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My Life in Ob-gyn Vance Mason, MD 4-16-2010. What is ob-gyn? Womens health care & reproduction Womens health care & reproduction I dont see men unless.

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Presentation on theme: "My Life in Ob-gyn Vance Mason, MD 4-16-2010. What is ob-gyn? Womens health care & reproduction Womens health care & reproduction I dont see men unless."— Presentation transcript:

1 My Life in Ob-gyn Vance Mason, MD

2 What is ob-gyn? Womens health care & reproduction Womens health care & reproduction I dont see men unless part of infertility I dont see men unless part of infertility I chose it because the patients are mostly healthy most of the time and I love surgery I chose it because the patients are mostly healthy most of the time and I love surgery

3 Schooling 4 years college 4 years college 4 years medical school- 1 st 2 books, 2 nd 2 field work 4 years medical school- 1 st 2 books, 2 nd 2 field work 4 years residency in Ob-Gyn ( also called specialty training) 4 years residency in Ob-Gyn ( also called specialty training) I now teach young doctors and care for patients in Westminster I now teach young doctors and care for patients in Westminster

4 How do embryos know what gender to be? Its complicated – Its complicated –

5 How do embryos know what gender to be? Y chromosome is key – Y chromosome is key – It tells fetal gonad to make testosterone and Mullerian Inhibiting Factor It tells fetal gonad to make testosterone and Mullerian Inhibiting Factor MIF tells tubes that make uterus and top half of vagina to go away MIF tells tubes that make uterus and top half of vagina to go away Testosterone tells lower vagina/cloaca to fuse together and make a penis and scrotum Testosterone tells lower vagina/cloaca to fuse together and make a penis and scrotum

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8 What if the testosterone receptor doesnt work? Tubes that make uterus still go away Tubes that make uterus still go away Bottom half of vagina stays vagina-like Bottom half of vagina stays vagina-like No scrotum made, No scrotum made, No penis made No penis made Fetal gonad is still a testis though Fetal gonad is still a testis though Chromosomes are still XY Chromosomes are still XY

9 What would a person like this look like?

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11 Jamie Lee Curtis Looks female (very) Looks female (very) Testosterone is converted to estrogen which assures breast development Testosterone is converted to estrogen which assures breast development Cant have children Cant have children Chromosomes are XY Chromosomes are XY

12 How fertility works Woman makes an egg (ovulates) Woman makes an egg (ovulates) Egg pops loose from ovary, Fallopian tube picks it up Egg pops loose from ovary, Fallopian tube picks it up As the egg travels down the tube, it meets the sperm-sperm does not have to swim much As the egg travels down the tube, it meets the sperm-sperm does not have to swim much A single sperm enters the egg A single sperm enters the egg Egg immediately changes so no more sperm can enter Egg immediately changes so no more sperm can enter

13 Fertility Egg cannot let in more than one sperm or there will be too many chromosomes – Egg cannot let in more than one sperm or there will be too many chromosomes – Our cells each have 46 chromosomes Our cells each have 46 chromosomes Egg has 23 Egg has 23 Sperm has 23 Sperm has 23 Another sperm would make 69 chromosomes, pregnancy would miscarry Another sperm would make 69 chromosomes, pregnancy would miscarry

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15 Fertilization Fertilized egg begins dividing Fertilized egg begins dividing Fertilized egg travels down tube to uterus Fertilized egg travels down tube to uterus Fertilized egg plants in uterine lining (endometrium) Fertilized egg plants in uterine lining (endometrium)

16 Pregnancy Fertilized egg becomes an embryo Fertilized egg becomes an embryo Embryo grows and grows Embryo grows and grows Nine months later, woman goes into labor Nine months later, woman goes into labor Baby is pushed out (head first is safest) Baby is pushed out (head first is safest)

17 Do I ever have to choose between baby and mothers life? No- No- Soap operas not very medically savvy Soap operas not very medically savvy

18 Can fraternal twins have different dads? Yes! Tricky though- Yes! Tricky though- Fraternal twins come from two different eggs Fraternal twins come from two different eggs If woman had sex with two different men on the same day, a sperm from one man could fertilize one of the eggs and the other man the other If woman had sex with two different men on the same day, a sperm from one man could fertilize one of the eggs and the other man the other Very rare Very rare

