• World-Class Embryologist Makes Medical Breakthroughs for Infertile Patients
• Institute Announces New Physician Leadership
• Understanding the Pill All Over Again
• Division of Gynecologic Oncology Awarded Membership into Prestigious National Cancer Group
• Women, Mood and Food Cravings
• Pelvic Organ Prolapse--- No Need to Suffer in Silence
• Ask An Expert

World-Class Embryologist Makes Medical Breakthroughs 
for Infertile Patients

Since 1987, world-renowned embryologist Jacques Cohen, Ph.D., Scientific Director of Assisted Reproduction at Saint Barnabas Medical Center, and his research team have quietly accomplished almost every major medical breakthrough in the field of reproductive medicine.  Despite these accomplishments, Dr. Cohen and his staff have largely remained the unseen players behind millions of pregnancies for previously infertile couples.

“There is no other field in medicine where you have another specialty involved to so large an extent in addition to the physician who treats the patient,” says Dr. Cohen. “Our embryology laboratory is open seven days a week and is among the top five in the nation in terms of patient volume*. More importantly, our laboratory is at the forefront in terms of developing reproductive strategies for the future to continue to give patients the best possible chance of having a baby.”

Patients are familiar with the vital role of the reproductive endocrinologist who diagnoses the cause of their infertility, administers a course of treatment and harvests eggs for those who require assisted reproductive technology. What they may not realize is that once the eggs are removed, it is the embryologist who unites the egg and sperm in the laboratory using one of any number of sophisticated techniques. Although patients rarely interact with the embryologist, his or her work helps determine the success of their procedure.

If the sperm fails to penetrate the egg during in vitro fertilization (IVF) or if the embryo fails to implant successfully, several other methods, known as micromanipulation techniques, may be employed. The following methods were either invented or pioneered by Dr. Cohen and his team of scientists and embryologists: assisted fertilization that later lead to the development of ICSI (Intracytoplasmic Sperm Injection) that was fine-tuned by others, Assisted Hatching, Fragment Removal, Embryo Co-Culture, Preimplantation Genetic Diagnosis, Blastocyst Culture and Cryopreservation, Cytoplasmic Transplantation and Single Sperm Freezing.

“In the last four years since joining the staff at Saint Barnabas, the Institute team has developed seven different potentially therapeutic and diagnostic laboratory technologies,” continues Dr. Cohen.

Because the role of the embryologist is crucial to the success of a fertility center, the experience of these individuals is the most vital measurement of competency. The field of assisted reproduction is relatively young, with the birth of Louise Brown—the first “test tube baby” in 1978—marking the start of the specialty. Dr. Cohen began working in clinical assisted reproduction over 20 years ago, making him one of only a handful of embryologists to have worked since the start of the field.

While studying molecular biology as a graduate student in the Netherlands in 1975, Dr. Cohen responded to a bulletin board advertisement seeking master’s degree candidates to work on a new technology called in vitro fertilization.

He enjoyed the work immensely, continued to pioneer new developments and was even hired by the team that produced Louise Brown to develop a process of freezing and storing embryos (cryopreservation). From one small posting, Dr. Cohen built a career around his love of embryology, applied science and medicine.

The only way to become an expert in the field of clinical embryology is to learn from others over time, Dr. Cohen relates. The Saint Barnabas embryology team, including accomplished embryologist and IVF Laboratory Director G. John Garrisi, Ph. D., has a combined total of 138 years of experience. Qualities Dr. Cohen attributes to outstanding embryologists include manual dexterity, patience, experience, quality control and the ability to make crucial decisions because eggs, sperm and embryos all vary greatly.  Dr. Cohen adds that he and his team view eggs and sperm, whether fertilized or not, with “total respect because they are a potential human life.”

Another area where the experience of the embryologist plays a critical part is the speed at which the professional can perform an assisted reproductive technique. For every hour of the process and every procedure done, a loss of eggs, sperm and embryos occurs.

