Ayutech Health Solutions

Polycystic ovaries and the different endocrinopathies that come with polycystic o***y syndromes, like high luteinizing hormone (LH) levels and hyperandrogenemia, have been linked to infertility and miscarriage for a long time. Even though women who have had multiple miscarriages are much more likely to have polycystic ovaries than women who have never had a baby, polycystic ovaries do not seem to be able to predict the outcome of future pregnancy in ovulating women who have had multiple miscarriages. Women who ovulate but keep having miscarriages don't have a higher chance of getting pregnant if they have a high level of LH or testosterone.
Recently, the link between Polycystic O***y Syndrome and compensatory hyperinsulinemia due to insulin resistance has been looked at as a risk factor for recurrent miscarriage. This relationship may be caused by a change in the fibrinolytic response, which is important for the remodeling of tissues that happens during embryonic implantation.
Insulin resistance is linked to a higher rate of miscarriage in women with Polycystic O***y Syndrome who are going through ovulation induction than in women who are not insulin resistant. And women who have a lot of miscarriages are more likely to have insulin resistance. Women with Polycystic O***y Syndrome who take Metformin during ovulation induction and early pregnancy may have better endometrial receptivity and implantation, which lowers the risk of miscarriage in the future.

A healthy corpus luteum is needed for embryo implantation and early pregnancy to continue. This is because the corpus luteum makes progesterone, which changes an endometrium that is growing into an endometrium that can hold an embryo. Luteal phase defect, which happens when the body doesn't make enough progesterone and causes the endometrium to develop slowly, has been linked to recurrent miscarriage for a long time. But there aren't any standard diagnostic criteria that can be used to figure out how common and bad luteal phase defects are. Serum progesterone measurements aren't reliable because they change throughout the day and depend on pulsatile secretion. Also, the results of an endometrial biopsy can be interpreted in different ways depending on the sample and the observer. Also, serum progesterone levels don't show how the pregnancy will turn out. Low progesterone levels early in pregnancy seem to mean that the pregnancy has already failed. Also, there are no studies that show for sure that treating a luteal phase defect improves the outcome of pregnancy in women who keep having miscarriages, although a Cochrane meta-analysis suggested giving some women extra progesterone in the early stages of pregnancy may help some of them.

A working corpus luteum is needed for embryo implantation and to keep an early pregnancy going. It does this mainly by
making progesterone: it changes an endometrium that is growing into one that can hold an embryo.
Luteal phase defect: It happens when the body doesn't make enough progesterone and causes the endometrium to develop slowly, has long been linked to recurrent miscarriage.
But there aren't any standard diagnostic criteria to figure out how common and bad luteal phase defects really are. Serum progesterone measurements aren't reliable because they change throughout the day and are affected by pulsatile secretion, and the results of an endometrial biopsy can be interpreted in different ways depending on the sample and the observer. Also, serum progesterone levels don't show how the pregnancy will turn out. Instead, low progesterone levels early in pregnancy seem to mean that the pregnancy has already failed. Also, there are no studies that show for sure that treating a luteal phase defect improves the outcome of pregnancy in women who keep having miscarriages, although a Cochrane meta-analysis suggested that progesterone supplementation in early pregnancy may help some women.
Researches suggest that progesterone plays an important immunoregulatory role in pregnancy by changing the production of cytokines, the activity of natural killer (NK) cells, and the expression of the human leukocyte antigen (HLA)-G gene. This has led to a call for more therapeutic intervention studies.
The results are eagerly awaited, and they will help shape clinical practice.

