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Adam S. Levine, M.D. recently finished his fellowship in reproductive endocrinology and infertility within the department of gynecology and obstetrics at the Johns Hopkins University School of Medicine. His areas of expertise include reproductive endocrinology, infertility, assisted reproductive technology, reproductive surgery, pediatric and adolescent gynecology, and menopause.

 

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this week's FEATURED Q&A's

Q:    My boyfriend and I  have been together for little over 5 months. We want to have children in the future, but I had problems earlier when I was 16.  I'm 18 now. I was on the shot and the pill at the same time. I still don't have regular periods. Will this effect our chances of having kids in the future?	A:    Usually couples wait for about 12 months before seeking help in becoming pregnant. I am not able to offer specific medical advice online. However, some women with irregular menses may have a hormonal imbalance. These hormonal imbalances may result in the woman not making an egg every month. There are a variety of medications available that will help these women to make an egg every month. I would advise that you consult with your regular gynecologist or with a reproductive endocrinologist (a physician who specializes in women's fertility issues).
Q:    For the past two years, I have had recurrent yeast infections. This is something I have never had a problem with, but seems to come every month a week before my period. I have been tested for diabetes and HIV, both tests were negative. My gynecologist has put me on Diflucan (one a month at first sign of infection), but this has not helped any. I am still getting this infection every month. What could be going on to make me continue having this problem? I don't know how much more of this I can take.	A:     Recurrent vaginitis is a common problem afflicting women. It is important that women not self-treat themselves but seek a gynecologist's care.  Women with a vaginal discharge should initially have a physical examination. The physician can look at a sample of the discharge under the microscope to determine if the discharge is from yeast, or is a bacterial infection. In some difficult to treat cases, specific culture of the discharge is necessary. It is important to remember that not all vaginal discharge is abnormal. The vaginal lining contains several glands that produce a discharge. If this lining is irritated (soap, deodorant, hygiene sprays, lubricants, douching etc.), it will produce more of the discharge. I generally recommend that women with a chronic discharge wear only cotton underwear, not self-treat themselves, not wear nylons, not use douches, tampons, hygiene sprays, etc., and try to keep the vaginal area dry. I prefer to examine patients directly and then determine the best treatment method.
Q:    My daughter has been treated for pelvic and bacterial infections. It clears up and whatever it always returns. She refuses a vaginal examine. What else can I do? Can the doctor relax her first? This been going on since 1/99.	A:     Gynecologic examinations in children can be fairly difficult for the physician and are usually extremely traumatic for the child. I would recommend that you consider bringing your daughter to a gynecologist who specializes in pediatric and adolescent gynecology. If you are located in Tampa, I would be happy to help you. If you live outside of Tampa, Florida, you might want to contact the North American Society for Pediatric and Adolescent Medicine (www.naspag.org) for a referral.
Q:    I AM 38 YEARS OLD AND HAVE ONE TUBE THAT IS BLOCKED AND THE OTHER HAS BEEN CUT & TIED.  WHAT ARE MY CHANCES OF GETTING THE TUBE OPEN LONG ENOUGH TO GET PREGNANT? THANK YOU, DESPERATE!!!!	A:     During a tubal ligation, most gynecologic surgeons will ligate (cut) both tubes. Success in reversing a tubal ligation depends on several factors. These factors include: how much of the tube still attached to the uterus is left, how much of the tube near the ovary is left, how much total tube is left, where on the tube the tubal ligation was performed, how the tubal ligation was done (electricity, clips, etc.) and what is the condition of the woman's pelvis. Successful pregnancy also depends on patient age. Fertility begins to decline a little after age 35 and a great deal after age 39. One option available for many women whose tubes are blocked is to undergo in vitro fertilization (IVF). Unfortunately, many women cannot afford the financial nor the emotional costs involved in IVF. These women would benefit from a consultation with a reproductive endocrinologist. A reproductive endocrinologist specializes in women's fertility issues and has had advanced training in reproductive surgery.
Q:    I had a tubal 2 years ago and have been in severe pain every since. The doctor has talked about a couple of things that could be happening. He said one is scarring from my tubal.  I was wanting to know what can be done to take care of this, if anything?  He also said the problem could be coming from my ovaries.  He has put me on birth control pills and Motrin. Thank You for any help that you can give me.	A:     In general, pelvic pain is difficult to properly evaluate. Ovaries normally produce cysts each month during the process of making an egg. Pain develops when the ovary becomes swollen from the cyst and also following cyst rupture when the fluid in the cyst causes mild pelvic inflammation. It is possible to evaluate these cysts by pelvic ultrasonography. It has been generally thought, but not well proven, that some types of oral contraceptives temporarily decrease ovarian cyst formation by shutting down the normal process of making an egg. Motrin is a non-steroidal anti-inflammatory medication. It helps decrease pelvic pain by minimizing inflammation. Post-operative pain can be difficult to evaluate. An adhesion is basically post-operative scar tissue that forms after surgery. Adhesions connect things together that generally do not belong together. Unfortunately, the only way that adhesions can be diagnosed is further surgery. Depending on the circumstances, a diagnostic laparoscopy (belly-button surgery) may be warranted. Laparoscopy is generally an outpatient surgery that can be used both to diagnose and to treat adhesive disease.