“There is no cookbook of embryology techniques because the field has not existed that long,” Dr. Cohen says in summation. “There is no school for becoming an embryologist. We have some guidelines now but that does not mean they will be done correctly by an inexperienced person. Frequently I hear of people making mistakes that we discovered and refined years ago. It is the experience that makes an embryologist and that is why there are still so few of them.”

All of the behind-the-scenes technology and dedication the Institute team brings together are focused on one overreaching goal: making the dreams of infertile couples come true. Dr. Cohen’s goals for the future of his program include determining with greater accuracy any problems with eggs and sperm before implantation, as well as determining which genes are most involved with early development.

“We try our very best every day to make people happy,” says Dr. Cohen.

Visit www.cdc.gov for the latest Clinic Specific Report by the Society of Assisted Reproductive Technology (SART).

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The Department of Obstetrics and Gynecology at Saint Barnabas Medical Center was pleased to welcome new physician leadership at the Institute for Reproductive Medicine and Science as of October 1, 1999.

David Sable, M.D., was named as the new Director of the Division of Reproductive Endocrinology and Infertility at The Institute. Dr. Sable brings an excellent reputation and leadership skills to the program with experience in providing specialized care to thousands of couples with fertility problems in New York and New Jersey.  He was educated and trained at some of the most prestigious institutions in the world, including the University of Pennsylvania, New York Hospital, Cornell University, Brigham and Women’s Hospital and Harvard Medical School.  Between 1993 and 1998, Dr. Sable was the Associate Director of Reproductive Endocrinology and Infertility at Saint Barnabas.  He has been in private practice in New York and a member of the Department of Obstetricians and Gynecologists at St. Luke’s ––Roosevelt Hospital Center in New York.

Margaret Graf Garrisi, M.D., who is board-certified in both Obstetrics and Gynecology, comes to Saint Barnabas as the new Medical Director of the Assisted Reproduction Program. From 1987 until 1999, she was an Associate Professor (Obstetrics & Gynecology) in the Center for Reproductive Medicine at the Weill Cornell Medical Center, where she also completed her residency training in Obstetrics & Gynecology. Dr. Garrisi completed her Fellowship in Reproductive Endocrinology at Mount Sinai Medical Center. She has been an attending physician in IVF, Reproductive Endocrinology and Infertility for more than 14 years.

Serena H. Chen, M.D., a board-certified reproductive endocrinologist, joins the Institute as the new Associate Director of the Division of Reproductive Endocrinology and Infertility. Dr. Chen completed both her residency in Obstetrics and Gynecology and her fellowship in Reproductive Endocrinology at Johns Hopkins Hospital. Before she joined Long Island IVF, she was on the teaching staff at Johns Hopkins University School of Medicine and an attending physician at Johns Hopkins Bayview Medical Center.

Also on the Institute team, attending physician Patricia Hughes, M.D., received her B.A. from Mount Holyoke College and her doctorate from Albany Medical College.  She completed a four-year residency in Obstetrics and Gynecology at St. Luke’s––Roosevelt Hospital Center and a two-year fellowship in Reproductive Endocrinology at Columbia Presbyterian Medical Center.  She was on the teaching staff at Columbia University College of Physicians and Surgeons and served as Medical Director of the IVF Program at Saint Barnabas from 1993-1995.

The best physicians, scientists and infertility team, extensive support services and a compassionate staff help couples manage the complex issues associated with infertility and its treatment.  For an appointment or information, please call (973) 322-8286.

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Recent advertisement tells us, “this is not your father’s Oldsmobile.”  A similar statement could be made that “this is not your mother’s birth control pill” when discussing the changes that have occurred since the first use of this oral contraceptive.

