General Gynaecology

We specialise in female reproductive health. We diagnose and treat reproductive system disorders such as hormone disorders, fibroids, endometriosis, ovarian cysts, pelvic pain, STI’s, infertility and others.

What can be expected during a Gynae visit?

What happens during your gynaecological visit depends entirely on the reason for the visit and your individual situation. On your first consultation, Dr Deo will make you feel comfortable and ask routine questions about your menstrual cycle, your sexual activity and general medical history, your health and lifestyle. Dr Deo will proceed with a general check-up and Dr Deo will carry out an examination to check if your reproductive organs are healthy. She may have to insert a speculum into your vagina to check your cervix and make sure that the uterus and ovaries are of good health.

Dr Deo will talk you through the entire examination and make sure that you are at ease and comfortable (She might include a prayer and a mini sermon free of charge). You may have a pap smear done. Pap smear is generally a procedure that is done to take a swab or sample of your cervix cells from your cervix area to be tested for any abnormalities in your cervix. A pelvic ultrasound is done to get images and assessment of your womb and ovaries.

Fertility

As a sub specialist in this field, Dr Deo deals a great deal with matters of fertility and treating infertility. Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Primary infertility is the inability to have any pregnancy, while secondary infertility is the inability to have a pregnancy after previously successful conception. You can expect the following steps to be taken when you consult with Dr Deo:

Couple’s first consultation:

The first consultation is a very critical and highly involved one as information is taken and investigations are done to determine the barriers which may  lead to difficulty in falling pregnant.

History Taking:

This is a consultation where Dr Deo and patient discuss how long they have been trying to conceive, the pattern of menstruation, previous pregnancies or attempts thereof, medical illnesses, medication, occupation and exposure, history of previous surgeries, and any previous intervention.

Female Client

1.Physical Exam

  • This involves the woman being checked by the doctor for any obvious problems that can be detected during the examination.
  • The exam includes checking the breast, thyroid, abdomen, and vagina

2.Pelvic sonar

  • This is when an ultrasound (sonar) is done to examine the womb for any abnormalities. We also assess the ovaries’  follicular (egg) count.
  • The transvaginal (intra-vaginal) sonar is usually performed for better accuracy.
  • 3D sonar may be done for better visualisation.

3.Blood Investigations

  • Blood is taken to assess the hormone status of the female  and to detect irregularities that need correcting.
  • A specific test to check the reserves of the ovary called antimullerian hormone (AMH) is also done to indicate the probability of pregnancy.
  • Other hormonal work may be done (TSH, Prolactin)

Male Client:

Semen Analysis

  • Semen analysis is done on the first consultation to check the quality and quantity of the sperm.
  • The semen is produced through masturbation and collected by the man into a specimen container provided.
  • It is then taken by our embryologist to be assessed under a microscope.
  • The quantity check on the sperm involves the sperm count and concentration of sperm per ml of semen.
  • The quality check on the sperm involves checking the shape of sperm and their motility (swimming ability), which are vital for successful fertilisation.
Fertility Treatment Options

Intrauterine Insemination

Intrauterine insemination (IUI) is a treatment for fertility, performed in couples unable to conceive despite trying for at least a year. IUI involves placing sperm in a women’s uterus to facilitate fertilisation (fusion of egg and sperm). IUI gives the sperm a head start in entering the womb, but will still have to reach and fertilise the egg on its own.

IUI is a fertility treatment indicated for couples with conditions such as unexplained infertility, abnormal sperm count or mobility, cervical problems and ejaculation dysfunction.

Preparing for the procedure

Semen is collected from your partner at the clinic. The sperm sample is washed to select only the best sperm that look normal and highly active, from the low-quality sperm. There are higher chances of conceiving if a highly-concentrated sample of healthy sperm is used. You will be monitored for signs of ovulation (release of an egg). Physicians may also ask you to take medication to stimulate the ovaries and improve egg production and chances of pregnancy. IUIs are usually performed a day or two after ovulation is identified.

Procedure

During the procedure, you will lie on an exam table. A hormone called human gonadotropin hormone is injected to release the eggs. Your doctor injects the sample of semen directly into the uterus through a catheter (long tube). After the procedure, you will be asked to remain lying on your back for a few minutes. This entire procedure may cause minimal discomfort and is completed in a short time.