Q:    I had a hysterectomy in November of 98'.  I kept one ovary.  My question is: Why after orgasm do I get a raging headache? It depends on the intensity of the orgasm, how big the headache is. It hits right after I climax?  I am not on a HRT at this point in time. I was doing fine when I went in for my one year check-up. Can you tell me why this is happening?	A:     I recommend that any women experiencing new onset headaches have a complete neurologic evaluation. However, in many cases, headaches are usually related to either muscle tension or to vascular (blood vessel) changes. Some women with post-coital headaches have found relief if they pre-medicate themselves with a non-steroidal anti-inflammatory medicine such as ibuprofen or Motrin.
Q:    I don't know if this is of general interest, but I'd really like you to answer me back. I have these tiny bumps on the outside of my vagina. Like on the lips and above the clitoris. I have had these for at least 7 years. And I've had them before I became sexually active. They've never gone away; they are just there. I've been to a gynecologist, many times, but they are too small to notice, and I've been too embarrassed  to ask. Do you know what they might be? I've looked up stuff, and nothing describes this. I feel so helpless. Please help.	A:     There are many different medical conditions ranging from completely normal and benign to more serious that can lead to vaginal bumps. I would recommend that you point these bumps out to your gynecologist and let your gynecologist evaluate them.
Q:    What does it mean when the placenta is getting smaller in a woman who is around 26-28 weeks pregnant, and they say the baby has bubbles in the bowels? Do you have any idea where I can get info to help a friend who is very scared?	A:     Any pregnant women with an obstetrical concern should discuss that concern with her obstetrician. Ultrasound is frequently used to evaluate the developing baby and the placenta. The placenta is where a developing baby gets its food and oxygen from. A variety of things can have a negative impact on the placenta. Breathing tobacco smoke either first-hand or second-hand can cause the placenta to age resulting in less oxygen delivery to the developing baby--this is why smokers have smaller less-developed babies than non-smokers. When the placenta ages, it can become smaller. During an ultrasound examination, it is generally possible to see the baby' s stomach and bladder. Sometimes the intestines are visible. In some cases, seeing gas bubbles in the baby's intestines is not normal. In this case, I would suggest having your friend discuss her care directly with her obstetrician. Sometimes, consultation with a maternal fetal medicine expert (high-risk obstetrician) may be helpful.
Q:    I am 27 and just recently found out that I am pregnant; yes, I am extremely happy and very surprised. I went to my gynecologist for a regular check up and I tested positive for pregnancy. They decided to do an ultrasound, but found no fetus. She then took a blood sample to make sure that HCG was found in the blood and every two days, she wants to take blood to make sure that the numbers are going up. My question is this, how far along does the pregnancy have to be before they are able to actually see something in my uterus during an ultrasound? I believe I conceived on January 9th or January 16th. They are monitoring me for ectopic pregnancy, but there are no signs of tubal pregnancy, i.e., spotting. I've had a 3D ultrasound and a regular ultrasound and they've found no baby in the tubes or the uterus. I'm just a little worried and wanted a second opinion other than being told not to worry. Can you draw a theory from this and is this normal?	A:     A home pregnancy test should be positive about the time of a missed period. During an early pregnancy, the first few weeks, a pregnancy hormone called hCG is made by the developing placenta. Blood levels of this hormone should double approximately every 48 hours. If the hCG level is not doubling it could mean that you have: 1) a completely normal, but very early pregnancy (hCG may not follow the doubling rule in very early pregnancies), 2) an abnormal pregnancy such as a blighted ovum where the placenta keeps growing but the embryo is abnormal and is reabsorbed, or 3) that you have an ectopic (or tubal) pregnancy. Ectopic pregnancies are life-threatening--and are generally diagnosed following the onset of abdominal pain and sometimes with vaginal bleeding. When I see someone as a newly pregnant patient, I check a vaginal sonogram. I should be able to see something by about 3-4 weeks of pregnancy, when the hCG is between 1,500 and 2000 international units. It should be noted that there are different ways of reporting hCG and the numbers I am using are the most common. When a pregnancy has reached between 6 and 8 weeks, I should see a fetal heart beat by vaginal sonogram and the hCG should be in the 6,000-8,000 international unit range. If I am doing an abdominal ultrasound, I may not see anything until the hCG level has reached between 6,000-8,000 international units.
Q:    I am 36 years old, and I have a 10 year-old daughter. I am on my second marriage. I stopped taking my pills on 1-29-00. I had been on them since the birth of my daughter. I need to know if it would be safe to get pregnant right away. Do I have to wait three months before I can try? I want to have a baby this year. Is it possible I can conceive quick and all will be fine? Your input would be greatly appreciated.	A:     Oral contraceptives generally have a short half-life. This means that with oral contraceptives, you can usually become pregnant immediately after stopping them with no risk to your baby. In fact, women who become pregnant on oral contraceptives usually do so after missing a pill or two. It is important to note that there is no increase in reported birth defects in children born to women who were exposed to oral contraceptives during their pregnancy. If you are actively trying to conceive, you may wish to speak to your obstetrician so that you can obtain a prescription for pre-natal vitamins.
Q:    My period is three weeks late and I'm a virgin, so I know that I'm not pregnant. Can stress, sickness, or the trauma of a car wreck (I rear-ended someone over the weekend and have a case of whiplash) cause my period to be this late?	A:     Over the course of a an entire year it is possible, and completely normal, for a healthy woman to have an abnormal period (absent or late). There is some evidence that stress from either emotional or physical trauma can adversely affect a woman's menstrual cycle. Irregular menses are also common in younger women who have recently had their first menses.