In the past, many endocrine disorders have been blamed for recurrent miscarriages, but few of them have stood up to scrutiny. Diabetes mellitus and thyroid disease have been linked to sporadic miscarriage, but there is no direct evidence that they cause recurrent miscarriage. Both endocrinopathies are about as common in women with recurrent miscarriages as they are in the general population. Women with diabetes who are pregnant in the first trimester and have high hemoglobin A1c levels are at risk for miscarriage and birth defects in the baby. On the other hand, well-controlled diabetes mellitus and treated thyroid dysfunction are not risk factors for recurrent miscarriage. A meta-analysis found a link between having thyroid autoantibodies, having had one or two miscarriages in the past, and how the next pregnancy turned out. Women who have recurrent miscarriages are no more likely to have thyroid antibodies in their blood than fertile women who serve as controls. In a prospective observational study, the presence of thyroid antibodies in euthyroid women with a history of recurrent miscarriage did not affect the outcome of their next pregnancy. But it was said that thyroxine therapy for euthyroid women with antithyroid antibodies improved the outcome of pregnancy in a general population, including a lower rate of pregnancy loss.
Prolactin is important for both ovulation and the maturation of the endometrium. People have said that hyperprolactinemia is a cause of recurrent miscarriage and that treatment with bromocriptine, which stops the anterior pituitary from making prolactin, greatly reduces the number of miscarriages. In one small study, it was found that recurrent miscarriage was linked to the endometrium not making enough prolactin during the luteal phase of the menstrual cycle.
So please be careful above things when you are pregnant.

Congenital uterine malformations are caused by problems with the development, fusion, canalization, and reabsorption of the septum. In the worst case, the whole uterus is duplicated (uterus diadelphous), while in the mildest case, the fundus is only slightly depressed (arcuate uterus). It's not clear how much congenital uterine anomalies cause recurrent pregnancy loss because it's not known how common uterine anomalies are in the general population or how they affect reproduction. The number of patients with recurrent miscarriages who have uterine abnormalities ranges from 1.8% to 37.6%. This is because the criteria and imaging techniques used to make the diagnosis are different, and the studies have included women who have had two, three, or more miscarriages at both early and late stages of pregnancy.
The number of women with uterine abnormalities seems to be highest among those who have had late miscarriages. This is likely because women with uterine malformations have a higher rate of cervical incompetence. But a large prospective study that used three-dimensional ultrasound as a diagnostic tool found that 23.8 percent of women with first-trimester recurrent miscarriage (three or more consecutive pregnancy losses) had uterine anomalies, compared to only 5.3 percent of low-risk women who were sent for an ultrasound for reasons that had nothing to do with their ability to have children. On the other hand, a recent review of the literature about uterine abnormalities in early and late recurrent miscarriage patients found that 16.7% of them had them (96 percent confidence interval: 14.8–18.6). A review of how patients with untreated uterine abnormalities reproduced in the past showed that these women have high rates of miscarriage and premature birth and only a 50% chance of having a full-term birth. Open uterine surgery is linked to infertility after the surgery, and there is a big chance that the scar will break during pregnancy. These problems are probably less likely to happen after hysteroscopic surgery, but no randomized trial has been done to compare the benefits of open or hysteroscopic surgery to fix problems with the uterus on how the pregnancy turns out.
Cervical incompetence is when the cervix can't hold on to pregnancy because of a problem with how it works or how it's built, even when there are no contractions or labor. The term is out of date, and it might be better to say that cervical insufficiency or dysfunction is happening. It is a known cause of late miscarriage, and the diagnosis is often made after a woman has lost a baby in the second trimester. Cervical incompetence can be mild, moderate, or severe. Severe cervical incompetence can cause a miscarriage in the middle of the third trimester, while milder cases can cause a baby to be born early. The real rate of cervical incompetence is not known because the diagnosis is mostly based on symptoms and there are no objective tests that can reliably find women with weak cervical muscles when they are not pregnant.
Intrauterine adhesions also called Asherman's syndrome, are a type of uterine defect that develops over time and can be mild or severe. They are caused by trauma to the uterus, such as when the endometrium is cut too hard or when retained products of conception are removed. Miscarriages that happen more than once have been linked to intrauterine adhesions. The likely causes are a smaller uterine cavity, fibrosis, and inflammation of the endometrium, which make the patient more likely to have problems with implantation, placentation, and pregnancy loss. But most of the evidence of the link is from the past and contradictory, and there isn't enough strong evidence from the present to prove a cause-and-effect relationship.

