GYNECOLOGY AND INFERTILITY TREATMENT PROGRAMS

Gynecology, also known as gynaecology, is the branch of medical science that deals with the treatment and care of female reproductive system and infertility. As such it is responsible for the diagnosis and treatment of conditions related to the uterus, cervix, Fallopian tubes, ovaries, vagina, vulva and breasts. A Gynecology specialist is specialized and trained in treating a full spectrum of conditions ranging from infertility, contraception, sexual functions, to hormone disorders, infections, menstrual problems and menopause. A large number of gynecologist are also obstetricians (OB/GYN) in that they give care to pregnant women and growing fetuses, as well as women who want to terminate their pregnancies.  

Gynecology is divided into three sub-specialty areas:

• Maternal – Fetal medicine: This is a specialty that cares for women who have difficult and high risk pregnancies due to complications in reproductive system. It involves monitoring and treatment including comprehensive testing and ultrasound
• Gynecologic oncology: A specialist that provides care for women with cancers in the female reproductive system. (For gynecologic cancers please refer to our Oncology Section). It includes sub-specialties such as uterine cancer, ovarian cancer, cervical cancer, vaginal cancer, and vulvar cancer
• Reproductive endocrinology and infertility: A specialist that studies and manages hormonal dysfunctions and infertility problems as well as anatomical disorders . It also involves an obstetrics and gynecology surgical sub-specialty

As with all medical and surgical treatment programs, Cuba offers comprehensive treatment programs headed by specialized and highly trained gynecologic teams to meet the health care needs of women experiencing complex and/or sensitive conditions. Depending on the nature of the condition, the Cuban gynecologist team may choose to treat the disorder medically or surgically and, for some conditions, may opt to use minimally invasive surgery decreasing the length of hospital stay and length of recovery. Due to its reputation, Cuba has become one of the favorite destinations for the treatment.

 

General Gynecological Examination Program

It is essential that for women over the age of 18 to have a yearly gynaecological examination in order to identify and detect potential health problems, mainly certain cancers, especially breast and cervical cancers. This is important even though some women may not be aware of any underlying gynecological problems that they may have so as to eliminate the risk of having undiagnosed conditions that may have an impact on the reproductive and sexual health of the individual.

The gynecological examination offered in Cuba include:

  • Consultation with a Gynecology Specialist : This consists of collecting Information about the patient’s overall health, menstrual history, previous smear tests, sexually active, pregnancy history and choice of contraception. The patient is encourged to discuss any gnogolocial concers they may have.
  • Clinical Laboratory Tests and blood tests
  • Microbiological and Gynecological Investigations : Pap smear. Colposcopy. Simple vaginal discharge study.
  • Imaging investigations: Gynecological ultrasound, breast ultrasound and mammography.

Gynecological Treatment Programs

The following is a list of gynecological conditions and the treatment programs offered in Cuba for such conditions:

 

  • Breast Nodules: affecting both men and women, nodules are lumps or masses that form in the breast tissue in any part of the breast and are usually benign. Nodules are removed through a small cut in the skin, if possible around the areola (the  pigmented skin surrounding a nipple) or in the fold under the breast to minimize cosmetic effects.  The removed tissue is then taken for biopsy to determine if it is cancerous or not.  

  • Uterine Myoma: also known as a fibroid, leiomyoma, leiomyomata, and fibromyoma, is a condition in which benign soft tissue tumours form within the muscle tissue of the uterus. Most women with uterine myoma do not experience symptoms, few however experience painful or excessive menstrual periods, at times leading to anemia. Uterine Myoma may also cause lower back pain, pain during intercourse, and in very rare cases, it can lead to infertility.   Myomectomy is the prefered method for the removal of uterine myoma.  This surgical procedure allows the uterus to remain in place allowing women the ability to conceive.  At times however a hysterectomy (the surgical removal of the uterus) may be necessary if other treatment option have not worked.

  • Uterine Septum and Bicornuate Uterus: Both of these conditions are congenital malformation as the uterine cavity is developing. Bicornuate uterus is heart shaped with a deep indentation at the top while a uterine septum is when the uterine cavity is divided by a septum (wall).   Metroplasty , also known as uteroplasty or hysteroplasty, is a reconstructive plastic surgery procedure to the uterus is the most common method of choice for the surgical correction for both conditions.

  • Pelvic Floor Disorders:  Involves the dropping down (prolapse) of the bladder (cystocele), urethra(urethrocele), rectum (rectocele) and/or small bowel (enterocele) into the vaginal canal due to weakness in or damage to the tissue. Anterior and Posterior Colporrhaphy , a minimally invasive surgery is performed in order to restore organs to their normal position as well as to give support to and strengthen the tissues. Anterior refers to the tightening of the frontal wall of the vagina while posterior refers to the tightening of the back wall of the vagina.


    -  Cystocele with Urinary Incontinence:  The bladder herniates into the vagina coupled with bladder control problems. Anterior colporrhaphy and Kelly plication are performed in which the connective tissue between the vagina, the urethra and the floor of the bladder are stitched to form support for the bladder.
    Genital Prolapse: Occurs when a part of the vaginal canal has dropped down into the opening of the vagina due to weakness and damage to the tissue in the pelvic floor. , Anterior colporrhaphy as well asVaginal cervical amputation (the removal of the neck , i.e. the cervix, of the uterus) are performed.
    Uterine prolapse: When the uterus drops down into the opening of the vagina due to weakness or damage to the tissue in the pelvic floor. The most common treatment method is Vaginal Hysterectomy in which the uterus is removed through the vagina.

