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Recurrent Miscarriages |
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The definition of recurrent miscarriages or habitual abortion is usually described as having had at least three consecutive spontaneous abortions. However, a history of only one spontaneous abortion clearly increases the risk for subsequent abortions.
In women who have not had at least one live birth, there is a 40% risk of loss after 2 or more abortions. The risk of abortion in older women increases with advancing age, rising to around 40% by age 44. The definition of habitual abortion must be made on the basis of prognosis for future pregnancies, and patients who have had two or more abortions probably should be evaluated.
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Polycystic Ovarian Syndrome |
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Ploycystic Ovarian Syndrome (PCOS) or Polycystic Ovarian Disease (PCOD) is characterized by menstrual dysfunction (usually oligomenorrhea or amenorrhea starting at menarche) and hyperandrogenism, usually associated with hirsutism. Obesity may or may not be present. Blood testosterone is usually either normal or moderately elevated, and sex hormone binding globulin is almost always reduced, resulting in an elevated serum level of free testosterone.
Vaginal ultrasound consistently shows the characteristic appearance of an enlarged stroma and many small follicles, often with a "string of pearls" appearance. Genetic studies suggest transmission as an autosomal dominant.
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Pelvic Surgery |
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Pelvic Reproductive Surgery: diagnostic and therapeutic.
Diagnostic Surgery:
Diagnostic surgical procedures are performed to evaluate the integrity of the woman's reproductive organs as well as their relationship to other pelvic structures and incorporate the following procedures:
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Ovulation Detection |
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Ovulation detection is accomplished with the use of an LH predictor kit. An LH predictor kit detects the increase of luteinizing hormone (LH) in the urine. Normally 1 – 2 days before the middle of a menstrual cycle, this hormone will have a sudden peak (this is called the LH surge). Usually an egg is then released from the ovary within 24-32 hours after the surge (ovulation). Ovulation predictor kits should be started cycle day 11, testing twice daily approximately 12 hours apart. When an LH surge is detected, intercourse or insemination should occur within 12 to 24 hours after the surge.
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Gonadatropins |
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Gonadotropins are injectable fertility drugs i.e., Follistim, Gonal-F, Pergonal, Repronex and Bravelle. Gonadotropins are the traditional therapy for non-responders. The dose is based on the weight and previous response, remembering that these patients are especially prone to hyperstimulation. Patients on gonadatropins are very closely monitored with ultrasound and estrogen levels, sometimes daily. The close monitoring allows for adjusting of the dosage and determining the best time to trigger ovulation with HCG.
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