Our Services

Major Minimal Invasive & Open Surgery


By not using large cuts and not exposing internal organs to air/excess handling, Minimal Access Surgery (MAS) allows faster recovery and improved long term benefits. An instrument with a light source and camera is passed into the abdomen via a small incision or into the uterus via the cervix. In the former, a few more small incisions are usually
required.

Most non-cancerous surgeries can be performed by MAS cystectomy, myomectomy, hysterectomy, tuba/ectopic pregnancy, tubal repair, prolapse repair, appendicectomy, neurectomy, adhesiolysis, vaporization of endometriosis and hysteroscopic polypectomy, myomectomy, endometrial resection. Your informed consent will include discussion on choice of approach MAS or laparotomy.

For technical reasons or to secure the objective for surgery, it may be necessary to revert to a traditional incision (laparotomy) in the course of any MAS. It is implicit that consent for a MAS approach includes that for laparotomy. Also, during surgery, other conditions not earlier apparent may be found and further or alternative procedures/approaches may be needed. Another surgeon may be asked to assist in the surgery or postoperative care.

Subfertility & Pregnancy Care


Most healthy couples take up to a year of regular sexual activity to conceive.

Note that if a physical problem or disease is present, treatment is needed. Where surgery can help, this is usually be performed by keyhole/laparoscopy/MAS approach.

Simple measures to improve chances include a healthy lifestyle and best coital timing. It helps to improve sperm quality by cutting smoking and alcohol intake, keeping the scrota cool and taking antioxidants & androgens.

Analysis & culture of a seminal specimen is needed to gauge male status and, if needed, a hormone profile. Testicle varicosities, erective/ejaculatory dysfunction or infections may need to be treated. Sperm entry problems due to the cervix, immune system or uterine position can be overcome by Intra Uterine Injection (IUI) of enhanced sperms.

A normal reproductive tract and ovulation are requisites. The former may be assessed by means of ultrasound (US), hysterosalpingography (HSG) or minimal access surgery (MAS). Ovulation can be induced by clomiphene citrate and confirmed by urine test (LH kits).

Recombinant gonadotrophins (rFSH) is more precise for ovulation induction. It is more effective (and at lower dose) and purer than urinary preparations. It is more effective (and at lower dose) and purer than urinary preparations. It is used either by itself or in combination with clomiphene citrate. About 2 weeks of treatment with daily injections for 10 to 12 days is required and support of the second half of your cycle by a progestogen is helpful. For better results, especially if egg collection is the objective, “downregulation”
from day 2 of pretreatment cycle or shorter duration “antagonists” may be used. Monitoring of response is by ultrasound and/or blood tests.

Screening tests like Hb, Hb electrophoresis, blood group, VDRL, Rubella IgG, HBsAg & Ab, HIV, Urine FEME, Chlamydia and Toxoplasma IgG, PAP smear and hormone profile may be needed prior to any treatment.

If all is well, a few cycles of each method is best prior to contemplating InVitro Fertilisation (IVF). IVF is best done in conjunction with IntraCytoplasmic Sperm Injection (ICSI) in event of low sperm count. You may
need various procedures like oocyte retrieval, oocyte and sperm preparation, gametes and embryo culture, embryo transfer and freezing of excess embryos for future use. We will provide further information and guidance should IVF/ICSI be required.

Weight Loss & Preventative Care


Enjoy Life & live healthily at ideal weight.
Fit easily into clothes to look and feel good .
REACHING A HEALTHY WEIGHT THAT IS STABLE requires having a regular form of exercise and being mindful of choices for a good diet . If you like to cook, observe good cooking tips ( provided) which will improve your health of the whole family. It is vital that you have the desire to change for and lead a happy quality lifestyle.
See article ” Weight Loss Healthily & Effectively for Long Term” under “Our Articles”

Menopause & Ageing Care

Bioidentical HRT
BioIdentical Hormone (BH) Replacement Therapy (BHRT)

Optimal health in ageing comes from a balance of hormone messengers such as those from the ovaries, thyroid and adrenals. BHs are those similar to that produced by the body, modified from plant precursors found in soy and wild yam.

Using BHRT for ageing, its dose and nature is tailormade according to each person’s profile. In contrast, conventional HRT for women utilizes synthetic or natural hormones (e.g. from horse urine) and in standard
doses.

