A high-risk pregnancy is one that threatens the health or life of the mother or her fetus.

Risk factors for a high-risk pregnancy can include:

• Existing health conditions, such as high blood pressure, diabetes, or being
  
• Overweight and obesity. According to the American Congress of Obstetricians and Gynecologists, more than half of all pregnant women in the United States are overweight or obese.2 Obesity increases the risk for high blood pressure, preeclampsia, gestational diabetes, stillbirth, neural tube defects, and cesarean delivery. NICHD researchers have found that obesity can raise infants' risk of heart problems at birth by 15%.3
• Multiple births. The risk of complications is higher in women carrying more than one fetus (twins and higher-order multiples). Common complications include preeclampsia, premature labor, and preterm birth. More than half of all twins and as many as 93% of triplets are born at less than 37 weeks’ gestation.
  
• Young or old maternal age. Pregnancy in teens and women aged 35 or over increases the risk for preeclampsia and gestational high blood pressure.

• Existing Health Conditions
• Age
• Lifestyle Factors
• Conditions of Pregnancy

• High blood pressure. Even though high blood pressure can be risky for mother and fetus, many women with high blood pressure have healthy pregnancies and healthy children. Uncontrolled high blood pressure, however, can lead to damage to the mother’s kidneys and increases the risk for low birth weight.
  
• Polycystic ovary syndrome. Polycystic (pronounced pah-lee-SIS-tik) ovary syndrome (PCOS) is a disorder that can interfere with a woman's ability to get and stay pregnant. PCOS may result in higher rates of miscarriage (the spontaneous loss of the fetus before 20 weeks of pregnancy), gestational diabetes, preeclampsia, and premature delivery.
  
• Diabetes. It is important for women with diabetes to manage their blood sugar levels before getting pregnant. High blood sugar levels can cause birth defects during the first few weeks of pregnancy, often before women even know they are pregnant. Controlling blood sugar levels and taking a multivitamin with 40 micrograms of folic acid every day can help reduce this risk.
  

• Kidney disease. Women with kidney disease often have difficulty getting pregnant, and any pregnancy is at significant risk for miscarriage. Pregnant women with kidney disease require additional treatments, changes in diet and medication, and frequent visits to their health care provider.
  
• Autoimmune disease. Autoimmune diseases include conditions such as lupus and multiple sclerosis. Some autoimmune diseases can increase a women's risk for problems during pregnancy. For example, lupus can increase the risk for preterm birth and stillbirth. Some women may find that their symptoms improve during pregnancy, while others experience flare ups and other challenges. Certain medications to treat autoimmune diseases may be harmful to the fetus as well.
  
• Thyroid disease. Uncontrolled thyroid disease, such as an overactive or underactive thyroid (small gland in the neck that makes hormones that regulate the heart rate and blood pressure) can cause problems for the fetus, such as heart failure, poor weight gain, and birth defects.
  
• Infertility. Several studies have found that women who take drugs that increase the chances of pregnancy are significantly more likely to have pregnancy complications than those who get pregnant without assistance. These complications often involve the placenta (the organ linking the fetus and the mother) and vaginal bleeding.
  

• Obesity. Obesity can make a pregnancy more difficult, increasing a woman’s chance of developing diabetes during pregnancy, which can contribute to difficult births. On the other hand, some women weigh too little for their own health and the health of their growing fetus. In 2009, the Institute of Medicine updated its recommendations on how much weight to gain during pregnancy. New recommendations issued by the American College of Obstetricians and Gynecologists suggest that overweight and obese women may be able to gain even less than what is recommended and still have a healthy infant.
  
• HIV/AIDS. HIV/AIDS damages cells of the immune system, making it difficult to fight infections and certain cancers. Women can pass the virus to their fetus during pregnancy; transmission also can occur during labor and giving birth or through breastfeeding. Fortunately, effective treatments exist to reduce the spread of HIV from the mother to her fetus, newborn, or infant. Women with very low viral loads may be able to have a vaginal delivery with a low risk of transmission. An option for pregnant women with higher viral loads (measurement of the amount of active HIV in the blood) is a cesarean delivery, which reduces the risk of passing HIV to the infant during labor and delivery. Early and regular prenatal care is important. Women who take medication to treat their HIV and have a cesarean delivery can reduce the risk of transmission to 2%.

• Teen pregnancy. Pregnant teens are more likely to develop high blood pressure and anemia (lack of healthy red blood cells), and go into labor earlier than women who are older. Teens also may be exposed to a sexually transmitted disease or infection that could affect their pregancy. Teens may be less likely to get prenatal care or to make ongoing appointments with health care providers during the pregnancy to evaluate risks, ensure they are staying healthy, and understand what medications and drugs they can use.
  
