Theresa Womens Clinic and Dr. Cheng Mei Ling Theresa Nee Wong

Theresa Womens Clinic is a Gynecology/Obstetrics clinic in Ang Mo Kio, Singapore. The clinic is visited by gynecology/obstetrics like Dr. Cheng Mei Ling Theresa Nee Wong. Dr. Theresa Brignac was born and raised in Baton Rouge. She attended St. Joseph’s Academy before completing her undergrad at LSU, medical school at LSUHSC in New Orleans, and OB/GYN residency with LSU at Woman’s Hospital in Baton Rouge.

In her spare time, she enjoys outdoor activities, local sporting events, and spending time with friends and family. With a passion for women's health from adolescence to menopause, Dr. Brignac emphasizes the importance of preventative care for all of her patients. Her medical interests include high and low-risk obstetrics, as well as natural childbirth including ambulation and intermittent electronic fetal monitoring during labor. Dr. Brignac is also experienced in minimally invasive pelvic surgery, including robotic assisted hysterectomy.

Theresa L. Robinson, MD, has been practicing obstetrics and gynecology for more than 20 years. She is a graduate of the second class of the High School for Health Professions, now the Michael E. Debakey High School for Health Professions. She received her undergraduate degree from Bryn Mawr College in Bryn Mawr, Penn. (one of the seven sister Ivy League colleges). She received her medical degree from Texas Tech University Health Science Center in 1984. She completed her residency at Baylor College of Medicine in 1988 where she is currently a clinical instructor in the Department of Obstetrics and Gynecology. Dr. Robinson is a member of numerous medical societies on the local, state and national level. She has been Chief of Staff and Chairman of the Board of Trustees at the Woman’s Hospital of Texas. Dr. Robinson's practice is devoted to the healthcare of women. This includes obstetrics, family planning, adult and adolescent gynecology, infertility, and menopause. She is trained in high risk obstetrics, the latest laser/laparoscopic techniques, and the latest contraceptive techniques and options. Dr. Theresa Robinson is a native Houstonian and has been married for over 25 years. She is active in her community and with various charities. She is a frequent speaker on women's health issues in her community. She has received numerous awards recognizing her commitment to educating the women and girls in her community. Her recent awards include the Impact Award by her church, Wheeler Avenue Baptist Church, and the National Association of Black MBAs Houston Chapter. She has been recognized for her professional excellence by being named Houston Doc for Women in 2006 and listed in Who's Who in Black Houston for the past three years.

A note from Dr. Robinson: "I remember when I was about 12, my mother gave me a pamphlet to read discussing the female reproductive system. She asked me if I had any questions but I could tell by the look on her face that she was praying I did not ask any. I could feel her discomfort about the subject and this was from a woman who had nine kids! Those subjects were just not discussed. I was born into the baby boomer generation and was raised to be a "Steel Magnolia" so I went to the library and read everything I could get my hands on concerning the female body and all of its capabilities. I was amazed and knew then that I wanted to study the female body and help future adolescent and adult females understand their bodies and be comfortable discussing any issues or concerns they may have. I have never regretted my decision to study and practice obstetrics and gynecology. I love the idea that I can care for my patients from the moment they are conceived into their golden years."

Dr. Cheng Mei Ling Theresa Nee Wong is a Gynecologist and Obstetrician in Ang Mo Kio, Singapore and has an experience of 34 years in these fields. Dr. Cheng Mei Ling Theresa Nee Wong practices at Theresa Women's Clinic in Ang Mo Kio, Singapore. She completed MBBS from Hong Kong University in 1978,MRCOG from Royal College of Obstetricians and Gynaecologists, London in 1984 and Fellow of the Academy of Medicine Singapore - Obstetricians and Gynaecologist (FAMS O&G) from Academy of Medicine, Singapore in 1989. The timings of Theresa Womens Clinic IUI IVF Clinic are: Mon, Thu: 9:30 AM-1:00 PM, 2:30 PM-6:00 PM, Tue, Fri: 9:30 AM-1:00 PM, 2:30 PM-7:30 PM and Wed, Sat: 9:30 AM-2:00 PM. Some of the services provided by the clinic are: Well Woman Healthcheck, HPV Vaccination, Evaluation of Infertility, Contraception Advice and Colposcopy.

She is a member of Singapore Medical Council. Some of the services provided by the doctor are: Well Woman Healthcheck,PCOD/PCOS Treatment,Contraception Advice,Hysterectomy (Abdominal/Vaginal) and Laparoscopy etc.

