Are you postponing pregnancy?

Because of increasing importance to studies and profession, nowadays women are postponing the pregnancy. 
So planning pregnancy in 30's is becoming common today. Compared with 20's, planning pregnancy in 30's can lead to few problems. 
With increasing age the function of ovaries will get affected, number of ovarian follicles will decrease and remaining follicles may not respond properly to hormones. 
Possibility of problems like hormonal imbalance, pelvic inflammatory disease, endometriosis etc increase with age. 
Adverse effects of using contraceptive measures for prolonged period, possible medical complications diabetes, hypertension etc will increase with age. 
Tensions at work place can also affect fertility by leading to hormonal imbalance. 
Before planning for pregnancy in 30's, the factors to be considered are: 
-Folic acid supplementation should be started around three months before pregnancy. 
It helps in neurological development of baby and helps in conditions like anencephaly. 
-If the woman is having irregular periods, menstrual irregularity should be corrected before planning for pregnancy because menstrual irregularities can lead to difficulty in planning pregnancy and also infertility. Usually menstrual cycle with length of 21 days to 35 days and menstrual flow for 2 to 7 days should be considered as normal only. Deviation from these normalcy needs evaluation.
 Physical examination to access weight, height, BMI, anemia, thyroid abnormalities and gynecological examination to access the size, shape of uterus and adenexal pathology helps in finding out the possible cause of irregular periods. 
Then depending on the findings required investigations like estimating hemoglobin, blood sugar levels, gonadal hormonal profile, thyroid hormonal profile, prolactin levels estimation, ultrasound etc can help finding out the possible cause of irregular periods and treatment can be taken accordingly. 
If decreased ovarian reserve is suspected in ultrasound due to age factor, AMH( (Anti-Mullarian hormone) levels estimation is adviced. AMH is produced by the ovarian anthral follicles. 
Normal AMH levels indicate good ovarian reserve. Women with low AMH levels should plan for pregnancy early without postponing. 
-In case of regular periods or after correction of irregularity, planning intercourse during the time of ovulation increases the possibility of pregnancy. 
Usually ovulation occurs in the middle of the cycle. In case of regular 28 to 30 days cycles, ovulation is possible between 14th to 16th day of the cycle. 
-In case of infertility not getting corrected with medicines, artificial reproductive methods may be needed depending on the problem. 
Like in case of seminal abnormalities depending on spermatozoa count artificial methods ranging from IUI (Intra uterine insemination) to ICSI (intra cytoplasmic sperms injection) may need. After becoming pregnant also elderly women are more to some problems like hyperemesis gravidarum, means excessive vomitings in the first trimester of pregnancy and also pregnancy induced stress is more in elderly pregnant ladies. 
Medical complications like pregnancy induced hypertension, gestational diabetes etc can increase with age. Already existing chronic hypertension, diabetes mellitus, thyroid abnormalities etc can aggrevate during pregnancy. Placental problems like decreased blood supply to placenta due to age related vascular changes and also placenta previa etc are more common in these elderly pregnant women. 
Incidence of operative deliveries also increase in elderly women because of uterine inertia. 
Babies of elderly pregnant women are more prone for chromosomal abnormalities like Down's syndrome, preterm or intrauterine growth retardation etc complications. 
So, better to think once again when you want to postpone the pregnancy. 

General gynaec checkup and routine investigations adviced during checkup

Nowadays because of increased awareness of gynecological problems women are approaching gynecologist early for different complaints. Tests advised during gynecological checkup depends on symptoms of the patient. For those women who come for general gynaec checkup: 
-General examination is performed to access the weight, height, BMI(Body mass index), anemia, thyroid swellings, blood pressure recording etc. 
-For women with age above 35 years or for women having problems related to breast, breast examination and mammography are adviced to rule out pathological conditions like benign or malignant lumps in the breast, fibrocystic changes etc. 
-Abdomen palpation will be done after emptying the bladder to rule out any abdominal lumps, to observe any scars over abdomen etc. 
-External genitalia is examined to find out any discoloration, ulcers, bumps, vaginal discharge etc. 
Perspeculum examination is done to observe the condition of cervix, to rule out erosion, polyps etc. 
Pap smear test is regular screening test to detect changes of cervical cancer, which is advised to all women above the age of 21 years. Yearly once examination is advised for first three years, if all three tests gives negative results, then three years once pap smear test is enough. If unhealthy cervix is noted or frank growth is noticed at the level of cervix, cervical biopsy will be taken. Depending on the reports further management can be planned. 
-Per vaginal examination will be done to observe the size of the uterus, position, mobility and to palate adnexal masses. This helps in finding out uterine pathology and adnexal pathology. 
Depending on the clinical findings if needed specific investigations like blood tests to detect hemoglobin levels, blood sugar levels, thyroid profile, gonadal hormonal profile, prolactin levels estimation, ultrasound etc are advised. 
In case of uterine tumors or ovarian cysts or tumors etc sometimes CT scan or MRI may be needed to confirm the diagnosis and plan the management. 
In case of ovarian cysts or tumors blood CA125 levels estimation is advised to find out the malignant nature of cyst or tumor.