The most common cause of miscarriage in women under 10 weeks of pregnancy is fetal aneuploidy. Chromosomal abnormalities of the embryo cause at least 50 percent of first-trimester spontaneous miscarriages and 29 percent to 57 percent of future miscarriages in couples with recurrent miscarriages. When miscarriage tissues are studied by comparative genomic hybridization, it seems that the contribution of chromosomal abnormalities to first-trimester miscarriage is about 70 percent. Knowledge of the karyotype of a miscarriage may help to predict future pregnancy outcome and guides clinical investigation. Aneuploid pregnancies are less likely to lead to subsequent miscarriages, but euploid pregnancies have a higher risk of recurrent miscarriage for the woman carrying them.
In approximately 3 percent to 5 percent of couples with recurrent miscarriage, one partner carries either a balanced reciprocal translocation, in which there is an exchange of two terminal segments from different chromosomes, or a Robertsonian translocation, in which there is a centric fusion of two acrocentric chromosomes Although carriers of balanced translocation are normally phenotypically normal, aberrant segregation at meiosis leads to 50 percent to 70 percent of their gametes and consequently embryos, being unbalanced. Because of the higher miscarriage rate, these pregnancies may lead to the birth of a child who has multiple congenital defects or a mental disability.
The great majority of human aneuploidies develop from mistakes in the first meiotic division of the egg, which begins prenatally and is not complete until ovulation. Meiosis in males begins only in adolescence when new s***matozoa are created continuously with an average lifespan of 70 days, in contrast to females who are born with their full complement of oocytes. While it has been shown that couples with a history of recurrent miscarriage are more likely to have defective s***m chromosomes, only 7% of fetal trisomies are the result of paternal meiotic mistakes.
Mesosome trisomy or chromosomal deletion are possible outcomes of the meiotic mistake (monosomy). Triploidy, in which there is a whole set of additional chromosomes, normally develops from fertilization of the oocyte by two s***matozoa, whereas tetraploidy (four times the haploid number) is frequently produced by the failure to complete the first zygotic division. Recurrent miscarriage is common in couples and standard cytogenetic analysis shows that 30%, 9%, and 4% of the time, miscarriage tissue has trisomy, polyploidy, and monosomy X.
Single-gene mutations that cause abnormal development of the embryo (especially placental and cardiac lesions) and skewed X chromosome inactivation (preferential expression of maternal or paternal X chromosome in maternal cells) are more common in women who have recurrent miscarriages than in controls. Transcervical embryo copy has shown that 18% of euploid pregnancies that resulted in miscarriage may also have the abnormal growth and development found in aneuploidy embryos.

so you should take medical opinion for overcoming those issues

To understand, why you should be concerned about bleeding and pain in the first trimester?

First-trimester complications are more common than at any other time of pregnancy. Most patients present with either bleeding or pain. About 20 percent of all pregnancies are clinically diagnosed as having vaginal bleeding. Both the woman and her partner are terrified. The vast majority of the time, there is no need for assistance. If the pregnancy is well-developed and viable, then the primary goal of clinical management is to get a correct diagnosis quickly and provide reassurance if it isn't. Although perinatal grief has been studied more thoroughly than early pregnancy loss, little is known about the psychological repercussions of both. As a result, the need for support for couples who experience an early miscarriage is becoming more widely recognized, which means it should be included in the care provided to these couples.

Why is advancing maternal age is increasing the risk of miscarriage ?

Due to an increase in chromosomally defective pregnancies as well as a decrease in uterine and ovarian function, miscarriage rates rise with age. Additionally, previous miscarriages and multiple pregnancies are well-known risk factors that are closely linked to mother age. Maternal age at conception is a strong and independent risk factor for miscarriage, regardless of past pregnancy outcomes, according to a large prospective register linkage study.

Are it having evidence ?