• First-time pregnancy after age 35. Older first-time mothers may have normal pregnancies, but research indicates that these women are at increased risk of having :

• Alcohol use. Alcohol consumed during pregnancy passes directly to the fetus through the umbilical cord. The Centers for Disease Control and Prevention recommend that women avoid alcoholic beverages during pregnancy or when they are trying to get pregnant. During pregnancy, women who drink are more likely to have a miscarriage or stillbirth. Other risks to the fetus include a higher chance of having birth defects and fetal alcohol spectrum disorder (FASD). FASD is the technical name for the group of fetal disorders that have been associated with drinking alcohol during pregnancy. It causes abnormal facial features, short stature and low body weight, hyperactivity disorder, intellectual disabilities, and vision or hearing problems.
  
  
• Cigarette smoking. Smoking during pregnancy puts the fetus at risk for preterm birth, certain birth defects, and sudden infant death syndrome (SIDS). Secondhand smoke also puts a woman and her developing fetus at increased risk for health problems.

• Multiple gestation. Pregnancy with twins, triplets, or more, referred to as a multiple gestation, increases the risk of infants being born prematurely (before 37 weeks of pregnancy). Having infants after age 30 and taking fertility drugs both have been associated with multiple births. Having three or more infants increases the chance that a woman will need to have the infants delivered by cesarean section. Twins and triplets are more likely to be smaller for their size than infants of singleton births. If infants of multiple gestation are born prematurely, they are more likely to have difficulty breathing.
  
  
• Gestational diabetes. Gestational diabetes, also known as gestational diabetes mellitus, GDM, or diabetes during pregnancy, is diabetes that first develops when a woman is pregnant. Many women can have healthy pregnancies if they manage their diabetes, following a diet and treatment plan from their health care provider. Uncontrolled gestational diabetes increases the risk for preterm labor and delivery, preeclampsia, and high blood pressure.
  
  

• Preeclampsia and eclampsia. Preeclampsia is a syndrome marked by a sudden increase in the blood pressure of a pregnant woman after the 20th week of pregnancy. It can affect the mother's kidneys, liver, and brain. When left untreated, the condition can be fatal for the mother and/or the fetus and result in long-term health problems. Eclampsia is a more severe form of preeclampsia, marked by seizures and coma in the mother.

The PC Program provides counseling to women who need assistance with decision-making and the emotional stress of an unplanned pregnancy. The infant’s needs are also of utmost importance.  We also provide services to the baby’s father and the parents’ families, when appropriate and when not in conflict with the client’s wishes.

Pregnancy Counseling services are available to expectant or newly parenting single or married women.  Most clients are single women between 15 and 25 who have never before given birth and who contact the agency in the early to middle of their pregnancy.  However, some are older or younger, some are married, divorced or separated.  Some have other children.  Some contact the agency after delivery.  Occasionally a client will bring her baby home for a period of time, then seek counseling about adoption when she feels she cannot parent adequately.

Referrals come to the program at any stage of the pregnancy from other CFS programs, prenatal clinics, crisis pregnancy centers, doctors, hospitals, schools, attorneys, family members, or therapists.  PC staff collaborates with the referral agent to provide comprehensive service.  Clients can be seen at any of our statewide offices, at their home, their school, at their prenatal appointment, or wherever is most comfortable and convenient for them.  There are no fees to clients, but we bill Medicaid or their insurance.

The goal of the PC Program is to assist the client in making a comfortable informed plan for herself and her baby.  We provide accurate objective information about all their options and encourage her to make an informed independent decision.  We offer her an opportunity to explore all her options in the context of her own life, her goals, relationships, values and available resources.  Prevention of future pregnancies is also explored and clients are encouraged to consult with their doctor about their family planning options.

Services are available regardless of the client’s choice, whether she chooses termination, parenting, adoption or other custody arrangement for the baby.  The philosophy of the program is that self-determination and un-pressured decision-making promotes a comfortable adjustment to whatever decision is made.  When adoptions are planned, this philosophy also promotes legally safe adoptions and stable permanence for children. 

Services include immediate, objective, in-depth counseling beyond the “options counseling” offered in other programs.  We do not impose a set of values or religious tenets upon our clients and our counseling is provided by a master’s level clinical staff.  The program is community based and we work with other providers involved.

Services are available in New Hampshire, south of Lebanon, and in bordering states if the client delivers in New Hampshire and the travel distance is manageable.

What is male infertility?

Reproduction (or making a baby) is a simple and natural experience for most couples. However, for some couples it is very difficult to conceive.

A man’s fertility generally relies on the quantity and quality of his sperm. If the number of sperm a man ejaculates is low or if the sperm are of a poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy.

Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male.

How common is male infertility?

Infertility is a widespread problem. For about one in five infertile couples the problem lies solely in the male partner.

