In the last post, I mentioned that I often talk with my patients about their options in genetics testing during the first prenatal appointment, but it actually goes much further. The genetics testing consultation is a separate appointment altogether.

If you were my patient, here’s what we’d discuss in this special consultation:

• A detailed health history of both mom and dad to find out if you are at risk of having a baby with a disorder.
• An overview of the tests available to you, the risks of each, and the reasons you may or may not want to proceed with each test.
• Options available to you should you discover that your baby may have a genetics disorder.

Understanding Genetics Disorders

You may remember that genetics are the traits passed from both parents to the child. The mother’s egg and the father’s sperm each have 23 chromosomes, which pair up within each cell of the fetus. Each of the 46 chromosomes contains a number of paired genes, some recessive and some dominant, which define a number of traits. These traits range from the color of the baby’s eyes to blood type.

A genetics disorder can result from a missing or damaged chromosome or gene or when inherited from a parent. Disorders could include Huntington’s Disease, Tay-Sachs disease, cystic fibrosis, hemophilia, Down syndrome, and others.

Types of Tests Available to You

Carrier test – A blood or saliva test completed at any time to determine if either parent is a carrier of a genetic defect.

Chorionic villus sampling (CVS) – Between 10-12 weeks, a sample of cells from the placenta is tested to find chromosomal problems.

Nuchal translucency screening – Between 10 and 14 weeks of pregnancy, this special ultrasound and blood test look for signs of Down syndrome, trisomy 18, and heart defects.

Maternal serum screening – Between 15 and 20 weeks of pregnancy, a blood test that measures certain substances to determine if the there is an increased risk of a neural tube defect, abdominal wall defect, Down syndrome, or trisonomy 18.

Amniocentesis – Between 15-20 weeks, a needle can be used to draw amniotic fluid and cells from the sac around the fetus to check for chromosomal problems.

Detailed ultrasound exam – If a screening test shows there is an increased risk, a detailed ultrasound will help to explain the screening. Test can be completed anytime after 18 weeks of pregnancy.

Fetal blood sampling/cordocentesis – Blood is taken from the umbilical cord when the results of an amniocentesis or CVS are not clear.

What Happens When You Decide To Do Genetics Testing

Ultimately, you get to choose what, if any, genetics testing you have done during your pregnancy. Depending on what the doctor finds, you may need additional tests, the doctor may want to monitor the baby more closely, you may need to deliver sooner than expected, or, nothing will be done at all, because you and your baby’s health looks fine.

Other Special Testing During Pregnancy

Not all prenatal testing looks for genetics disorders. You doctor may want you to complete any number of special tests to look for potential problems (tests include fetal movement counts, ultrasound, Doppler ultrasound of the umbilical or other artery, nonstress test, biophysical profile, and contraction stress test).

As published by the American Congress of Obstetrics and Gynecology (ACOG), most obstetricians will request frequent tests if you have any of the following:

• Blood disorders
• Thyroid disease
• Heart disease
• Lupus
• Kidney disease
• Diabetes
• High blood pressure

To read more about genetics and special prenatal testing, visit our library of resources that contains a pamphlets published by ACOG. You may also subscribe to our RSS feed to get our blog updates directly to your feed.

In my last blog I wrote about Essure, a relatively new procedure that offers a highly effective option for permanent birth control. One of the best ways to evaluate whether or not a medical procedure is right for you is to look at it in terms of its risks and benefits. Here are some more questions and answers that I hope will help you with your decision.

Is the Essure procedure effective?

While no form of birth control is 100% effective, fewer than one in 100,000 pregnancies occur when tubal blockage has been confirmed by the three-month test. The Essure procedure is the only birth control method with zero pregnancies in clinical trials.

Is the Essure procedure safe?

Studies have shown that the Essure procedure is safe. However, as with most birth control methods, there are risks. In some cases one or both Essure coils may not place properly in the Fallopian tubes and may have to be re-applied.

Is the Essure procedure painful?

In most cases the pain of an Essure procedure is far less and shorter-lasting than the pain often associated with a surgical procedure such as tubal ligation. Symptoms during or immediately after an Essure procedure may include mild to moderate cramping, nausea, vomiting, dizziness and bleeding. However, pain from the procedure is usually relatively mild. In a medical study published in 2005, 72 women who were surveyed immediately after undergoing the Essure procedure said the pain they felt was slightly less on average than the pain they experienced during their menstrual cycle.

