What Women Need To Know About Fertility: The Menstrual Cycle

David Sable, M.D.
Director of the Division of Reproductive Endocrinology
The Institute for Reproductive Medicine and Science at Saint Barnabas

Part of making infertility treatment easier is not requiring a couple study a year’s worth of human physiology to understand the treatment options available to them and the reasons behind the diagnostic tests recommended.

Reproduction requires the joining of two special cells, each of which contains half the normal amount of DNA, the human blueprints that control production of the baby formed by the joining and development of the two cells. In humans these cells are sperm cells from the male and egg cells (oocytes) from the female.

Although unexpected pregnancy is a major societal problem, in reality human reproduction is an incredibly inefficient process. Women are born with hundreds of thousands eggs more than they will ever ovulate, and most ovulated eggs do not become pregnancies, even if there is adequate sperm for their fertilization at the time they are released.

Men constantly turn over millions of sperm throughout their long reproductive lives, and fertilization of a single oocyte through intercourse requires the release of millions of sperm all at once. Deficiencies in the production and release of sperm and eggs are the basis of most cases of human infertility.

Men can release sperm just about any time. Women, on the other hand, release a single egg every four weeks or so, through a carefully coordinated and timed process called ovulation. This process requires the brain and ovaries to “talk to” each other through hormones that gradually promote the preparation of a single mature egg, one that can be fertilized and developed into a baby. If sperm is deposited into the reproductive tract during the window of time leading up to release of the egg, that egg can be fertilized and pregnancy is possible.

The Female System
Since sperm is expelled from the male in order to do its job, the integrity of the female reproductive system is critical. From bottom up, the reproductive tract consists of the vagina, where the sperm is deposited during intercourse, the cervix, a sort of “gate” into the uterus that controls sperm entry into the higher reproductive tract by producing different types of mucous, a thick and impenetrable mucous during most of the cycle and a thin, watery mucous leading up to the important fertilization window.

The cervix is the lowest part of the uterus or womb in which the pregnancy develops. Attached to the uterus are the fallopian tubes. The tubes have three jobs: 1.) to pick up the mature egg after it is released by the ovary 2.) to provide an appropriate environment for fertilization to take place, since the egg and sperm cells actually meet in the tube and 3.) to propel the resulting fertilized egg (embryo) into the uterus approximately three days later.

Higher up the reproductive tract are the ovaries, which contain the immature eggs that develop based on the hormonal signals from the brain. The ovaries also produce hormones in great supply.

Both men and women have closely regulated hormonal, or signaling, systems that control the egg and sperm production. In women, the brain tells the ovaries to choose and mature an egg. As the ovary does this, it releases increasing amounts of estrogen, an important hormone that comes mainly from the ovary. The release of estrogen does two things: it gradually decreases the stimulation of egg maturation and it indirectly triggers ovulation, or release of the matured egg by triggering an LH surge, a sudden huge rush of hormone from the brain.

The process from the beginning of the menstrual cycle through ovulation is termed the follicular phase, since it results in the formation of a follicle, a small fluid filled area (technically a cyst) which contains a matured egg.

The Fertilization Process
After ovulation, the fallopian tube picks up the egg in a process not well understood and propels it to its center where the sperm should be waiting. Remember: the sperm must always wait for the egg—not the other way around.

If the egg is fertilizable and the sperm is capable of fertilization, and there are adequate amounts of sperm present, fertilization can occur. The resultant embryo develops in the fallopian tube for approximately three days, then travels (or is pushed by the tube) into the uterus.

The uterus, or more specifically its lining, responds to a hormonal signal from the ovary. The cells in the ovary that surround the maturing egg release estrogen. The lining responds by thickening and forming an environment likely to support the embryo’s effort to burrow into the wall and continue to divide. The principal signal for the uterine lining (known as the endometrium) is also estrogen.

