HAPPILY EVER AFTER: PRESERVING CHILDBEARING POTENTIAL IN AT-RISK WOMEN
Washington University Physicians by Mary Jo Blackwood, RN, MPH, posted May 15, 2011
A woman’s ability to bear children is shaped by a variety of influences starting before birth. In rare cases the internal sexual organs fail to develop normally. Other factors can affect reproductive capabilities for girls with a normal anatomy, including hormones, trauma, infection and environmental exposures.
Modern medicine is providing some solutions to these problems, in part due to professionals who dedicate their careers to making a normal reproductive and sexual life eventually possible for these girls.
As a professor of obstetrics and gynecology and director of pediatric and adolescent gynecology at Washington University School of Medicine, Dr. Diane Merritt diagnoses and treats girls ranging in age from newborns to adulthood. Her unique practice serves as a bridge between pediatrics and obstetric/gynecologic care for young women.
“Pediatricians have a full plate, managing children’s growth and development, nutrition, vaccinations, illnesses and injuries; whereas Ob/Gyn physicians are dealing with pregnancy, birth, menopause and a multitude of reproductive issues.”
Merritt defines her role as helping infants, children, teens and young women with unique reproductive concerns that require special diagnostic, therapeutic and subsequent coordinated services.
One aspect of her position is serving on the multi-disciplinary team based at St. Louis Children’s Hospital for disorders of sexual development (DSD). The DSD team was established here and at other children’s hospitals to handle complex sexual issues starting from birth.
This group of specialists from several disciplines: pediatric urology, gynecology, endocrinology, genetics, psychology, social work and neonatology, review specific cases as a team and recommend appropriate next steps. One team member serves as the point person to communicate and coordinate with the family.
Merritt specializes in the diagnosis and surgical correction of reproductive anomalies like blocked or missing sex organs. She treats a wide range of anatomical/congenital malformations in patients referred from the Midwest, the West Coast and as far away as Hawaii. As an experienced surgeon in this specialty, she also trains and teaches other surgeons these techniques.
Says Merritt, “Some women have a uterus but no cervix or vagina. Some have neither vagina nor uterus; and others have only a vagina. Each of these patients presents a unique situation, requiring a range of strategies to allow for successful future sexual and reproductive function. Key is the presence of normal ovaries, which provide a source of female hormones and potential follicles.
“Many of my patients with normal ovaries and no uterus are able to have children by assisted reproductive technologies (ART). With a normal vagina and uterus but non-functional ovaries, they can use donor eggs or embryos implanted through ART.”
While some reproductive surgery is performed in the neonatal period in conjunction with other procedures, most of Merritt’s patients come to her later in life. Some teens have a normal sexual development but never have their first menstrual period (amenorrhea); others do not undergo the physical maturation associated with normal puberty.
She works closely with the patient and her family to properly diagnose the problem and determine the best time to surgically create a vagina, unblock an obstructed uterus, or otherwise correct the malformation.
Merritt’s therapeutic interventions may include creating a new vagina by dilation or surgically creating a vagina using tissue grafting techniques or laparoscopy. A stent keeps the new vagina open while it heals.
Her goal is to do everything she can to create or preserve reproductive capacity in her patients. “For instance, if we discover a tumor on an ovary, we will use ultrasound to monitor it and see if it resolves with the menstrual cycle; or if it has to be removed. Our surgery preserves as much healthy tissue as possible. Even a small amount of an ovary will have years of reproductive potential.”
Patients Preserve Their Reproductive Capacity by Making Good Choices
Says Merritt: “Young people are our most precious resource; they are also capable of making decisions that have far-reaching consequences. I counsel my patients to avoid substance abuse, sexually transmitted diseases, unplanned pregnancies, and threats to their self-esteem.
"I am a contraceptive provider and try to help my patients make responsible and safe decisions. My goal is to enable young women to reach their full potential by partnering in a thoughtful process.”
Dr. Diane Merritt sees patients at the Center for Advanced Medicine and in West County. To make an appointment call 314-362-0049.