[vc_row][vc_column][vc_column_text]<\/p>\n
\u0395\u03ba\u03c4\u03cd\u03c0\u03c9\u03c3\u03b7<\/span><\/a><\/p>\n [\/vc_column_text][vc_tta_accordion color=”sky” c_icon=”chevron” active_section=”1″ no_fill=”true” collapsible_all=”true”][vc_tta_section title=”When is a thyroid operation advisable” tab_id=”1615975356574-814f1578-a50b”][vc_column_text]A surgical operation is needed when the pharmaceutical treatment fails \u2013 within a reasonable timeframe \u2013 to counter the problem (functional, morphological or combination thereof) or when it is from the beginning it is deemed ineffective, or when there are or going to be cases of pressing on the adjacent anatomical elements (oesophagus, trachea, nerves of the larynx) and \u2013 especially in our times \u2013 when there is a suspicion of malignancy, something which is common unfortunately during the last years.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”When should I undergo an operation? Is it something urgent” tab_id=”1615975356596-08586a48-adda”][vc_column_text]Due to the often asymptomatic and insidious route of the thyroid diseases,\u00a0<\/span>the earlier<\/b>\u00a0someone removes an affected thyroid gland from his organism,\u00a0<\/span>the better<\/b>. The continued presence of a large nodule in the thyroid despite the pharmaceutical treatment, allows for\u00a0<\/span>the possibility of mutation, of a group of cells to malignancy, without absolutely no warning sign.<\/b><\/p>\n It sometimes happens that the histological report (the biopsy after the surgery) describes the cancer having invaded the capsule (the enclosure) of the thyroid gland and having branched out to the lymph nodes. This may be happening, despite the different information provided by the usual ultrasound. And then we have in front of us \u201cinconsolable\u201d patients that blame themselves for the detrimental delay of the surgery.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Why should I undergo an operation, since I do not feel any symptoms” tab_id=”1615975445991-abbe6e0b-76e0″][vc_column_text]A\u00a0<\/span>symptom<\/b>\u00a0is something completely different than a\u00a0<\/span>disease<\/b>. The fact that we, subjectively, do not feel any discomfort at present, has absolutely nothing to do with the disease, from which, objectively and proven, we maybe ailing and which continuously worsens.<\/span><\/p>\n The particularity of thyroid diseases especially is that when they finally start causing symptoms, then the destruction of the gland has already advanced.\u00a0<\/span>Thyroid cancer<\/a> causes absolutely no symptom<\/b>, until it has developed enough so that lymph nodes or distant metastases become detectable.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Is it possible that the physicians\u2019 opinions differ regarding whether an operation is necessary” tab_id=”1615975481588-25200828-4edd”][vc_column_text]There are\u00a0<\/span>international guidelines\u00a0<\/b>regarding whether the removal of the thyroid gland is appropriate. Based on these guidelines, but also based on\u00a0the <\/span>clinical history of the patient and the clinical judgement of the Endocrinologist for each case individually,<\/b> an operation is decided upon.<\/span><\/p>\n As in many cases, in Medical Science, there are \u201cgrey zones\u201d in diagnosis and treatment. In these cases there should be an exhaustive conversation, between the doctor and the patient, as to which is the ideal treatment. The pros and cons of the conventional and the surgical treatment should be analysed by the Endocrine Surgeon.<\/span><\/p>\n In the daily operation of the Endocrine Surgery Practice,\u00a0<\/span>it is sometimes ascertained that precious time is wasted\u00a0<\/b>for the patient, until he undergoes surgery.\u00a0Sometimes an undiagnosed cancer has already reached the edge of the thyroid, breaking through its capsule, and is ready to invade the lymph nodes.<\/span><\/p>\n The hesitation of the patient to undergo surgery, the seeking of the opinion of many doctors until \u201cthey tell us what we want to her, which is: do not go into surgery\u201d, as well as the insistence on an ineffective pharmaceutical treatment, beyond a reasonable timeframe, are the most common causes of the surgical treatment, with usually adverse effects for the patient.