When oral contraceptives were introduced in the United States in 1960, many women believed they had found the answer to their need for convenient, safe and reliable birth control.  By 1965, “the pill” was America’s leading contraceptive.  With the 1970’s came disillusionment; the pill was not perfect.  While it was highly effective and convenient, it had many minor side effects and a few serious ones.  Though severe complications were rare, pill scare reports created an aura of danger and pill use subsequently dropped in the mid-70’s.  Today the pill has been put into perspective.  It is not for everyone, but recent studies show it to be safe and effective for most women from early adolescence through menopause. 

Ten years ago, physicians often prescribed birth control pills with 100 to 150 micrograms of estrogen.  Today our best pill has no more than 50 micrograms of estrogen with some containing as little as 20 micrograms of estrogen.  This new version is just as effective as the pill of yesteryear but not nearly as plagued by the risks and side effects.  Taken properly, the pill is about 98 to 99 percent effective.

For some women, health conditions make use of the pill unsafe.  Using pills with estrogen is too risky for women who have had blood clots, heart attack, or stroke, known or suspected breast cancer or cancer of the uterine lining, undiagnosed abnormal vaginal bleeding, liver tumors or pregnancy.

Despite widespread publicity on the pill’s drawbacks, its benefits are substantial.  It is still the most popular reversible birth control method in America, with an estimated eight to nine million women taking it daily.  For most healthy women in their thirties or forties, there is no reason at all to stop taking the pill, and benefits can be substantial.

Birth control has a bonus for the mature woman; the pill lowers the risk of both ovarian and uterine cancers and helps bones stay b.  It may help prevent unnecessary hysterectomies, and it even seems to soothe the mood swings, insomnia, and hot flashes that begin to bother some women years before menopause, or the “peri” (around) menopause stage as we currently refer to it. 

Not that the pill’s first advantage– easy and dependable birth control – is something to take for granted. 

As women go through their forties, monthly cycles can become capricious and surprise pregnancies are a distinct possibility.  By supplying low but steady doses of estrogen and progesterone, the pill shuts down the natural production of these hormones, eliminating the peaks and valleys that trigger ovulation.  On the pill’s hormonal plateau, cycles stay as regular as clockwork. 

Regular cycles are important because erratic cycles pose problems even if they do not lead to an unplanned pregnancy.  The first step for any woman having abnormal bleeding past the age of 35 is to make sure that there is not an underlying problem such as polyps or uterine cancer.  Evaluation requires a visit to the obstetrician/gynecologist and if tests show nothing wrong, the pill can avert “nuisance” bleeding and hysterectomies. 

In the largest investigation to date, the Cancer and Steroid Hormone Study (CASH) reveals short term use of the pill cuts a woman’s risk of uterine cancer by forty percent.  Her danger drops further the longer she uses the pill.  Because ovarian cancer rarely announces itself until malignant cells have begun to spread, the CASH study gives the same forty percent decreased risk and women were better defended the longer they had been on the pill. 

Another plus: the pill helps keep the skeleton sound.  We all understand that bone mass starts eroding once menopause arrives (up to twenty percent in five years).  Since menopause doesn’t happen all of the sudden, there would be estrogens on board to help prevent the earliest start of osteoporosis. 

In addition, even though we really do not know what causes premenstrual syndrome (PMS), physicians frequently hear that PMS seems to get worse as patients age.  The pill helps reduce and ease these mood swings. 

Protection against pregnancy, osteoporosis, cancer, perimenopause and PMS symptoms is a large benefit from one tiny pill.  This is precisely why more women today in their thirties and forties are using the pill.  The pill offers less risk of contraception, less water retention, less weight gain and fewer migraine headaches, in other words fewer side effects and significant protection in more ways than one.  The benefits offered by the pill look more alluring these days than they did decades ago when the method set off a sexual revolution.  Now it is clear that the pill has advantages for the body and spirit as well as the libido.

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Division of Gynecologic Oncology Awarded Membership 
into Prestigious National Cancer Group

Saint Barnabas Medical Center, through the Division of Gynecologic Oncology and Reconstructive Pelvic Surgery, has become one of only four health care institutions in New Jersey to be chosen as a member of the prestigious National Cancer Institute-funded Gynecologic Oncology Group (GOG).

