• Postmenopausal Hormone Replacement Therapy – What are the Facts?
• Nation's Obstetrical Care Endangered by Growing Liability Insurance Crisis
• Editorial Regarding “Red Alert” Nation’s Obstetrical Care Endangered : “Common Sense”
• Institute Pioneers Revolutionary Treatment for Unexplained Recurrent Pregnancy Loss
• Saint Barnabas’ Executive Maternal/Child Pavilion Opens
• Menopause and Self Care
• Understanding Ovarian Cysts
• The Institute for Reproductive Medicine and Science Receives Grant for Oocyte Freezing Clinical Trial

Postmenopausal Hormone Replacement Therapy – What are the Facts?  

A 51-year-old woman has been on estrogen/progesterone therapy for more than four years. She was initially placed on the medication for the treatment of mild hot flashes. The woman, who had a heart attack last year, has no history of osteoporosis and no known cases of breast cancer in her family. After hearing about a recent study by the Women’s Health Initiative (WHI) involving possible risks of hormone replacement therapy for some patients, the woman visits her physician and, together, a decision is made to gradually discontinue the medication and try some non-pharmacological methods for the treatment of hot flashes.  

As the above example occurs in physician’s offices nationwide, Saint Barnabas Medical Center’s Department of Obstetrics and Gynecology offers some insight into the ramifications of the discontinued study. 

“Physicians and patients alike have recently been bombarded with information about hormone replacement therapy,” states Veronica Ravnikar, M.D., Chairwoman of the Department of Obstetrics and Gynecology at Saint Barnabas. “As a former Co-Principle Investigator on the WHI, I feel it is important to explain some of the reasoning behind that study and to share with our readers the American College of Obstetricians and Gynecologists (ACOG) statement regarding the results.” 

The following is a statement on the Estrogen Plus Progestin Trial of the WHI, which was given by ACOG,  the national medical organization representing over 40,000 physicians who provide health care for women. 

ACOG has formed a special Task Force on Hormone Replacement Therapy, a multi-specialty panel of medical experts, to make clinical practice recommendations in light of the latest research findings on estrogen/progestin use in postmenopausal women.  

ACOG’s Task Force, formed in June, will expedite its research review and deliberations in light of recent study findings on the effect of combined estrogen and progestin therapy in women, including the announcement by the National Heart, Lung, and Blood Institute of the National Institutes of Health that it has stopped a major clinical trial on the risks and benefits of this combination therapy in healthy menopausal women. The trial was halted after 5.2 years of an 8-year study, due to an increased risk of invasive breast cancer.  

The trial, a part of the WHI, also found small increases in coronary heart disease, stroke, and pulmonary embolism in study participants taking estrogen plus progestin (specifically, 0.625 mg conjugated estrogens plus 2.5 mg medroxyprogesterone acetate daily) compared to the placebo group. The trial found benefits to the estrogen/ progestin combination, including reduced rates of hip fracture and colon cancer. However, the primary objective to proving that estrogen/progesterone prevented heart disease was not met. The WHI trial on estrogen use alone is continuing, as study authors report no increased risk for breast cancer in the estrogen-only study group. 

A full study report appeared in the July 17, 2002, issue of the Journal of the American Medical Association (JAMA), and is also available today on the JAMA web site at www.jama.com. 

This WHI population study group was 16,608 healthy women ages 50 to 79. The data indicate that if 10,000 women take the hormone combination for one year, as compared to 10,000 women not taking the hormone combination,

• 8 more will develop invasive breast cancer
• 7 more will have a heart attack or other coronary event
• 8 more will have a stroke, and
• 8 more will have blood clots in the lungs.
• However, among women receiving combination hormone therapy, as compared to the placebo group,
• 6 fewer will have colorectal cancers, and
• 5 fewer will have hip fractures. 

The increased breast cancer risk did not appear in the first four years of use. Risks for blood clots were greatest during the first 2 years of hormone use. The reduced risk of colorectal cancer emerged after 3 years of hormone use.  

Saint Barnabas Cares about Women’s Health

Dr. Ravnikar summarizes that the decision about use of estrogen/progestin therapy requires evaluation and consultation with a physician. After counseling, women who want to continue taking estrogen/progestin therapy for general improvement and well being may do so provided they understand the potential risks, she adds. 