Risks and complications

IUI is relatively safe and is not associated with serious complications; however, certain risks may occur such as infection and vaginal bleeding due to the placement of the catheter inside the uterus. IUI by itself may not be associated with a risk of multiple pregnancies. However, when coupled with ovulation inducing medication, you are at a higher risk of multiple pregnancies.

Assisted Reproductive Techniques

ART refers to lab-based fertility treatments that use eggs and sperm outside of the human body to start conception. The techniques we offer are In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI).

In Vitro Fertilisation

IVF is the process of fertilisation by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. The process begins on the second day of a woman’s menstrual cycle and takes approximately 30 days in total, as seen with the overview below.

Intracytoplasmic Sperm Injection

Intracytoplasmic Sperm Injection (ICSI)

For people experiencing infertility, intracytoplasmic sperm injection (ICSI) may lead to a successful pregnancy. This type of in vitro fertilization (IVF) is most helpful when there are male infertility issues. Your healthcare provider injects sperm into an egg to aid conception. Pregnancy may happen after an embryo transfer.

What is intracytoplasmic sperm injection (ICSI)?

Intracytoplasmic sperm injection (ICSI) is an infertility treatment. It involves injecting live sperm into a person’s eggs in a laboratory. This procedure can create an embryo (fertilised egg). ICSI is a form of in vitro fertilisation (IVF).

ICSI is a type of IVF. With traditional IVF, a healthcare provider places thousands of sperm next to an egg on a laboratory dish. Whether one of the sperm penetrates the egg to fertilise it is left up to chance. If none of the sperm fertilise the egg, conception (also called fertilisation) doesn’t occur.

ICSI promotes fertilisation through the direct injection of a single sperm into a single egg. Still, ICSI doesn’t guarantee fertilisation.

In both ICSI and traditional IVF, your healthcare provider implants the fertilised egg (embryo) into your uterus or womb. Pregnancy occurs if the embryo attaches to the lining of your uterus.

ICSI is most helpful for people experiencing male infertility. Your healthcare provider may recommend ICSI if a person has:

  • Anejaculation (inability to ejaculate).
  • Blockage in their male reproductive system.
  • Low sperm count.
  • Poor sperm quality.
  • Retrograde ejaculation (semen flows backward into their bladder).

You may also need ICSI if:

  • Traditional IVF hasn’t led to the creation of embryos.
  • The person supplying the eggs is older than 35.
  • You’re using previously frozen eggs or sperm (cryopreservation) to try to conceive.

Before ICSI takes place, your healthcare provider must collect the eggs and sperm.

These steps take place for egg retrieval:

  • Ovulation induction (also called ovarian stimulation): The person supplying the eggs receives medication injections for eight to 14 days. This stimulates ovaries to produce multiple eggs to mature at once. Next, a Lupron or human chorionic gonadotropin (hCG) injection will assist with final maturation of the eggs.
  • Egg retrieval: Your healthcare provider uses transvaginal ultrasound technology to guide the insertion of a thin needle through the wall of your vagina into your ovaries. This step is done with a mild anaesthetic, so there isn’t any pain. A suction device connected to the needle draws out and collects the eggs.

Unless you’re using frozen sperm, sperm collection takes place on the same day as the egg retrieval. The person supplying the sperm:

  • Abstains from sex and masturbation (no ejaculation) for two to three days prior to the sperm collection.
  • Masturbates at home or in a private room at a fertility clinic, collecting the ejaculate into a lab-provided container. The specimen must be received by the laboratory within 60 minutes from ejaculation.

A semen analysis takes place immediately to check sperm volume, mobility and quality. People who experience azoospermia, anejaculation or retrograde ejaculation may need a procedure to collect sperm. This is also true for people who undergo an unsuccessful vasectomy reversal. Procedures like electroejaculation and microscopic testicular sperm extraction may take place in a hospital instead of a fertility clinic. A lab may freeze and store the sperm (sperm banking) for later IVF use at the clinic.

During ICSI, your healthcare provider:

  1. Uses a pipette (small glass tube with a suction bulb) to hold the mature egg in place on a lab dish.
  2. Immobilizes and picks up one sperm using a thin needle.
  3. Inserts the needle into the egg to reach the cytoplasm.
  4. Injects the sperm into the cytoplasm.
  5. Withdraws the needle from the egg.

After ICSI, your healthcare provider monitors the fertilised egg in the laboratory for signs of successful fertilisation. Within five to six days, a healthy fertilised egg should divide into cells, forming a blastocyst. Your healthcare provider will evaluate the blastocyst’s size and cell mass to determine when it’s most likely to lead to a pregnancy.