After releasing the mature egg, the ovary shifts its production efforts. It continues to produce estrogen, but adds many other hormone products, principal among these is a hormone called progesterone. Progesterone has many effects, and is believed to be the most important contributor to maintaining and supporting the uterine lining.

When an embryo successfully implants into the uterine lining, it gives off signals that tell the ovary to continue supporting the lining with progesterone. In the absence of this signal, the ovary stops its progesterone production. Without this progesterone support the lining sloughs off, causing the bleeding that we see as the menstrual flow.

As you can see, a variety of conditions must be present before conception can occur. For those experiencing fertility problems, a visit to a specialist may help a couple to pinpoint any problem areas and address treatment options.

For information about the Institute for Reproductive Medicine and Science, please call (973) 322-8286.

[ top ]

Esteemed Physician Chosen As Chairperson of the Department of OB/GYN

John F. Bonamo, M.D., Executive Director at Saint Barnabas Medical Center, announced the appointment of Veronica A. Ravnikar, M.D., as Chairperson of the Department of Obstestrics and Gynecology.

"Dr. Ravnikar, an esteemed obstetrician/ gynecologist with expertise in reproductive endocrinology, is a widely published expert in her field and an asset to the state’s largest obstetrical service," says Dr. Bonamo.

Dr. Ravnikar, M.D., a Professor of Obstetrics and Gynecology at the University of Massachusetts Medical Center for eight years and the Director of UMMC’s Division of Reproductive Endocrine and Infertility, was also an Associate Clinical Gynecologist at Massachusetts General Hospital and a Lecturer at Harvard Medical School.

"The leadership of the Department of Obstetrics and Gynecology at Saint Barnabas has spearheaded an outstanding program and I hope to further that vision in the future," says Dr. Ravnikar. "The Department is an esteemed program nationwide, known for the excellence of its staff and patient care. My experience as both a clinician, a teacher and a director will assist me in enhancing current programs and services to continue to address the health care needs of New Jersey women."

Dr. Ravnikar finished her residency at Northwestern, Chicago, and trained in reproductive endocrinology and infertility at Brigham and Women’s Hospital, Harvard Medical School. She was on staff at Brigham for 10 years and Mass. General for three years. In 1991, she received an award for "Excellence in Teaching Reproductive Endocrine" from the gynecologic residents at Harvard Medical School.

Active In Her Field
Dr. Ravnikar holds positions in numerous professional societies and health-related organizations. She has been Chair for the Menopause Division of the American Society of Reproductive Medicine; Chair of the Hormone Therapy Group of the Women’s Health Initiative; Advisory Board Member for the American Heart Association; and has served on the editorial boards of Women’s Health Digest and Prevention Magazine. She is a member of A.S.R.M., A.C.O.G., S.G.I., and the Endocrine and Menopause Societies. Her original research covers such topics as meno- pause and sleep; bone density loss in amennorrheic women; menopause and smoking; menopausal osteoporosis; and the effects of hormone replacement therapy.

The Acting Chairperson since July 2000 and Vice Chairperson from 1969, Caterina Gregori, M.D., will continue in her practice of outstanding medicine with The Division of Gynecologic Oncology at Saint Barnabas.

“Dr Ravnikar brings a wealth of knowledge, talent and experience to the position and I speak on behalf of the entire department in welcoming her to Saint Barnabas,” says Dr. Gregori.

Saint Barnabas Medical Center meets the needs of women throughout the lifecycle. The Medical Center has the largest obstetrical service in the state, with 7,110 babies born at the hospital in 2001. The three subspecialty Divisions within the Department, with exceptionally qualified staff, provide outstanding medical care for women with gynecologic cancers; those with high-risk or complicated pregnancy; and women with conditions that effect the menstrual cycle, fertility and hormonal issues.

The Department of Obstetrics and Gynecology can be reached by calling (973) 322-5282.