“In conclusion, based on the WHI data, combined continuous estrogen/progesterone therapy is no longer recommended for the prevention of cardiovascular disease and if previously prescribed for that purpose, it should be discontinued,” says Dr. Ravnikar. “Lifestyle modifications, such as exercise, smoking cessation, weight loss, should be encouraged for all women. Periodic reassessment of the need for estrogen/ progestin therapy is recommended, at least at every annual visit or more frequently if indicated.”

To withdraw hormone therapy, there is no definite data to suggest which is the better process. Dr. Ravnikar says that stopping abruptly may cause bleeding, at times heavy, and also precipitate hot flashes, and so tapering the therapy over time is appropriate, especially if the patient is symptomatic. 

In conclusion, Dr. Ravnikar is confident that gaining knowledge from clinical trials will continue to assist researchers and pharmaceutical companies to find “even safer, more effective hormone treatment therapies for women.”

“New hormonal treatments, along with other approaches, including healthy lifestyles, will be beneficial in our desire to age in good health,” says Dr. Ravnikar.

[ top ]

Nation's Obstetrical Care Endangered  by Growing Liability Insurance Crisis

Alarmed by a recurring medical liability insurance crisis— the third in three decades—The American College of Obstetricians and Gynecologists (ACOG) at a May 2002 press conference issued a national “Red Alert” on the condition of obstetrical care. ACOG warned that without federal and state reforms, chronic problems in the nation’s medical liability system could severely jeopardize the availability of physicians to deliver babies in the U.S.  

“Across the country, liability insurance for obstetrician-gynecologists is becoming unaffordable or even unavailable, as insurance companies stop insuring doctors,” reported ACOG President Thomas F. Purdon, M.D., at ACOG’s annual clinical meeting. “Without insurance, ob-gyns are forced to stop delivering babies, stop surgical services, or close their doors.” 

ACOG identified nine ‘hot states’ with a liability insurance crisis now threatening the availability of physicians to deliver babies. They are: Florida, Mississippi, Nevada, New Jersey, New York, Pennsylvania, Texas, Washington, and West Virginia. In three other states—Ohio, Oregon, and Virginia—a crisis is brewing, while four other states—Connecticut, Illinois, Kentucky and Missouri—should be watched for mounting problems. 

Solutions Needed: Meaningful Reform

“Fifteen years ago, the Institute of Medicine (IOM) urged Congress and the states to provide both immediate relief and long-term solutions to the crisis compromising the delivery of care,” said ACOG President-Elect Charles B. Hammond, M.D. “We still need reform at the federal and state level.” 

Dr. Hammond noted that an effective liability system, involving both the insurance industry and the court system, would fairly spread the insurance risks of providing affordable health care while at the same time compensating patients harmed by negligent medical care. A humane system would go even farther–caring for patients with devastating medical outcomes that may not be related to negligence.  

He listed ACOG’s three-pronged approach for reform:

“First, we consider insurance market reforms, to answer the question, why are premiums so volatile for doctors? Second, we reform our “medical justice” system: those tort system and court procedures that lend themselves to lawsuit abuse. Finally, we must be willing to explore alternatives—for better ways to address cases of poor medical outcomes, while protecting patient care.”

[ top ]

Editorial Regarding “Red Alert” Nation’s Obstetrical Care Endangered 
“Common Sense”
Donald M. Chervenak, M.D., F.A.C.O.G.
Attending OB/GYN, Saint Barnabas Medical Center 

On February 14, 1776, Thomas Paine wrote a pamphlet entitled “Common Sense.” This article presented the fact that an island could not control a continent. The island was Great Britain and the continent was North America, and more specifically the future United States. This concept also inspired native Indians in the subcontinent of India to dissociate from the island nation of Great Britain later in history. 

Today, the island of insurance special interests and the island of medical - legal profit are holding an unfair grip on the continent of medical care. These small, self-serving groups, because of economic clout and legal savvy, are bringing the entire medical community to its knees. 

As was stated in the ACOG News release on May 6, 2002, our nation’s obstetrical care is on “Red Alert” status. Obstetrics is disproportionately affected by rising malpractice rates. Patients are losing access to medical care. Meaningful reform is critical. 

