Q&A Topic: What do women of all ages need to know about their reproductive health?
Dr. John Orris
Q: How early should girls start seeing a doctor about their reproductive health?
As young adults and during their high school years, women have to become educated about fertility and overall reproductive health. Whether it’s from a class, health class, their pediatrician/gynecologist, or a reproductive endocrinologist, it sets the stage to educate and address problems that happen down the road. What we see in adolescents is, it often takes several years to establish a regular menstrual pattern. For example, we have the high school athlete, who practices and has a negative energy balance, and often that can cause menstrual aberrations. Typically, that is addressed by putting her on the pill for cycle regulation, but it’s something that should be addressed holistically in the form of making sure the coaches and trainers are cognizant of where the athletes’ BMI is and are these menstrual abnormalities a sign of something else going on.
Q: What is a reproductive physical?
After college, women that are interested in childbearing who have concerns about their reproductive health should undergo a reproductive physical. The reproductive physical involves an extensive history, taking into consideration sisters’ and mothers’ gynecologic health, and also family history as it relates to insulin resistance, heart disease and other issues. We run laboratory testing to make sure the hormones in the pituitary are functioning at the normal level, which gives us an objective way to quantify the number of eggs that young person has available. Women are born with the number of eggs they will have in their lifetime; not everybody is born with the same number. Lifestyle factors like smoking, drinking, or nutrition—too much sugar or flour-based food consumption—will work against fertility. The physical exam is head-to-toe, taking into consideration appropriate development. We tend to do an ultrasound of the pelvic organs, too. It makes sure the uterus is normal, rules out fibroids, and allows us to examine the ovaries. It screens for problems that can be concerning.
Q: What are some abnormalities that girls and women should keep an eye out for?
Menstrual irregularities that are red flags to look into irregular menstrual intervals or flow and the relationship to other metabolic abnormalities like childhood obesity, insulin resistance and problems with cholesterol and triglycerides. As the obesity epidemic becomes more prevalent, we’re seeing more of this in our younger population. It has to be addressed proactively, in the form of lifestyle modification, sometimes pharmacologic intervention, but also getting young people talking to their nutritionists early to avoid some of the metabolic derangements that will later play into fertility.
Q: For women past peak fertility, what are steps they can take to get pregnant?
We will do everything in our power to utilize a woman’s own eggs, but I think it’s very important that your fertility doctor or clinic has your best interest in mind, because many women think that if you come in later in life, you’ll immediately elect to do IVF. It’s much perceived like a time machine, like it makes everything better—and it does, but you can’t make your eggs any younger. If you want to procreate and you’re at the older age group, we don’t like to mess around with conservative therapies—like ovulation induction—for more than three or four months. We would go to the IVF path because we get to create embryos and watch what happens. When they make it to the “finish line,” we take a biopsy of what would be the primitive placenta and we study it and can give you the chromosomes. Through the testing of embryos, called pre-implantation genetic screening, we can minimize miscarriage rates.
Q: What are options for couples and individuals who aren’t ready to have children?
When people get married, I think it’s something to think about proactively. It’s nice to have a reproductive check because a lot of problems may take three months to a year to rectify. It could take a long period to drop weight or metabolically correct somebody so they can ovulate again. For single women, egg freezing is an option. It allows us to recover eggs in harvest. We use high-speed freezing processes to keep them at their state of age today, while the patient gets older. The other alternative would be, if you’re married and it’s not the time, making and freezing embryos. I take out eggs, fertilize them with the husband’s sperm, and we freeze them as embryos. You can even have those genetically tested, so not only would they know how many embryos they have in the bank, they’ll know how many are normal and also know the sexes. This significantly contributes to family planning.
Main Line Fertility
Bryn Mawr Medical Arts Pavilion
825 Old Lancaster Road
Bryn Mawr, PA 19010