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”If it is believed that I am a \u201cgrey zone\u201d with regard to whether or not i should undergoan operation, with whom can I discuss my problem with” tab_id=”1762173024473-a272b0a5-b2ac”][vc_column_text]I<\/span>nitially with the Endocrinologist, but also with the Endocrine Surgeon, who is the most competent in informing regarding the patient about the relevant \u00a0surgical risks.<\/span><\/p>\n A simple\u00a0<\/span>meeting and medical consultation<\/b>, in a surgical practice, based on the personal, clinical and laboratory date of the patient,\u00a0<\/span>does not mean<\/b>\u00a0that it\u00a0 necessarily leads to surgery.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”What exactly do we excise during the operation” tab_id=”1762173135402-a9a03df8-2900″][vc_column_text]In our times usually a\u00a0<\/span>\u201cTotal Thyroidectomy\u201d<\/b>\u00a0is performed. Medical science used to believe that it was sufficient to remove only the part of the thyroid that bore the nodule. Frequently though, with this practice, the patient undergoes surgery again, either because his biopsy showed cancer, or because nodules reappeared in the part that remained inside.<\/span><\/p>\n In our era, the recommendation for\u00a0<\/span>\u201cPartial\u201d Thyroidectomy<\/b>\u00a0reoccurs which is considered sufficient in some cases.<\/span><\/p>\n By evaluating the data of each patient, taking into account the position of the Endocrinologist, a discussion with the patient takes place regarding the pros and cons of each treatment option and the appropriate type of operation is decided upon.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”\u0397ow safe is thyroid operation” tab_id=”1615975590436-b57265fb-fab9″][vc_column_text]Thyroidectomy is a surgical operation of medium gravity, which\u00a0<\/span>is performed safely in our times<\/b>. The medical literature reports, as in every surgical operation, possible complications regarding respiration, speech, the need for taking calcium pills, post-operative haemorrhage, infection etc., which you can discuss with the doctor. These cases amount to a very small percentage.<\/span><\/p>\n It has been internationally proven that\u00a0<\/span>the operation being performed by a Specialised Surgeon in the Endocrine Surgery ward, in a Centre that offers modern infrastructure, minimises the possibility of any complication.<\/b>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”\u0397ow long does the operation take” tab_id=”1615975556038-9e4b248f-329d”][vc_column_text]The duration is about 1 to 1\u00bd hours. The surgical schedule is arranged to ensure that each patient receives a <\/span>precise, safe, thorough, and effective operation without time pressure.<\/b>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Who is the specialist for this operation\u2014Is there a specialised surgeon for the thyroid” tab_id=”1615976016751-0a946bcb-71fc”][vc_column_text]A thyroid operation\u00a0<\/span>historically<\/b>\u00a0belongs, among many others, to the broad range of operations of a General Surgeon. The uniqueness of this \u201cdelicate procedure\u201d to the neck and its possibly grave complications, demand a\u00a0<\/span>Specialised Endocrine Surgeon<\/b>.<\/span><\/p>\n A very limited number of surgeons has specialised in the particular field and the performance of an operation by these surgeons has the best result, practically nullifying the possibility of complications.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”What kind of anesthesia is required” tab_id=”1615976104393-438a3c43-b7c5″][vc_column_text]General anaesthesia.<\/b>\u00a0The Greek patients \u2013 in utter contrast with what is happening abroad \u2013 have an unjustified phobia regarding the procedure of anaesthesia. The science of Anaesthesiology has nowadays advanced by leaps and bounds, which\u00a0<\/span>with the assistance of advanced computers<\/b>; monitors in full detail all the vital functions of the organism, providing safety of the highest order for the patient.<\/span><\/p>\n Mr Karvounis has incorporated into his team Anaesthesiologists with long experience and scientific interest in the surgical operations on the endocrine glands.