19 These Dutch twins were conceived in vitro with sperm from 2 different donors accidentally

20 These twins look different but are really from the same dad- both mom and dad are mixed race- normal variation comes up with new gene combos to keep parasites and germs guessing

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22 Why do some babies go breech? No one really knows No one really knows Most probably just get stuck that way Most probably just get stuck that way Half or more can be turned around by pushing on mothers stomach at 36 weeks (external version) Half or more can be turned around by pushing on mothers stomach at 36 weeks (external version)

23 Why is breech birth more risky? Head is biggest part of baby Head is biggest part of baby Head can be trapped if baby is breech Head can be trapped if baby is breech Baby can die Baby can die Head makes the best cork – umbilical cord can sometimes pop out if breech Head makes the best cork – umbilical cord can sometimes pop out if breech Prolapsed umbilical cord can get strangled, baby cant get oxygen from cord Prolapsed umbilical cord can get strangled, baby cant get oxygen from cord

24 Who gets a Cesarean section? Baby too big to fit through pelvis or Baby too big to fit through pelvis or Baby suffers too much stress for safety or Baby suffers too much stress for safety or Mother is very ill or Mother is very ill or Breech presentation – dangerous for baby or Breech presentation – dangerous for baby or Mother wants a repeat CS after past CS Mother wants a repeat CS after past CS 32% of all babies in US now delivered by C- section 32% of all babies in US now delivered by C- section

25 How to operate on a uterus It takes many people – at least 4 – It takes many people – at least 4 – Anesthesia person to take away pain Anesthesia person to take away pain Surgeon Surgeon Surgical assistant Surgical assistant Helper for the baby if a c-section Helper for the baby if a c-section Scrub nurse Scrub nurse Circulating nurse Circulating nurse Recovery room nurse Recovery room nurse

26 How to operate on a uterus Cut the skin Cut the skin Cut the fascia – strong white layer under skin Cut the fascia – strong white layer under skin Cut the uterine wall – Cut the uterine wall – Be careful not to cut baby or moms bladder Be careful not to cut baby or moms bladder Deliver baby and placenta Deliver baby and placenta Sew each layer up Sew each layer up

27 Can you operate on a baby that is still in the womb? Some super-specialists do this – Some super-specialists do this – Some babies have large growths that must be removed or their lungs cant grow Some babies have large growths that must be removed or their lungs cant grow Very experimental still – Very experimental still – Risks preterm delivery Risks preterm delivery

28 Miscarriage If pregnancy doesnt develop properly, it will miscarry If pregnancy doesnt develop properly, it will miscarry Most miscarriages are before the 12 th week Most miscarriages are before the 12 th week Most miscarriages are from chromosome mismatches, even when both parents have normal chromosomes Most miscarriages are from chromosome mismatches, even when both parents have normal chromosomes 1/2 our chromosomes from Mom, ½ from Dad 1/2 our chromosomes from Mom, ½ from Dad

29 Miscarriage Miscarriage is very common – at least 25% of women will have one Miscarriage is very common – at least 25% of women will have one Mothers health usually normal even after several miscarriages Mothers health usually normal even after several miscarriages Mothers body usually has no trouble miscarrying and getting ready for future pregnancy afterward Mothers body usually has no trouble miscarrying and getting ready for future pregnancy afterward

30 Infertility If 100 couples try, 90 will be pregnant within one year If 100 couples try, 90 will be pregnant within one year Half of those who try will get pregnant within 3 months Half of those who try will get pregnant within 3 months Womans most fertile time is the few days around ovulation – days of a 28 day cycle (day 1 is first day of any bleeding) Womans most fertile time is the few days around ovulation – days of a 28 day cycle (day 1 is first day of any bleeding)

31 Infertility Can vigorous weight lifting cause infertility? Can vigorous weight lifting cause infertility? No No

32 Infertility – what is the workup? Make sure man is making sperm (40% of men getting workup will not be) Make sure man is making sperm (40% of men getting workup will not be) Make sure woman is ovulating Make sure woman is ovulating Make sure Fallopian tubes are open Make sure Fallopian tubes are open Make sure uterus has normal shape Make sure uterus has normal shape Make sure womans other hormones are normal (thyroid, prolactin, insulin) Make sure womans other hormones are normal (thyroid, prolactin, insulin)