At this point in time, all obstetrician/gynecologists are facing upward spiraling costs with absolutely no way to compensate for them, except increasing the volume of patient load. At some point the system will reach unsustainable levels and then collapse. 

For many parts of the United States, the majority of patients have their health care provided by HMO’S. These plans have not significantly increased their payment to physicians in over a decade. Because obstetricians are not meaningfully able to organize themselves and receive fair compensation, many are now leaving practice. Because many physicians have a conscience and do not drop less profitable plans, they essentially weaken themselves, even though it is for a morally good cause. 

In the past 14 years, obstetrician/gynecologists have lost over 60 percent of profit from procedures such as laparoscopy,  laparotomy, hysterectomy, and subcomponents of obstetrical  care. In the same time interval, salaries, rents and equipment costs have easily doubled. When considering the typically strenuous schedule and time intensive requirements, most OB/GYN’S have been pushed to the breaking point. 

Into this maelstrom of bad news, is projected the medical liability crisis. What is traditionally referred to as “malpractice insurance” used to comprise approximately 5 percent of a practice’s overhead. By 1995 a more typical figure was 10 percent. But now, with the sudden explosion of malpractice premiums, with three months forewarning, a malpractice premium could become 40 percent to 50 percent of an office’s overhead in West Virginia, Pennsylvania and New Jersey. This is a factor that either forces a physician to close shop or change the entire nature of the way he or she practices. The new practice leaves virtually no time for physician - patient interaction. 

The problem with the present situation is that most patients and physicians are suffering to benefit few patients and a very few physicians. The continent is bending to the island. 

When thinking about the physicians and components of the medical systems that are profiteering from its brink of collapse, we should remember some cogent words from one of the men who inspired the American Revolution: Thomas Paine. 

“... a long habit of not thinking a thing wrong, gives it a superficial appearance of being right, and raises at first a formidable outcry in defense of custom. But the tumult soon subsides. Time makes more converts than reason.”

[ top ]

Institute Pioneers Revolutionary Treatment for Unexplained Recurrent Pregnancy Loss  

A couple experiences the joy of pregnancy, only to suffer a devastating loss five weeks later when a miscarriage occurs. Still grieving, they become pregnant six months later. Their excitement is tempered by fear of another loss, and tragically, another miscarriage happens at the four-week point. When yet another unexplained miscarriage occurs months later, the couple is grief stricken and unsure if they are emotionally equipped to handle any further pregnancy losses.  

Now, a procedure called Preimplantation Genetic Diagnosis (PGD) offers hope of normal pregnancy to women who have experienced the anguish of unexplained recurrent miscarriages in the first trimester. At the Institute of Reproductive Medicine and Science at Saint Barnabas Medical Center, the rate of future miscarriage in women who had experienced repeated miscarriage was reduced significantly after PGD, from 23 percent to 9 percent. 

The Institute is one of the major centers for PGD in the world. Director of Implantation and Genetics, Santiago Munne, Ph.D., who performed the procedure more than 400 times last year, is one of the leading pioneers of PGD in the world. 

PGD is performed after a couple has created embryos through in vitro fertilization. Before implanting the embryos, physicians at the Institute test a single cell from each embryo for a variety of conditions. They then implant in the woman’s womb only those embryos which appear to be chromosomally normal. 

A Pattern of Loss

In most first trimester miscarriages, the vast majority of lost fetuses have chromosomal abnormalities, reports Reproductive Endocrinologist Serena Chen, M.D., Director of Ovum Donation at the Institute. Approximately four percent of the population will experience unexplained recurrent miscarriages, defined as three or more pregnancy losses. In women 35 and older, approximately 35 percent of pregnancies are miscarried. 

After two or three miscarriages, couples often have no explanation for the continued loss, especially when both partners have had their chromosomes analyzed and no abnormalities were found. 

Even when both partners have normal chromosomal alignment, says Dr. Chen, a fetus can be produced with abnormal numbers of chromosomes, a condition called aneuploidy. In the body’s relatively complicated process of making ovum (eggs), sometimes mistakes are made; and the bodies of some individuals may make these same mistakes on a regular basis. If an error occurs that leads to the egg or sperm having an extra or missing chromosome, the resulting embryo will also carry the error. 

