WOMEN'S HEALTH AND FERTILITY.
AN INTERVIEW WITH MUDR MARINA TOMILOVA, A REPRODUCTIVE GYNAECOLOGIST FROM PRAGUE
Today’s guest of our publication Life in Prague is Dr. Marina Tomilova, she graduated from the Moscow Medical Academy in 1999 and then continued her education at Obstetrics and Gynaecology clinic of the 1st Faculty of Medicine (if you remember, this is the Snegiryovka Clinic. - Editor's note). She specialised in gynaecological endocrinology there and completed her postgradual education with PhD title.
Marina lives in Czech Republic, since 2011, she confirmed her medical education and specialised again in obstetrics and gynaecology to obtain a European certificate, and then specialised and has got a certificate in reproductive medicine.
Since 2014, MUDr Marina Tomilova has been providing medical services in her private practice called GynPrahaPlus in Prague and also works as a reproductive specialist at the fertility clinic EuropeIVF.
Marina, what are the most common problems, that you discuss with your patients as a gynaecologist?
Questions and concerns are very different and depend on the age mostly. The majority of women visit me to undergo annual checkups and are healthy. In their twenties and thirties the most common issues are contraception and menstrual cycle, later in life we talk about pregnancy planning; and starting in mid-forties, we discuss how to stay healthy and youthful in perimenopause and after the menopause.
Despite the abundance of information in the mass media, it is often confusing and chaotic, and many women have a very vague idea of how the reproductive system works, so I spend a lot of time explaining and educating how the female body works, what is really dangerous and what can be ignored. I often have to deal with old but persistent myths such as "hormones will make me fat and me grow a moustache" or "birth controls will make infertile".
What difficult questions do you discuss most often?
Both men and women know relatively little about cervical pre-cancer and cancer and their relationship with HPV HR (high oncogenic risk human papillomaviruses), how infection spreads and how the disease develops. Unfortunately, condoms do not protect against HPV. However, you can protect yourself by getting vaccinated. In the past, the vaccination was offered only for young people under the age of 25, but now there are vaccines for women up to the age of 45.
In Czech Republic, the HPV vaccination is included in the national calendar and covered by insurance for both girls and boys at the age of 13 to 14 years. In fact, our screenings were created primarily to prevent cervical cancer. The second complex issue is the relationship between age and pregnancy.
Can you be more specific about this?
Female biology dictates that the optimal age to become pregnant and give birth is between 18 and 30, and that's a fact that does not change, and has to be accepted. But modern society is evolving so that it's not enough for a woman to be just a mother, she wants to get education, have a career, fulfill many other goal with motherhood possibly being one of them. How to manage all of this? Take also in consideration the cult of beauty and youth, trends about 50th being the new 30th. Let´s be honest, before the age of 30, most people don´t think about family and children. Between the ages of 30 and 35, the female reproductive potential gradually decreases, and after 35 y.o. it declines rapidly. On the other side, we see celebrities having children at 45 and even after 50. And how do you make sense of it all? Nobody tells us that 99% of pregnancies after the age of 42 are achieved using either a donor oocyte or your own oocytes frozen in a young age.
Tell me about oocyte freezing.
This is a relatively new trend. It has been widely used for the last 10-15 years. It starts with ovarian stimulation to retrieve as many mature oocytes as possible in this particular cycle, then we provide oocyte pickup in short general anaesthesia, then our lab freezes the obtained oocytes. Young women in general have 15-20 oocytes retrieved in one cycle. The best age for this procedure is between 28 and 35 years of age. Frozen oocytes can wait for you for many years. If the woman wants to use them, we thaw them, fertilize with partner's or donor's sperm and 5 days later transfer the embryo in the prepared uterine cavity.
To ensure a birth of a healthy child, 20-25 eggs should be frozen for a 30-year-old woman, and the older the woman, the more eggs would be needed.
Is the menopause really the end women´s healthy and happy life?
No, of course not. Yes, it is true that the level of oestrogens starts to decline after the age of 40 and that menstruations stop around the age of 50. But we have a wide range of medicines, so called hormonal replacement treatment, mostly bioidentical hormones, that maintain the minimum levels of oestrogens in blood stream, needed for the women´s health, especially for her nervous system, cardiovascular system, her bones and muscles, and that can prevent dementia later in life. The hormonal replacement treatment is safe when prescribed correctly. Of course, there are some restrictions and contraindications. Women who use HRT need regular check-ups, including mammograms. Every year at the annual check-up, we discuss their health in detail, considering benefits and risks of the treatment. But of course, let's also not forget how important healthy lifestyle in general is, good sleep, healthy food and being physically active is playing a huge role in maintaining youth and health.
Private gynaecological practice GynPrahaPlus:
Sokolovská 979/209, Praha 9 - Vysočany, 2nd floor.
Tel: 778 046 108
Interview by Anna Navotná