An embryo transfer occurs on either on the fifth or sixth day following the egg retrieval procedure or commonly the transfer is delayed for a month or even years. Your doctor will discuss the timing of your embryo transfer with you. Using ultrasound technology, your healthcare provider will insert a catheter (long, thin tube) into your vagina and inject the embryo into your uterus. For pregnancy to happen, the embryo needs to implant (attach) to your uterus. Your healthcare provider may recommend waiting at least two weeks before taking a pregnancy test.

Compared to traditional IVF, ICIS appears to be more successful in helping those experiencing male infertility become parents. Some centres do ICSI for all people, regardless of infertility diagnosis.

Aesthetic Gynaecology

Aesthetic gynaecology has seen increasing patient and physician demand. Although this typically falls in the reign of obstetrics and gynaecology, plastic surgeons and cosmetic surgeons have also developed great interest in this field. Currently, few if any obstetrics and gynaecology residency or fellowship programs teach this subject matter though inroads have taken place in plastic surgery and cosmetic surgery training programs that had the foresight to include specific training in this field. Currently, many surgeons start by first training in various established certification and preceptorship programs based in the United States and the United Kingdom. New programs worldwide in 2016-2017 have also been launched to offer certification training to interested physicians in both surgical and non-surgical treatments. A steady flow of certificate programs continues to evolve in Turkey, the Middle East, Spain, and South America, as a second wave of experts emerge. We present a review of surgical and non-surgical techniques of what is presently called “aesthetic gynaecology” and the approaches of prominent gynaecologic societies regarding this relatively new subspecialty.

Surgery

Advanced laparoscopic surgical procedure is done by making an incision in the abdominal area. The incision is made several inches in length. In medical terms, it is also referred to as minimally invasive surgery.

How advanced laparoscopic surgery is done?

During the surgery, the surgeon uses laparoscopy to diagnose/treat the problem. Laparoscopy is a thin and long tube that is put into the abdomen after the incision is made. This device has a camera attached to it which allows the surgeon to the inside of the abdomen with ease. Through this device, the pelvic organ and abdomen are seen easily. In case, there is some issue then an instrument might be inserted into the abdomen and a laparoscope is inserted which is referred to as single-site laparoscopy.

Dr Deo will talk you through the entire examination and make sure that you are at ease and comfortable (She might include a prayer and a mini sermon free of charge). You may have a pap smear done. Pap smear is generally a procedure that is done to take a swab or sample
of your cervix cells from your cervix area to be tested for any abnormalities in your cervix. A pelvic ultrasound is done to get images and assessment of your womb and ovaries

Hysteroscopy is a procedure that can be used to both diagnose and treat causes of abnormal bleeding. The procedure allows your doctor to look inside your uterus with a tool called a hysteroscope. This is a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be a part of the diagnosis process or an operative procedure.

How is hysteroscopy performed?

Prior to the procedure, your doctor may prescribe a sedative to help you relax.
You will then be prepared for anaesthesia. The procedure itself takes place in
the following order:

  • The doctor will dilate (widen) your cervix to allow the hysteroscope to be inserted.
  • The hysteroscope is inserted through your vagina and cervix into the uterus.
  • Carbon dioxide gas or a liquid solution is then inserted into the uterus, through the
    hysteroscope, to expand it and to clear away any blood or mucus.
  • Next, a light shone through the hysteroscope allows your doctor to see your uterus
    and the openings of the fallopian tubes into the uterine cavity.
  • Finally, if surgery needs to be performed, small instruments are inserted into the
    uterus through the hysteroscope.

The time it takes to perform hysteroscopy can range from less than five minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is done at the same time.

Myomectomy is a surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. This procedure is considered standard of care for removing fibroids and preserving the uterus. Hysterectomy is the surgical removal of all or part of the uterus, or womb. The doctor may also remove the fallopian tubes, ovaries and/or the cervix during the same surgery. It is important to know that most women undergoing hysterectomy DO NOT need to have their ovaries removed, and will therefore not experience menopausal symptoms after surgery. Hysterectomies are commonly performed as final treatment option for chronic issues such as: Uterine fibroids, Endometriosis, Pelvic support problems (i.e.uterine prolapse), Abnormal uterine bleeding, Cancer, and Chronic pelvic pain.