Repeated Loss, Repeated Pain

For women who suffer unexplained recurrent miscarriages, the mystery of the situation is often compounded by both misinformation and a sense of helplessness. 

“Most patients are told to just keep trying, but often this is a painful situation fraught with grief over the losses,” says Dr. Chen. “Couples may become frustrated or be offered treatments with no legitimate scientific basis. With PGD, we can provide a potential solution based on scientific evidence.”  

Diane Rinaldi of Monmouth County, N.J., suffered four miscarriages in the first trimester and describes the experiences as “very upsetting.” After spontaneously miscarrying the first three times, Ms. Rinaldi and her husband became pregnant through artificial insemination for their fourth attempt. 

“We thought that would fix it,” she recalls. “But I had another miscarriage. It became clear that our problem was not becoming pregnant, it was staying pregnant. It seemed like we should give up at that point, but we just could not.” 

She learned of the PGD procedure and decided to come to the Institute to see if there was anything to be gained by having physicians examine the health of the embryos before implantation. Of eight embryos that were produced by the Rinaldis, only three proved to be viable for implantation. 

The Rinaldis became pregnant after the in vitro fertilization with PGD and delivered a healthy 7 and a half-pound boy, Joseph, on March 5, 2002. 

“It was truly amazing,” says Ms. Rinaldi. “I know for certain that this is the only way that we could have had a baby. If it were not for PGD and the Institute, we would have given up. Thank goodness this is something that is available right here in New Jersey.” 

New Hope for a Variety of Patients

While this technique offers new hope to couples with unexplained recurrent first trimester pregnancy loss, PGD is also an increasingly important technique for women over 35 who wish to become pregnant but who are concerned about the increased risk of recurrent miscarriage or birth defects. Although not as accurate as amniocentesis or chorionic villus sampling, PGD has the advantage of  being performed before pregnancy occurs.

“The average rate of genetic abnormality in patients with recurrent miscarriage is 50 to 60 percent, but this figure rises greatly with increased maternal age,” says Dr. Munne.

Of note, the Institute performs PGD for gender selection only when there is a risk of sex related diseases. 

For More Information

PGD fees are in addition to the cost of in vitro fertilization and embryo transfer, the latter two of which may be covered by individual insurance through the New Jersey Family Building Act. For further information about PGD, please contact the Institute for Reproductive Medicine and Science at (973) 322-8286.

[ top ]

[ top ]

Menopause and Self Care
Susan Weinstein, R.N., B.S., H.N.C.
Director, Women’s Health Education

As a woman approaches middle adulthood, she experiences gradual changes in her menstrual cycle. Her periods can become very heavy at times or in some women, they are less frequent, lighter and erratic. Eventually, the process of menstruation ceases and the cycle of menopause is complete. 

Some women experience this change with little or no symptoms and actually enjoy the new found freedom of menopause. But many women experience a multitude of uncomfortable feelings and changes in their physical and mental bodies due to this alteration in hormone production. 

Common experiences that can occur in peri-menopause and menopause are:

• Hot flashes or flushes
• Weight gain and water retention
• Night sweats
• Fatigue
• Irritability and increased anxiety
• Sleeplessness
• Anxiety and/or depression
• Dryness in the eyes and vagina
• Mood swings
• Lack of libido
• Heart palpitations
• Confusion and “fuzzy thinking

Until recently, many women have been provided with HRT or Hormone Replacement Therapy by their physician. While this may still be appropriate for some women, it is now thought that HRT is not always the best way to help women with their symptoms. 

The following are suggestions for the management of these experiences. It is not intended to be a guide for self-treatment. Be sure to check with your physician before stopping your HRT and discuss these alternatives as well.  

Self-Care Recommendations

Maintain a healthy lifestyle

• Nurture yourself daily

• Optimize your nutrition– reduce the amount of animal fat in your diet; a high fat diet can increase hot flashes.

• Adopt a regular exercise program

• Reduce stress in your daily life. Learning a relaxation technique can be a vital part of symptom relief.

Consider Vitamin supplementation-

1. Take a daily multiple vitamin. It should contain the full B complex, including 50-100 mg B6, which decreases anxiety and water retention. Antioxidant formula protects against free-radical damage and slows down the aging process. Vitamin C, 1,000 mg, is critical to the immune system and the manufacturer of skin collagen. 