[ top ]

Saint Barnabas To Open Premier Maternity Unit This Summer

A major initiative to enhance the obstetrical service at Saint Barnabas Medical Center is the newly constructed additional private room postpartum unit. Scheduled to open this summer, the inviting new area immediately relieves some of the intense demand for maternity rooms in the third floor James L. Breen, M.D., Obstetrical Pavilion, resulting in a higher proportion of private rooms throughout the maternity service.

Saint Barnabas continues to have the busiest maternity unit in the state and leads in childbirths with 7,151 babies born at the hospital in 2001. In the year 2000, Saint Barnabas was ranked 14th, nationwide, in the number of live births per year in a single hospital.

The new luxury unit provides a spacious, warm and comforting environment for new mothers and their babies to encourage the bonding and celebration that every family desires and deserves. This unit has upgraded services with many special amenities.

Special Amenities:

A continental breakfast

An afternoon dessert cart

Complimentary daily newspaper

Coffee and tea available throughout the day

Gourmet menu (guest trays available upon request)

Premium bed linens

Free TV and VCR

In-room refrigerators stocked with complimentary snacks

Free parking for one family member

Complimentary toiletries kit

Computer access in all rooms

Special Features

Extended Visiting Hours

Gourmet meals

Patient Library

Rooming-In

The daily fee is $200 over and above insurance. For more information, please contact a patient representative at 
(973) 322-2728 or (973) 322-5478.

[ top ]

Caterina A. Gregori, M.D. International Recognized Physician Retires as Acting Chairperson of the Department of OB/GYN, While Continuing as an Outstanding Physician

In 1969, Caterina Gregori came to Saint Barnabas Medical Center in the role of Vice Chairperson of the up and coming Department of Obstetrics and Gynecology. In those years she and James L. Breen, M.D., Emeritus Chairman, faced a daunting task. Their goal was to convince the voluntary staff that they were there to improve the professional standards of the Department and to enhance the residency program. At the time there were many skeptics.

Now, 33 years later, Dr. Gregori retires as Acting Chairperson of a Department that has garnered national and international acclaim. A team of over 125 attending obstetricians/ gynecologists have made the Saint Barnabas Obstetrical Service the largest in New Jersey with over 7,000 deliveries last year. Today, the outstanding reputation of the three sub-specialty divisions—Gynecologic Oncology & Reconstructive Pelvic Surgery; Maternal-Fetal Medicine; and The Institute of Reproductive Medicine and Science— has attracted national attention and ensured the finest, most state-of-the-art medical care for New Jersey women. An internationally-recognized physician, Dr. Gregori has dedicated her life to improving the health of women. Through her many roles, including Vice and Acting Chairperson of the Department, attending physician in gynecologic oncology and reconstructive pelvic surgery, researcher and lecturer, Dr. Gregori has distinguished herself as a pioneer in women’s health care.

A major milestone in the 1970s was the creation of the Division of Gynecological Oncology at Saint Barnabas. A pre-eminent surgeon renowned for her skill and experience, Dr. Gregori is Director of the Division and will continue to provide sensitive, compassionate care along with the team of gynecologic oncologists. Their Division has one of the highest patient volumes in the Northeast.

In 2002, Dr. Gregori became the first woman to receive the Distinguished Surgeon Award from the Society of Gynecologic Surgeons (SGS). The award is presented to a physician who has “contributed immeasurably to this specialty,” and is based on clinical expertise, contributions to the health care of women and humanitarian efforts. Past recipients are of national and international prominence and constitute the most recognized and respected group of gynecologic oncologists in the world. Dr. Gregori has contributed in a prolific manner to gynecologic and obstetric literature and films. She has presented her work nationally and internationally.

Dr. Gregori has been a mentor and active developer of the premier Saint Barnabas residency program. She also has acted in an advisory capacity as an Examiner for the American Board of Obstetrics and Gynecology from 1986 through 1998, ensuring the quality of resident education throughout the country. In 1994, she was the recipient of the CREOG national Faculty Award for Excellence in Resident Education.

