in exploring and potentially incorporating cutting-edge regenerative medicine approaches into the treatment of infertility. Stem cell therapy holds considerable promise for addressing certain types of infertility that are currently difficult to treat with conventional ART. This collaboration suggests that Dr. Layyous is at the forefront of investigating new therapeutic avenues and is committed to offering his patients the most advanced treatment options available in the rapidly evolving field of reproductive medicine. Dr. Layyous has demonstrated significant expertise in the application of advanced obstetric ultrasonography, with a particular focus on 3D and 4D ultrasound technologies.1 His emphasis on these advanced imaging modalities suggests an early recognition of their potential to significantly enhance prenatal diagnosis and monitoring of fetal development. His own website, www.layyous.com, is referenced as a key source of information regarding the clinical advantages offered by 3D and 4D ultrasound in obstetrics.23 This indicates his active role in educating both patients and medical professionals about the benefits of these technologies, which include improved visualization of fetal anatomy and the potential for earlier and more accurate detection of congenital anomalies. The fact that his 3D and 4D ultrasound images have been featured in numerous scientific publications and within science photography libraries 22 is a strong testament to the high quality and diagnostic value of his work in this specialized area. These images serve as valuable educational tools for the medical community worldwide, illustrating various stages of fetal development and showcasing his skill in utilizing these advanced imaging techniques. Notably, one source 41 specifically mentions the availability of a "22 Week Foetus, 3-d Ultrasound Scan" image captured by Dr. Layyous for purchase as a canvas print. This not only underscores the clarity and intricate detail of his ultrasound imagery but also suggests a broader recognition and appreciation of his work extending beyond the purely medical context into the realm of visual science. Dr. Layyous's early adoption and promotion of 3D and 4D ultrasound technologies in obstetrics indicate a commitment to leveraging technological advancements to enhance the quality of prenatal care.1 These advanced imaging techniques offer significant advantages over traditional 2D ultrasound, including the ability to visualize fetal structures in multiple planes and in real-time, which can lead to more accurate diagnoses and improved management of pregnancies. By focusing on the clinical benefits of these technologies, Dr. Layyous likely played a significant role in introducing and popularizing their use within his practice and potentially within the broader Jordanian medical community, contributing to elevated standards of prenatal care. Furthermore, the widespread use of his ultrasound images in diverse medical publications and reputable science libraries 22 indicates that his work in obstetric imaging is highly regarded and serves as a valuable resource for education and research within the field. These images likely provide clear and illustrative examples of normal and abnormal fetal development, contributing to the collective knowledge base of medical professionals globally. Dr. Layyous has made notable contributions to medical literature through various channels. He is the author of "Infertility: The Basic Facts: A Guide for Patients" 48, demonstrating his commitment to patient education by providing accessible and informative content on a complex medical subject. He is extensively credited for capturing high-quality medical images, particularly within the domain of obstetric ultrasound, which have been featured in a wide array of publications, including medical textbooks and research articles.22 This indicates that his expertise in advanced imaging technologies and his skill in medical photography have made a significant contribution to the visual documentation within his fields of specialization. Dr. Layyous's name appears in the acknowledgements sections of several academic publications 29, implying that his materials, images, or professional insights were utilized and appreciated by other researchers and authors within the medical community. Furthermore, his work is directly cited in research articles, such as in discussions pertaining to hysteroscopic metroplasty 50 and the clinical applications of ultrasound technology in obstetrics.23 These citations indicate that his findings and perspectives have been considered relevant and influential by other researchers in these specific areas of study. Dr. Layyous has also engaged in collaborative research, as evidenced by his co-authorship on a publication focusing on infertility.4 This collaboration suggests an active engagement with broader scientific inquiry and a commitment to contributing to peer-reviewed medical literature. His authorship of a patient guide on infertility, coupled with the widespread use of his medical images in professional publications, underscores his dual commitment to both public education and the advancement of medical knowledge within his field.22 This balanced approach reflects a dedicated medical professional who recognizes the importance of both individual patient well-being and the collective progress of medical science. The frequent appearance of his name in acknowledgements and citations within academic works 23 indicates that Dr. Layyous has established a strong reputation as a reliable and valuable contributor to the medical community, extending beyond his primary publications. This suggests that his expertise, resources (such as his advanced imaging capabilities), and insightful perspectives have been sought after and appreciated by other researchers and authors, further solidifying his standing within the field of gynecology and obstetrics. Dr. Layyous holds the esteemed Fellowship of the Royal College of Obstetricians and Gynaecologists (FRCOG).6 His