2. Take additional Vitamin E (400-800 IU daily is the suggested amount, take into consideration the amount in your multiple vitamin)
Actions: 

• important to immune function
• decreases hot flashes
• reduces breast tenderness
• helps dry skin and improves vaginal dryness

3. Get enough Calcium - 1,000-1,200 mg daily (spilt into two doses, 500 or 600 mgs each) Calcium citrate is better for absorption and decreases risk of kidney stones. 

4. Get enough Essential Fatty Acids

• Particularly important in menopausal women because a deficiency in these oils is partly responsible for the drying of skin, vaginal tissues and other mucous membranes.

• Take Flaxseed (fresh ground is best, 2 tablespoons daily) or Cod Liver oil capsules or Fish Oil capsules; they are all good supplements of essential fatty acids. Follow label directions.

5. Try Soy:

Soy products have been found to be helpful in reducing some menopausal symptoms. Soy is a non-animal high quality protein, which contains isoflavones. This soy protein is composed of phytoestrogens which are plant-based estrogens that have estrogen-like actions. They help balance hormone levels by binding to estrogen receptors. They increase the effects of estrogen stores in women with low levels while helping to decrease the effect of estrogen levels that are too high. Suggested amount is 3 servings daily. (Women with known breast cancer or thyroid problems should discuss soy supplementation with their physician.) 

6. Herbal supplements:

Herbals may be taken as tea, tinctures, or capsules. Dosages are not standardized following package guidelines is best. 

The effects of some herbal remedies occur slowly, allow 8-10 weeks to discern effectiveness. 

I.  Black Chosh (Cimicifuga racemosa)
Actions: anti-inflammatory, suppress LH levels-therefore helps control hormone surges that cause hot flashes, also helps alleviate insomnia.
Dosage: tincture 10-60 drops/daily
Root or tea 1-2 gms/daily
Most common form of Black Cohosh is Remifemin-usual dose 2 tablets (60 or 120 mg per tablet) twice a day.
**Black Cohosh can interact with medicines for high blood pressure and may result in excessively low blood pressure in some women.

II. Dong Quai (Angelica sinensis)
Actions: Has good phytoestrogen activity and called female ginseng because of its ability to enhance energy and sense of well-being. Also used for irregular periods, heavy bleeding and cramping.
Dosage: follow label on packaging-best used in capsules or tablets. 

III. Chaste Berry (Vitex Agnus-Castus)
Actions: Helps balance irregular periods especially in peri-menopause. Helps with PMS symptoms. Can take several months to work.
Dosage: Vitex (most common form of Chaste Berry) is found in health food stores-follow labeling.
*Chaste Berry can cause rashes in susceptible individuals. Do NOT take with neuroleptic medicines such as haloperidol (Haldol) or thioridazine (Mellaril), or when pregnant or nursing.

IV. Valerian Root
Actions: Acts as a sedative to induce sleep and relaxation. Does not induce morning sleepiness.
Dosage: Take in capsule form, 150-300 mg of a product standardized to 0.8% valerenic acid at bedtime. 

Mind/Body Approaches: 

• Eliciting a relaxation response, which encompasses breath focus, positive mind focus and muscle relaxation, can significantly reduce anxiety in women at menopause. Women also find mind/body techniques can relieve insomnia and mild depression. Hot flashes will become significantly less frequent and intense when using a daily relaxation technique.

• Emotional expression and social support are essential during this life transition stage. Women are seeking out creative ways to optimize their health and take control of their well being.   

[ top ]

Understanding Ovarian Cysts 

The ovaries are two small organs, one on each side of a woman’s uterus. It is normal for a small cyst (a fluid-filled sac or pouch) to develop on the ovaries. These cysts are harmless and in most cases go away on their own. Others may cause problems and need treatment. 

“A physician’s finding that, ‘You have an ovarian cyst’ should not reflexly produce fear and serious concern in the minds of our patients,” says Richard G. Binetti, M.D., F.A.C.O.G., Clinical Chair of the Department of Obstetrics and Gynecology at Saint Barnabas Medical Center. “Too often, perhaps because of inappropriate or exaggerated media coverage, our patients equate an ovarian cyst with ovarian cancer. This assumption is almost always incorrect and produces much unnecessary anxiety.” 