Nationally respected, Dr. Gregori has held leadership posts in and received awards from the major national societies in this field, including a 1997 award recipient from the American Cancer Society. Dr. Gregori also was chosen by Good Housekeeping Magazine for its list of "The Best Doctors for Women." The magazine published a list of outstanding physicians nationwide in a variety of specialties and Dr. Gregori was chosen for the category of "Gynecological Oncologist."

A visionary, a pioneer, a mentor; all of these words describe Dr. Gregori. For the past three decades she has focused her inexhaustible efforts on patient care, physician education and the advancement of women’s health in New Jersey, across the country and nationwide.

[ top ]

Tubal Ligation: Your Questions Answered

Gerald Ciciola, M.D.
Attending Saint Barnabas Obstetrician/Gynecologist with a practice in West Orange

Women face important decisions about contraception and contraceptive methods. Contraceptive methods available to women are generally safe and effective; however, the preferred method may depend on several factors. Age, marital status, reproductive history and medical history may influence a contraceptive decision. Each contraceptive method has a certain ease of use, level of reliability and potential side effects that are important to consider when choosing which method to use.

Contraception can be temporary (reversible) or permanent. Discontinuing a reversible method would lead to a resumption of fertility. Today, however, we focus on a permanent form of contraception, namely tubal ligation, a commonly performed female sterilization procedure. The decision to undergo a sterilization procedure is a major one for women, or even couples as they complete their childbearing years. Over the past two decades, in fact, nearly a million Americans per year (women more often than men) have made the decision to undergo permanent sterilization as their contraceptive choice.

Candidates
Women considering tubal ligation should have completed childbearing. They should be able to tolerate a short surgical procedure and be aware of the permanent nature of the operation, its efficacy, safety and potential complications. Alternative methods, including oral contraception, long-acting hormonal methods, barrier methods, and intrauterine devices, should be considered before a permanent decision is made.

Current low-dose oral contraceptive pills, for example, may also offer menstrual cycle regulation in addition to other non-contraceptive benefits. Alternatively, condoms act as a barrier method and may prevent several sexually-transmitted conditions as an added benefit. Lastly, male sterilization or vasectomy, is also a safe and effective option for couples to consider when facing choices about contraception and family planning.

Candidates with mixed feelings about the procedure, or any significant risk of future regret, should delay tubal ligation as a method and reevaluate all contraceptive options. Accordingly, women contemplating tubal ligation should have no future intention for the procedure to be reversed.

Methods
This procedure, the tubal ligation, has evolved over the years. Originally described in the 1800’s, tubal sterilization consisted of removing part of each fallopian tube at the time of cesarean
section. In 1929, Brooklyn physician Ralph Pomeroy described one current method of tubal ligation performed at cesarean section. Few sterilizations were performed over the next forty years, as many physicians required strict criteria, such as the woman being over 40 years old and having given birth to eight or more children.

In the early 1970’s, laparoscopy was introduced, and the annual number of tubal sterilization procedures began to rise rapidly. After the administration of general anesthesia, a laparoscopy is performed by inserting a small tube-like cannula into the umbilicus (or belly-button) in order to view the fallopian tubes. The fallopian tubes are then “ligated” or blocked by electrical coagulation (thermal energy) or by mechanical means (clips or rings).

The transition to laparoscopy generally eliminated the need for any overnight hospital stay. This popular method, in its current form, allows women to undergo sterilization operations at times other than immediately after childbirth or cesarean section.

Tubal ligation can still be performed immediately following a cesarean section, after the baby is delivered. Most tubal ligations performed at the time of cesarean section require no separate anesthesia and generally involve removing a portion of each fallopian tube, as originally described in the 1800’s, as the method of choice.