Infertility is a significant medical problem that affects many couples. Evaluation is the starting point for treatment of infertility as it may suggest specific causes and appropriate treatment modalities. Although the history and physical examination provide important information, specific diagnostic tests are required to evaluate infertility. Because the causes of infertility can be multifactorial, a systematic approach typically is used and involves testing for male factor, ovulatory factor, uterotubal factor, and peritoneal factor. Many of these diagnostic tests are laboratory based, including semen analysis, serum progesterone level, serum basal follicle-stimulating hormone level, and clomiphene citrate challenge, and can be done by the primary care physician. Moreover, by understanding the infertility evaluation, the primary care physician can serve as an important resource for advice about infertility. This article briefly reviews the diagnostic approach to infertility, with particular emphasis on important laboratory tests used for evaluation.

Practice Essentials
Infertility is the failure to conceive (regardless of cause) after 1 year of unprotected intercourse. This condition affects approximately 10-15% of reproductive-aged couples.

Female and male factor infertility
Female factors that affect fertility include the following categories:

Cervical: Stenosis or abnormalities of the mucus-sperm interaction
Uterine: Congenital or acquired defects; may affect endometrium or myometrium; may be associated with primary infertility or with pregnancy wastage and premature delivery
Ovarian: Alteration in the frequency and duration of the menstrual cycle—Failure to ovulate is the most common infertility problem
Tubal: Abnormalities or damage to the fallopian tube; may be congenital or acquired
Peritoneal: Anatomic defects or physiologic dysfunctions (eg, infection, adhesions, adnexal masses)
Male factors that affect fertility include the following categories:

Pretesticular: Congenital or acquired diseases of the hypothalamus, pituitary, or peripheral organs that alter the hypothalamic-pituitary axis
Testicular: Genetic or nongenetic
Posttesticular: Congenital or acquired factors that disrupt normal transport of sperm through the ductal system
Factors that affect the fertility of both sexes include the following:

Infertility is defined as the inability of a couple to become pregnant after one year of unprotected intercourse in women under 35 years of age and after six months in women 35 or older. Infertility is a common condition: in any given year, about 15 percent of the couples in the United States who are trying to conceive are not able to do so.

The ability of a couple to become pregnant depends on normal fertility in both the male and female partners. In one study, among all cases of infertility in developed countries, about 8 percent can be traced to male problems, 37 percent can be traced to female problems, and 35 percent can be traced to problems in both the male and female partners. In about 5 percent of couples, the cause of the infertility cannot be traced to specific problems in either partner.

Because pregnancy requires normal fertility in both the male and female, healthcare providers routinely involve both partners in the evaluation.

EVALUATION OF INFERTILITY IN MEN

Fertility in men requires normal functioning of the hypothalamus, pituitary gland, and testes. Therefore, a variety of different conditions can lead to infertility. The evaluation of male infertility may point to an underlying cause, which can guide treatment. A healthcare provider usually begins with a medical history, physical examination, and a semen test. Other tests may be needed.

History — A man's past health and medical history are important in the process of evaluation. A healthcare provider will ask about childhood growth and development; sexual development during puberty; sexual history; illnesses and infections; surgeries; medications; exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility testing.

Physical examination — A physical examination usually includes measurement of height and weight, assessment of body fat and muscle distribution, inspection of the skin and hair pattern, and visual examination of the genitals and breasts (figure 1).

Special attention is given to features of testosterone deficiency, which may include loss of facial and body hair and decrease in the size of the testis.

Other conditions that might affect fertility include:

●Varicocele, a varicose vein of the testicle

●Absent vas deferens or thickening of the epididymis (figure 1)

Semen analysis

Lab testing — A semen analysis (sperm count) is a central part of the evaluation of male infertility. This analysis provides information about the amount of semen and the number, motility, and shape of sperm.

A man should avoid ejaculation (sex and masturbation) for two to seven days before providing the semen sample. Ideally, a sample should be collected in a clinician's office after masturbation; if this is not possible, the man may collect a sample at home in a sterile laboratory container or chemical-free condom. The sample should be delivered to the lab within one hour of collection.

If the initial semen analysis is abnormal, the clinician will often request an additional sample; this is best done one to two weeks later.

Blood tests — Blood tests provide information about hormones that play a role in male fertility. If sperm concentration is low or the clinician suspects a hormonal problem, the clinician may order blood tests to measure total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (a pituitary hormone).