professional journey within the Royal College commenced with his acquisition of the Membership (MRCOG) in 1982, followed by his elevation to the Fellowship in 1995.6 This progression signifies a high level of expertise, extensive experience, and significant contributions to the field of obstetrics and gynecology, as formally recognized by a leading international professional body. He is listed as a specialist in Obstetrics and Gynecology on various online medical directories 9, which enhances his visibility and accessibility to patients seeking his specific medical services. These professional listings often provide essential contact information and details about his practice. His clinic is featured on Accessible Jordan 7, a platform that specifically highlights the accessibility features of various locations for individuals with disabilities. This inclusion indicates a commitment to providing inclusive healthcare services to a diverse range of patients with varying needs. Dr. Layyous is also documented as a participant and speaker at a medical conference held in Jordan 54, suggesting his active engagement within the local medical community and his willingness to share his knowledge and expertise with his colleagues. Notably, his website received an award for excellence 5, recognizing his significant efforts in providing valuable online resources and information related to his specialized fields. This award underscores his commitment to both patient and professional education through the effective use of digital platforms. The FRCOG fellowship is a significant indicator of professional achievement and recognition within obstetrics and gynecology, signifying that Dr. Layyous has met the rigorous standards of training, experience, and ethical practice as defined by the Royal College.6 This prestigious affiliation lends considerable credibility and authority to his professional standing within the international medical community. The combination of listings on general medical directories and a specialized accessibility platform like Accessible Jordan 7 suggests a comprehensive outreach strategy aimed at reaching a broad spectrum of patients with diverse healthcare needs. This indicates a patient-centered approach that prioritizes both visibility and inclusivity in his medical practice. Furthermore, the award received by his website 5 highlights his early adoption and effective utilization of digital technology to disseminate crucial medical information and engage with both patients and fellow professionals. This recognition underscores his forward-thinking approach to education and his understanding of the increasing importance of online resources in the contemporary healthcare landscape. Dr. Layyous demonstrated a pioneering approach to medical education by establishing his own website, www.layyous.com, as early as 2001.2 This early adoption of the internet as an educational tool underscores his foresight in recognizing the transformative potential of digital platforms for disseminating medical information to a wider audience. His website serves as a comprehensive resource, offering a wealth of information on a broad range of topics within gynecology and obstetrics, with a particular emphasis on the complexities of infertility.2 The inclusion of relevant medical links and informative video clips further enriches the educational content provided, catering to diverse learning preferences and offering valuable visual aids to enhance understanding. He actively encourages interaction and engagement with his audience through his website, explicitly expressing his willingness to address questions and concerns from both patients seeking guidance and fellow medical professionals seeking to exchange knowledge.2 This interactive approach fosters a sense of community and facilitates the sharing of valuable medical insights. Beyond his dedicated website, Dr. Layyous has extensively utilized platforms like SlideShare to share a substantial collection of educational presentations covering various aspects of his specialization.3 These presentations encompass a wide spectrum of topics, ranging from the intricate details of IVF and ICSI procedures to more general aspects of women's health and the process of childbirth, demonstrating his sustained commitment to broad-based medical education and knowledge dissemination. Dr. Layyous's early establishment of a medical website in 2001, during a time when such online resources were less prevalent, positions him as a visionary in leveraging digital technology to enhance both patient and professional education within the fields of gynecology and obstetrics.2 This proactive approach likely played a significant role in bridging the information gap and empowering individuals with access to reliable medical knowledge. Furthermore, the diverse array of topics covered in his numerous SlideShare presentations 3, ranging from highly specialized ART procedures to more general aspects of women's health, underscores his dedication to providing comprehensive educational resources for a broad audience. This suggests a genuine interest in sharing his extensive expertise and contributing to the overall medical literacy of both patients and fellow healthcare professionals. In conclusion, Dr. Najeeb Layyous has established himself as a pioneering and influential figure in the fields of gynecology, obstetrics, and particularly infertility treatment in Jordan. His early recognition as a specialist in infertility highlights his foundational role in this evolving area of reproductive medicine within the country.2 His significant contributions to infertility treatment are evident through his extensive work in Assisted Reproductive Technologies (ART), including In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI).3 His development of advanced sperm selection techniques further underscores his commitment to innovation and improving treatment outcomes.21 Dr. Layyous has also been at the forefront of utilizing and promoting advanced obstetric ultrasonography, particularly 