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Is there a special scientific team” tab_id=”1763109792028-8d3d20a2-4775″][vc_column_text]A special scientific team is headed by Mr Karvounis, with the aim of providing a\u00a0<\/span>high safety level<\/b>\u00a0at the rendering of medical and surgical services. The team is comprised of extensively trained associates,\u00a0doing pioneer work in Greece, focusing on \u00a0the scientific upgrading of thyroid Surgery.<\/span><\/p>\n Excellent Anaesthesiologists, Registrars-Scientific associate Surgeons, Surgical Pathologists, Cytologists, Radiologists, E.N.T., Thoracic\/Vascular\/Neurosurgeons, Nuclear Medicine Physicians, Pathologists and Endocrinologists proudly comprise our\u00a0<\/span>large medical family<\/b>.<\/span><\/p>\n Disposing of the\u00a0<\/span>technical know-how and the scientific authority<\/b>, the competent human\u00a0 resources are there to make the most of the latest developments in Surgery,\u00a0<\/span>taking care of your health in the best possible way<\/b>.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Are there new techniques for thyroid gland operation” tab_id=”1763109834981-6c35c2bb-948e”][vc_column_text]Thyroid surgery is\u00a0nowadays\u00a0performed in various ways,\u00a0all around us. One can come across (too often unfortunately) the\u00a0traditional surgical\u00a0technique with the large incisions, the tubes, and the long recovery. At the same time one hears of the very latest techniques,\u00a0with considerable limitations in their applicability, untested and lacking validation\u00a0through time, which have not become widely accepted by the scientific community (significant reservations are maintained and discord is voiced).<\/span><\/p>\n Mr Karvounis, Surgeon, applies the minimally invasive thyroidectomy (<\/span>minimally invasive surgery<\/b>), which is the modern and pioneering technique that is applied\u00a0<\/span>internationally<\/b>\u00a0with absolute success,\u00a0<\/span>in specialised centres of endocrine surgery<\/b>.<\/span><\/p>\n Instead of the\u00a0traditional scalpel and scissors, the dissection, the detachment of the thyroid gland and at the same time the haemostasis are performed with the use of\u00a0<\/span>radiofrequency<\/b>\u00a0and\u00a0<\/span>ultrasonic rays\u00a0<\/b>(<\/span>Ultracision<\/b>). These are special, modern surgical tools that provide\u00a0maximum accuracy and efficiency, without causing damage to the tissue\u00a0and or even post-operative pain to the patient, as happens with the traditional technique.<\/span><\/p>\n Moreover, the speech of the patient is safeguarded through the use of\u00a0<\/span>neuromonitoring<\/b>. It is the most\u00a0revolutionary and impressively useful technique\u00a0which warns the Surgeon and protects, to a great extent, the patient from having problems with their vocal cords.<\/span><\/p>\n A second safeguard<\/b>\u00a0for the integrity of the vocal cords is achieved through\u00a0<\/span>video-laryngoscopy<\/b>\u00a0during the extubation and waking of the patient.<\/span><\/p>\n A special, detailed operative preparation, sometimes undergoing the effort of marking them, aims at the\u00a0<\/span>checking and safeguarding of the adjacent parathyroid glands<\/b>.<\/span><\/p>\n Exhaustive pre-operative, ultrasonic mapping of the neck, often with imaging re-checking, in the surgery room (<\/span>portable sonography<\/b>), provides the information for a more\u00a0<\/span>complete, successful neck dissection<\/b>, in cases of malignancy.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”\u0399s there a thyroidectomy technique that does not include an incision to the neck” tab_id=”1763109858304-97eb7821-2988″][vc_column_text]During the last decades, a large number of surgical techniques for removing the thyroid gland have been described.<\/span><\/p>\n The desired,\u00a0<\/span>ideal surgical approach<\/b>\u00a0is the one that minimises, as much as possible, the exit opening of the gland (incision), is less bloody without necessitating a draining tube, has the smallest risk of injury to the elements adjacent to the thyroid, provides the surgeon with immediate access during an emergency situation (e.g. profuse and threatening haemorrhaging), affects the possibility of a proper, thorough cleaning of the gland and the metastatic lymph nodes, causes the minimum possible discomfort\/pain post-operatively, ensures an uneventful and quick recovery, and is of affordable cost.