One in every three pregnancies ended in loss, according to this study, although the likelihood of miscarriage based on the mother's age at conception rose sharply over time, going from 9% at 20–24 years of age up to almost 70% at 45 years. After 35 years of age, the rate of risk increases dramatically, and the chances of a successful pregnancy in women aged 40 and more are quite low. Ectopic pregnancies and stillbirths have both shown a rise in risk.

Reproductive behavior has seen a dramatic shift in our society over the past few decades. For social and professional reasons, many women postpone motherhood. The availability of donor gametes and assisted fertility therapies will unquestionably speed up this process. Miscarriage rates are not published, but it is plausible to deduce that the rate of miscarriage has grown as the maternal age at conception has increased. The older the father is, the more likely he is to miscarry. So please be careful

what are spontaneous abortion and miscarriage ?

The words spontaneous abortion and miscarriage suggest the natural loss of a pregnancy before the independent viability of the fetus. When talking to patients, the term "miscarriage" was commonly used instead of the phrase "abortion," but that has all changed in recent years. Abortion has come to be associated with "elective termination of pregnancy," which many patients find objectionable, and as a result, there has been a move away from using the phrase to describe spontaneous miscarriage. By "viability," we mean the fetus's ability to live outside its mother's womb. Fetuses born before this point seldom survive or exhibit signs of life for more than a short time. This is widely accepted to be around 24 weeks. The World Health Organization recommends that the term "miscarriage" be reserved for pregnancies past 22 weeks (154 days).

How can it happen ?

Pregnancy loss can be clinically obvious, such as bleeding or pain, or clinically silent, such as a routine ultrasound screening identifying a pregnancy loss. The treatment of early miscarriage has changed dramatically since scans to identify gestational age have become virtually routine. In a fifth of pregnancies, bleeding begins before the 20th week of pregnancy. However, there is likely a much higher rate of undetected pregnancy loss in the background, with more pregnancies lost before they are discovered, recognized, or confirmed.

What's the best way to tell?

A hospital, family doctor, or other medical facility is where most women will seek help.

Painless bleeding
Bleeding with anguish (with the possible passage of pregnancy tissue vaginally).
Bleeding is excruciatingly painful with signs and symptoms of blood loss.
The bleeding stopped as the pregnancy progressed, and the symptoms began to fade.

The amount of bleeding is a prognostic indicator that might vary widely. Miscarriage loss is more likely when bleeding occurs without discomfort. Reassurance can be used in this case if the pregnancy is confirmed via ultrasound. In most situations, the bleeding will be caused by local factors, such as changes in cervix physiology. Tissue or blood clots flowing through the cervical aperture can cause additional agony, which can be excruciating to deal with. A vagal reaction can be triggered by blood loss, and the passage of tissue via the cervical os can cause shock, which is quickly restored if the products are removed from the os.

How should you faced it ?

Pregnant women are prepared for the possibility of miscarriage. Women can be confident that their pregnancies will continue if the bleeding is light and not accompanied by any pain or discomfort. Cases of full spontaneous miscarriage might be managed optimistically. Most difficulties in the management of early pregnancy bleeding concerns occurrences of missing or partial miscarriage

Surgical emergencies have traditionally been treated by surgery ("evacuation of retained products of conception.") Traditionally, o**m forceps and curettage were used, but vacuum aspiration has now taken its place. Vacuum aspiration is connected with less blood loss and pain and a shorter process than surgical curettage. Expectant treatment avoids a surgical procedure and allows the woman to continue in her normal daily routine. With less impact on quality of life, it is more acceptable to women. Primary care has readily adopted this method without the need for hospitalization.

For practical reasons, expectant management is well-tolerated, cost-efficient, and safe and should be employed for women in the first instance, providing that they are hemodynamically stable. It appears difficult to determine for which women expectant treatment will be helpful. Medical management isn't significantly better than expected, but it's more expensive, so its value as a management choice is less evident. As far as I can see, the only options are to wait it out or get it surgically fixed if that's the only option available. Contrary to surgical curettage, vacuum aspiration is more effective, less unpleasant, and faster than curettage. Not sure which women should opt for surgical treatment over any other, however women with high parity are more likely to have a complete abortion following surgical treatment than any other group.