“This membership is another example of how our Division at Saint Barnabas can offer the most up-to-date and most ethically supervised patient protocols and the most current treatment for gynecologic cancer management,” says Robert Taylor, M.D., Associate Director of the Division at the Medical Center.

John R. Kellner, administrator of the GOG, reports that membership is awarded to centers that treat a large number of gynecologic cancers and adhere to strict research protocols and conscientious follow-up care. The GOG is the only national cooperative group that works exclusively with female pelvic cancers.

“We are doing the majority of research in women’s gynecologic malignancies and our member institutions have access to the latest treatments,” says Mr. Kellner.

Through Saint Barnabas’ membership, patients of The Division of Gynecologic Oncology and Reconstructive Pelvic Surgery are given the opportunity to partake of new protocol treatments. Those who choose not to participate in protocols still reap the benefits of the Medical Center’s membership, says Dr. Taylor.

“When you have a centralized group collecting as much information as possible about these terrible tumors, the information comes much faster and this assists us in the treatment of all of our patients,” Dr. Taylor relates.

In order to gain membership to the GOG, Saint Barnabas’ Division had to make a formal application showing large patient volume, appropriately sophisticated equipment and physical operations, a highly skilled staff and overall excellence in patient care. Saint Barnabas also has an institutional review board to further scrutinize and refine all patient treatments.

The Division of Gynecologic Oncology and Reconstructive Pelvic Surgery, part of the Department of Obstetrics and Gynecology at Saint Barnabas, is led by Chairman James Breen, M.D.  Dr. Breen is also a renowned physician in the field of gynecologic oncology/surgery and received the 1995 NJ Governor’s Clara Barton Medical Service Award, the highest honor the state can bestow on a person, for his outstanding medical care of women. Dr. Breen and Assistant Department Chair Caterina Gregori, M.D., Thad Denehy, M.D., Associate Director of the Division, and Dr. Taylor comprise the medical staff of The Division of Gynecologic Oncology and Reconstructive Pelvic Surgery.

For further information about The Division of Gynecologic Oncology and Reconstructive Pelvic Surgery Saint Barnabas Medical Center, please call (973) 322-5280.

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Women, Mood and Food Cravings

Can you eat just one cookie or do they keep calling from the cupboard until they are all gone?  Do you sometimes feel an overwhelming urge that only chocolate or potato chips will satisfy?  Do you eat when you are upset, lonely, stressed or angry?  For most women, forgoing favorite foods at certain times is not only unthinkable; it seems beyond our ability to control.  When women eat in response to emotion or moods, rather than in response to true physical hunger it is called emotional eating or food cravings.   

Approximately 97% of women experience food cravings according to a survey conducted by H.P. Weingarten, Ph.D., (Appetite, Dec. 91).  Despite the fact that cravings are so widespread, research is lacking a scientific explanation as to why they arise. 

At what point does the desire for food become sufficiently intense to be termed a craving?  A scientific definition of food craving does not exist; a craving is self-reported and is influenced by the person’s view of the intensity of the craving.

True hunger is a biological and physiological response in which the body tells the brain that nourishment is needed. 

If you are truly hungry, your body feels stomach pangs, intestinal rumblings and a headache may occur.  When you are hungry, any number of foods can satisfy you.  The brain regulates hunger, how much you eat and what you eat.  Food’s sensory appeal (how a food smells, looks or how you remember it tasting) can be the trigger that stimulates the brain.  Hunger may also start at a cellular level when messages are sent to the brain that fuel is needed. 

A craving, however, is a highly specialized, emotionally-based, intense desire to eat a particular type of food.  During a craving, the desire may be so b, you might go out of your way to get the food.  When you are craving chocolate cake, carrot sticks just won’t cut it.  Food cravings may be dictated by time of day with late afternoon or early evening as the prime time for cravings to occur.  Hormones also play a role; pregnancy and the menstrual cycle are common times for food cravings.  Dieters, especially those who frequently go on and off diets, experience cravings most often.