<\/span><\/p>\n The patient has to be informed\u00a0\u00a0 about\u00a0 \u00a0the surgical technique by his doctor. However, it is simply noted that many techniques, no matter how \u201centicing\u201d they are presented to be in medical conferences and posts on the internet, bring with them significant drawbacks, which have forced the international scientific community of endocrine surgeons, in its vast majority, not to adopt them in the current medical practice.<\/span><\/p>\n In spring 2018, Mr Karvounis travelled to the Singapore Academy of Medicine, where he underwent training in the pioneering technique of\u00a0<\/span>removing the thyroid through the mouth<\/b>\u00a0assisted by video camera. While being the only Greek participant in this international workshop, he was trained in performing the aforementioned technique, among top endocrine surgeons from all five continents.<\/span><\/p>\n Daily, Mr Karvounis, Surgeon, by monitoring closely the developments in endocrine surgery as well as the international literature, makes the performance of\u00a0<\/span>modern, minimally invasive, safe, uneventful, thorough, practically bloodless and aesthetically whole operation for his patients<\/b>\u00a0his priority.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Are there reoperations on the thyroid” tab_id=”1763109881998-4ab0e1bb-cf05″][vc_column_text]In some relatively rare cases, a second operation on the thyroid is necessary. This usually occurs when part of the thyroid gland was not removed during the first operation\u2014often because the initial procedure was performed by a non-specialist surgeon. Reoperation may also be required in cases of disease recurrence, to remove lymph nodes.<\/span><\/p>\n A thyroid reoperation is a particularly demanding procedure, and ideally it should be performed by a specialized surgeon. At the Thyroid Surgery Center of Excellence, we take great pride in offering effective surgical solutions and successfully managing many such technically challenging reoperations every year, for patients from across the country.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”How long must I be hospitalised for a thyroidectomy” tab_id=”1763109910185-0c60ed9b-832e”][vc_column_text]One day. <\/b>The patient arrives at the Clinic in the morning, the surgery is performed and by midday the I.V. is removed.<\/span>\u00a0Immediately after surgery he can speak, move about and by midday receives stable food.<\/b>\u00a0Having no I.V. or other tube in the neck, he can move about freely, remains in the Clinic for the night and exits in the morning of the next day.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”When and how will I eat after the operation” tab_id=”1763111376608-1db70d1a-1944″][vc_column_text]The patient starts receiving food approximately 3 hours after the surgery. Although his diet can be free,\u00a0<\/span>some patients prefer generally tender food for the first 24 hours;<\/span><\/i>\u00a0<\/span>free diet<\/b>\u00a0after that.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Will I be able to speak after the operation” tab_id=”1763111411416-160371b3-9c33″][vc_column_text]Of course.<\/b>\u00a0Immediately after the surgery is over, the patient\u00a0<\/span>speaks normally<\/b>.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Will there be a blood transfusion needed” tab_id=”1763111455260-6ad3eda3-4a77″][vc_column_text]No<\/b>, there will be no blood needed. No blood donor is required.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Will I have a drainage tube after the operation” tab_id=”1763111481112-e64d1247-2193″][vc_column_text]No<\/b>, with the particular surgical technique \u2013 in the vast majority of the patients \u2013 we do not place a drainage tube.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Why do some people report hoarseness in the voice after the operation” tab_id=”1763111506047-e32d8afa-f547″][vc_column_text]The anatomical position of the laryngeal nerves, which are responsible for the vocal chords, is adjacent to the thyroid gland.