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34 Infertility - treatments Use donor sperm Use donor sperm Give drugs to woman to help her ovulate Give drugs to woman to help her ovulate Operate on Fallopian tubes to open them Operate on Fallopian tubes to open them Bring egg and sperm together in petri dish, then put embryo in uterus Bring egg and sperm together in petri dish, then put embryo in uterus

35 Signs of ovulation Mittelschmerz – side pains when ovary stretches ovary capsule Mittelschmerz – side pains when ovary stretches ovary capsule Clear, sticky cervical mucus (Spinbarkeit mucus) Clear, sticky cervical mucus (Spinbarkeit mucus)

36 Contraception Abstinence Abstinence Withdrawal – not very effective, better than nothing Withdrawal – not very effective, better than nothing Condoms – also prevents most infections Condoms – also prevents most infections Birth control pill/Vaginal ring/ Patches Birth control pill/Vaginal ring/ Patches Morning after pill Morning after pill Intrauterine device (IUD)(hormone or Cu) Intrauterine device (IUD)(hormone or Cu) Depo Provera shots (hormone shots) Depo Provera shots (hormone shots) Implanon (Hormone implant in arm) Implanon (Hormone implant in arm) Vaginal sponge with spermicide Vaginal sponge with spermicide

37 contraceptive myths You cant get pregnant the 1 st time you have sex You cant get pregnant the 1 st time you have sex You cant get pregnant unless youre married You cant get pregnant unless youre married You cant get pregnant if your periods are irregular You cant get pregnant if your periods are irregular

38 Which contraceptives affect hormones? Birth control pills Birth control pills Vaginal ring Vaginal ring Implanon Implanon Depo Provera Depo Provera Patch Patch Plan B Plan B Hormone IUD (Mirena) Hormone IUD (Mirena)

39 What are pill hormone side effects? Bad side effects: Bad side effects: Nausea Nausea Headache Headache Sore breasts Sore breasts Good side effects: Good side effects: Lighter periods or no periods Lighter periods or no periods Less painful periods Less painful periods Less acne Less acne

40 Morning after pill Brand name: Plan B Brand name: Plan B The sooner after sex you take it the more effective The sooner after sex you take it the more effective 90% effective if taken <72 hrs after sex 90% effective if taken <72 hrs after sex Prescription needed if under 17 Prescription needed if under 17 Cost is $50 Cost is $50

41 How does Plan B work? Egg has to travel down fallopian tube at a normal rate to be fertile Egg has to travel down fallopian tube at a normal rate to be fertile Hormones in Plan B probably speed up tubal transport Hormones in Plan B probably speed up tubal transport Egg may be in wrong part of tube when sperm arrives, cant receive/accept sperm Egg may be in wrong part of tube when sperm arrives, cant receive/accept sperm Egg may arrive in uterus before it is ready and cannot implant Egg may arrive in uterus before it is ready and cannot implant

42 How does Birth control pill work? Hormones in pill tell ovary not to make an egg Hormones in pill tell ovary not to make an egg Hormones in pill tell cervix not to make stringy, clear mucus (sperm need that type of mucus to get through the cervix) Hormones in pill tell cervix not to make stringy, clear mucus (sperm need that type of mucus to get through the cervix)

43 Ovary Cancer Affects one woman in 50 Affects one woman in 50 Symptoms are often vague until too late Symptoms are often vague until too late Oncologists specialize in cancers Oncologists specialize in cancers Gyn-oncologists ( Gyn-Oncs) care for women with ovary cancer Gyn-oncologists ( Gyn-Oncs) care for women with ovary cancer Five year survival after diagnosis is 20% Five year survival after diagnosis is 20% Taking birth control pill cuts risk 50% Taking birth control pill cuts risk 50%

44 Age at first sex National average is 16 National average is 16 The more schooling you get, the older you are when you first have sex The more schooling you get, the older you are when you first have sex For college students, average is 19 For college students, average is 19 All persons having sex should be contracepting unless they want to get pregnant All persons having sex should be contracepting unless they want to get pregnant

45 Stress and ob-gyn doctors Sleep deprivation Sleep deprivation Lawsuits Lawsuits People can die People can die Many things happening at once Many things happening at once Need to be able to make good decisions quickly Need to be able to make good decisions quickly Money decreasing Money decreasing

