Obesity is caused by excess fat accumulation in the body. This is a gender-neutral disease, and more or less affects everyone the same way. While a multitude of health-related risks are associated directly with obesity, many pathologies enable gain in weight and also make it an arduous task to shed some pounds. A standard way of concluding if you’re overweight or borderline obese is to calculate your body mass index (BMI). All you need for this calculation is an accurate weight (in Kilograms) and height (in meters), however, these units can be easily converted to and from pounds, centimeters, or ft. The simple formula is to divide the weight in kilograms by the square of height in meters. The resultant BMI can then be matched with the following paradigm:
BMI (kg/m2)
What It Means
<18.5
Underweight
18.5-24.9
Normal
25-29.9
Overweight
>30
Obese
When you calculate the BMI a few times, you will realize that a few extra kilograms make a lot of difference since after reaching a certain age, the only variation between height and weight is in weight. A key point to remember here: BMI does not differentiate between body types. Your BMI may classify you as obese when you are only muscular or pregnant. Therefore, it is not the ultimate test of your body health under every circumstance but an accurate comparison index besides that.
Nevertheless, obesity has now become a pressing problem worldwide but especially in the developed regions. This imposes a burden on the healthcare system as obesity never sustains on its own. It is not how the human body is designed, and it certainly impacts the person in more than one way: all of which are severely detrimental if not considered as such in due time. Obesity without any underlying condition such as metabolic disorders is mainly caused by a long-term ignorance of a balanced diet and lack of physical activity.
However, when obesity impacts not just an individual’s mental health but also bleeds into other consequences such as reproductive health, the disease becomes ten times as serious and of concern.
Infertility in Women
Several studies have successfully drawn a link between obesity and infertility in women. Data suggest Polycystic Ovary Syndrome(PCOS) is associated with obesity, thus leading to infertility. Although the underlying mechanism of PCOS is not precisely understood, insulin resistance is often seen to be at the foothold of the syndrome. Influence of Obesity is further confirmed in nonobese women with PCOS who are not as frequently diagnosed with Insulin Resistance. Moreover, even in an otherwise normal weight female, the abdominal pattern of fat can decrease fertility. In fact, this may be more detrimental than being obese overall.
The way in which obesity affects reproductive health is predicated on metabolism. Altered follicle production and complications in embryo development are found to be associated with steroid metabolism and other adipokines(signaling molecules of metabolism). Consequently, an overall poor ovarian response in obese women causes reduced oocyte (egg) retrieval.
Moreover, even miscarriages are more common in obese women. Nevertheless, there is also some discrepancy in the data for obesity and infertility due to a variation in what is considered as the endpoint for obesity to start associating it with infertility. As a general rule of thumb, BMI and infertility are linked when the former is above 30.
Infertility in Men
Contrary to the responsibilities of a female body that produces eggs and becomes the site for fertilization and implantation, the reproductive health of men is majorly equitable to the health of their sperms. While obesity might directly impact androgen production, it may also play a role in Erectile Dysfunction, which influences the delivery of sperm. Studies have reported a prominent decrease in the levels of free testosterone in the blood in obese men. The levels of testosterone are found to be associated with impaired stimulatory and inhibitory processes.
Even though obesity is not as widely studied in men as it is in women, the association of abnormal weight with men’s infertility can not be ignored. Hence, to circumvent health issues arising from being overweight or obese, the minimally invasive bariatric embolization procedure is now available in Pakistan, conducted by the pioneer of embolization procedures Dr. Imtiaz Ahmed, who is a consultant Endovascular surgeon and an Interventional Radiologist.
Treatment For Obesity: Bariatric Embolization
Infertility in women and men who are obese can be restored once the underlying reason is addressed i.e. excess weight. Bariatric embolization is a minimally invasive alternative to the infamous bariatric surgery, which comes with a glut of side effects. On the contrary, Bariatric Embolization works on the same principle but comes under the umbrella of Interventional Radiology. This not only increases the precision of this minimally invasive endovascular procedure and makes it many fold effective but also reduces the recurrence rate and post-procedure patient noncompliance.