\u00a0<\/span>Depending on the nature of each patient\u2019s issue<\/span><\/i>\u00a0there is a varying degree of difficulty and risk for the function of the vocal chords. Undergoing the operation at the<\/span>\u00a0experienced hands of a specialised Surgeon<\/b>\u00a0and through the use of the most\u00a0<\/span>modern technological equipment, minimises any possibility of voice disorder.<\/b>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”What about parathyroid glands and calcium balance” tab_id=”1763111548600-d40d24e3-6e21″][vc_column_text]The parathyroid glands are 4 small glands, at the size of a lentil, which, in the anatomical sense, neighbour the thyroid. Their function is linked with the calcium metabolism in our organism.\u00a0<\/span>Always depending on the nature of each patient\u2019s problem, the identification and preservation of the parathyroid glands necessitates great care and detailed process on the part of the Surgeon<\/span><\/i>. The\u00a0<\/span>specialised surgical technique<\/b>\u00a0that the Surgeon applies, in combination to the\u00a0<\/span>modern technological support<\/b>, contributes to the calcium balance not being affected.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Is there a method for identifying and protecting the parathyroid glands” tab_id=”1763111608276-dd6ff68e-8689″][vc_column_text]Primarily, the expertise and experience of the Endocrine Surgeon are crucial. The <\/span>parathyroid glands<\/span><\/a> are tiny organs that have a color similar to surrounding tissues (fat, lymph nodes), are often embedded within neighboring tissues or even within the thyroid, and do not always have a fixed anatomical location in the neck. Therefore, locating and preserving them remains a constant challenge and \u201ctrap\u201d for the surgeon.<\/span><\/p>\n The intraoperative imaging method of parathyroid tissue using autofluorescence in the near-infrared spectrum can selectively assist in visualizing the parathyroids within the surgical field. Additionally, intraoperative angiography using indocyanine green (ICG) contributes to detecting functional parathyroid glands with modern fluorescence cameras.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Is the patient in pain after the operation” tab_id=”1763111635842-04195cca-2310″][vc_column_text]No<\/b>, with the particular surgical technique, there is no pain.\u00a0<\/span>Actually, we do not even prescribe analgesics<\/span><\/i>\u00a0upon the patient\u2019s discharge.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Will there be a scar on my neck” tab_id=”1763111662017-fa50d73e-a9f3″][vc_column_text]Plastic reconstruction is applied at the end of the surgery.\u00a0<\/span>There are no sutures.<\/b>\u00a0Nothing is removed. The\u00a0<\/span>impressively small incision<\/b>\u00a0is done\u00a0<\/span>on the natural skin fold<\/b>\u00a0(where skin makes a fold by itself) yielding an\u00a0<\/span>aesthetically perfect result<\/b>. Mr Karvounis has developed this technique in particular, and moreover, recommends special beauty products, which achieve cellular reconstruction and provide a beautiful and without scars skin.<\/span><\/p>\n It is quite often according to our patients that a few days after the surgery they are asked by their unsuspecting friends: \u201cWhere did you scrape yourself\u201d, instead \u201cwhen did you have surgery\u201d, due to the microscopic, imperceptible scar!\u00a0<\/span><\/p>\n Weeks or months after surgery, the patient himself has to greatly insist to convince the person that he is talking to that he indeed underwent surgery, as the latter sees no scar.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”When can I go back to work” tab_id=”1763111783636-a3325f6f-7462″][vc_column_text]Whenever you want.<\/b>\u00a0<\/span>The recovery is rapid and there is no pain<\/span><\/i>. Many of our patients return to their job, the following day of their discharge. Depending on the nature of their employment, some desire sick leave.\u00a0<\/span>In the latter case, the doctor, in conjunction with the patient, determines the desired length of the sick leave<\/span><\/i>.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Might the issue recur after the operation” tab_id=”1763111832533-23297f55-2524″][vc_column_text]No.