Dr. Miklos Toth, MD

Hi,

It is an intriguing question. Vitamins definitely help your body to get in a better shape for your pregnancy. I am not aware of any well designed study that shows certain vitamins to improve conception rate. We generally recommend starting vitamins before conception. They will help you to maintain your pregnancy. So, if you thinking about having a baby, start your prenatals right now. Your baby in you will love them.

Good luck,

Dr Miklos Toth

Hi,

I am so happy to read your question. Your sister deserves to be complimented! I have been an OB/GYN doctor for over 40 years and I can tell you it has been a very rewarding experience, because it demands every bit of your energy and talent all the time. I would do it all over and over again in a heart beat. Recently, I am more focused on teaching the next generation of OB/GYN doctors, our young residents in training, and have to tell you all of them are superb quality doctors. Over two-thirds are women!! This should encourage your sister even more! Here is what she can expect: After medical school, she has to enroll in an Obstetrics/Gynecology training program of a teaching hospital. There are no Gynecology or Obstetrics only programs. She has go through a 4-year training in an Obstetrics-Gynecology residency program. After completing the residency, she can start practicing OB/GYN right the way. That includes delivering babies, seeing Gyn patients, doing surgery, research, etc. Should she want to become a sub-specialist, she has the following options after 2-3 years of additional training: She can choose to become a fellow in these sub-specialities: Maternal-Fetal Medicine, GYN Oncology, Minimally-Invasive Surgery, and Uro-Gynecology. If she really wants to be a "gynecologist only," she should plan doing a fellowship in GYN Oncology (cancer sub speciality) or Uro-Gyn, treating patients for problems of urinary and pelvic anatomy, like incontinence or uterine prolapse, etc. As you see the opportunities almost endless. Takes time, but it is the best investment she can make. It sure was for me.

Wish her best of luck.

Dr. Miklos Toth

Hi,

Most likely you do not have to worry at all. Platelets are necessary for clot formation that stops the bleeding and the normal count is between 150.000-450.000. This number doesn't change too much over time. It is quite possible that you have already had low platelet counts prior to pregnancy and your current values just represent a further decline because the normal, pregnancy associated anaemia. As long as you or your family members never had any bleeding problem or prolonged clot formation after minor injuries, the condition is most likely rectifies itself after your baby is born. Your number right now qualifies only for mild thrombocytopenia because you are pregnant. Should the number of platelets further decline, you should consult a hematologist. He/she then will run further tests on you, including a peripheral blood smear and maybe a bone marrow biopsy. The hematologist will also check your blood for the presence of certain particles called autoantibodies that can destroy your own platelets. On rare occasions, low platelet count is associated with severe multi-organ disease that needs to be addressed by a team of experts.
As I said before, you most likely have a mild case of gestational hypothrombocytaemia, and will be fine during and after pregnancy.

Dr. Toth

Hi,

Your problem is quite common and most of the time it is easy to deal with. You describing a condition called: oligomenorrhea. It means delayed and shorter, lighter periods. This so-called "endocrine" or "hormonal" problem most commonly occurs in adolescence and before menopause, but can develop anytime during the reproductive years. Oligomenorrhea is usually associated with some rather uncomfortable physical symptoms. Some of them can be skin changes like increased tenderness, local swelling, puffiness or discoloration. Just as you describe it. The good news is that we gynecologists only worry about oligomenorrhea when the failure of coordination between your hormone producing and regulating organs (the hypothalamus, the pituitary gland ,and the ovaries ) is more severe and results in menstrual intervals of more than 35 days, i.e., less than 9 periods per year. To better understand the condition and the associated bodily changes, lets quickly recap the hormonal driving forces of the normal 28-day menstrual cycle:

Days 1-7: Large amounts of Prostaglandins (PG) are being secreted while the female hormones, Estrogen and Progesterone (E and P) both drop. Hence the emotional instability. PG, a strong vasoconstrictor, brings on the period with cramps and discomfort. It also increases the sensitivity of your skin. Any spots will feel more sensitive and new ones may appear. It is time for pain medication and hydration for your hypersensitive skin. Your diet should include some magnesium to relax the contracting uterine muscles and improve your mood.
Days 7-10: Your body resumes producing E and later P as well, which puts you in the "feel good" mood. Even your skin is much better now. Look for a diet which is rich in iron to compensate for the loss during the period. Eat plenty of spinach, kale, and dates. This is the time for a little red meat (not much) to improve your own red blood cell production.
Days 12-16: This is the ovulatory phase, you look at your best. Time to take pictures of yourself. You also are most fertile at this point in your cycle. One caveat: too much E sometimes causes increased sebum production by your skin glands. Some acne may appear but your skin should feel super normal now, but may have increased photo sensitivity. Time to give some nutritional support to your skin in the form of Vitamin A. Eat a lot of carrots and squash. Stay away from too much sun as well. For your face, collagen masks should be beneficial.
Days 17-24: Your hormone levels start dropping again. While P increases further before start dropping, your skin may become oily and sticky a bit. This is the time when your spots may appear again, but now that you know the cause and that they are just some minor nuisances, you accept them as natural changes in your body. A response to your own hormonal milieu. Testosterone, the male hormone that women also have, but much less than men, can produce skin discomfort, especially in this part of the cycle. Eating broccoli and some cucumber will help to get rid of any excess hormones in your body at this point in the cycle.
Day 15-28: This is the pre-menstrual phase. Your hormones are so low now that they cannot nourish and support the inner lining of your uterus. It begins sloughing. You start feeling bloated, puffy, and moody again. Your insulin sensitivity increases, resulting in low blood sugars and craving for carbs. The spots may be more sensitive now, but you know they will be gone soon again. Drink herbal and hot ginger teas for calmness and hydrate your skin to prevent wrinkles.
All will be fine in a few days and your spots will again be history.