Ideally, tissue from every miscarriage would be sent to a lab for histologic analysis. However, there are apparent practical obstacles to accomplishing that goal if medical and expectant management is undertaken. Patients undergoing surgical curettage should make sure to request this form. If an ultrasound reveals evidence of trophoblastic illness, surgical intervention is the only option.

Ultrasound and biochemical testing may be used to help establish the best treatment plan, according to some experts' theories... It may be helpful to know how much tissue remains in the uterine cavity using ultrasound. by this risk of spontaneous abotions and and miscarriage can be reduced

what are spontaneous abortion and miscarriage ?

The words spontaneous abortion and miscarriage suggest the natural loss of a pregnancy before the independent viability of the fetus. When talking to patients, the term "miscarriage" was commonly used instead of the phrase "abortion," but that has all changed in recent years. Abortion has come to be associated with "elective termination of pregnancy," which many patients find objectionable, and as a result, there has been a move away from using the phrase to describe spontaneous miscarriage. By "viability," we mean the fetus's ability to live outside its mother's womb. Fetuses born before this point seldom survive or exhibit signs of life for more than a short time. This is widely accepted to be around 24 weeks. The World Health Organization recommends that the term "miscarriage" be reserved for pregnancies past 22 weeks (154 days).

why is it happening ?

Pregnancy loss can be clinically obvious, such as bleeding or pain, or clinically silent, such as a routine ultrasound screening identifying a pregnancy loss. The treatment of early miscarriage has changed dramatically since scans to identify gestational age have become virtually routine. In a fifth of pregnancies, bleeding begins before the 20th week of pregnancy. However, there is likely a much higher rate of undetected pregnancy loss in the background, with more pregnancies lost before they are discovered, recognized, or confirmed.

What's the best way to tell?

A hospital, family doctor, or other medical facility is where most women will seek help.

Painless bleeding
Bleeding with anguish (with the possible passage of pregnancy tissue vaginally).
Bleeding is excruciatingly painful with signs and symptoms of blood loss.
The bleeding stopped as the pregnancy progressed, and the symptoms began to fade.

The amount of bleeding is a prognostic indicator that might vary widely. Miscarriage loss is more likely when bleeding occurs without discomfort. Reassurance can be used in this case if the pregnancy is confirmed via ultrasound. In most situations, the bleeding will be caused by local factors, such as changes in cervix physiology. Tissue or blood clots flowing through the cervical aperture can cause additional agony, which can be excruciating to deal with. A vagal reaction can be triggered by blood loss, and the passage of tissue via the cervical os can cause shock, which is quickly restored if the products are removed from the os.

Is it possible to do this?

Pregnant women are prepared for the possibility of miscarriage. Women can be confident that their pregnancies will continue if the bleeding is light and not accompanied by any pain or discomfort. Cases of full spontaneous miscarriage might be managed optimistically. Most difficulties in the management of early pregnancy bleeding concerns occurrences of missing or partial miscarriage

Surgical emergencies have traditionally been treated by surgery ("evacuation of retained products of conception.") Traditionally, o**m forceps and curettage were used, but vacuum aspiration has now taken its place. Vacuum aspiration is connected with less blood loss and pain and a shorter process than surgical curettage. Expectant treatment avoids a surgical procedure and allows the woman to continue in her normal daily routine. With less impact on quality of life, it is more acceptable to women. Primary care has readily adopted this method without the need for hospitalization.

For practical reasons, expectant management is well-tolerated, cost-efficient, and safe and should be employed for women in the first instance, providing that they are hemodynamically stable. It appears difficult to determine for which women expectant treatment will be helpful. Medical management isn't significantly better than expected, but it's more expensive, so its value as a management choice is less evident. As far as I can see, the only options are to wait it out or get it surgically fixed if that's the only option available. Contrary to surgical curettage, vacuum aspiration is more effective, less unpleasant, and faster than curettage. Not sure which women should opt for surgical treatment over any other, however women with high parity are more likely to have a complete abortion following surgical treatment than any other group.

