Q. Please explain molecular karyotyping report taken after miscarriage.

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,

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 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.

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,

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.

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Dr. Balakrishnan. R

Experience: 22 + Yrs

Obstetrics And Gynaecology

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