It is estimated that one in 20 men has some kind of fertility problem with low numbers of sperm in his ejaculate. However, only about one in every 100 men has no sperm in his ejaculate.

What are the symptoms of male infertility?

In most cases, there are no obvious signs of infertility. Intercourse, erections and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye.

Medical tests are needed to find out if a man is infertile.

What causes male infertility?

Male infertility is usually caused by problems that affect either sperm production or sperm transport. Through medical testing, the doctor may be able to find the cause of the problem.

About two-thirds of infertile men have a problem with making sperm in the testes. Either low numbers of sperm are made and/or the sperm that are made do not work properly.

Sperm transport problems are found in about one in every five infertile men, including men who have had a vasectomy but now wish to have more children. Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen.

Other less common causes of infertility include: sexual problems that affect whether semen is able to enter the woman’s vagina for fertilisation to take place (one in 100 infertile couples); low levels of hormones made in the pituitary gland that act on the testes (one in 100 infertile men); and sperm antibodies (found in one in 16 infertile men). In most men sperm antibodies will not affect the chance of a pregnancy but in some men sperm antibodies reduce fertility.

Ovulation problems may be caused by one or more of the following:

• A hormone imbalance
• A tumor or cyst
• Eating disorders such as anorexia or bulimia
• Alcohol or drug use
• Thyroid gland problems
• Excess weight
• Stress
• Intense exercise that causes a significant loss of body fat
• Extremely brief
  menstrual cycles

Damage to the fallopian tubes or uterus can be caused by one or more of the following:

• Pelvic inflammatory disease
• A previous infection
• Polyps in the uterus
• Endometriosis or fibroids
• Scar tissue or adhesions
• Chronic medical illness
• A previous ectopic (tubal) pregnancy
• A birth defect
• DES syndrome (The medication DES, given to women to prevent miscarriage or premature birth can result in fertility problems for their children.)

• A urine or blood test to check for infections or a hormone problem, including thyroid function
• Pelvic exam and breast exam
• A sample of cervical mucus and tissue to determine if ovulation is occurring
• Laparoscope inserted into the abdomen to view the condition of organs and to look for blockage, adhesions or scar tissue.
• HSG, which is an x-ray used in conjunction with a colored liquid inserted into the fallopian tubes making it easier for the technician to check for blockage.
• Hysteroscopy uses a tiny telescope with a fiber light to look for uterine abnormalities.
• Ultrasound to look at the uterus and ovaries. May be done vaginally or abdominally.
• Sonohystogram combines an ultrasound and saline injected into the uterus to look for abnormalities or problems.
  
  Tracking your ovulation through fertility awareness will also help your healthcare provider assess your fertility status .
  

Female infertility is most often treated by one or more of the following methods:

• Taking hormones to address a hormone imbalance, endometriosis, or a short menstrual cycle
• Taking medications to stimulate ovulation
• Using supplements to enhance fertility – shop supplements
• Taking antibiotics to remove an infection
• Having minor surgery to remove blockage or scar tissues from the fallopian tubes, uterus, or pelvic area.

There is usually nothing that can be done to prevent female infertility caused by genetic problems or illness.

However, there are several things that women can do to decrease the possibility of infertility:

• Take steps to prevent sexually transmitted diseases
• Avoid illicit drugs
• Avoid heavy or frequent alcohol use
• Adopt good personal hygiene and health practices
• Have annual check ups with your GYN once you are sexually active

A cyst is located within the tissue, and can develop anywhere in the body and may vary in size - some are so tiny they can only be observed through a microscope, while others may become so large that they displace normal organs.

In anatomy, a cyst can also refer to any normal bag or sac in the body, such as the bladder. In this text, cyst refers to an abnormal sac or pocket in the body that contains either liquid, gaseous or semi-solid substances.

Functional ovarian cysts

There are two types of functional ovarian cysts:

Follicular cysts are the most common type of ovarian cyst. A female human has two ovaries, small round organs which release an egg every month. The egg moves into the uterus (womb), where it can be fertilized by a male sperm. The egg is formed in the follicle, which contains fluid to protect the growing egg. When the egg is released, the follicle bursts.

In some cases, the follicle either does not shed its fluid and shrink after releasing the egg, or does not release an egg. The follicle swells with fluid, becoming a follicular ovarian cyst. Typically, one cyst appears at any one time and normally goes away within a few weeks (without treatment).

2) Luteal ovarian cysts

Cystadenomas are ovarian cysts that develop from cells that cover the outer part of the ovary. Some are filled with a thick, mucous substance, while others contain a watery liquid. Rather than growing inside the ovary itself, cystadenomas are usually attached to the ovary by a stalk. By existing outside the ovary, they have the potential to grow considerably. Although they are rarely cancerous, they need to be removed surgically.