How long does the Essure procedure take?

Essure patients are asked to arrive an hour before the procedure time. Once inside the examination room, the cervix is numbed and the uterus is filled with a liquid saline solution. The next step, insertion of the coils into the Fallopian tubes, takes about 10 minutes. The three-month test usually takes about an hour.

How long does Essure procedure recovery last?

Most women return to their normal activities in less than a day.

How quickly does the Essure procedure work?

It usually takes about three months for the Essure treatment to completely block both Fallopian tubes. During this time, women should continue to use a backup form of birth control. After three months, the Essure procedure’s effectiveness is tested using an HSG (hysterosalpingogram) test, which uses dye to test the seal. In some cases it may take six months or longer for the Fallopian tubes to become completely obstructed.

Will the Essure procedure affect my monthly cycle?

Unlike many temporary methods of birth control such as birth control pills, the patch and some IUDs, the Essure coils do not contain hormones. They will not interfere with your monthly cycle.

Is the Essure procedure covered by my insurance?

Essure procedures are covered by most insurance providers. If the procedure is performed in a doctor’s office, a co-pay may be all you need to pay. My office can work with you and your insurance company to determine what your insurance company will cover.

How does the Essure procedure compare to getting your tubes tied?

Tubal ligation, or “getting your tubes tied” is a procedure that involves severing Fallopian tubes or pinching them shut. It can be done via cutting or burning the Fallopian tubes, or by using rings or clips that restrict part of the Fallopian tubes. The procedure usually takes one to two hours, with general anesthesia. It’s usually done in a hospital or a clinic.

The Essure procedure is different from tubal ligation in that it does not involve cutting, it does not require general anesthesia, and it usually takes about 10 minutes. More than half of all Essure procedures are performed in a doctor’s office.

More information

If you’d like additional information, you can click on any of the links below, or you can contact my office directly.

Links to Essure resources

Essure’s home page
Essure patient and physician testimonials
Essure patient information booklet pdf
Essure confirmation test booklet pdf
Dr. Garofalo’s webpage on permanent birth control and Essure
Dr. Garofalo’s Essure consent form pdf

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

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Lately I’ve been getting a lot of questions from my patients about the Essure birth control procedure. Maybe it’s because of the recent publicity from Olympic gold medalist Picabo Street, who announced earlier this year that she’d undergone the procedure. In any case, I thought I’d answer some of the most common questions I’ve heard. I’ve also included some useful links at the bottom of this blog.

What is Essure?

The Essure procedure is a permanent birth control method developed by an American company called Conceptus. Essure is their main product.

During the procedure, tiny flexible coils made out of polyester fibers, nickel-titanium and stainless steel are passed by a small tube called a catheter from the vagina through the cervix and uterus and into the Fallopian tubes. (Fallopian tubes are two very thin tubes that lead from the ovaries into the uterus.) Once in place, the Essure coils cause tissue growth (scarring), which seals a portion of the Fallopian tubes. This tissue barrier prevents sperm from reaching the ovaries.

How long has the Essure procedure been used?

Hundreds of thousands of women have had the Essure procedure, which was approved for use in the United States in 2002. I’ve been conducting Essure procedures for several years.

While the Essure procedure is relatively new, Essure coils are made from materials that have been used successfully for many years in cardiac stents and other medical devices that are placed in the body.

Is the Essure procedure permanent?

According to the manufacturer, the Essure procedure is intended to be permanent and non-reversible. However, as of last month, less than two dozen successful Essure reversals have been performed – all in the past three years – and the first “Essure reversal baby” was born just a few months ago.

Before having the Essure procedure, you should be sure that you do not want to have any more children.

Is the Essure procedure right for me?

Most women are candidates for the Essure method, but sometimes the coils cannot be placed due to issues such as prior tubal blockage, fibroids distorting the uterine cavity, or uterine septum (when a wall of tissue divides part or all of the uterus). In addition, the Essure procedure is not recommended for women who:

• are pregnant or have been pregnant in the past six weeks
• are not certain they are finished having children
• have had a recent infection in the pelvis
• have serious, chronic health problems
• are allergic to contrast dye or nickel
• are taking corticosteroids (a type of anti-inflammatory drug)

If you’ve had any of these conditions, we can discuss whether Essure is appropriate for you.