Scientists have proposed many theories for why food cravings exist.  One idea is that food cravings reflect the body’s need for a specific nutrient. Another is that food deprivation, such as following a calorie-restricted diet, induces cravings.  Additional theories are that people may crave foods because they contain substances that influence brain chemistry; or food cravings may be due to hormonal changes.  Finally, perhaps food cravings can be attributed to sensory and psychosocial factors because people simply enjoy the food’s taste, texture, aroma or association (popcorn with movies, birthday cake at a birthday party, etc.)  Research surrounding many of these theories is conflicting.

The number one food craved by women is chocolate.  Only one study has been done to directly research this craving (see Michener, Rozin, Physiological Behavior, 94).  Participants were given several samples which included a chocolate bar, a capsule containing all ingredients found in a chocolate bar and a capsule containing only flour and water.  The results revealed that only the consumption of chocolate itself satisfied the craving, bly suggesting that chocolate craving is due to its sensory properties such as aroma, sweetness, texture and psychological attributes rather than its actual ingredients.  Substances found in chocolate also occur in other foods including pickled herring, cheddar cheese, and pineapple juice, yet people seldom crave these foods.

Mood affects eating, whether you are stressed, angry, lonely or tired.  Some people lose their appetite while some eat more than usual, especially more “comfort foods.”  The more deeply you feel the effects of your emotions, the more you are apt to eat.  For overweight women, this may be especially problematic.  A study conducted by Michael Lowe & Edwin Fisher, Jr. (Journal of Behavioral Medicine, June 83) compared the emotional reactivity and emotional eating of normal and overweight females.  The results showed that the overweight women were more likely to engage in emotional eating than normal-weight females.  The more emotional the women were feeling, the more they ate and the heaviest women were found to be the most emotional in that study.  If foods with pleasurable tastes and textures are used as a reward or to provide solace, then the psychological component for craving such foods grows even ber.

Carbohydrates have been called “mood food” because many women find comfort, calmness and improved mood from eating them.  Foods containing carbohydrates, including starches and sweets (chocolate), increase serotonin.  Serotonin is a brain chemical that regulates sleep, mood, food intake and pain tolerance.  When serotonin levels are high, you are less irritable.

Although further research is needed, it is believed that when serotonin levels are low another chemical in the brain called Neuropeptide Y (NPY) is stimulated due to decreased carbohydrate storage in your body and decreased blood sugar levels.  When NPY is stimulated, so is your desire for sweet and starchy foods.  This may explain why our favorite breakfast foods (cereals, bagels, fruits, etc.) are rich in carbohydrates since carbohydrate stores are depleted while you sleep.  Skipping breakfast increases NPY levels further so that by afternoon you are set up for a carbohydrate binge.  This craving for carbohydrates is not the result of lack of will power; it is your body at work.  When serotonin increases, NPY decreases, which tells your body that you have had enough food.  Stress and dieting have been bly linked to stimulating this process as well.

Excessive dieting interferes with appetite control.  As the body’s cells are fed, a chemical called cholecystokinin (CCK) is released.  This appetite control chemical sends signals of fullness to the brain resulting in your appetite being “turned off.”  The appetite control system is disrupted with chronic dieting.  The result is your body becomes desensitized to feelings of fullness and oversensitized to feelings of hunger, making it much more difficult to determine when you are truly, physically hungry.

Hormonal states during the menstrual cycle influence cravings.  With menstruation there are decreased levels of serotonin, causing depression.  Serotonin levels rise when increased amounts of carbohydrate foods are eaten, producing a calming effect.

A survey reported in American Journal of Psychiatry found that 36% of women reported severe cravings for sweet foods, 7% for salty foods and 11% for other foods before and during their menstrual cycle. 