Dr. Binetti relates that the vast majority of ovarian cysts discovered on pelvic examinations are benign and require little or no treatment. These cysts are usually physiologic, which means that they develop as a result of the normal functioning of the ovary. Although they can produce symptoms, such as pelvic pain, Dr. Binetti says most are small and transient and often resolve spontaneously. Those that do not resolve are most often treated with oral contraceptives. 

“Factors, such as the patient’s age, size of the cyst, and the characteristics or appearance of the cyst on an ultrasound examination will determine if other testing or surgery is indicated,” says Dr. Binetti. “While close surveillance is always the rule, we should thoroughly explain all these factors to our patients in order to keep this very common finding in perspective.” 

The following information on ovarian cysts is provided by the American College of Obstetricians (ACOG).  

Your Monthly Cycle

One of the two ovaries - each about the size of a walnut - produces an egg every month during your menstrual cycle. An egg, encased in a sac called a follicle, grows inside the ovary. On about day 5 of your menstrual cycle, the hormone estrogen signals the endometrium (the lining of the uterus) to grow and thicken to prepare for a possible pregnancy. About day 14, the egg is released from the ovary. This is called ovulation. 

Around the time of ovulation, a woman can get pregnant. The egg moves into one of the two fallopian tubes connected to the uterus where it can be fertilized by a man’s sperm. After ovulation, the empty follicle becomes the corpus luteum, which remains until the next period. The corpus luteum makes hormones that cause the endometrium to grow. 

Types of Ovarian Cysts

Ovarian cysts are quite common in women during their childbearing years. Most cysts result from the changes in hormone levels that occur during the menstrual cycle and the production and release of eggs from the ovaries. A woman can develop one cyst or many cysts. Ovarian cysts can vary in size - from as small as a pea to as big as a grapefruit. 

There are different types of ovarian cysts, and each type causes a variety of symptoms. All cysts can bleed, rupture (burst), twist and cause pain. Most cysts are benign - not cancerous. A few cysts, though, may turn out to be malignant (cancerous). For this reason, all cysts should be checked by your physician. 

Functional Cysts

The most common type of ovarian cyst is called a functional cyst. It develops from tissue that changes in the normal process of ovulation. There are two types of functional cysts - follicle and corpus luteum. Both of these cysts usually have no symptoms or minor ones when they occur. They disappear within a few months. 

Dermoid Cysts

Dermoid cysts are made up of different kinds of tissue, such as skin. They may be found on both ovaries. Dermoid cysts are often small and may not cause symptoms. They can, however, become large and cause symptoms. 

Cystadenomas

Cystadenomas are cysts that develop from cells on the outer surface of the ovary. They are usually benign, but they can create problems. Cystadenomas can grow very large and interfere with abdominal organs and cause pain. 

Endometriomas

Endometriomas are cysts that form when endometrial tissue grows in the ovaries. This tissue then responds to monthly changes in hormones. The tissue bleeds monthly, which may cause it to form a gradually growing cyst on the ovary. An endometrioma is also known as a “chocolate cyst” because it is filled with dark, reddish-brown blood. 

An endometrioma is often linked to a condition known as endometriosis. It can be painful, especially during the menstrual period or during sexual intercourse. 

Multiple Cysts

Women who do not ovulate regularly can develop multiple cysts. This is a disorder in which the ovaries are enlarged and contain many small cysts. It can be linked to a condition called polycystic ovary syndrome (PCOS). This condition causes irregular menstrual periods, infertility and increased body hair.

Symptoms

Some may cause symptoms because of twisting, bleeding and rupturing. They may cause a dull ache in the abdomen and pain during sexual intercourse. 

Some cysts may be cancerous. The risk of ovarian cancer increases as you get older. Although ovarian cancer often has no symptoms in its early stages, you should be aware of its warning signs. Signs of cancer of the ovary include enlargement or swelling of the abdomen, nausea or heartburn that doesn’t go away, loss of appetite and pelvic pain. 

If you have any of these symptoms, see your physician. If ovarian cysts are found early, many of the problems caused by them can be treated. 