Efficacy
Tubal ligation is a highly effective method of birth control. Contraceptive effectiveness is generally measured by the number of unplanned pregnancies that occur during a specific period. Failure rates are less than 0.5 percent and this makes it one of the most effective means of pregnancy prevention. Sterilization failures, although rare, can occur. Women should be aware that a reliable form of contraception should be used up until the procedure. A pregnancy test is often done immediately prior to the tubal ligation procedure, aiding in detection of an already existing pregnancy.

Recovery
In most patients, laparoscopic tubal ligation is performed in an outpatient setting with minimal disruption of weekly activities. Returning to work in one to a few days is usually possible. The procedure is generally well tolerated with few side effects. Specific expectations, side effects, and potential complications, as with any procedure, should be reviewed with your physician.

Contraceptive advice is a component of good preventive health care. Informed choices are an important part of contraception, and physicians can provide much of the necessary information and guidance through decision-making time. Many women benefit greatly with the ease and safety of permanent sterilization; thus tubal ligation remains an effective option for the right candidate.

STATISTICS FOR THE  JAMES L. BREEN, M.D., OBSTETRICAL PAVILION AT SAINT BARNABAS FOR 2001

[ top ]

Endometriosis Teenagers

Angela Wimmer, M.D.
Attending Saint Barnabas Obsterician/Gynecologist with offices in West Orange and North Arlington

What is endometriosis?
Chronic pelvic pain in women is one of the most widespread and challenging conditions encountered by patients and their physicians. Surveys in the United States and the United Kingdom demonstrate a prevalence of almost 25 percent. Most commonly the pain originates from a gynecologic source, specifically endometriosis. It was described in medical literature more than 300 years ago and has since been recognized as a chronic, painful, and often progressive disease in women. Unfortunately the causes are unknown.

Today, it has become increasingly common for teenagers who visit the gynecologist for the treatment of painful periods to be diagnosed with endometriosis. This is not a disease only for the adult woman and can also occur in any social or ethnic group. Approximately 40 - 60 percent of women with endometriosis report symptoms before age 25. Some experts believe endometriosis may be responsible for between 45 percent and 70 percent of chronic menstrual pain in adolescence.

The endometrium is the tissue that normally lines the inside of the uterus. In some women this tissue grows outside the uterus and is called endometriosis. Most commonly the abnormal growth of endometrium occurs on the reproductive organs, the ovaries, fallopian tubes and uterus, but it can also exist on the intestines, bladder, rectum as well as the lining of the pelvic area and abdomen. Just as normal endometrium responds to the hormones of the menstrual cycle, the misplaced tissue also bleeds each month. However, if the tissue is not in the uterus the blood has no way of leaving the body. Therefore, cysts, adhesions and scar tissue form and the area around the endometriosis thickens.

Who is at risk?
An estimated 2-4 percent of all premenopausal adult women have detectable endometriosis, and over one third of these women experience noticeable pain. Because many women with endometriosis have no symptoms, the actual percentage of premenopausal women with the disorder may be as high as 15 percent. Some experts report that almost 7 percent of first-degree female relatives of endometriosis patients also develop it. A family history of endometriosis not only puts women at high risk for the condition, but possibly a more severe manifestation of it as well.

Women with more frequent than normal cycles, heavier periods or a longer duration of bleeding are at greater risk of developing the condition. Women with a uterine abnormality which obstructs normal blood outflow can also be at higher risk. Interestingly, red heads carry an increased risk. Experts hypothesize that the gene determining red hair might be located near other genes that make women susceptible to endometriosis. Women with a personal or family history of asthma and allergies are also more prone. In addition, women who consume large amounts of caffeine or alcohol have increased levels of estrogen, thereby increasing their risk as well.

How does it occur?
Although many theories exist as to why endometriosis develops, none of them explains all cases. One theory suggests that in some women endometrial tissue flows backward during menstruation, into the fallopian tubes and abdomen, where it attaches and grows. Another theory suggests that some endometrial tissue in the uterus backs up in all women. The immune system usually destroys the misplaced tissue. In women who develop endometriosis, an abnormal immune system exists which is incapable of destroying the misplaced tissue.