To delineate, Gamma block bariatric arterial embolization is performed under 3-dimensional live imaging to precisely identify the vessels leading to the fundus of the stomach. This innovative procedure was first introduced by Dr Imtiaz Ahmad in 2017 and since then has been performed successfully on hundreds of patients with excellent results to date. Microcatheters are guided under imaging to either the radial or the femoral artery, which then reaches the left gastric artery, right gastroepiploic artery and short gastric arteries supplying arterial blood to a specific area in the gastric fundus. Embolization, too, is performed under image guidance, which blocks the blood supply to the fundus; the part of the stomach ”Hunger center” that releases hunger hormone(ghrelin). Consequently, ghrelin is inhibited, reducing the feeling of hunger in the patient. As a result, the patient can focus on reducing weight through physical activity and not get distracted by his/her hunger pangs.
Weight loss through Gamma block bariatric arterial embolization has the potential to tackle the serious epidemic of obesity and infertility. If you are tired of seeing the weighing scale reading and depressed over getting repeatedly negative pregnancy tests, it is time to consider Bariatric Embolization. In Pakistan, you can consult Dr. Imtiaz Ahmad through an appointment in Karachi or Lahore.
What is Pelvic Congestion Syndrome (Pelvic Congestion Syndrome)?
Pelvic congestion syndrome is a vascular disease that presents itself in the form of chronic pelvic pain lasting for more than three to six months. Since Pelvic Congestion Syndrome is essentially a venous syndrome, it must be the incompetency in the interconnected veins around the pelvic region that cause it. To understand the anatomy underlying Pelvic Congestion syndrome, let’s consider the nervous system in the area around the pelvis. Generally, uterine and internal Iliac veins drain the blood from the uterus and vagina. However, sometimes the fundus of the uterus is drained not into the uterine veins but into the ovarian plexus. The ovarian plexus divides into left and right wherein the former drains into the left renal vein and the right ovarian plexus drains right below the right renal vein. Eventually, these vulvoperineal veins drain into the femoral vein. When the veins in this route are damaged, it may result in inefficient drainage, also known as ‘congestion’, hence giving the syndrome its name.
Increased pressure in the pelvic veins is the primary cause of Pelvic Congestion Syndrome. Consequently, the patient will suffer at the hands of ovarian vein reflux or/and varicose veins. While ovarian reflux happens as a result of faulty valves, varicosities are more commonly seen in multiparous women or in simple words, women who have had more than one full-term pregnancy. The dilatation of veins around the pelvis plays a major role in compromising the venous drainage as it allows pooling of the blood, and increases pressure. Research suggests a 60-fold increase in the capacity of pelvic veins during pregnancy/post-pregnancy to sustain the pregnancy, however this often results in chronic pelvic pain pre and post pregnancy. Moreover, while the woman is pregnant, the veins are compressed by the belly, increasing the pressure and eventually leading to venous incompetency. Now that we have touched on the anatomy of Pelvic Congestion Syndrome, let’s delve into its symptoms, diagnosis and treatment.
Symptoms of Pelvic Congestion Syndrome
It is important to understand that Pelvic Congestion Syndrome can be easily misdiagnosed as there are many reasons for pelvic pain. Only a close eye on the pelvic congestion syndrome symptoms can tell apart Pelvic Congestion Syndrome from other causes of pelvic pain. These include but are not limited to pain in the lower back, thigh and pelvic region which also extends to the postcoital region. The painful sensations may worsen on the onset of menstruation and also during strenuous activity, including standing for a long duration. Once these symptoms are ruled out against other pelvic pathologies, a thorough analysis, diagnosis and treatment will be done by an interventional radiologist or a vascular specialist. To recapitulate, consider consulting your doctor to rule out Pelvic Congestion Syndrome if you have identified all or majority of the following symptoms:
A prominent pressure felt in the pelvic region
The pelvic pain has lasted for over 6 months
Pain extending to lower back; dull but discomforting
Irritable bladder leading to urinary/stress incontinence
Anomaly in bowel movements; Alternating between diarrhea and constipation
Dyspareunia: painful sexual intercourse
How to diagnose Pelvic Congestion Syndrome?