Pregnancy also influences a woman’s food cravings.  Up to 50% of women report food cravings during pregnancy, especially during the first trimester.  They most frequently crave fruit, fruit juices, and sweet foods including chocolate and dairy products.  A possible connection may be changes in olfactory and taste sensitivity at this time as well as metabolic changes.

Currently, scientific research has not supported most claims about the physiological basis of food cravings or the association between food and mood.  Women who develop and practice healthy eating habits are better able to manage their food intake and food cravings throughout their life stages.  If emotional eating becomes excessive and interferes with lifestyle and good health, seek professional help with a counselor trained in eating problems.

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Pelvic Organ Prolapse, which occurs when a female organ such as the vagina or uterus protrudes through connective tissue or cavity wall, has been described in women throughout the ages.  In lay terms, Pelvic Organ Prolapse describes a herniation or protrusion of the vagina and uterus (if present) along with or without various organs such as small bowel (enterocele), bladder (cystocele) and rectum (rectocele).  Most patients with Pelvic Organ Prolapse have no symptoms.  In other cases, however, the condition may progress to where the vagina, bladder and rectum are bulging between the patient’s legs, severely affecting her hygiene and quality of life.

Symptoms

The symptoms of Pelvic Organ Prolapse do not always directly parallel the severity of the condition, but are generally related to the type of defects. 

Prolapse of the urethra (the tube that drains the bladder), called an urethrocele, often causes symptoms of stress incontinence.  On the other hand, pure bladder prolapse (cystocele) generally leads to two complaints: the first being difficulty in voiding which may be slow, intermittent, require straining, leaning forward, momentary voiding with resting or manual upward replacement of the protruding bladder.  The second symptom is the sensation that something is “bulging out” with or without actual vaginal protrusion.

Not surprisingly, symptoms of a rectal prolapse center on defecation.  Soft stools are easily expelled; however, bowel movements that are more firm, such as those experienced in simple constipation, may pass with great difficulty. Changes in dietary habits (i.e. eating more fiber) and medications (i.e. using stool softeners) will often correct simple constipation but not the symptoms of a significant rectal prolapse, due to the deep pocket formed by the bulging of the rectum into the vagina.

Symptoms of rectal prolapse are most significant when the pocket made by the protrusion is especially deep and when stools are particularly firm.  Rectal prolapse may also be accompanied by the feeling of “something coming out of the vagina.”  Patients with pure rectal prolapse have the chronic urge to move their bowels, but cannot expel the stool for mechanical reasons.  Expulsion often requires pushing the rectum back into place, splinting the vagina or tilting the body to one side.  Many patients often resort to chronic laxative or enema use. On the other hand, patients with chronic constipation have little or no urge to defecate; however, they too, often use enemas and laxatives.

Symptoms of uterovaginal prolapse and small bowel prolapse (enterocele) are usually a feeling of heaviness, fullness or pressure, as well as a sensation of a bulge, with or without an actual protrusion.  Standing will often accentuate these symptoms, and conversely, bedrest will relieve them.  Pelvic pressure that remains despite urinary voiding or bowel movement is considered to be due to uterovaginal prolapse if the uterus is in place or a small bowel prolapse if the uterus has been surgically removed.  Occasionally, a patient will complain of an immediate recurrence of vaginal prolapse after surgery for this condition. In most instances, this signifies that an undetected small bowel prolapse was not repaired at the time of surgery and usually requires an additional procedure.

In general, and at all sites, symptoms tend to occur relatively late in the process of Pelvic Organ Prolapse.  Rarely, patients will complain of progressive incontinence of stool or bowel gas, a serious and socially alienating embarrassment.  A surprising number of these patients learn to control their problem by eating a constipating diet and using adjacent muscles to more or less control their incontinence, while others entirely remove themselves from social interaction.  These patients often have experienced injury to the anal sphincter during childbirth (perineal lacerations) which may not show itself until years later, due to the progressive effects of aging.