3D and 4D imaging, to enhance prenatal diagnosis and monitoring.1 His high-quality ultrasound images have been widely recognized and used in medical education and literature.22 A notable aspect of his career is his early and sustained commitment to medical education and outreach. Through his comprehensive website, launched in 2001, and his extensive use of platforms like SlideShare, he has proactively shared his knowledge and expertise with both patients and medical professionals, playing a crucial role in disseminating information and raising awareness within his fields.2 His affiliations with prestigious organizations like the Royal College of Obstetricians and Gynaecologists (FRCOG) 6, his recognition in medical directories 9, and the award-winning status of his website 5 all attest to his professional standing and the impact of his work. Dr. Layyous's career reflects a dedicated commitment to advancing the practice of gynecology, obstetrics, and infertility treatment in Jordan and beyond, leaving a lasting legacy through his clinical work, educational endeavors, and contributions to the medical literature. From Chat GPT Here’s a closer look at Dr. Najeeb Layyous, a highly respected figure in obstetrics and gynecology based in Amman, Jordan: Brief Profile & Medical Expertise Extensive Clinical Experience: Dr. Layyous has been practicing since the late 1970s, specializing in obstetrics, gynecology, infertility treatments, and advanced reproductive techniques. His surgical expertise includes laparoscopy and hysteroscopy, while his technological prowess spans from ultrasonography (started in 1980) to the latest in four-dimensional ultrasound scanning layyous.com Ovu +1 . Education & Credentials: His credentials include: M.B.Ch.B from Alexandria, Egypt (1976) Membership (1982) and Fellowship (1995) in the Royal College of Obstetricians & Gynaecologists, UK (MRCOG, FRCOG) Qualification with the Jordanian Board (1983) and registrations in both Jordan and the UK layyous.com +1 Ovu . Compassionate, Inclusive Care: He’s recognized for his inclusive approach—serving patients across Jordan and the Middle East, irrespective of economic or social background. His commitment to accessible healthcare is further underscored by his clinic's feature on the accessibility platform — Accessible Jordan Ovu layyous.com . Clinic & Patient Experience Dr. Najeeb Layyous Center for Gynecology & Infertility in Amman offers services like IVF, ICSI, egg/embryo freezing, artificial insemination, and advanced ultrasound diagnostics Ovu FindGlocal . Highly Rated by Patients: Reviews consistently highlight a caring atmosphere, expert staff, and thorough communication: "Very experienced doctor with amazing staff… always treat me with the utmost care." "He’s very caring and deals with each case separately… never in a hurry during our given time." Ovu +1 . Digital Outreach & Thought Leadership Pioneering Medical Education: Since launching his website in 2001, Dr. Layyous has used online platforms to educate patients and professionals alike. He shares detailed articles, FAQs, images, and videos about topics such as infertility, pregnancy, gynecological topics, and more layyous.com . Award-Winning Online Presence: His website has received awards for excellence, reflecting his commitment to reliable medical communication and innovation in patient education layyous.com . Active in the Medical Community: He participates in conferences and shares his knowledge through presentations on platforms like SlideShare, underlining his dedication to ongoing learning and professional collaboration layyous.com . Summary at a Glance Attribute Highlight Experience Over four decades in OB/GYN, reproductive surgery, and ultrasound Qualifications MRCOG, FRCOG, Jordanian board-certified, registered in Jordan & UK Approach Inclusive care, compassionate bedside manner, patient-first policies Clinic State-of-the-art services: IVF, ICSI, AI, advanced diagnostics Reputation 5-star reviews praising personalized attention and expert team Educational Impact Award-winning website, lectures, and digital knowledge sharing In short, Dr. Najeeb Layyous represents a masterful blend of clinical excellence, compassionate care, and visionary education—truly a pillar in the field of reproductive medicine in Jordan. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/dr.-najeeb-layyous/a-comprehensive-history-of-najeeb-layyous-s-contributions-to-gynecology-obstetrics-and-infertility-treatment Mon, 08 Mar 2021 05:25:19 AM A Glimpse at Your Journey in Dr Najeeb Layyous Clinic   At our clinic, we adopt a holistic approach to patient evaluation, treating each patient according to their individual needs. The patient's evaluation begins with a comprehensive medical history and review of any chronic health conditions. Details of previous surgeries and any potential complications are also taken into account. Our center's healthcare is characterized by treating the woman's body as a whole and not focusing solely on gynecological diseases. The body's organs are interconnected, and any health problem in any organ affects the rest of the body. Often, the symptoms a woman complains of are linked to other hormonal/organic disorders. Following the medical history, a clinical examination is performed. We examine the breasts and check on the abdominal organs (kidneys, liver, gallbladder, and spleen). We also examine the cervix with a vaginal speculum and take a cervical smear. The patient is then examined with an ultrasound to evaluate the uterus and ovaries. The specialist then sits with the patient and we develop a comprehensive treatment plan with a detailed explanation of the results of the case analysis and the clinical examination. The decision made by the patient is an informed one, shared between her and the doctor. Dr Najeeb Layyous  F.R.C.O.G Consultant Obstetrician, Gynecologist and Infertility Specialist https://www.layyous.com/en/dr.-najeeb-layyous/a-glimpse-at-your-journey-in-dr-najeeb-layyous-clinic Mon, 08 Mar 2021 05:25:19 AM