I've heard a lot about minimally invasive surgery in the news lately. What is this surgery and why would I choose to have my uterine fibroids removed this way?

Minimally invasive surgery can be used to remove or repair a part of the body by inserting a laparoscope (i.e., telescope) and surgical instruments through a series of small incisions. Laparoscopy is also used for diagnostic purposes, for example, to detect endometriosis.

Minimally invasive surgery is used by a variety of surgical specialties including, gynecology, gastroenterology, orthopaedics, vascular, urology, thoracic and more.

“Minimally invasive gynecologic surgery can be used to treat cervical and uterine cancer, uterine fibroids, endometriosis and other conditions,” according to Thomas Randall, MD, chief of gynecologic oncology at Pennsylvania Hospital.

What are the benefits of minimally invasive surgery?

• Lower risk of infection
• Fewer medications
• Less pain and scarring
• Quicker recovery
• Shorter hospital stay
• Less trauma and blood loss

Most of us don't think about surgical options until a significant event occurs in our life. New technologies including robotic surgery allow for more surgical options.

In most cases, uterine fibroids can be removed via minimally invasive surgery. Talk to your physician to review which procedure will benefit you most.

I am 36 years old and my husband and I would like to have a baby. I am concerned that I have not gotten pregnant after six months of trying to conceive. Should I see a specialist?

Generally, fertility shows signs of decline by age 30, dips
sharply at age 35, and plunges as a woman nears age 40.

Kurt Barnhart, MD, MSCE, Associate Director of Penn Fertility Care, advises, “If you’ve experienced any of the following, it may be time for you to see a fertility specialist”:

• If you are under 35 and have been unable to conceive after a year of trying to get pregnant.
• If you are over 35 and have been unable to conceive after 6 months of trying to get pregnant.
• When you've lost two or more pregnancies to miscarriage.
• When other infertility treatments have not been successful.

If you do not have regular menstrual cycles, or if you have had prior gynecological problems including endometriosis, pelvic surgery, tubal pregnancy or infections, you should see a fertility specialist sooner.

Barnhart continues, “Based on your age and that you have been trying to conceive for six months, I recommend that you and your partner have a fertility evaluation to determine if you need fertility assistance.”

I am a black woman who is two months pregnant with my first child. My sister was considered high-risk and delivered at 34 weeks gestation. Should I see a high-risk physician earlier in my pregnancy?

Babies born before 37 weeks are defined as preterm, and those born between 24 and 28 weeks are considered extremely premature.” It is not certain exactly what triggers premature labor and delivery as there does not seem to be one single cause.

“The most common factor of preterm labor is premature rupture of the membranes commonly referred to as when one’s ‘water breaks’,” states Harish Sehdev, MD, a maternal fetal medicine specialist at Penn. “Race is one of the greatest risk factors for preterm birth. Black women have almost twice the preterm rate as white women. Some suspect a genetic predisposition to deliver early; or that black women simply have more of the risk factors.”

There are a variety of risk factors that can create a high-risk pregnancy or cause preterm labor.

They include:

• A previous preterm birth
• Obesity or poor nutrition in pregnancy
• Diabetes
• A multiple gestation (twins or triplets)
• Intrauterine infection
• Cervical insufficiency (early dilation)
• Uterine bleeding
• Smoking/drug use
• Hypertension
• Abuse
• Race

Babies born too soon can have lifelong or life-threatening health problems. A few critical weeks make a big difference in survival. More than 98 percent of babies born between 32 and 35 weeks survive but are still at increased medical risk.

You are still early in your pregnancy. Talk to your obstetrician about your family history and any other health conditions you may have. Your physician may refer you to a maternal fetal medicine specialist. This specialist evaluates, diagnoses and monitors high-risk pregnancies.