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Q. Please explain molecular karyotyping report taken after miscarriage.

Answered by
Dr. Balakrishnan. R
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 10, 2018 and last reviewed on: Nov 22, 2022

Hello doctor,

I had a miscarriage and vacuum Aspirin procedure a month back. The miscarriage was mostly due to low FHR as evident in the report (bradycardia at 6W3D). I had spotting around 10th week and doctor reported it as a missed abortion. I also had high TSH around 6.7 and was on 25 mg Thyronorm every day. Please let me know your detailed view based on the molecular karyotyping report.

  1. It has been around two weeks since the procedure. I am feeling better; however, do not feel completely normal or energetic yet. I get exhausted after few hours of going out (without any strenuous activity). Initially, had pain in the waist and abdomen. Now I feel like my waist is still fragile and not sure if I should start normal exercises or still be cautious. I am not working currently for some time and taking adequate rest.
  2. Given my age, TSH count (was almost 6.7 TSH last month) and other reports need your complete guidance on how to proceed further. I take 50 mg of Thyronorm every morning on empty stomach and 1 folic acid 5 mg (Folivate) late evening after dinner. The course of medicines after the miscarriage has been completed (five days course). Bleeding is almost negligible these days. My Vitamin D levels are low so should I again continue with Uprise tablet once every week along with Becosule tablet?
  3. I have migraine issue for the past three to four years. It is more in control since last two years; however, I still need to take 1 Naxdom 500 (once every three to four days average) which is an emergency painkiller.
  4. In terms of general health, normally I tend to get exhausted or tired or fatigued or sleepy very soon. All this combined with the tendency to get highly stressed out frequently. The conditions demand some kind of special medications for sure I feel for my future normal pregnancy.
  5. Please note that my AMH was pretty low as well a few months back when I got tests done.
  6. Are there good books or online websites you can suggest that also act as a guide for me, please?
  7. Please suggest me all the possible tests I should get done at this stage to be absolutely sure of any complications that we should be aware of. Given my age and general health, I want to take all possible measures.

The laboratory tests performed are molecular karyotyping, general blood, thyroid, pregnancy tests, AMH, Vitamin D.

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#

Hi,

Welcome to icliniq.com.

How are you doing? I am very sorry for your loss and do understand the mental stress which you are presently suffering. But let me start on a positive note that you are fine and will surely have a healthy pregnancy. Do not worry about your age and do not feel you are aged, up to 35 years you have a very bright chance of pregnancy. Many get married at this age.

  1. Even though you have undergone an evacuation procedure, the hormones of pregnancy will still be in your body for few more weeks. There would have been minimal blood loss in the procedure. You must be mentally and physically stressed out, that may be the reason for the easy fatigability. Just have any Iron tablets (like Orofer or Ferox-XT or Livogen or Autrin) one tablet at bedtime for two to three months. Also a multivitamin (like capsule Becosules or Polybion or Beplex forte) once a day for the same duration. If you are having uneasy and sleepless nights, meet a local doctor and have an anxiolytic like tablet Alprax or Anxit 0.5 mg at bedtime for four to five days. You will feel better with an improvement in blood levels and a good sleep.
  2. Thyroid hormone is not to be so much bothered about. Ideally, it should be less than 4.5 Miu/ml. You are on a very low dose and it is quite well controlled. You can check it along with others (I will be mentioning). Keep having the same dose of thyroid medicine till then. Vitamin D again is only a health improver. Actual course if you have had is 60000 IU weekly once for two months and then monthly once for four months. Then maintenance dose of 2000 IU per day.
  3. Before trying for pregnancy, better stop all other medicines. A migraine is due to lack of good sleep or disturbed sleep or bad timing of going to bed or straining of eyes or some smells or bright light or fasting, etc. Try to correct that, instead of spoiling your precious liver and kidney with painkillers. Try some mind relaxation yoga, breathing exercise or steam inhalation regularly.
  4. Try for next pregnancy only after three to four months, start Folic acid 5 mg one month before trying.
  5. I did not find the AMH (anti-Mullerian hormone) values anywhere in the reports (attachment removed to protect patient identity). Hope it was done in 14 days after periods and it is greater than 1.1 ng/ml. If you have got pregnant once then that means good eggs are still available and your chances of a next healthy pregnancy are 97 %.
  6. I do not agree with the finding of fetal bradycardia. The fetal heart rate of 110-160 bpm is normal, a beat less need not be worried. No meaning in counting the heartbeat of such small fetus. It is normal. Maybe a rate of 80 bpm or less may mean impending problem. No studies give importance to karyotyping or evaluation of the fetal tissue. So do not bother about the genetics of your partner or yourself of the fetal tissue. The tests I can suggest after two months of the miscarriage (that is after another month because the pregnancy hormones can still alter the results) are repeat blood sugars or HbA1c (glycosylated hemoglobin, should be less than 6.5 %), thyroid profile, rule out APLA syndrome (antiphospholipid antibody syndrome). Baby is a foreign body in mother's body and your body will try to reject it. But the baby has to survive the rejection. If the rejection is very strong, baby's heartbeat will stop. So check PTT (partial thromboplastin time), lupus anticoagulant (LA), anticardiolipin antibody (ACA), ANA ( anti-nuclear antibody). After proper periods have a 3D scan of the uterus to rule out any uterine anomalies. Finally, have your husband's semen analysis to rule out any problems. All these problems can be corrected.