“Estrogens” are a class of 3 major hormones – estrone (E1), estradiol (E2) and estriol (E3). The powerful E1 and E2 are produced in the ovaries and also converted from testosterone (T) in fatty tissue. At high doses, it is felt that these increase the risk of endometrial and breast cancer.

E3 comes mainly from liver conversion of E1, some of E2, with the ovaries producing very small amounts directly. Though a weak E, it protects the body from carcinogenic effects of E1 and E2. It has been shown that cancer risk is reduced when the amount of E3 is >1 compared with total E1 + E2 (estrogen quotient).

Progesterone (P), secreted by the corpus luteum, negates the effect of estrogens. It is used to treat premenstrual symptoms (PMS), menopausal symptoms and postnatal depression. It helps new bone formation, prevent fibrocystic breasts and uterine cancer and contributes to cardiovascular health. It also has a calming effect – promoting sleep. It is best to add P when T is given in men as it prevents T conversion to E2.

T, an androgen hormone, causes male pattern baldness, male voice and acne. It improves bone and muscle formation, maintains energy and increases libido.

Thus the benefits of BHRT include:
(a) Relief of menopausal symptoms – hot flush, night sweat, fatigue, dry skin / vagina
(b) Improves sleep, mood, memory / concentration, libido
(c) Prevent and reverse osteoporosis
(d) Maintain muscle mass and strength
(e) Long term cardiovascular and health benefits

To determine the need for and the nature and dosage of BHs to be used if so, urine, blood and saliva tests are variously used. A symptom based Hormone Balance Test for ease of use follows.

Urine Incontinence Treatment & Management

Treatment is keyed to the type of incontinence. The usual approaches are as follows:

    • Stress incontinence – Surgery, pelvic floor physiotherapy, anti-incontinence devices, and medication
    • Urge incontinence – Changes in diet, behavioral modification, pelvic-floor exercises, and/or medications and new forms of surgical intervention
    • Mixed incontinence – Anticholinergic drugs and surgery
    • Overflow incontinence – Catheterization regimen or diversion
    • Functional incontinence – Treatment of the underlying cause

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Some experts recommend a trial of medical therapy before considering surgical treatment. Others believe that if the incontinence is severe and correctable by surgical means, a trial of medical therapy is not mandatory and does not need to be performed if the informed patient chooses to proceed directly to surgery.

Treatment of comorbid disease may minimize incontinence episodes. Measures such as smoking cessation, control of asthma, and relief chronic constipation may be beneficial.

Urinary Incontinence may also be fairly well controlled by ERYAG laser treatment. Check out “OUR ARTICLES” Laser Treatment of Urinary Incontinence

Natural Conception


Besides treating specific problems you may have, there are simple steps to help conceive.

For both of you

      • reduce stress and obesity
      • exercise regularly
      • do not smoke or consume (excessive) alcohol

 

For your husband, it is important to keep the scrotum “cool” – reduce chances of their being heated, squeezed or too retracted into the body, e.g.:

      • wear loose underwear – such as “boxer” type, wear loose trousers, avoid “hot” places & crossing legs, have cool showers [on scrotum] and use a rattan seat cover with holes for car and office seat
      • take antioxidants and andriol 40mg twice a day
      • avoid soya and alcohol

 

For you, do not be pressured. You are more likely to get pregnant by being relaxed and continuing to enjoy life and your marriage (& sex).

Take folic Acid 5mg daily and antioxidants and know when you ovulate for coital timing.

Ovulation can be more certain if you take Clomiphene Citrate 50mg to 200mg daily from day 2 of your menses for 5 days. If it occurs, ovulation is consistently 14 days before the next menses – thus, if you have a 28 day cycle on D14, 30 day cycle – on D16, 33 day cycle – on D19, etc.

The Ovulation Test Kit (LH kit) is a simple lunchtime or morning sample urine test done from a few days prior to when you expect to ovulate. Once clomiphene has given you regular cycles, start this test on D12.

In each cycle, stop testing further if negative after 5 days or so. You may not ovulate every month – no problem, just try again next month!

When the test is positive, it means you will ovulate 36 to 48 hrs later.

It is best you have coitus 4 to 5 days before you ovulate and have again only when you ovulate (the night after the test becomes positive) and again two (not every night!) nights later. Sperms live for 48 to 72 hours within your body. Your egg survives for a few days.