Infertility & Miscarriage

 

Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. There are two types of infertility

Primary infertility

When a woman is unable to ever bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth she would be classified as having Primary Infertility. Thus women whose pregnancy spontaneously miscarries, or whose pregnancy results in a stillborn child, without ever having had a live birth would present with primary infertility.

Secondary infertility

When a woman is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following either a previous pregnancy or a previous ability to carry a pregnancy to live birth, she would be classified as having Secondary Infertility. Thus those who repeatedly spontaneously miscarry or whose pregnancy results in a stillbirth, or following a previous pregnancy or a previous ability to do so, are then not unable to carry a pregnancy to a live birth would present with secondarily infertile.

Miscarriage  

Miscarriage, also known as spontaneous abortion and pregnancy loss, is the natural death of an embryo or fetus before it is able to survive independently. Some use the cutoff of 20 weeks of gestation, after which fetal death is known as a stillbirth. The most common symptom of a miscarriage is vaginal bleeding with or without pain. Sadness, anxiety and guilt may occur afterwards. Tissue and clot-like material may leave the uterus and pass through and out of the vagina. When a woman keeps having miscarriages, infertility is present.

Risk factors

Risk factors for miscarriage include an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, thyroid problems, and drug or alcohol use. About 80% of miscarriages occur in the first 12 weeks of pregnancy (the first trimester). The underlying cause in about half of cases involves chromosomal abnormalities. Diagnosis of a miscarriage may involve checking to see if the cervix is open or closed, testing blood levels of human chorionic gonadotropin (hCG), and an ultrasound. Other conditions that can produce similar symptoms include ectopic pregnancy and implantation bleeding.

Causes  

Age, Obesity, eating disorders and caffeine, Endocrine disorders, Food poisoning, Amniocentesis and chorionic villus sampling, Surgery, Medications, Immunizations, Treatments for cancer, Intercurrent diseases. Immune status, Anatomical defects and trauma

Type of uterine structure	Miscarriage rate associated with defect
Bicornate uterus	40–79%
Septate or unicornuate	34–88%
Arcuate	Unknown
Didelphys	40%
Fibroids	Unknown

Smoking, Morning sickness, Chemicals and occupational exposure, Other

Genetic abnormalities

A genetic abnormality can occur when an embryo (fertilized egg) receives an abnormal number of chromosomes during fertilization. This type of genetic cause usually occurs by chance and there is no medical condition associated with it. In a small number of couples who have recurrent miscarriages, one partner may have chromosome translocation (when one piece of a chromosome breaks off and reattaches to a second chromosome).

Anatomic abnormalities

A septate uterus, in which a wall of tissue divides the uterus into two sections occurs very commonly and can result in recurrent miscarriage. While it is not entirely clear why this leads to recurrent miscarriage, some providers believe that poor vascularity in the septum causes the embryo to stop growing if it implants there. If the pregnancy does make it to term, the fetus may be breech. Fortunately, removing a uterine septum is typically very easy to do surgically.

An incompetent cervix is one that cannot remain closed due to weakened muscles. As the developing fetus reaches a certain weight, the weakened cervix cannot support the fetus and sometimes results in miscarriage.

 

Medical conditions

Various types of medical conditions can increase the risk of recurrent miscarriage including:

• Antiphospholipid syndrome (APS) – An autoimmune disorder that occurs when a person’s immune system mistakenly makes antibodies to certain substances that are necessary for blood clotting.
• Thyroid/hormonal issues – An overactive or underactive thyroid (an endocrine gland at the base of the neck) can result in hormonal imbalances. Hormonal imbalances can cause a miscarriage if the uterine lining doesn’t develop normally for implantation and nourishment of a fertilized egg. Elevated prolactin (a reproductive hormone produced in the pituitary gland) levels can alter proper development of the uterine lining.
• Fibroids and polyps – Noncancerous growths that can grow into and invade the uterus.
• Asherman’s syndrome – A condition in which scar tissue forms inside the uterus and may result in miscarriage.

Diagnosis

In the case of blood loss, pain, or both, transvaginal ultrasound is performed. If a viable intrauterine pregnancy is not found with ultrasound, blood tests (serial βHCG tests) can be performed to rule out ectopic pregnancy, which is a life-threatening situation.

If hypotension, tachycardia, and anaemia are discovered, exclusion of an ectopic pregnancy is important.

A miscarriage may be confirmed by an obstetric ultrasound and by the examination of the passed tissue. When looking for microscopic pathologic symptoms, one looks for the products of conception. Microscopically, these include villi, trophoblast, fetal parts, and background gestational changes in the endometrium. When chromosomal abnormalities are found in more than one miscarriage, genetic testing of both parents may be done.

Australian Concept Infertility Medical Centre first IVF Clinic was established in March 1998 in Karachi. In fact, this was the first time in the IVF history of Pakistan that Consultants, Embryologists and Nursing staff were flown overseas to acquire state of the art and the most advanced hands-on assisted reproductive training and quality assurance techniques. Australian Concept Infertility Medical Centre ‘ACIMC’ is proudly Pakistan’s 1st ISO 9001:2015 Certified IVF Clinic with the largest presences having clinics in all major cities of Pakistan.

·         IVF Clinic in Lahore

·         IVF Clinic in Karachi

·         IVF Clinic in Islamabad