46 Prenatal diagnosis Can you tell if a baby will have a mental health issue before they are born? Can you tell if a baby will have a mental health issue before they are born? Usually no – Usually no – Exceptions: Fetal Alcohol syndrome (babies born to alcoholics often mentally retarded), Down syndrome (trisomy 21) Exceptions: Fetal Alcohol syndrome (babies born to alcoholics often mentally retarded), Down syndrome (trisomy 21)

47 Pregnant women who smoke & drink Smoking during pregnancy causes preterm delivery and skinny babies Smoking during pregnancy causes preterm delivery and skinny babies Alcohol during pregnancy causes mental retardation and skinny babies Alcohol during pregnancy causes mental retardation and skinny babies Counsel women to stop, give nicotine patch, Alcoholics Anonymous, jail if judge thinks baby threatened enough (rare) Counsel women to stop, give nicotine patch, Alcoholics Anonymous, jail if judge thinks baby threatened enough (rare)

48 Career highlights/lowlights Worst part: Time away from family Worst part: Time away from family Best part: Working w/mostly healthy patients most of the time Best part: Working w/mostly healthy patients most of the time Worse part: Stifling, nonsensical, bureaucratic regulatory agencies and insurances Worse part: Stifling, nonsensical, bureaucratic regulatory agencies and insurances Better part: Getting to talk to all different kinds of people Better part: Getting to talk to all different kinds of people

49 Career highlights/lowlights First surgery ever: circumcision First surgery ever: circumcision Most unexpected thing: Finding two babies at a c-section when only one was expected Most unexpected thing: Finding two babies at a c-section when only one was expected Best moment of my career: Graduating residency Best moment of my career: Graduating residency

50 What areas of gynecology are poorly understood? All of them All of them Research is hard to do – Research is hard to do – Many human-subject-committees reluctant to allow research on pregnant women Many human-subject-committees reluctant to allow research on pregnant women American health system very fragmented, no good central databases American health system very fragmented, no good central databases

51 Drugs Drugs are expensive to research Drugs are expensive to research Because of all the testing required, new American drugs are very expensive Because of all the testing required, new American drugs are very expensive After 13 years, exclusive patent on new drugs expires and anyone can make them After 13 years, exclusive patent on new drugs expires and anyone can make them Generic drugs are cheaper and often better than newer non-generics Generic drugs are cheaper and often better than newer non-generics

52 Common drugs I use Antibiotics Antibiotics Vaccines Vaccines Anti-depressants Anti-depressants Anti-hypertensives (for high blood pressure) Anti-hypertensives (for high blood pressure) Birth control pills Birth control pills

53 Common surgeries I do Remove tubal pregnancies Remove tubal pregnancies Remove ovary growths Remove ovary growths Remove uteruses that bleed often Remove uteruses that bleed often Tie tubes to prevent pregnancy Tie tubes to prevent pregnancy Scrape inside of uteruses that are miscarrying if needed Scrape inside of uteruses that are miscarrying if needed C-sections C-sections Drain abscesses Drain abscesses

54 Pap smears and cervix ca vaccine Women should get 1 st pap age 21 Women should get 1 st pap age 21 Women should get cervix cancer vaccine before 1 st sex – Women should get cervix cancer vaccine before 1 st sex – can be given age 9-12 or anytime before 1 st sex can be given age 9-12 or anytime before 1 st sex Vaccine is 3 shots over 6 months Vaccine is 3 shots over 6 months Covered by Medicaid and insurances Covered by Medicaid and insurances Men should get vaccine too Men should get vaccine too

55 Chlamydia Sexually transmitted infection that is rampant in teens and early 20s Sexually transmitted infection that is rampant in teens and early 20s Can be found with simple urine test Can be found with simple urine test Can silently kill/clog off the Fallopian tubes, making woman infertile Can silently kill/clog off the Fallopian tubes, making woman infertile Often no symptoms Often no symptoms Sexually active teens and early 20s should be urine-tested at least yearly Sexually active teens and early 20s should be urine-tested at least yearly

56 How can women not know they are pregnant? Denial is a psych condition where we deny reality because the truth is too painful Denial is a psych condition where we deny reality because the truth is too painful It helps in the short term, hurts in the long term It helps in the short term, hurts in the long term A woman who does not want to be pregnant may deny it and unconsciously hope it goes away somehow A woman who does not want to be pregnant may deny it and unconsciously hope it goes away somehow

57 The End


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