Symptoms of ovarian cysts

Even if there are symptoms, they alone cannot determine whether a patient has an ovarian cyst. There are several other conditions with similar signs and symptoms, including endometriosis, pelvic inflammatory disease, ectopic pregnancy or ovarian cancer. A ruptured ovarian cyst may present similar signs and symptoms to those of appendicitis or diverticulitis.

• Irregular menstruation - periods may also become painful, heavier or lighter than normal
• A pain in the pelvis. This may be persistent pain or an intermittent dull ache that may spread to the lower back and thighs
• Pelvic pain may appear just before menstruation begins
• Pelvic pain may occur just before menstruation ends
• Dyspareunia - pelvic pain during sexual intercourse. Some women may experience pain and discomfort in the abdomen after sex
• Pain when passing a stool (doing a poo)
• Pressure on the bowels
• Some pregnancy symptoms, including breast tenderness and nausea
• Bloating, swelling, or heaviness in the abdomen
• Problems fully emptying the bladder
• Pressure on the rectum or bladder - the patient may have to go to the toilet more often, either to urinate or pass a stool
• Hormonal abnormalities - in some rare cases the body produces abnormal amounts of hormones, resulting in changes in the way the breasts and body hair grow.

• chronic pelvic pain
• uncontrollable vaginal bleeding
• cancer of the uterus, cervix, or ovaries
• fibroids, which are benign tumors that grow in the uterus
• pelvic inflammatory disease, which is a serious infection of the reproductive organs
• uterine prolapse, which occurs when the uterus drops through the cervix and protrudes from the vagina
• endometriosis, which is a disorder in which the inner lining of the uterus grows outside of the uterine cavity, causing pain and bleeding
• adenomyosis, which is a condition in which the inner lining of the uterus grows into the muscles of the uterus

There are several different types of hysterectomy.

During a partial hysterectomy, your doctor removes only a portion of your uterus. They may leave your cervix intact.

Total Hysterectomy

A hysterectomy is considered to be a fairly safe procedure. As with all major surgeries, however, there are associated risks. Some people may have an adverse reaction to the anesthetic. There is also the risk of heavy bleeding and infection around the incision site.

• bladder
• intestines
• blood vessels

After your hysterectomy, you’ll need to spend two to five days in the hospital. Your doctor will give you medication for the pain and monitor your vital signs, such as your breathing and heart rate. You’ll also be encouraged to walk around the hospital as soon as possible. Walking helps prevent blood clots from forming in the legs.

If you’ve had a vaginal hysterectomy, your vagina will be packed with gauze to control the bleeding. The doctors will remove the gauze within a few days after the surgery. However, you may experience bloody or brownish drainage from your vagina for about 10 days. Wearing a menstrual pad can help protect your clothing from getting stained.

When you return home from the hospital, it’s important to continue walking. You can walk around inside your house or around your neighborhood. However, you should avoid performing certain activities during recovery. These include:

• pushing and pulling objects, such as a vacuum cleaner
• lifting heavy items
• bending
• sexual intercourse

Uterine fibroids are very common non-cancerous (benign) growths that develop in the muscular wall of the uterus. They can range in size from very tiny (a quarter of an inch) to larger than a cantaloupe. Occasionally, they can cause the uterus to grow to the size of a five-month pregnancy. In most cases, there is more than one fibroid in the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding.

Fibroids can dramatically increase in size during pregnancy. This is thought to occur because of the increase in estrogen levels during pregnancy. After pregnancy, the fibroids usually shrink back to their pre-pregnancy size. They typically improve after menopause when the level of estrogen, the female hormone that circulates in the blood, decreases dramatically. However, menopausal women who are taking supplemental estrogen (hormone replacement therapy) may not experience relief of symptoms.

• Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots; this can lead to anemia
• Pelvic pain and pressure
• Pain in the back and legs
• Pain during sexual intercourse
• Bladder pressure leading to a frequent urge to urinate
• Pressure on the bowel, leading to constipation and bloating
• Abnormally enlarged abdomen

Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that's the case for you, watchful waiting could be the best option.

Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause, when levels of reproductive hormones drop.

• Gonadotropin-releasing hormone (Gn-RH) agonists. Medications called Gn-RH agonists (Lupron, Synarel, others) treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves. Your doctor may prescribe a Gn-RH agonist to shrink the size of your fibroids before a planned surgery.

Many women have significant hot flashes while using Gn-RH agonists. Gn-RH agonists typically are used for no more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone.

• Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn't shrink fibroids or make them disappear. It also prevents pregnancy.
• Tranexamic acid (Lysteda). This nonhormonal medication is taken to ease heavy menstrual periods. It's taken only on heavy bleeding days.
• Other medications. Your doctor might recommend other medications. For example, oral contraceptives or progestins can help control menstrual bleeding, but they don't reduce fibroid size.