What are the symptoms?
Symptoms of endometriosis vary from woman to woman. Although a woman may have one or more of these features, she does not necessarily have endometriosis. Many gynecologic problems share the same characteristics. Common symptoms may include:

Abnormal or heavy menstrual flow

Back or flank pain before or during the menstrual period

Very painful menstrual cramps

Painful intercourse

Pelvic pain, especially before or during the menstrual period

Painful bowel movements, diarrhea, constipation or other intestinal upsets during the menstrual period

Painful urination or feeling the need to urinate often during the menstrual period

Difficulty becoming pregnant

Adolescents are more likely to experience pain both during their periods and at other times during the cycle. The emotional effect of severe endometriosis can be almost as devastating as the pain. It can affect school and extracurricular activities. In one survey patients reported the following emotional effects:

84 percent felt depressed during periods of pain

75 percent felt irritable

Over half reported feelings of anxiety and anger

About 20 percent said they felt hopeless

How is it diagnosed?
Diagnosing endometriosis involves speaking with a physician regarding a woman’s symptoms and allowing him/her to perform a pelvic exam to check for cysts or nodules or any abnormal tenderness or thickening in your pelvic area. To diagnose with certainty may require a one-day surgical procedure known as a laparoscopy. After general anesthesia is given a small cut is made near the navel and the abdomen is infused with gas. The surgeon then inserts an instrument to look at the organs and the pelvic cavity to identify the size, location and number of endometrial growth. Sometimes a piece of tissue is removed (a biopsy) to help with the diagnosis. In addition, the abnormal tissue can be destroyed with special instruments; however, the tissue can grow back.

How is it treated?
Unfortunately endometriosis is a condition that cannot be prevented or cured and the symptoms can become progressively more severe as a woman ages. However, there are many ways to decrease the symptoms and complications, but no regimen has been found to be 100 percent effective. Treatment depends on the severity of the symptoms, the location and degree of endometriosis, the patient’s age and plans for childbearing.

If mild premenstrual pain exists, the only treatment necessary may be an anti-inflammatory medication such as ibuprofen. Some women report relief by avoiding dairy products and eating a diet rich in fiber and low in saturated fats. Fiber-rich foods along with plenty of fluids are not only healthy but also help prevent constipation, which can intensify symptoms. A woman should be sure to ensure adequate calcium and avoid alcohol, caffeine and chocolate. Exercise, which relieves stress and tension and may reduce estrogen levels, may also be very helpful.

For more devastating symptoms options include birth control pills or progesterone pills to control the hormonal stimulation of the endometriosis areas. A more aggressive approach involves an injection that suppresses a woman’s estrogen, thereby placing her in a temporarily menopausal state. These are usually prescribed for at least six months, but the length of time varies with individual circumstances. Unfortunately none of these treatments prevents a woman’s infertility in later years. Also, hormonal therapy, which can have distressing side effects, is not curative and symptoms recur in approximately half of patients within five years.

What can be done to help prevent endometriosis?
Endometriosis is a condition that cannot be prevented or cured. However, treatment can help control the symptoms. The Endometriosis Association is a support group run by women with endometriosis. Contact the Endometriosis Association International Headquarters, 8585 North 76th Place, Milwaukee, WI 53223
(1-800-992-3636), http://www.endometriosisassn.org

[ top ]

Saint Barnabas Chosen As One Of The Best Hospitals In The United States

Saint Barnabas Medical Center has been chosen as the best hospital in New Jersey and one the top 50 leading metropolitan hospitals in the country in the May/June 2002 issue of AARP Modern Maturity Magazine.

"Choosing a hospital that will meet your needs during a health crisis can be one of the most important decisions of your life," said Hugh Delehanty, editorial director for AARP Modern Maturity, America’s largest circulation magazine in making the announcement. "We wanted to provide consumers with reliable unbiased information that will improve their ability to make these decisions. Not all hospitals are created equal and when you need one, it’s good to know which are the standard-bearers in safety and innovation."