Tune in next week …

In my next blog I’ll write about the Essure procedure’s risks and benefits, and how it compares to another procedure, called tubal ligation – or “getting your tubes tied”.

More information

If you’d like additional information, you can click on any of the links below, or you can contact my office directly.

Links to Essure resources

Essure’s home page
Essure patient and physician testimonials
Essure patient information booklet pdf
Essure confirmation test booklet pdf
Dr. Garofalo’s webpage on permanent birth control and Essure
Dr. Garofalo’s Essure consent form pdf

Dr. John Garofalo, M.D., is gynecologist located in Fairfield County, Connecticut including Bridgeport, Norwalk, Stamford, Westport and Danbury. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

da Vinci myomectomy

In my last blog I wrote about hysterectomy (surgical removal of the uterus) and how this surgery is well-suited for surgery using the da Vinci approach. One of the main reasons a woman might consider a hysterectomy is the presence of uterine fibroids, which are non-cancerous tumors that grow out from the muscle layer and connective tissue in the uterus. Uterine fibroids (also called leiomyomas or myomas) are very common, especially during a woman’s middle and later reproductive years: about 20-40% of women will be diagnosed with uterine fibroids at some point in their lives.

In most cases uterine fibroids are harmless. But sometimes they can cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency. Uterine fibroids that are located inside the uterine cavity can make it difficult or impossible to conceive a child, and they can cause complications in pregnancy, including bleeding, miscarriage, premature labor, or interference with the position of the fetus.

If you or someone you know has problems with uterine fibroids, there are several options for treatment. In some cases, simple observation or medication may be enough. Hysterectomy is another option. But in certain cases, especially if you’re trying to get pregnant, myomectomy (surgical removal of uterine fibroids) may be worth considering, especially because myomectomy preserves the uterus for reproduction. Similar to the da Vinci hysterectomy, da Vinci myomectomy uses small incisions in the abdomen. From a nearby console, I control cameras and various surgical instruments to expose and remove the fibroids. Once the removal is complete, the incisions in the uterine wall and the abdomen are closed and sealed.

As I’ve mentioned in my other blogs, the da Vinci approach allows precision and control that’s crucial when working in close proximity to delicate organs. Compared to open abdominal surgery, there’s typically less bleeding, less pain, minimal scarring, quicker recovery, a shorter hospital stay, and a lower likelihood of complications. After a da Vinci myomectomy, most women will require an overnight hospital stay and should be able to resume normal activities within two  weeks – about three times faster than recovery from an open procedure.

Here are a few quotes from women who have had da Vinci myomectomies. These quotes and the stories behind them can be found on www.davincistories.com.

“da Vinci Surgery is really rather pleasant (as surgery goes). I woke up with nothing but Band-Aids on my tiny wounds. I also immediately felt the absence of my fibroid. I have no more wicked pains during menstruation, so I am really glad I had this surgery. I’d highly recommend it. I am better than new now.” – Lisa, White Plains NY

“[My fibroid] was removed without leaving big scars on my body and leaving me in bed for weeks. Additionally and most importantly, my fertility was not affected.” – Ivanice, Montclair NJ

“I was amazed at how quick the recovery was. It was done as an outpatient procedure, and I was out of the hospital the next day. – Deniza, Syracuse, NY

More information

If you’d like more information, including a video description of the procedure, go to this page on my website. The testimonial video links are on the left:

http://www.garofaloobgyn.com/uterine_fibroids.html

If you need additional information, you can click on any of the links below, or you can contact my office directly.

In my next blog, I’ll write about another condition called sacrocolpopexy that can also be treated using da Vinci.

Links to da Vinci surgery resources

daVinciSurgery.com

da Vinci Myomectomy

da Vinci Surgery Patient Stories

Dr. Garofalo’s da Vinci information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon and OB-GYN in Norwalk, CT and sees patients throughout Fairfield County including Norwalk, Westport, Stamford, Bridgeport and Danbury. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

This combination of detail and precision makes da Vinci very well suited for a variety of surgery types and procedures, including several that I do regularly as part of my medical practice. For this blog I thought I’d talk about da Vinci surgery and hysterectomy.