<\/b> The total thyroidectomy operation aims at removing the entire thyroid gland. Therefore there is no recurrence.<\/span><\/p>\n In case of malignancy, the patient is monitored for the rare possibility of the appearance of a relapse\/metastasis in the future.<\/span><\/p>\n The\u00a0<\/span>thoroughness of the operation<\/b>\u00a0is a main attribute of successful surgery for the Endocrine Surgeon.<\/span><\/p>\n Our surgical team, under the direction of Mr Karvounis, has as one of its core values that a thorough clearing constitutes an affirmation challenge for the Surgeon that practices diligently thyroid Surgery.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”What happens if the biopsy after the operation shows malignancy” tab_id=”1763111906175-36d1a49e-673b”][vc_column_text]Thyroid cancer is one\u00a0<\/span>of the \u201cbest cancers\u201d of the human organism<\/b>. Its most common type (papillary Ca) has excellent prognosis at a very high percentage.\u00a0<\/span>Most of the patients with this type of thyroidal cancer will live deep into old age,\u00a0<\/span><\/i>as long as they have removed it from their organism in time.<\/b>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”What about radioactive iodine therapy” tab_id=”1763111970401-93a185ea-fafb”][vc_column_text]In the case of a biopsy positive for cancer following a thyroidectomy, depending on the details of the histological examinations, the Endocrinologist decides regarding the therapeutic application of Iodine or not.<\/span><\/p>\n Having no relation to typical chemotherapy and radiotherapy<\/b>\u00a0that are applied in other types of cancer, in the case of thyroid malignancy the intake of\u00a0<\/span>radioactive iodine pills<\/b>\u00a0and some scintigraphic measurements from the Nuclear Medicine Physician are enough. It is usually recommended avoiding contact with infants and pregnant women for a few days.<\/span><\/p>\n There is no reason why the patient should worry (in advance) regarding Iodine intake. This is a process that\u00a0<\/span>might<\/b>\u00a0be needed some weeks after the surgery, or it\u00a0<\/span>might not<\/b>. The decision will be exclusively taken when we have in front of us the final findings of the biopsy.<\/span><\/p>\n A timely, safe and thorough surgical operation is the first and most important step<\/b>\u00a0in the treatment approach of a malignancy in the thyroid.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Will I get fat after the surgery” tab_id=”1763112102732-3b6c6ec6-178d”][vc_column_text]No<\/b>. Having surgically removed the damaged thyroid gland from your organism, you will receive a\u00a0<\/span>replacement therapy<\/span><\/i>. This means that you Endocrinologist will administer the required dosage for your organism. Very soon, after the necessary calibration of the dosing regimen,\u00a0<\/span>you will become euthyroid. This translates to a perfectly normal function of your organism<\/b>, for which there is no reason for metabolic change and thus weight gain.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Will my life change after the surgery” tab_id=”1763112155097-dadc8ef1-2ad1″][vc_column_text]Millions of people have undergone a thyroidectomy operation and post-operatively take a thyroxine pill daily. This\u00a0<\/span>regulates the organism perfectly right, having a totally normal life<\/b>. The presence of an ailing thyroid where the normal part of the gland would produce one amount of hormone, the damaged area of the gland would produce another and your Endocrinologist would administer in the form of a pill yet a possibly different one, is a delicate balance that is easy to upset,\u00a0<\/span>while the surgical removal of the gland provides a permanent solution<\/span><\/i>.<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Will fertility and\/or a woman\u2019s cycle be negatively affected aftehr the surgery” tab_id=”1763112146338-3d05eb06-efb2″][vc_column_text]On the contrary, the hormonal balance that is achieved through the perfectly controlled hormone dose in the form of a pill that is administered after the surgery, ensures a\u00a0<\/span>smooth menstrual cycle<\/b>.<\/span><\/p>\n Moreover, ladies that are scheduling to give birth either naturally or through techniques of assisted reproduction are often referred,\u00a0<\/span>