Consumers’ Checkbook, a nonprofit consumer education organization, rated the quality of care for adults at acute care hospitals in major metropolitan areas in the United States. The two-year research project included surveying more than 20,000 physicians, analyzing statistics and mortality rates from more than 1,300 hospitals. Saint Barnabas was rated the best hospital in New Jersey, and the 13th best in the country. Only one other New Jersey hospital was included in the overall best hospital list, behind Saint Barnabas.

In the survey in which the average hospital was ranked "very good" or "excellent" by 33 percent of responding physicians, Saint Barnabas received an 80 percent approval rating. Saint Barnabas Medical Center shared the spotlight with some of the most well-respected health care facilities in the country including the Cleveland Clinic, Brigham and Women’s Hospital in Boston, New York-Weill Cornell and Thomas Jefferson University Hospital in Philadelphia, all of which were rated behind Saint Barnabas. “We are extremely pleased that Saint Barnabas has received such an honor,” said Executive Director John F. Bonamo, M.D. “The staff and attending physicians’ commitment and dedication to medical excellence and patient satisfaction is the reason why Saint Barnabas was selected as one of the best hospitals in the nation.”

Susan Weinstein, R.N., Director of Women’s Health, emphasized the Medical Center’s focus on the needs of “the more mature woman.”

“There are more and more gender-based health concerns and Saint Barnabas’s inpatient and outpatient facilities are sensitive to the needs of an aging population of women,” says Ms. Weinstein. “Women are living longer and their needs are expanding.”

Saint Barnabas is New Jersey’s oldest and largest nonprofit, nonsectarian hospital where traditionally more patients are treated annually than any other facility in New Jersey. The 601-bed health care institution cares for over 40,000 inpatients and almost 60,000 Emergency Department patients each year. The Department of Obstetrics and Gynecology also delivers more than 7,000 babies annually, more than any other hospital in New Jersey. In addition, the Medical Center and the Saint Barnabas Ambulatory Care Center provide treatment for over 300,000 patients each year.

For more information on the programs and services offered at New Jersey’s top hospital, log onto www.saintbarnabas.com then select Saint Barnabas Medical Center under system facilities.

[ top ]

Saint Barnabas Medical Center Leads The State in Childbirth

Saint Barnabas Medical Center continues to have the busiest maternity unit in the state and leads in childbirth with 7,151 babies born at the hospital in 2001. In fact, on any given day at Saint Barnabas, approximately 20 women may be delivering babies. In the year 2000, Saint Barnabas was ranked 14th, nationwide, in the number of live births per year in a single hospital.

Several factors make Saint Barnabas Medical Center a well-known facility for childbirths. First, it has more than 120 obstetrician/gynecologists on staff. These ob/gyns from the surrounding communities credit the Medical Center for offering distinct, specialized services for a wide range of women’s health issues. Among these areas of specialization are The Institute for Reproductive Medicine and Science for women seeking fertility treatment, a maternal-fetal medicine program for high-risk pregnancies, the most advanced intensive care for all premature and ill newborns through the Neonatal Intensive Care Unit (NICU), and a specialized gynecologic oncology program that can help women plan for their reproductive needs while undergoing treatment for cancer.

Saint Barnabas is a state-designated Regional Perinatal Center. In 2001, 1,433 premature infants and critically ill newborns were cared for in its 48-bed NICU. Babies treated in the Saint Barnabas NICU receive the highest level of intensive care and sophisticated technology provided in a family-centered environment that fosters parental attachment, as well as healing, growth and development.

For more information about Saint Barnabas Medical Center’s Institute for Reproductive Medicine and Science, the Department of Maternal-Fetal Medicine, the Division of Gynecologic Oncology, or Neonatal Intensive Care Unit, please call Women’s Health Services.