Newer causes of me=ale or female subferrtlity or Rec preg losses=What may be the causes??

Is recurrent pregnancy loss and infertility do have same common associated etiology which can cause either or singularly  both  ?

There is  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. Many are of opinion that subfertility and recurrent pregnancy  loss are  considered  mutually of same etiology.   Infertility, as members are aware that 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. Instance 1 :-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. Instance 2:-Patient with genital koch’s    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.

Instance 3:-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. Instance 4:-This treats infertility as well as averts  recurrent   pregnancy losses  as well endocrine  disorders like PCOS 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  . Instance 5 :- 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.

Instance 6:-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. So    the  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.

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Instance 6:- Less AFC , Low AMH; Dwindling ovarian reserve: Whereas in   male partner  loss of telomere( ends or caps of chromosomes)  of sperm of elderly men ---> 45 yrsà so either subfertility/RPL:-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. Recurrent pregnancy loss : Old  problem-A   New  solution ? Again question of poor quality oocytes:à Failure to fertilize ( Fertilization failure) à fertilized but poor implantation (implantation,  disorders / embryonic  arrestà failure  to grow in orderly way after implantation!!  Can quality of oocytes be increased by  CoQ10 / DHEA ?? One million dollar Question?

Instance 7 :-Environmental toxins , workplace toxicity 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. Instance 8 Mitochondrial dysfunction : may cause either subfertility or Rec Preg loss:-:- 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  75-8 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.