Causes

The specific cause of Pelvic Organ Prolapse is unknown.  One theory is that it occurs from damage sustained to the pelvic nerves and muscles at childbirth.  However, previous pregnancy is not a prerequisite for prolapse because it can be seen in women who have never been pregnant, especially in those who have a congenitally elongated cervix.  Another theory is that Pelvic Organ Prolapse may be a result of an inherent weakness of connective tissue which loosens, stretches and ultimately prolapses upon repeated pressure.  Finally, chronic constipation with a lifelong history of repeated straining and pelvic pressure may lead to disruption of the nerves supplying the pelvic muscles.  This damage may lead to a gradual weakening of these muscles, resulting in prolapse.  More than likely, the actual cause is some combination of the above, which research will hopefully reveal.

Treatment

Long before the modem surgical era, physicians attempted various non-surgical methods to reduce Pelvic Organ Prolapse, which eventually led to the development of pessaries (devices worn in the vagina to support the uterus), many of which have their origins in the nineteenth century.  Today, these pessaries are constructed of medical grade silicon and are easily fitted into most women for relief of symptoms.  Pessaries are usually reserved for those symptomatic patients who do not want immediate surgical correction, as well as for those patients who are not candidates for surgery due to severe medical problems.

Treatment of Pelvic Organ Prolapse is primarily surgical with tailored reconstruction of the protruding organs and supportive tissues.  Most commonly, the surgery is performed entirely through the vagina, eliminating the need for an abdominal incision.  Surgical procedures include vaginal hysterectomy (with/without removal of the ovaries and uterine tubes), bladder repair (anterior colporrhaphy), rectal repair (posterior colpoperineoplasty), and small bowel repair.  Occasionally additional procedures, such as urethral slings and repair of old perineal lacerations, are required to address specific problems.  The surgeries usually take between two and two and a half hours.  Patients are generally hospitalized for two to three days with minimal discomfort.

Most gynecologists are trained in the treatment of Pelvic Organ Prolapse and provide excellent repair of these conditions. The Division of Gynecologic Oncology and Pelvic Reconstructive Surgery at Saint Barnabas Medical Center serves as a regional referral center for advanced, recurrent and unusual cases of Pelvic Organ Prolapse and perineal lacerations.  For more information or for an appointment, please call (973) 322-5280.

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Ask An Expert

Angela Wimmer, M.D., FACOG
Attending Saint Barnabas Physician, Obstetrics and Gynecology, with offices in West Orange and North Arlington

Q. Is sex during pregnancy dangerous to me or my baby?

A. As with many things in life, if it feels good, do it.  Under most circumstances sex during pregnancy is absolutely safe for both the pregnant mother and her baby.  The amniotic fluid cushions the baby, thereby protecting him or her from any injury.  However in certain situations, such as placenta previa, placental abruption or preterm rupture of the membranes, intercourse may be discouraged.  As with all pregnancy issues, you should discuss your individual medical situation with your obstetrician.

Anthony Quartell., M.D., FACOG
Attending Saint Barnabas Physician, Obstetrics and Gynecology, with an office in Livingston

Q. What is an ectopic pregnancy?

A. The sperm and egg unite in the fallopian tube.  As the tiny embryo begins to develop, the fallopian tube helps it pass into the uterus where implantation occurs approximately five to six days later.  It is in this intrauterine environment (the womb) in which the developing fetus then grows to maturity.  When the fertilized egg gets “stuck” in the fallopian tube and does not travel to its normal intrauterine location, the pregnancy is referred to as a tubal, or ectopic, pregnancy.

The early diagnosis of tubal or ectopic pregnancy is a difficult one, in that it may have no symptoms at all. In other cases, patients with ectopic pregnancies may show spotting, cramping, bleeding and lower abdominal pain, all symptoms which can be confused with either a threatened miscarriage or, in most cases, a normal, healthy pregnancy.  Predisposing factors to ectopic pregnancy include the history of a prior tubal pregnancy and the history of pelvic inflammatory disease or infections.