Ideally, tissue from every miscarriage would be sent to a lab for histologic analysis. However, there are apparent practical obstacles to accomplishing that goal if medical and expectant management is undertaken. Patients undergoing surgical curettage should make sure to request this form. If an ultrasound reveals evidence of trophoblastic illness, surgical intervention is the only option.

Ultrasound and biochemical testing may be used to help establish the best treatment plan, according to some experts' theories... It may be helpful to know how much tissue remains in the uterine cavity using ultrasound. by this risk of spontaneous abotions and and miscarriage can be reduced

what is an ectopic pregnancy?

An ectopic pregnancy occurs in a site outside the uterine cavity, although frequently in a nearby region. Most ectopic pregnancies occur in the fallopian tube, with the o***y, abdominal cavity, or cervix as secondary locations. In the fallopian tube, roughly 80 percent of the pregnancies will occur in the ampullary region. This article focuses mostly on locations in the extrauterine fallopian tubes because of the high relative frequency of these conditions.
Anemia and its ramifications (which we'll discuss in more detail in a moment), as well as the emotional toll of a pregnancy Ectopic pregnancy, is notoriously difficult to diagnose. Unilateral iliac fossa pain is more in keeping with ectopic pregnancy, however, bilateral pain is not unusual. Abdominal palpation can reveal indications of peritonism, such as guarding, rigidity, and tenseness. Guarding may be minimized if the knees are brought up to relax the abdominal muscles
On vaginal examination, it may be feasible to elicit tenderness on the afflicted adnexal side by manipulating the cervix laterally (“cervical excitation”) or by direct adnexal palpation. Transverse cervical ligament rotation results in uterine movement in an opposite direction, increasing tension on the side that has an ectopic pregnancy. Increased levels of progesterone in the endometrium and myometrium can soften the uterus and even cause it to expand somewhat in cases of ectopic pregnancy.

Management of an ectopic pregnancy

Management of the acutely unwell woman differs from the more usual presentation of a clinically stable woman, in which circumstance there are several therapy choices.

Expectant Management

Expectant Management is most appropriate when the lady is hemodynamically stable, with no signs of pain. A fetal heartbeat and/or a gestational sac larger than 4 centimeters are contraindications, according to some writers. In practice, expectant management requires establishing a solid diagnosis of early extrauterine pregnancy failure, advising the patient of available treatment choices, and obtaining consent that this way of therapy is appropriate.

Medical Management

A single dose of methotrexate is currently the most common medical care technique, however, multiple-dose regimens are less frequently employed.

Surgical Management

Salpingectomy has long been regarded as the gold standard treatment for ectopic pregnancy. This may be unavoidable in cases of emergency care and fallopian tube rupture. However, there has been a significant shift in recent years toward preserving the fallopian tubes if possible, and discussion has shifted to

When should a fallopian tube be saved?
What is the effect of fallopian tube preservation on subsequent fertility rates?

After salpingectomy, in the existence of a normal fallopian tube on the contralateral side, the likelihood of an intrauterine pregnancy is greater than 50 percent.

Intrauterine pregnancy is around 65 percent likely following salpingotomy. The chance of a second ectopic pregnancy varies little with the care of the index case. Previous tubal rupture does not appear to hurt future fertility. Smoking is an independent risk factor for fertility and the likelihood of a subsequent intrauterine pregnancy appears to be raised by discontinuing smoking.

Future fertility also diminishes if the woman is older than 35 years or has had previous tubal injury or infertility.

For these women, possibly, assisted conception may offer a better possibility of an intrauterine conception. The risk for a further ectopic is greatly raised (three to four times) if the woman was previously nulliparous, if this was not her first ectopic, if she has had previous tubal surgery, or if there are adhesions around either fallopian tube. A second ectopic pregnancy is more common for a woman who has already experienced an ectopic birth.

but proper management can overcome those situations