Diagnosis

An ovarian cyst is often found during a routine pelvic exam. When your doctor detects an enlarged ovary, he or she may do other tests to confirm the diagnosis:

• Ultrasound: A procedure that uses sound waves to create pictures of the internal organs that can be viewed on a screen.
• Laparoscopy: A surgical procedure that allows a doctor to look directly inside the body. The laparoscope - a thin lighted telescope - is inserted into the abdomen to view the pelvic organs. Laparoscopy can also be used to treat your cyst.
• Blood tests: Tests to measure substances in the blood and help confirm the diagnosis. One such test measures CA 125, which may be used to detect a risk for ovarian cancer. 

Some of these tests provide further information about the cyst that is helpful in planning treatment. Some may be used only if there is a high risk of problems. 

Treatment

If your cyst is not causing any symptoms, your physician may simply monitor it for 1 month to 2 months. Most functional cysts go away on their own over one or two menstrual cycles. 

If your cyst is large or causing symptoms, your physician may suggest treatment with hormones or surgery. The type of treatment depends on several factors:

• Size and type of cyst
• Your age
• Your symptoms
• Your desire to have children

Hormonal Therapy

Your doctor may prescribe oral contraceptives (birth control pills) to treat functional ovarian cysts. The hormones in birth control pills stop ovulation. This prevents follicles from developing and stops new cysts from forming. Birth control pills may not be right for every woman, especially if you smoke cigarettes and are over age 35. 

Surgery

Your physician may suggest surgery to remove the cyst. The extent and type of surgery that is needed will depend on several factors. Sometimes, a cyst can be removed while leaving the ovary (cystectomy). In other cases, one or both of the ovaries may have to be removed. Your physician may not know which procedure is needed until the surgery begins. 

Finally...

Ovarian cysts are common in women during their childbearing years. Although most cysts are harmless and go away on their own, your physician will want to keep track of any cyst to be sure that it does not grow and cause problems. 

If you have ovarian cysts, you probably have some concerns. Share your concerns with your physician. Together, you can reduce your risk of further problems and help you to stay healthy.

[ top ]

The Institute for Reproductive Medicine and Science Receives Grant for Oocyte Freezing Clinical Trial  

Physicians and scientists at Saint Barnabas Medical Center’s Institute for Reproductive Medicine and Science invite volunteers to participate in an innovative clinical trial to examine a new approach for freezing oocytes (eggs) as a result of oocyte retrieval. The Institute has been given a $30,000 grant from Organon Inc., to help conduct a clinical trial of a newly developed method of freezing and thawing oocytes. 

While sperm and embryo cryopreservation are routinely used today and can safety yield high pregnancy rates, oocyte freezing remains unreliable. Pregnancy rates using previously frozen oocytes have been extremely poor. 

“We are very excited about our preliminary results and feel confident that our technology will make a difference,” says Serena Chen, M.D., Associate Director of the Institute. “There are many groups who could benefit from a reliable method of egg freezing. For example, female cancer survivors would have a chance to conceive after therapy. Currently the only option for young, single women with cancer is embryo cryopreservation, which requires the use of donor sperm. Also, successful oocyte freezing could be an option for women who postpone childbearing but still want the option to conceive.” 

Participants—who should be between the ages of 21 and 34, with normal ovarian reserve and who require in vitro fertilization (IVF) to conceive—will receive a significant discount in the cost of IVF for participation in the study. 

The pilot study, which will consist of 10 patients and has already begun, involves oocyte retrieval from all participants. Half of the eggs will be immediately frozen using the new techniques, while the remaining eggs will be combined with sperm and frozen as embryos using standard techniques. The frozen eggs will then be thawed, fertilized and the resulting embryos will be transferred to the uterus. If a pregnancy does not result from the frozen eggs, then a routine cycle will be performed using the embryos frozen with standard techniques. 

As one of the nations leading fertility centers, the Institute maintains pregnancy rates that are among the highest in the world and treats patients from 43 states and 17 foreign countries. World-renowned embryologist Dr. Cohen and his research team have accomplished numerous major medical breakthroughs in the field of reproductive medicine.

If you are interested in participating, please call the Institute at (973) 322-8286, or speak with your obstetrician about a referral to the Institute.