The prerequisite of correct diagnosis for Pelvic Congestion Syndrome is having awareness and working knowledge of the syndrome. Since pelvic pain is a symptom that is cross-cutting in the pathophysiology of several diseases, it is important to first rule out other possibilities. The doctor does not only do confirmatory tests to diagnose Pelvic Congestion Syndrome but also tests that help avoids misdiagnosis. Firstly, a manual examination of the pelvic and abdominal area is performed. This may reveal varicosities in the region and tenderness around the ovaries/uterus area, which will need further attention. Secondly, blood and urine tests may be advised to rule out the possibility of an infection or even pregnancy, which are frequent causes of pelvic pain. A transabdominal ultrasound will also be performed. During this, the patient is lying down in the supine position. However, there is a greater possibility of missing Pelvic Congestion Syndrome in the supine position since there is no distension of the veins and hence no pressure. Therefore, a better approach is to consider examinations in both positions. Furthermore, a transvaginal Doppler Ultrasound gives a comprehensive picture of the venous blood flow in the pelvic region and final confirmation can be drawn from an MRI.
How to Avoid Pelvic Congestion Syndrome – Risk factors
While Pelvic Congestion syndrome can occur in both men and women, the data is strongly bent in the direction of females. Approximately 3 in every 10 women develop Pelvic Congestion Syndrome. In most cases, multiparous women develop congestion in the pelvic after giving birth. The reason for this has already been discussed above. However, even in a non-pregnant state, the pelvic veins are more vulnerable to dilatation. Even more so, female hormones and congenital venous defects are also counted amongst the causes of Pelvic Congestion Syndrome. Finally, obesity is one of the causes of venous insufficiency and pelvic congestion, too. This is why one of the preventive measures for Pelvic Congestion Syndrome includes maintaining healthy weight gain during pregnancy and otherwise.
Pelvic Congestion Syndrome Treatment: Know Your Options
Medical therapy as a part of conservative management can be employed in patients with non-faulty ovarian veins or isolated dilatation in the venous plexus of the pelvic region. Hormone treatment, non-steroidal anti-inflammatory drugs, psychotropic agents combined with psychotherapy all are approaches taken in medical therapy for PCS. Surgical methods to alleviate PCS include vein ligation, hysterectomy and even uterus repositioning. All of these are highly invasive and data suggests a high recurrence rate, too.
Minimally Invasive Endovascular Treatment
With the advancement in medical science, the treatment options for vascular diseases like pelvic congestion syndrome transitioned from being only a few in number and invasive to becoming minimally invasive and alternative approaches. Pelvic Congestion Syndrome treatment through Endovascular embolization is the safest option and has supplanted other surgical routes.. The treatment aims to remedy the underlying cause of Pelvic Congestion Syndrome, which is the venous reflux. The procedure begins with locating and treating the most severely dilated veins or the ones that are distal. This is done via venography in a semi upright position by inserting guiding catheters into the transfemoral or brachial veins with special dyes. This is performed under anesthesia to reach maximum patient compliance. Once the detailed procedure is performed using valsalva maneuver, the Endovascular surgeon detects the varicose veins and vein reflux. The patient is now ready to go under embolization.
Using microcatheter, the distal/dilated veins are chosen for embolization. A well titrated mixture of Cyanoacrylate mixed with lipoidal or a copolymer dissolved in DMSO serves as the embolizing agent while micronized tantalum powder acts as a contrast agent for easy fluoroscopic guidance and visualization. Through this process, reflux veins are blocked up till the distal ovarian vein to include all possible collateral branch points. The embolization procedure requires no coils. Sometimes, complex venous syndrome calls for multiple embolizations. The success of embolization is assessed on the visual analog scale through the pain scores. The patients undergo a strict follow-up after 1 month and then every six months. Eventually yearly follow up for about five years can be expected.
If you reside in Pakistan and suspect that you might have developed Pelvic Congestion Syndrome then it is time to consult Dr. Imtiaz Ahmad, who is a Consultant Endovascular Surgeon and an Interventional Radiologist. He is the pioneer in bringing and conducting embolization in the country since 2017 in the two cities of Pakistan: Karachi and Lahore. So far, he has treated thousands of patients with varying forms of vascular diseases.
Feel free to WhatsApp all your reports to 03302963300 for free assessment by Dr. Imtiaz Ahmad.