Thank you.

Hi doctor,

Thank you for the reply,

I will get the tests done after this month as per your advice. Also, attaching the AMH report and Vitamin D report (not recent yet should be indicative).

#

Hi,

Welcome back to icliniq.com.

How are you doing? AMH (anti-Mullerian hormone) is in the low fertility potential area (attachment removed to protect patient identity), but still, if follicle growth is slow, those final few follicles can be stimulated with good HMG (human menopausal gonadotropin) injections. It should be tested within first two weeks after periods. You can reconfirm it.

Vitamin D is low, so it is better to have the full dosage schedule I had advised. I could not open one of the files, I think it has the karyotyping. Normal genotype or genetic makeup is 46 chromosomes or 23 pairs. It will be 44+1 pairs of sex chromosome. They would have mentioned the number and if any defect in the chromosome size. I again say, no need to worry about this. Whatever this is, it will not be repeated in next pregnancy.

For a migraine simpler medications like tablet Dolopar (Acetaminophen and Caffeine) or Dolo 650 (Paracetamol) can be taken. Have coffee or steam inhalations two to three times a day. Try some yoga or mind relaxation exercises or pranayama. Ayurveda is also good. All the components are natural, containing anti-oxidants. They may help you psychologically.

For more information consult an infertility specialist online.

Hello doctor,

I had done antral follicle count test on the first day of my period on a local doctor's advice, and I have attached the reports. Would request you help me interpret the same and suggest further steps.

Thank you.

#

Hello doctor,

I have reviewed the attached reports (attachments removed to protect the patient's identity). Six follicles are growing in one ovary and one in another. The volume of ovaries and their dimensions are normal. You are absolutely fine, and one among those multiple eggs will mature. Do not worry about the doppler finding; in a non-pregnant uterus, they are unimportant.

Thank you.

Hi doctor,

Wanted to update you that regarding the above report, the doctor has picked up that I have adenomyosis (based on the ultrasound scan). I have taken Zoladex 3.6 mg. My periods have now been delayed by almost 26 days. Is that normal? What are the health effects of adenomyosis? What would be the effect of Zoladex on my pregnancy (whenever I plan next)?

Thank you.

#

Hello,

Welcome back to icliniq.com.

Adenomyosis is a minimal collection of blood In the uterine wall during periods. As long as periods occur, they will keep happening. So the best and only way to stop it is to stop periods. Getting pregnant is the best option, but since you have to give a gap of 3 months after a miscarriage, medicine like Zoledex is ok. Once you stop, the medication periods will restart, and you can get pregnant. This medication will not affect your future pregnancy outcomes. Medicine only keeps the uterus in normal condition till you get pregnant.

Thank you.

Hello doctor,

Wanted to update you that in the last cycle, two months after the Zoladex shot, we went for medications and timed intercourse. Failed to conceive, though. Medicines were Cordova 50 and Progyonova 2 mg twice daily until the hCG shot (from day 1). Took hCG shot 10000 when follicle size was 18.5 mm. Then stopped both and started Duphaston thrice a day. Thyronorm 50 (once a day) and Folate (twice a day) continued throughout. Stopped Duphaston now after a negative hCG beta report. Have been asked to continue the same protocol again for this cycle.

1) I started my period today. I have had light bleeding for the last 2 to 3 months. A doctor said it is because of Progyonova mostly. Hope it is not an indication of early menopause, given my low AMH (0.44), heavy bleeding in the past, etc., as it feels very abnormal.

2) What is your opinion about the medications? Godiva 50 should still be okay versus 100 this time.

3) Progyonova is good to start from day 2. However, a doctor advised starting it from day 7, while another advised day two until the hCG shot. Should Progyonova and Duphaston continue together after the hCG shot or only Duphaston?

4) Is it better to wait for 21 to 22 cm before taking an hCG shot? Then, after the hCG shot, when should one start relations ideally, and till when?

Thank you.

#

Hello,

Welcome back to icliniq.com.

Zoladex will be lighter a few periods later, with nothing to be done. I suggest you a schedule. This will clear all the confusion or questions. Days suggest periods. So if you started bleeding today, today is day 1; keep counting further. Consult your specialist doctor, talk with them, and take medications with their consent.

1. On day 3, take tablet Goodova 100 mg once at night for five days. Maybe your dose of 50 mg was less. It always has to be started before the fifth day, as by then, follicles are already recruited

2. On day 7, start Progynova 2mg once daily for seven days. This will improve the inner lining of the uterus. No need after that.

3. On day 13 or 14, have the trigger of 10000 IU.

4. Once the bleeding stops, start having sex daily or on alternate days left to you. This is not for pregnancy's sake. It is to discard old sperm.

5. On days 13 to 18, have sex at least once daily.

6. On day 15, have tablet Duphastone once a day for 14 days.

This will support the embryo on implantation. Check urine for pregnancy on the day after Duphastone is over. This is just duplicating your hormonal cycle occurring naturally. I hope this clears all your queries, do write back if any more queries and for feedback.

Thank you.


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