Not your mother’s hysterectomy

If your mother or grandmother had a hysterectomy, it was probably done vaginally or through a horizontal incision in the abdomen. She probably stayed in the hospital for about six days, with a recovery period that lasted four weeks or longer. In comparison, women who have a da Vinci hysterectomy can expect to stay in the hospital for about one day, followed by about a week of recovery.

As a minimally invasive procedure, the da Vinci hysterectomy is a much simpler and less traumatic experience. Instead of a long incision, da Vinci hysterectomy uses five small incisions, spaced across the abdomen. Compared to open abdominal surgery, there’s less bleeding, less pain, minimal scarring, quicker recovery, a shorter hospital stay, and a lower likelihood of complications.

Here are a few quotes from women who have had da Vinci hysterectomies, including one of my own patients. These quotes and many others can be found on www.davincistories.com.

“I am truly amazed how quickly I was able to recover after having major surgery. My incisions were minimal, my recovery was quick.” – Maureen, Madison CT

“The da Vinci procedure has transformed the surgical procedure from a long, difficult recovery to a relatively painless, quick procedure with very little downtime. It is perfect for active working people who don’t have six weeks to be down.” – Anne, Enfield CT

“I had my surgery a week before Christmas, and I was up to entertaining for the holidays.” – Tina, West Suffield CT

More information

If you’d like more information or to see a da Vinci hysterectomy testimonial, go to this page on my website. The testimonial video is at the bottom:

http://www.garofaloobgyn.com/hysterectomy.html

If you need additional information, you can click on any of the links below, or you can contact my office directly. In my next blog, I’ll write about another condition called myomectomy that can also be treated using da Vinci.

Links to da Vinci surgery resources

daVinciSurgery.com

da Vinci Hysterectomy

da Vinci Surgery Patient Stories

Dr. Garofalo’s da Vinci information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon and gynecologist in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

As I mentioned in my last blog, the da Vinci Surgical System uses a computerized interface between the surgeon and the instruments to conduct surgical procedures. The name “da Vinci” was chosen for the system because legendary artist and inventor Leonardo da Vinci is credited with designing the first robot. It’s also a fitting name because Leonardo da Vinci used anatomical accuracy and three-dimensional details to lend realism to his art.

For many people, the use of robots or robotic tools in surgery raises some concerns. One commonly accepted definition of a robot is “an automatically guided machine, able to do tasks on its own.” This definition is a bit vague, but experts generally agree that robots tend to do some or all of the following: move around, operate a mechanical limb, sense and manipulate their environment, and exhibit intelligent behavior, especially behavior which mimics humans or other animals.

Given only those definitions to describe da Vinci technology, I’d be concerned too. To be honest, I’ve avoided using the word “robot” or “robotic” to describe the da Vinci Surgical System in my website. It’s not really an accurate term, since the da Vinci system is directed and controlled by a human being – in this case, a specially trained surgeon whose finger movements are transmitted electronically from a console in the surgery room to the da Vinci cameras and surgical instruments. Along with the surgeon and the equipment, an assistant surgeon, an anesthesiologist, and a nurse are generally by the patient’s bed.

While it’s definitely not the kind of robot you might picture from the movies, da Vinci surgery draws upon years of robotic technology. The cameras and surgical tools are truly state-of-the-art, and provide a level of precision which is crucial when working in close proximity to delicate organs like the bladder. Benefits of da Vinci surgery usually include:

• Less pain after surgery
• Less scarring
• Lower risk of infection
• Less blood loss
• Faster recovery

When my patients ask me about da Vinci technology, I generally tell them this: The da Vinci Surgical System is not the only option for surgery, but it has many advantages and few disadvantages relative to more traditional methods of surgery.

In my next blog, I’ll write about the types of conditions that can be treated using da Vinci. If you need information more quickly, you can click on any of the links below, or you can contact my office directly.

Links to da Vinci surgery resources

daVinciSurgery.com

da Vinci Surgery Patient Stories

Dr. Garofalo’s da Vinci information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.