Good luck,

Dr. Toth

Hi,

Your question addresses one of the most important issues in women's reproductive health in general. Chlamydia trachomatis infection is the most common sexually
transmitted disease. It can have serious consequences on the reproductive health, especially in women who are desirous of having children. The most serious consequences of a chlamydial infection are pelvic inflammatory disease (PID), tubal factor infertility, ectopic pregnancy (pregnancy in the tubes), chronic pelvic pain, pregnancy loss, and, finally, as our own research showed, abnormal uterine bleeding (uterine bleeding other than a menses).

The CDC estimates that there are about 2.8 million cases of chlamydia infections in the U.S. every year, but a large number of cases are not reported because the disease often doesn't produce any symptoms. It is very important that one in 20 sexually active young women aged 14-24 years has chlamydia, but only 10% of men, and 5%-30% of women with laboratory-confirmed chlamydial infection develop symptoms. Furthermore, 10%-15% of women with an untreated infection will develop symptomatic pelvic
inflammatory disease or an upper genital tract infection (PID). Chlamydia can also cause a subclinical inflammation of the upper genital tract (subclinical PID). Both the above mentioned acute and the subclinical PID can cause permanent damage to the upper genital tract and lead to tubal obstruction. This latter is called "tubal factor
infertility." This explains why many women first find out about their infertility due to a chlamydial infection after several years of unsuccessfully trying to conceive and finally making a trip to a fertility specialist. How easy it would have been to thoughtfully get tested and treated at the beginning of every new sexual relationship with an untested partner when there was no barrier protection (condom) used for sex.

The most important issue is to be aware of the nature and prevention of this disease. Timely antibiotic treatment is mandatory if the laboratory diagnosis is made and a "test of cure" follow-up culture is mandatory in a few weeks after treatment. Testing the sex partner is mandatory. If testing is not available or refused, he should be treated as well. Barrier protection (condom) is a MUST with each and every new sexual partner, even if you are already on birth control. The most important advice I can give you is: Being protected from getting pregnant and being protected from a sexually transmitted infection are two entirely different, but very important issues in every woman's life.

Warm regards,

Dr. Toth

Dear patient,

According to their manufacturers, Home Pregnancy Tests (HPTs), when properly used, are accurate in 99 percent of the time. These tests measure the amount of a pregnancy associated hormone, called hCG, in your urine. The so-called "immunometric assay" they use requires the presence of certain amount of hCG in the urine to show a positive result. Most HTPs are set to show a positive result when urine hCG level reaches a minimum of 5.5 milli-international units/milliliter. In a normal, singleton
pregnancy this occurs before the time of the expected period. HPTs are the so-called "Qualitative" pregnancy tests which give you a yes or no answer. You may remember the one line (NO) and the two lines (YES) set up in the little window on your kit?
Alternatively, there are Quantitative blood pregnancy tests which are more sensitive and can detect as low as 1-2 milli-int. units of the so-called "beta fraction" of the hCG hormone. These tests are done at the doctor's office.
When a pregnancy test becomes positive depends on multiple factors, most importantly on cycle length, timing of the ovulation and the sensitivity of the hCG assay used.
My suggestion to you is to see your doctor in one week and ask for a Beta hCG blood pregnancy test. Next day you will know not only if you are pregnant or not, but also how many days you are from your conception.

Best of luck,
Dr. Miklos Toth

Viral diseases are most dangerous at the beginning and at the end of the pregnancy. Early on, while the baby's organs are not fully developed, viruses can cause developmental anomalies. In the last few weeks of pregnancy, however, the mother's immune system may not have enough time left to clear the virus from the maternal circulation before delivery, and she may give birth to a baby with the virus in her/his blood. The 6th month of the pregnancy is probably the safest time to have a viral infection. The baby has already been fully developed, it just has to keep growing. Also, at six months the maternal immune system will have ample time to clear the virus from the maternal blood, reducing the chances of neonatal viremia (virus in the baby's blood). Even a normal pregnancies brings about changes in the body which
make a pregnant woman more likely to develop complication during a simple viral infection (increased heart rate, increased oxygen consumption, decreased lung capacity, etc.). Your doctor may be worried about a pulmonary bacterial infectious complication and put you on antibiotics as treatment or prevention. There are antibiotics which can safely be used in pregnancy especially in the second trimester. I am sure your doctor is well aware of this.
In summary: Take it easy, your virus should be over in a few more days, however, if you develop shortness of breath, persistent high fever with persistent productive cough, you may need to go to the hospital. At this point in your pregnancy, your uterus is the safest place for your baby to be.

Dr. Miklos Toth