Causes of female factor subfertility and early pregnancy failure : Our ignorance!! How far we dont know??

Let me express my ignorance on etiology!!

Recurrent  pregnancy  loss as well as infertility is seen increasingly  in our  daily practice in the recent  years  social and cultural  trends  especially     in urban areas have resulted   in women delaying  childbirth  thereby   making reproductive  senescence a major  health problem.

Subfertility and early preg failure are the two sides of same coin. So    there is definite   overlap   between infertility    & recurrent   pregnancy  losses  due to similar   pathophysiology needs  to be addressed  to get the best pregnancy  outcome for these  patients whose  desire  is to achieve a successful pregnancy. Are etiology, pathology, genesis, outcome and detailed investigations are almost same? Are the causes of subfertility give a path to early preg failure? To what extent such two culprits or curse are similar?? How RPL is elated to   infertility 

As we know , subfertility  is defined  as the inability  to conceive   after  12  months or more    of unprotected intercourse while RPL  is ambivalently characterized by a history of  2 or 3  clinically documented pregnancy loss. Not only   do these patients   share the same unfulfilled   desire to deliver a baby in many cases they also share a common etiologic   characteristics diagnosis  & management.  A)  For instance a women with partial or complete septum or a bicornuate  or unicornate   uterus may face either infertility or  recurrent pregnancy   losses because   of poor vascularity of the septum  &   disordered  myometrial   contractions. A Hysteroscopic septal   ablation would give a successful live birth  rate in 85% of   cases  solving   both these issues. B) Patient with  genital koch’s  (difficult ro prove )  may face  either infertility or   subsequent   recurrent pregnancy  loss due to a thin endometrium.  A full course of Anti Tubercular   treatment   would go  a long  way in treating both  these conditions. C) similarly Luteal phase defects  are known  to cause  recurrent  pregnancy  losses as well as infertility. Traditionally progesterone supplementation in the luteal  phase    has been recommended due to its  immunomodulatory  & uterine   relaxation  action. This treats infertility as well as averts  recurrent   pregnancy losses  as well endocrine  disorders like D) PCOS E) untreated   hypothyroidism and poorly  controlled  diabetes  may  pose a risk for infertility as well as  recurrent   pregnancy loss and treating  these endocrine disorders  could be  a rewarding    experience for both an infertility  expert or the obstetrician dealing with RPL   Increased  & subsequent RPL in case pregnancy  happens. thus proving  that both RPL &   infertility and RPL have many etiology n common. F)  Decreased ovarian   reserves  affects  both quality  &     quantity of oocyte & is  a known  cause  for infertility  & RPL . So infertility   experts  need to stimulate   the ovaries by  ovulation induction. The improved ovarian response in these patients ameliorates infertility  &  subsequent   recurrent   pregnancy   losses  as well.

G) Environmental  factors such as smoking alcohol exposure  to toxins  or chemicals  anaesthetic gases obesity  daily caffeine intake of > 300 mg can cause   both infertility.   & subsequent   recurrent  pregnancy  losses.

Recurrent pregnancy loss: Old  problem  : Any New  solution ? When challenges by the relatives we say that her oocyte in this cycles were poor quality? But to what extent this is true??? Role of Ubiquilone ( CoQ10 ) in improving RPL or subfertility where no cause could be substantiated?? Have we ever thought of supplementing CoQ 10 in unexplained subfertile women to  improve mitochondrial tissue respiration  before an old man from Kolkata whispered to our ears?? By supplementing Co Q 10 to a subfertile women the oocyte become more attractive to sperms –they become life long  partnerà Co Q 10 to women is akin to a young teenager coming out  from the most reputed beauty parlor after paying10,000/- for one sitting as my granddaughters do.

There is a complex  interaction of  the pro-oxidants and antioxidants  resulting in the  maintenances of intracellular   homeostasis Oxidative stress dysmorphogenesis   , recurrent miscarriages and intrauterine  growth  restriction.

There is supportive evidence  to the central role of mitochondrial  function   and oxygen  radicals in the process of aging and reproductive loss.

Spontaneous pregnancy  loss is the most  common  complication of pregnancy with 70% of conceptions  fail to achieve  viability clinically recognized loss occurs in 15% before   20 wks   of gestation

Treatments that work for RPL includes

High  dose folic acid 5mg /day  progesterone 400-800 mcg/ day Aspirin  75-8o mg/day  Low molecular weight  heparin Immunosuppressant   steroids   immunoglobulins endocrine correction infection screening  and treatment   vitamin D correction and vitamins B6 , B12 and vitamin C supplementation

Supplementation with antioxidants and cellular energizers such as coenzyme Q10 and Melatonin

Artificial Reproductive Techniques – IVF

Evidence   suggests that CoQ10  synthesis declines with  increasing age. Here  the role of Coenzyme Q10  as a mitochondrial rejuvenator  it deficiency  and its  supplementation to improve  outcomes  is explored.