Genetic tests — If genetic or chromosomal abnormalities are suspected, specialized blood tests may be needed to check for the number and structure of the chromosomes as well as absent or abnormal regions of the male chromosomes (Y chromosome). Some men inherit genes associated with cystic fibrosis that can result in male infertility due to a low sperm count. However, these men do not have the other usual signs of cystic fibrosis, such as lung or gastrointestinal disease.

Although infertility treatments may be able to overcome genetic or chromosomal abnormalities, there is a possibility of transferring the abnormality to a child. In this case, genetic counseling is often recommended to inform a couple about the possibility of parent-to-child transmission and the possible impact of the abnormality.

Other tests — If a blockage in the reproductive tract (epididymis or vas deferens) is suspected, a transrectal ultrasound test may be ordered.

If retrograde ejaculation (movement of semen into the bladder) is suspected, a post-ejaculation urine sample is needed.

A testicular biopsy (collection of a small tissue sample) may be recommended in men with no sperm on the semen analysis. The biopsy can be done by surgically opening the testis or by fine-needle aspiration (inserting a small needle into the testis and withdrawing a sample of tissue). An open biopsy is usually done in an operating room with general anesthesia, while a fine-needle aspiration may be done with local anesthesia in an office setting. The biopsy allows the physician to examine the microscopic structure of the testes and determine if sperm are present. The presence of sperm production in the testes when there are none in the ejaculate suggests blockage in the reproductive tract.

EVALUATION OF INFERTILITY IN WOMEN

Although a variety of tests are available for evaluating female infertility, it may not be necessary to have all of these tests. Healthcare providers usually begin with a medical history, a thorough physical examination, and some preliminary tests.

Medical history — A woman's past health and medical history may provide some clues about the cause of infertility. The healthcare provider will ask about childhood development; sexual development during puberty; sexual history; illnesses and infections; surgeries; medications used; exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility evaluations.

Menstrual history — Amenorrhea (absent menstrual periods) usually signals an absence of ovulation, which can cause infertility. Oligomenorrhea (irregular menstrual cycles) can be a sign of irregular ovulation; although oligomenorrhea does not make pregnancy impossible, it can interfere with the ability to become pregnant. (See "Patient education: Absent or irregular periods (Beyond the Basics)".)

Physical examination — A physical examination usually includes a general examination, with special attention to any signs of hormone deficiency or signs of other conditions that might impair fertility. The provider will also perform a pelvic examination, which can identify abnormalities of the reproductive tract and signs of low hormone levels (figure 2). The physical examination may be performed by the patient's primary care provider, gynecologist, or infertility specialist.

Blood tests — Blood tests can provide information about the levels of several hormones that play a role in female fertility; in women, key hormones are produced by the hypothalamus, the pituitary gland, and the ovaries. These hormones can include follicle-stimulating hormone (FSH), estradiol, and antimullerian hormone (AMH) level to assess how well the ovaries are functioning, TSH to test thyroid function, and prolactin to assess the presence of a benign pituitary tumor.

Levels of luteinizing hormone (LH) rise abruptly beginning approximately 38 hours before ovulation (figure 3). This hormone surge can be detected using an over-the-counter home urine test. However, this kit fails to detect the hormone surge about 15 percent of the time. Therefore, a clinician may recommend a blood test to confirm ovulation.

Blood levels of the hormone progesterone are a more accurate indicator of ovulation. Normally, levels of progesterone rise approximately one week after ovulation. A test to measure the progesterone level is usually performed 20 to 24 days after the first day of a menstrual period.

Basal body temperature — Monitoring of basal body temperature (measured before getting out of bed in the morning) was previously recommended to determine if ovulation occurred. A woman's temperature usually rises by 0.5ºF to 1.0ºF after ovulation. However, basal body temperature patterns can be difficult to interpret and are not generally recommended in the evaluation of infertility.

Tests to evaluate the uterus and fallopian tubes — Uterine abnormalities that can contribute to infertility include congenital structural abnormalities, such as a uterine septum (a band of tissue that makes the uterine cavity small) (figure 4); fibroids; polyps; and structural abnormalities that can result from gynecologic procedures.

Scarring and obstruction of the fallopian tubes can occur as a result of pelvic inflammatory disease, endometriosis, or pelvic adhesions (scar tissue) from abdominal infection or surgery.