  • Bartholin’s gland cyst: Bartholin glands produce fluid secreted through the bartholin ducts that moistens the outer vulva. When the ducts are blocked fluids build up forming a cyst known as Bartholin’s gland cyst. In most cases Surgical Excision of the cyst is the general procedure, however if the cyst is too large then a Marsupialization may be required. This is a procedure in which the abscess wall is opened to allow drainage of the fluid. The abscess memberane is then stitched to the vagival lining allowing new tissue to form and heal the wound.

  • Dysfunctional Uterine Bleeding (DUB): Abnormal uterine bleeding that has no recognizable general medical problems. The bleeding is unpredictable in that it may be excessive or light, frequent or random.Diagnostic Endometrial Curettage which involve the diagnosis of the endometrium (tissue lining the inner cavity of the uterus) using a curette is used to remove material by scraping the walls of the uterus.

  • Paraovarian Cyst: Appear alongside the ovaries or the fallopian tubes. At times the cysts may tear, bleed or become infected. Laparoscopic Exeresis of the cyst is standard procedure for the treatment of this condition.

  • Polycystic ovaries : Is a condition due to hormone imbalance with high androgen levels. For women who have not benefited from other options, laparoscopy may be recommended, especially if the woman is having difficulties in getting pregnant.   

  • Pelvic Endometriosis: Occurs when the endometrial tissue (the lining of the inner cavity of the uterus) appear on the outside of the uterus. Videolaparoscopy (a surgery with a small incision in the pelvis or abdomen with the aid of a camera) as well as Vaporization with Argon plasma may be used for the treatment of this condition.

  • Unilateral and Bilateral Hydrosalpinx: Is a condition in which one or both fallopian tubes are dilated with fluids due to blockage at the end of the tubes away from the uterus . Salpingectomy is the surgical removal of one (unilateral salpingectomy) or both (bilateral salpingectomy) fallopian tubes.

  • Tubal Infertility: Is a condition in which the fallopian tubes are blocked or damaged hindering a fertilized or unfertilized ovum (the egg cell) from reaching the uterus .   Treatment for this condition is byVideolaparoscopy with unilateral and bilateral Tubal Plasty Surgery.

  • Previous Tubal Ligation: Reversal of what is commonly known as “tied tubes” and involves Contrasted Laparoscopy (a minimally invasive surgery in which a lighted tubes is inserted through a small incision to diagnose problems in the abdomen and the female pelvic organ) as well as End To End Anastomosiswhereby the remaining fallopian tube segments are reconnected.

Evaluation of Infertile Couples program

Infertility is defined as being unable to conceive inspite of having unprotected sexual intercoursse for above a year or the inability to carry a pregnancy to term. Women 35 years or older who have not conceived in a 6 months period of unprotected sexual intercourse should consider consulting with a specialist.

Cuba has a team of committed and dedicated staff physicians, specialized nursing and support team whose main objective is to identify the the root cause of infertility and treating the condition in the most effective method while maintaining the overall health and wellbeing of the patient.

Evaluation of infertility in Females:

  • Laboratory Tests

    -  Erythrocyte sedimentation rate
    : Testing the rate at which red blood cells settle in a period of one hour.Differential white blood cell count: Study of the different white blood cells.  
    Blood type and RH factor Complete coagulation.
    Quantitative serology: Examination of the blood serum (the yellowish fluid found in the blood that does not contain red or white blood cells and does not clot)
    VDRL (Venereal Disease Research Laboratory) HIV.
    Cyturia: The passage of cells in unusual numbers in the urine.
    Glycemia: The presence of glucose in the blood.
    Creatinine Level: Testing the amount of creatinine removal by the kidneys.
    Follicle Stimulating Hormone Level (FSH) and Luteinizing Hormone (LH). Both FSH and LH are hormone that helps control the menstrual cycle and the production of eggs.
    Estrogen Level: Estrogen is a steroid hormones that control the development and maintenance of female characteristics of the body.
    Progesterone: Progesterone is a steroid hormone needed to stimulates the uterus to prepare for pregnancy.
    Prolactin: Prolactin is a hormone needed to stimulates milk production after childbirth.

  • Vaginal discharge and vaginal cytology
  • Sperm penetration test
  • Cervical Test
  • Imaging studies:

    Hysterosalpingography: This uses a special form of x-ray called fluoroscopy and a contrast material to examine the uterus and fallopian tubes.
    Skull and Sella radiography.
    Transvaginal ultrasound.
  • Instrumentation and diagnostic examination
  • Contrasted Laparoscopy

Evaluation of infertility in Males:

  • Cultures and Antibiograms
  • Testosterone
  • Spermatic vein Doppler examination
  • Semen analysis

Pregnancy Termination Program

This program includes:

  • Specialized Medical Consultation in Gynecology


  • Laboratory tests:
    -  Hematocrit
    -  Erythrocyte sedimentation rate
    -  Differential white blood cell count
    -  Determination of blood type and RH factor.

  • Quantitative serology (VDRL)

  • HIV

  • Cyturia

  • Glycemia

  • Creatinine

  • Microbiological tests:
    -  Vaginal discharge. Endocervical exudate.


  • Imaging investigations: Gynecological ultrasound

  • Interruption of Pregnancy Right of operating room (minor surgery), right to anesthesia and post-operative resuscitation


Types of Pregnancy Terminations:

 

  • Up to 12 weeks Pregnancy: Termination of pregnancy

  • Pregnancy over 12 weeks to 20 weeks: Termination of pregnancy with D&C procedure

  • Ongoing, deferred or incomplete Abortion: D&C procedure

  • Ectopic pregnancy: videolaparoscopy (a surgery with a small incision in the pelvis or abdomen with the aid of a camera) with unilateral salpingectomy (surgical incision into a fallopian tube)

  • Tubal pregnancy:  Salpingectomy