Hysterosalpingogram — Hysterosalpingogram (HSG) is used to help identify structural abnormalities of the uterus and fallopian tubes. It involves inserting a small catheter through the cervix and into the uterus. A liquid that can be seen on x-ray is injected through the catheter, which fills the uterus and fallopian tubes. An x-ray is taken after the liquid is injected, which shows the outline of the uterus and tubes. An abnormally shaped uterus or blocked fallopian tube would be visible on the x-ray.

The test is done while the woman is awake and lying on an x-ray table. Most women experience moderate to severe pelvic cramps when the liquid is injected, but this usually improves after 5 to 10 minutes. The test is usually performed 6 to 10 days after the menstrual period (before ovulation has occurred).

Hysteroscopy — In a hysteroscopy, a small tube containing a light source is inserted through the cervix and into the uterus to directly visualize the lining of the uterus and the sites where the fallopian tubes enter the uterus. Air or fluid is injected to expand the uterus and to allow the physician to see inside the uterus.

A hysteroscopy is usually performed in women who are thought to have an abnormal uterus, based upon history, hysterosalpingogram, or ultrasound. Diagnostic hysteroscopy can be performed in the physician's office without anesthesia or sedation. If hysteroscopic surgery is necessary, this is usually performed in a day surgery operating room with a regional anesthesia (local, epidural, or spinal) or general anesthesia.

Pelvic ultrasound — In a transvaginal ultrasound, a small ultrasound probe is inserted into the vagina; this provides a clearer image of the uterus and ovaries than ultrasound that is performed through the abdomen. It does not require that the patient is sedated or anesthetized, and has few to no risks. It is used to measure the size and shape of the uterus and ovaries and to determine if there are structural abnormalities (such as fibroids or ovarian cysts). If abnormalities are seen, further testing may be needed.

Sonohysterogram — Infusion of sterile saline into the uterine cavity via a small catheter placed through the cervical opening enhances visualization of the inside of the uterus during transvaginal ultrasound.

Laparoscopy — During laparoscopy, a thin, lighted tube is inserted through a small incision in the abdomen, allowing the physician to view the uterus, ovaries, and fallopian tubes. Laparoscopy is performed as a day surgery procedure and requires that the patient receive general anesthesia.

Laparoscopy can detect damage and obstruction of the fallopian tubes, endometriosis, and other abnormalities of the pelvic structures. It is the best test for diagnosis of endometriosis or pelvic adhesions (scarring). Furthermore, endometriosis can be treated during laparoscopy, which can help to improve pregnancy rates in women with infertility who have endometriosis. However, laparoscopy is not routinely done during an evaluation of infertility.

Genetic tests — Genetic testing may be recommended if there is a suspicion that genetic or chromosomal abnormalities are contributing to infertility. These tests usually require a small blood sample, which is sent to a laboratory for evaluation.

Although assisted reproductive techniques may be able to overcome genetic or chromosomal abnormalities, there is a possibility of transferring the abnormality to a child. Genetic counseling is often recommended to educate a couple about the possibility of parent-to-child transmission, possible impact of the abnormality, and treatments available to prevent parent-to-child transmission.

EMOTIONAL SUPPORT DURING INFERTILITY EVALUATION

The inability to become pregnant can lead to a variety of emotions, including anxiety, depression, anger, shame, and guilt. In one study, 40 percent of infertility patients suffered with some type of psychiatric disorder; the most common diagnosis was an anxiety disorder (23 percent), followed by major depressive disorder (17 percent) [1].

Both men and women can suffer from these problems, which can further hinder a couple's ability to become pregnant. Psychological distress is associated with infertility treatment failure, and interventions to relieve stress are associated with increased pregnancy rates.

The best approach for treatment of psychological distress related to infertility treatment has not been determined. However, some experts suggest relaxation techniques, stress management, coping skills training, and group support. Evaluation by a psychiatrist may be needed for some persons with significant symptoms of anxiety or depression.

INFERTILITY TREATMENT

There are a number of options for treatment of both male and female infertility. Separate topic reviews are available. (See "Patient education: Treatment of male infertility (Beyond the Basics)" and "Patient education: Ovulation induction with clomiphene (Beyond the Basics)" and "Patient education: Infertility treatment with gonadotropins (Beyond the Basics)" and "Patient education: In vitro fertilization (IVF) (Beyond the Basics)".)

For More Information You Can Contact Us
Block 30, East Patel Nagar, Rajendra Place, New Delhi, Delhi 110008
+(91)-7899912611
contact@elawoman.com
https://www.elawoman.com/

Ela Facebook Ela Twitter Ela Instagram Ela Linkedin Ela Youtube